32 Questions
Where is the lesion most commonly located in younger patients?
Epiphysis
Which type of lesion should be included in the differential diagnosis for patients aged 20-40?
Giant Cell Tumor (GCT)
In older patients, which type of lesion should be considered in the differential diagnosis along with a geode?
Aneurysmal Bone Cyst (ABC)
What location should be looked for specifically when considering arthrosis?
Epiphysis
Which location is associated with lesions such as Chondrosarcoma and Enchondroma?
Metaphysis
What is the biologic activity of a bone with a Codman's triangle?
Osteosarcoma
What type of periosteal reaction is indicative of a benign osteoma?
Smooth + thick edges
Which condition is associated with an onion-skin periosteal reaction?
Ewing's sarcoma
In the context provided, what does a smooth periosteum typically indicate?
Benign process
Which tumor type might present with a sunburst reaction?
Osteosarcoma
What distinguishes a Codman triangle in terms of bone formation?
Reactive bone formation at proximal and distal extremes
What is the term used to describe the layers of reactive bone formation seen in a tumor as it expands successively?
Onion-skin
Which periosteal reaction is associated with a less malignant nature of the tumor?
Onion-peel
In the context of musculoskeletal tumors, which term describes a solid sunburst appearance?
Onion-skin
What term is associated with the most malignant type of periosteal reaction in musculoskeletal tumors?
Codman's triangle
What matrix component is associated with stippled calcification in lesions?
'Chondroid'
Which feature in musculoskeletal tumors is NOT associated with a more malignant nature?
'Stippled calcification'
What is the most helpful method for diagnosing soft tissue tumors and bony tumors with homogenous cell types?
Core needle biopsy
What type of incision is recommended during a biopsy procedure?
Longitudinal incision
What size should the windows in bone be during a biopsy procedure?
Oval and small
When performing a biopsy, what is essential to avoid tracking haematomas?
Careful haemostasis
Which imaging technique may aid in performing a core needle biopsy?
Ultrasonography
Where would amputation usually provide better postoperative function and reduced risk of recurrence for tumors?
Tumors located in the distal leg
When should limb salvage surgery be considered for treatment of tumors?
For tumors in the proximal aspect of an extremity
Which type of tumor is characterized by pain and is found in the metaphysis of the femur and tibia?
Osteoid osteoma
Where do primary osteosarcomas grow outward to?
Lifting periosteum and inward to the medullary cavity
Which bone-forming tumor is specifically associated with facial bones and skull?
Osteoma
What is a new solution to disfiguring surgical resections of lower limb sarcomas?
'Rotationplasty'
In what age range are osteomas typically found?
40-50 years
'Ewing’s sarcoma' belongs to which category of bone tumors?
'Miscellaneous tumors'
'Nonossifying Fibroma' belongs to which category of bone tumors?
'Fibrous tumors'
'Giant Cell Tumor of Bone' is an example of which type of tumor?
'Bone-forming tumor'
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
Test your knowledge on the location of musculoskeletal tumor lesions in this quiz aimed at students. Questions cover different locations such as medullary centric, medullary eccentric, juxtacortical, and more.
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