Bone Tumor PDF

grambart Tumor/growth Benign/malig Age / sex Fibrous dysplasia Benign 20-30s (M>F) Osteoid osteoma Benign F) F) Giant cell tumor Benign, but can rarely metastasize 30s+ (F>M) End of long bones metaphysis or shaft >2cm talus Epiphysis (base of 1st, heads of 25 met, Metaphysis Aneurysmal bone cyst Ben...

grambart Tumor/growth Benign/malig Age / sex Fibrous dysplasia Benign 20-30s (M>F) Osteoid osteoma Benign F) F) Giant cell tumor Benign, but can rarely metastasize 30s+ (F>M) End of long bones metaphysis or shaft >2cm talus Epiphysis (base of 1st, heads of 25 met, Metaphysis Aneurysmal bone cyst Benign (CYST) 5-20 Metaphysis Chondroblastoma Benign, but can metastasize 10-25 Talus, cuboid, calcaneus Epiphyseal plate extending into epiphysis Location / size Symptoms appearance Brown skin macules, endocrine disorders Produces high amounts of prostaglandins Ground glass Very aggressive expansion and can lead to pain Swelling and pain Notable thing Circumscribed lucent NIDUS with zone of sclerosis, NIDUS can have calcific center Large >2cm Night pain treated by aspirin Large eccentric, oval, radiolucent, destructive lesion in epiphysis subperiosteal BLOWOUT appearance May metastasize to lungs or transform to fibrosarcoma or osteogenic sarcoma MRI – mosaic glass Well demarcated, expansile, oval lesion with thin sclerotic bone margin Spotty calcification Derived from chondroblasts CHICKEN WIRE MATRIX Composition Replacement of bone interior with fibro-osseous tissue Osteoid tissue intermixed with woven bone surrounded by sclerosis Osteoid tissue intermixed with woven bone in vascular connective tissue stroma Cortical erosion and thinning Av or other vascular anomaly from local circulatory disturbance in bone Tumor/growth Benign/malig Age / sex Chondromxoid fibroma Benign F) Hyperparathyroid Benign 30-50 3F:1M Location / size Phalanges Non-ossifying fibroma Benign 30%-40% kids Tibial shaft Metaphysis Enchondroma Benign (may convert to chondrosarcoma in older pt) 30-60s Proximal phalanx Medullary cavity Phalanges and metatarsal Osteochondroma Benign F Epiphysis Bone island Benign (not a tumor) Metatarsal Calcaneus Symptoms Hypercalcemia leading to calcification in blood vessels Asymptomatic appearance Notable thing Composition Ovoid shape with long axis parallel to bone with sclerotic margin and lobulated contour Generalized loss of bone density with endosteal resorption, lightly trabeculated with expanding bone lesions Increase T2 signal Origin from cartilage forming connective tissue Thin zone of transition Soap bubble Central or slightly eccentric, well circumscribed or bubbly radiolucent lesion finely stippled with calcification Bony projection from bone surface with cortex and medullary canal Area of sclerotic bone due to high osteoblast activity Decreased T1 signal BROWN TUMOR due to hemosiderin deposits in bone SUBPERIOSTEAL BONE RESORPTION SOAP BUBBLE End of bone with speckled tone Look like mushroom cap Often come back in open growth plate Don’t need to biopsy Start as fibrous cortical defect that enlarges into medullary cavity Mature hyaline cartilage in medullary cavity Cap of hyaline cartilage that projects away from epiphysis Tumor/growth Benign/malig Age / sex Location / size Eosinophilic granuloma Benign F Central in diaphysis or metaphysis Solitary (unicameral) bone cyst Benign 3-19 M>F Calcaneus (under middle facet) Metaphysis Ewing sarcoma Malignant 20s (high aggression; 88% survival if don’t metastasize; 0-10% survival with metastasis Malignant 2M>1F Calcaneus Diaphysis Osteogenic sarcoma (osteosarcoma) Chondrosarcoma 20% 5 yr survival due to metastasis to lung Malignant 40% 5 yr survival >20 (primary OSA) Older pt (pagets DZ) 2M>1F 40+ M>F Symptoms 1/3 hindfoot, 2/3 forefoot pain, swelling, warmth, fever, increased ESR (mimic osteomyelitis) appearance Notable thing Composition Oval, radiolucent with border of sclerosis resembling osteomyelitis Central, symmetrical lesion surrounded by thin rim of bone Endosteal scalloping Histiocytic lesions Diaphysis with periosteal rxn leading to ONION SKIN and has soft tissue mass Matrix, periosteum, develop in places of active growth like long bones of knee 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 FALLEN FRAGMENT (piece of bone on margin of tumor that breaks off and deposits on gravity dependent edge of tumor Mottled moth eaten destructive lesion Onion skin Neuroectodermal cell origin (+) ALKALINE PHOSPHATASE Proliferating malignant spindle cell stroma producing immature bone 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 Metastasis / myeloma Malignant (from somewhere else) >40 Child – neuroblastoma Adult M -Lung Adult F – breast Location / size Symptoms appearance Notable thing Composition Most common primary malignant tumor in body Plasma cells with lytic lesions, monoclonal gammopathy johnstone US – ultrasound Tumor/growth Benign/malig Ganglion cyst Benign 1/3 of all benign lesions Mucoid cyst Benign Lipoma Benign age location 50-70 40-60 Synovial lining (Distal IP joint) (fingers) Toe, finger Painless Anywhere where fat persists Painless (unless compress nerve, subQ in most (deep are painful) More on back, shoulder, neck, ab, proximal extremity Fibroma Benign Symptom Joint capsule Plantar/palmar fascia 2 types: deep and superficial (more common) Pressure caused by cyst may erode bone Deep- spreads along fascia, nerve, tendon sheath Appearance Notable thing cause treatment US – anechoic and may be septate MRI – Smooth may have stalk T1 hypointense T2 hyperintense Lights up Trauma; herniation of joint capsule US- anechoic, smooth Lights up 1- observe 2- aspirate (but high recurrence rate unless use steroids after aspiration) 3- excision 1- observe 2expression (like zit pop) 3- aspirate 4- excise 5- DIPJ arthrodesis (if recur) 1- watch 2- excise MRI- sharp border T2 high signal intensity MRI- look similar to other fatty areas T1 – hyperintense T2intermediate signal (low signal if due fat suppression) US – single well demarcated iso-echoic with plantar fascia MRI- fusiform thickening of plantar fascia T1/T2 low signal intensity Equally transilluminate with skin 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 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 Look like coral reef T1/T2 has low intensity due to having hemosiderin causing issues with MRI 1- observe 2- excise Repressed signal intensity on MRI 1- excise (re-excise if recur) Giant cell tumor of tendon sheath Benign 30s-50s Synovium of Tendon sheath (often hand and wrist) (less aggressive than PVNS) F>M Neurilemmoma (schwannoma) Benign 50-60 Perineum (peripheral nerve sheath) Nerve ( flexor surface) Hemangioma Benign Most common pediatric tumor 1st week of life and go away by 4YO Blood vessels Painless, mass along tendon course Older mass may erode and destroy bone and cartilage Nerve displaced by tumor eccentrically Can be moved perpendicularly but not longitudinally Paresthesia, numb Blue/pink nodular lesion on skin with rubber feel Skin elevate MRIperiarticular or synovial mass Low signal T1/T2 MRI (best method) Low T1/T2 Moderately enhanced with contrast T1: Isointense or if with contrast high intensity T2 hyperintense, SPLIT FAT SIGN (thin rim of peripheral fat, TARGET SIGN (peripheral high t2 signal) US- echogenic, tons of color if use Doppler MRI T1-intermediate T2hyperintense due to blood flow (fluid) cause treatment Tinnel sign since on nerve MRI: “split fat sign” and “target sign” Schwann cells 1- observe 2-excise (better know how or refer out) 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 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 Malignant 15-35 YO Soft tissues Periarticular regions (tendon sheath, bursae, joint capsule) Painful Xraycalcification eccentrically or peripheral CALCIFICATION MRI: triple signal sign Undifferentiated mesenchymal cells 1- wide excision 2amputate Synovial sarcoma 5-10% soft tissue tumors CT - Enhance with contrast Lower extremity 80% 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) MRIT1- hypointense T2hyperintense with contrast MRI – T1 heterogenous deep seated soft tissue mass T2 triple signal sign (areas of hypo, iso, and hyperintense Contrast look heterogenous 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 Fibrosarcoma Malignant 30s-80s Fibrous connective tissue Trunk and upper extremities Swelling, difficulty moving limb CT- nonspecific area of isoattenuated soft tissue mass Fibroblast Trunk, upper extremity Superficial or deep Extend to involve tendons, tendon sheath, fascia, 2-6cm firm painless papule May ulcerate Epithelioid sarcoma Malignant 10-25 2M>F MRI – T1 hypointense T2 hyperintense and enhanced with contrast Xraycalcification (10-20% of time) and erosion of adjacent bone MRIindeterminate in appearance T1 hypointense T2 hyperintense Herring bone pattern – interlacing sheets of spindle like fibroblasts Calcification cause treatment Infantile form (F Knee Metaphysis near epiphyseal plate Xray – polypoid growth (MUSHROOM) Benign Most common intraosseous tumor 20-40 M>F Distal skeleton (hand/feet) Metaphysis Xray – well defined with Ca Chondroma CODMAN TRIANGLE (DESTROY CORTEX) (elevation of periosteum) Contains hyaline cartilage (mushroom cap) bone and bone marrow Histologic – interlacing trabeculae of woven bone surrounded by osteoblasts, loose connective tissue stroma, giant cells Histologic – interlacing trabeculae of woven bone surrounded by osteoblasts, loose connective tissue stroma, giant cells Preop chemo à Radical surge à post op chemo Histologic – tons of osteoid Tumor/growth Benign/malig Chondrosarcoma Malignant Ewing sarcoma (EWS) Malignant Primitive neuroectodermal tumor (PNET) Malignant Age / sex location 40-60 Metaphysis Pelvic bones Axial skeleton, Symptom Appearance Notable thing Xray – variably calcified and multilobular Diaphysis long bone CD99 stain Neural phenotype and identical chromosome translocation UNDIFFERENTIATED Homer wright rosettes Diaphysis long bone Neural phenotype and identical chromosome translocation NEURAL DIFFERNTIALTION Fibrous cortical defect Benign Fibrous dysplasia Benign Giant cell tumor Benign (90%) ; Malignant (10%) More locally aggressive 4-8 DZ of 1st two decades of life 10-30 Metaphysis of distal femur and proximal tibia Anywhere (long bone, jaw, skull….) Asymptomatic incidental finding on xray 20-55 Epiphysis of long bone (knee distal radius) Pt complain of arthritis symptoms Scalloped Xray – radiolucent in diaphysis Xray – radiolucent in epiphysis Curvilinear spicules of immature WOVEN BONE surrounded by fibroblastic proliferation Osteoclasts Aggressiveness determined by cellularity, degree of nuclear atypia, mitotic activity will determine the grade (grade 1 good, grade 3 bad) Small round blue tumor Small round blue tumor From precursor multipotent stem cell