yay bone tumor stuffs.docx

grambart Tumor/growth Benign/malig Age / sex Location / size Symptoms appearance Notable thing Composition Fibrous dysplasia Benign 20-30s (M>F) Brown skin macules, endocrine disorders Ground glass Replacement of bone interior with fibro-osseous tissue Osteoid osteoma Benign <20 (M>F) <2...

grambart Tumor/growth Benign/malig Age / sex Location / size Symptoms appearance Notable thing Composition Fibrous dysplasia Benign 20-30s (M>F) Brown skin macules, endocrine disorders Ground glass Replacement of bone interior with fibro-osseous tissue Osteoid osteoma Benign <20 (M>F) <2cm Calcaneus talus Produces high amounts of prostaglandins Circumscribed lucent NIDUS with zone of sclerosis, NIDUS can have calcific center Night pain treated by aspirin Osteoid tissue intermixed with woven bone surrounded by sclerosis Osteoblastoma Benign 7-20 (M>F) End of long bones metaphysis or shaft >2cm talus Large >2cm Osteoid tissue intermixed with woven bone in vascular connective tissue stroma Giant cell tumor Benign, but can rarely metastasize 30s+ (F>M) Epiphysis (base of 1st, heads of 2-5 met, Metaphysis Very aggressive expansion and can lead to pain Large eccentric, oval, radiolucent, destructive lesion in epiphysis May metastasize to lungs or transform to fibrosarcoma or osteogenic sarcoma Cortical erosion and thinning Aneurysmal bone cyst Benign (CYST) 5-20 Metaphysis Swelling and pain subperiosteal BLOWOUT appearance MRI – mosaic glass Av or other vascular anomaly from local circulatory disturbance in bone Chondroblastoma Benign, but can metastasize 10-25 Talus, cuboid, calcaneus Epiphyseal plate extending into epiphysis Well demarcated, expansile, oval lesion with thin sclerotic bone margin Spotty calcification Derived from chondroblasts CHICKEN WIRE MATRIX Tumor/growth Benign/malig Age / sex Location / size Symptoms appearance Notable thing Composition Chondromxoid fibroma Benign <30 (M>F) Ovoid shape with long axis parallel to bone with sclerotic margin and lobulated contour Increase T2 signal Decreased T1 signal Origin from cartilage forming connective tissue Hyperparathyroid Benign 30-50 3F:1M Phalanges Hypercalcemia leading to calcification in blood vessels Generalized loss of bone density with endosteal resorption, lightly trabeculated with expanding bone lesions BROWN TUMOR due to hemosiderin deposits in bone SUBPERIOSTEAL BONE RESORPTION Non-ossifying fibroma Benign 30%-40% kids Tibial shaft Metaphysis Asymptomatic Thin zone of transition Soap bubble SOAP BUBBLE Start as fibrous cortical defect that enlarges into medullary cavity Enchondroma Benign (may convert to chondrosarcoma in older pt) 30-60s Proximal phalanx Medullary cavity Phalanges and metatarsal Central or slightly eccentric, well circumscribed or bubbly radiolucent lesion finely stippled with calcification End of bone with speckled tone Mature hyaline cartilage in medullary cavity Osteochondroma Benign <20 M>F Epiphysis Metatarsal Bony projection from bone surface with cortex and medullary canal Look like mushroom cap Often come back in open growth plate Cap of hyaline cartilage that projects away from epiphysis Bone island Benign (not a tumor) Calcaneus Area of sclerotic bone due to high osteoblast activity Don’t need to biopsy Tumor/growth Benign/malig Age / sex Location / size Symptoms appearance Notable thing Composition Eosinophilic granuloma Benign <10 M>F Central in diaphysis or metaphysis Oval, radiolucent with border of sclerosis resembling osteomyelitis Endosteal scalloping Histiocytic lesions Solitary (unicameral) bone cyst Benign 3-19 M>F Calcaneus (under middle facet) Metaphysis Central, symmetrical lesion surrounded by thin rim of bone FALLEN FRAGMENT (piece of bone on margin of tumor that breaks off and deposits on gravity dependent edge of tumor Ewing sarcoma Malignant (high aggression; 88% survival if don’t metastasize; 0-10% survival with metastasis 20s 2M>1F Calcaneus Diaphysis 1/3 hindfoot, 2/3 forefoot pain, swelling, warmth, fever, increased ESR (mimic osteomyelitis) Diaphysis with periosteal rxn leading to ONION SKIN and has soft tissue mass Mottled moth eaten destructive lesion Onion skin Neuroectodermal cell origin Osteogenic sarcoma (osteosarcoma) Malignant 20% 5 yr survival due to metastasis to lung >20 (primary OSA) Older pt (pagets DZ) 2M>1F Matrix, periosteum, develop in places of active growth like long bones of knee (+) ALKALINE PHOSPHATASE Proliferating malignant spindle cell stroma producing immature bone Chondrosarcoma Malignant 40% 5 yr survival 40+ M>F Most common malignant bone tumor of foot/ankle Large lesion in interior of diaphysis or metaphysis Bone enlarged, focal periosteal rxns, extent into soft tissue Bubble radiolucency, calcifications, SCALLOPED regions where inner cortex destroyed Cartilage without tumor osteoid or bone being formed by sarcomatous stroma Tumor/growth Benign/malig Age / sex Location / size Symptoms appearance Notable thing Composition Metastasis / myeloma Malignant (from somewhere else) >40 Child – neuroblastoma Adult M -Lung Adult F – breast Most common primary malignant tumor in body Plasma cells with lytic lesions, monoclonal gammopathy johnstone US – ultrasound Tumor/growth Benign/malig age location Symptom Appearance Notable thing cause treatment Ganglion cyst Benign 1/3 of all benign lesions Joint capsule US – anechoic and may be septate MRI – Smooth may have stalk T1 hypointense T2 hyperintense Lights up Trauma; herniation of joint capsule 1- observe 2- aspirate (but high recurrence rate unless use steroids after aspiration) 3- excision Mucoid cyst Benign 50-70 Synovial lining (Distal IP joint) (fingers) Toe, finger Painless Pressure caused by cyst may erode bone US- anechoic, smooth MRI- sharp border T2 high signal intensity Lights up 1- observe 2- expression (like zit pop) 3- aspirate 4- excise 5- DIPJ arthrodesis (if recur) Lipoma Benign 40-60 Anywhere where fat persists More on back, shoulder, neck, ab, proximal extremity Painless (unless compress nerve, subQ in most (deep are painful) MRI- look similar to other fatty areas T1 – hyperintense T2- intermediate signal (low signal if due fat suppression) Equally transilluminate with skin 1- watch 2- excise Fibroma Benign Plantar/palmar fascia 2 types: deep and superficial (more common) Deep- spreads along fascia, nerve, tendon sheath US – single well demarcated iso-echoic with plantar fascia MRI- fusiform thickening of plantar fascia T1/T2 low signal intensity SPINDLE CELLS and collagen fibrils 1- watch 2- orthotic 3- steroid injections (causes atrophy of mass) 4- excise Tumor/growth Benign/malig age location Symptom Appearance Notable thing cause treatment Pigmented villonodular synovitis (PVNS) Benign 20-50 Synovium lining of joint Can erode bone and joint Joint pain and swelling “catching”, “locking” stiffness or instability Xray – may show some erosion, sclerosis if old enough MRI- periarticular or synovial mass Low signal T1/T2 Look like coral reef T1/T2 has low intensity due to having hemosiderin causing issues with MRI 1- observe 2- excise Giant cell tumor of tendon sheath Benign (less aggressive than PVNS) 30s-50s F>M Synovium of Tendon sheath (often hand and wrist) Painless, mass along tendon course Older mass may erode and destroy bone and cartilage MRI (best method) Low T1/T2 Moderately enhanced with contrast Repressed signal intensity on MRI 1- excise (re-excise if recur) Neurilemmoma (schwannoma) Benign 50-60 Perineum (peripheral nerve sheath) Nerve ( flexor surface) Nerve displaced by tumor eccentrically Can be moved perpendicularly but not longitudinally Paresthesia, numb T1: Isointense or if with contrast high intensity T2 hyperintense, SPLIT FAT SIGN (thin rim of peripheral fat, TARGET SIGN (peripheral high t2 signal) Tinnel sign since on nerve MRI: “split fat sign” and “target sign” Schwann cells 1- observe 2-excise (better know how or refer out) Hemangioma Benign Most common pediatric tumor 1st week of life and go away by 4YO Blood vessels Blue/pink nodular lesion on skin with rubber feel Skin elevate US- echogenic, tons of color if use Doppler MRI T1-intermediate T2- hyperintense due to blood flow (fluid) MRI: “bag of worms” Blood vessels multiply at abnormal rates 1- watch 2-compress 3-embolize and excise Tumor/growth Benign/malig age location Symptom Appearance Notable thing cause treatment Glomus Benign Version of hemangioma 20s-40s Under nail in nail bed Deep subQ fat of finger/toe or under nail bed Blue-red blanchable papule US- color Doppler MRI- T1- hypointense T2- hyperintense with contrast Loves test Hildreths sign Cold sensitivity From glomus body (feature of dermis from av shunt surrounded by connective tissue 1- watch 2- excise nail unit Synovial sarcoma 5-10% soft tissue tumors Malignant 15-35 YO Soft tissues Periarticular regions (tendon sheath, bursae, joint capsule) Lower extremity 80% Painful Xray- calcification eccentrically or peripheral CT - Enhance with contrast MRI – T1 heterogenous deep seated soft tissue mass T2 triple signal sign (areas of hypo, iso, and hyperintense Contrast look heterogenous CALCIFICATION MRI: triple signal sign Undifferentiated mesenchymal cells 1- wide excision 2- amputate Clear cell sarcoma 1% soft tissue tumors Malignant Aggressive melanocytic sarcoma 30s-40s F>M Deep seated regions of extremities (aponeurosis, tendon) (dorsal metatarsal space) 1/3-1/2 people have pain Xray- soft tissue swell MRI- may look benign T1 homogenous T2 heterogenous Melanocytic Tumor/growth Benign/malig Age/sex location Symptom Appearance Notable thing cause treatment Fibrosarcoma Malignant 30s-80s Fibrous connective tissue Trunk and upper extremities Swelling, difficulty moving limb CT- nonspecific area of isoattenuated soft tissue mass MRI – T1 hypointense T2 hyperintense and enhanced with contrast Fibroblast Herring bone pattern – interlacing sheets of spindle like fibroblasts Infantile form (<2YO) chemo Surge Amputate Epithelioid sarcoma Malignant 10-25 2M>F Trunk, upper extremity Superficial or deep Extend to involve tendons, tendon sheath, fascia, 2-6cm firm painless papule May ulcerate Xray- calcification (10-20% of time) and erosion of adjacent bone MRI- indeterminate in appearance T1 hypointense T2 hyperintense Calcification Carnevale Tumor/growth Benign/malig Age / sex location Symptom Appearance Notable thing Osteoid Osteoma Benign <2cm 40-50 Knee hip Cortical bone of skull and face Usually asymptomatic Local and mechanical issues (ie obstruction) Painful Xray- central area (nidus) radiolucent with sclerotic rim NIDUS Pain relieved by ASPIRIN Histologic – interlacing trabeculae of woven bone surrounded by osteoblasts, loose connective tissue stroma, giant cells Osteoblastoma Benign >2cm Teens – 20s Vertebral column Usually asymptomatic Local and mechanical issues (ie obstruction) Painful Xray- central area (nidus) radiolucent with sclerotic rim NIDUS Histologic – interlacing trabeculae of woven bone surrounded by osteoblasts, loose connective tissue stroma, giant cells Osteosarcoma Malignant (very aggressive with 20% metastasis to lung when diagnose) Primary - <20 1.6M>F Secondary – older pt (more aggressive) Metaphysis of long bones of extremities Pain, swell, pathologic fracture Xray- large destructive mixed blastic and lytic mass with CODMAN triangle Mesenchymal may have osteoid Bimodal age CODMAN TRIANGLE (DESTROY CORTEX) (elevation of periosteum) Preop chemo Radical surge post op chemo Histologic – tons of osteoid Osteochondroma Usually benign 10-30 3M>F Knee Metaphysis near epiphyseal plate Xray – polypoid growth (MUSHROOM) Contains hyaline cartilage (mushroom cap) bone and bone marrow Chondroma Benign Most common intraosseous tumor 20-40 M>F Distal skeleton (hand/feet) Metaphysis Xray – well defined with Ca Tumor/growth Benign/malig Age / sex location Symptom Appearance Notable thing Chondrosarcoma Malignant 40-60 Metaphysis Pelvic bones Axial skeleton, Xray – variably calcified and multilobular Aggressiveness determined by cellularity, degree of nuclear atypia, mitotic activity will determine the grade (grade 1 good, grade 3 bad) Ewing sarcoma (EWS) Malignant Diaphysis long bone CD99 stain Neural phenotype and identical chromosome translocation UNDIFFERENTIATED Small round blue tumor Primitive neuroectodermal tumor (PNET) Malignant Diaphysis long bone Homer wright rosettes Neural phenotype and identical chromosome translocation NEURAL DIFFERNTIALTION Small round blue tumor From precursor multipotent stem cell Fibrous cortical defect Benign 4-8 DZ of 1st two decades of life Metaphysis of distal femur and proximal tibia Asymptomatic incidental finding on xray Scalloped Fibrous dysplasia Benign 10-30 Anywhere (long bone, jaw, skull….) Xray – radiolucent in diaphysis Curvilinear spicules of immature WOVEN BONE surrounded by fibroblastic proliferation Giant cell tumor Benign (90%) ; Malignant (10%) More locally aggressive 20-55 Epiphysis of long bone (knee distal radius) Pt complain of arthritis symptoms Xray – radiolucent in epiphysis Osteoclasts