Podcast
Questions and Answers
Where is the lesion most commonly located in younger patients?
Where is the lesion most commonly located in younger patients?
- Epiphysis (correct)
- Diaphysis
- Cortical
- Metaphysis
Which type of lesion should be included in the differential diagnosis for patients aged 20-40?
Which type of lesion should be included in the differential diagnosis for patients aged 20-40?
- Giant Cell Tumor (GCT) (correct)
- Chondrosarcoma
- Geode
- Osteosarcoma
In older patients, which type of lesion should be considered in the differential diagnosis along with a geode?
In older patients, which type of lesion should be considered in the differential diagnosis along with a geode?
- Simple Bone Cyst (SBC)
- Enchondroma
- Chondromyxoid Fibroma (CMF)
- Aneurysmal Bone Cyst (ABC) (correct)
What location should be looked for specifically when considering arthrosis?
What location should be looked for specifically when considering arthrosis?
Which location is associated with lesions such as Chondrosarcoma and Enchondroma?
Which location is associated with lesions such as Chondrosarcoma and Enchondroma?
What is the biologic activity of a bone with a Codman's triangle?
What is the biologic activity of a bone with a Codman's triangle?
What type of periosteal reaction is indicative of a benign osteoma?
What type of periosteal reaction is indicative of a benign osteoma?
Which condition is associated with an onion-skin periosteal reaction?
Which condition is associated with an onion-skin periosteal reaction?
In the context provided, what does a smooth periosteum typically indicate?
In the context provided, what does a smooth periosteum typically indicate?
Which tumor type might present with a sunburst reaction?
Which tumor type might present with a sunburst reaction?
What distinguishes a Codman triangle in terms of bone formation?
What distinguishes a Codman triangle in terms of bone formation?
What is the term used to describe the layers of reactive bone formation seen in a tumor as it expands successively?
What is the term used to describe the layers of reactive bone formation seen in a tumor as it expands successively?
Which periosteal reaction is associated with a less malignant nature of the tumor?
Which periosteal reaction is associated with a less malignant nature of the tumor?
In the context of musculoskeletal tumors, which term describes a solid sunburst appearance?
In the context of musculoskeletal tumors, which term describes a solid sunburst appearance?
What term is associated with the most malignant type of periosteal reaction in musculoskeletal tumors?
What term is associated with the most malignant type of periosteal reaction in musculoskeletal tumors?
What matrix component is associated with stippled calcification in lesions?
What matrix component is associated with stippled calcification in lesions?
Which feature in musculoskeletal tumors is NOT associated with a more malignant nature?
Which feature in musculoskeletal tumors is NOT associated with a more malignant nature?
What is the most helpful method for diagnosing soft tissue tumors and bony tumors with homogenous cell types?
What is the most helpful method for diagnosing soft tissue tumors and bony tumors with homogenous cell types?
What type of incision is recommended during a biopsy procedure?
What type of incision is recommended during a biopsy procedure?
What size should the windows in bone be during a biopsy procedure?
What size should the windows in bone be during a biopsy procedure?
When performing a biopsy, what is essential to avoid tracking haematomas?
When performing a biopsy, what is essential to avoid tracking haematomas?
Which imaging technique may aid in performing a core needle biopsy?
Which imaging technique may aid in performing a core needle biopsy?
Where would amputation usually provide better postoperative function and reduced risk of recurrence for tumors?
Where would amputation usually provide better postoperative function and reduced risk of recurrence for tumors?
When should limb salvage surgery be considered for treatment of tumors?
When should limb salvage surgery be considered for treatment of tumors?
Which type of tumor is characterized by pain and is found in the metaphysis of the femur and tibia?
Which type of tumor is characterized by pain and is found in the metaphysis of the femur and tibia?
Where do primary osteosarcomas grow outward to?
Where do primary osteosarcomas grow outward to?
Which bone-forming tumor is specifically associated with facial bones and skull?
Which bone-forming tumor is specifically associated with facial bones and skull?
What is a new solution to disfiguring surgical resections of lower limb sarcomas?
What is a new solution to disfiguring surgical resections of lower limb sarcomas?
In what age range are osteomas typically found?
In what age range are osteomas typically found?
'Ewing’s sarcoma' belongs to which category of bone tumors?
'Ewing’s sarcoma' belongs to which category of bone tumors?
'Nonossifying Fibroma' belongs to which category of bone tumors?
'Nonossifying Fibroma' belongs to which category of bone tumors?
'Giant Cell Tumor of Bone' is an example of which type of tumor?
'Giant Cell Tumor of Bone' is an example of which type of tumor?
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Study Notes
Musculoskeletal Tumors
Periosteal Reactions
- Onion-skin (Ewing's sarcoma): more malignant
- Sunburst reaction (osteosarcoma): more malignant
- Codman's triangle: a triangle of reactive bone formation found at the proximal and distal extremes of the elevated periosteum
- Solid sunburst: less malignant
- Onion-peel (Ewing's sarcoma): more malignant
Four Questions of Enneking
- What is in the lesion?
- Clues: bone/calcific soft tissue component radiolucent/ground glass
- Matrix: osteoid/forming process, chondroid/stippled calcification, myxoid/cartilaginous
- Where is the lesion?
- Location: epiphysis, metaphysis, diaphysis
- What is the biologic activity?
- Endosteal and periosteal response: smooth periosteum (benign process), onion-skin (Ewing's sarcoma), sunburst reaction (osteosarcoma), Codman's triangle
- What is the extent of the lesion?
Biopsy
- Indications: diagnosis of musculoskeletal tumors
- Techniques: fine needle aspiration (FNA), core needle biopsy
- Considerations: appropriate staging studies, local anesthesia, ultrasonography, fluoroscopy, computed tomography (CT), and magnetic resonance imaging (MRI)
Limb Salvage Versus Amputation
- Considerations: postoperative function, local control, and quality of life
- Limb salvage surgery: preferred for tumors in the proximal aspect of an extremity
- Amputation: usually provides better postoperative function and reduced risk of recurrence for tumors located in the distal leg
Rotationplasty
- Solution for disfiguring surgical resections of lower limb sarcomas
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