4 - Primary Malignant Bone Tumors

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80 Terms

1
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Distal femur

Bone

<p>Bone</p>
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- Longitudinal: diaphysis/metaphysis/epiphysis

- Eccentricity: central

- Transverse: medullary

Location

<p>Location</p>
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Monostotic

Mono/polyostotic

<p>Mono/polyostotic</p>
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>1 cm

Size

<p>Size</p>
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- Mixed

- Long zone of transition

Behavior

<p>Behavior</p>
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Cortical destruction

Cortex

<p>Cortex</p>
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Osseous

Matrix

<p>Matrix</p>
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Spiculated

Periosteal reaction

<p>Periosteal reaction</p>
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- Soft tissue swelling

- Soft tissue extension

- Soft tissue calcification

Soft tissue involvement

<p>Soft tissue involvement</p>
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None

Joint involvement

<p>Joint involvement</p>
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Aggressive

Aggressive or non-aggressive?

<p>Aggressive or non-aggressive?</p>
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- Osteosarcoma*

- Ewing's Sarcoma

What are 2 differential diagnoses?

<p>What are 2 differential diagnoses?</p>
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Refer to pediatric oncologist

Next step?

<p>Next step?</p>
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- Left leg is very swelled up

• Spiculated periosteal reaction

• Soft tissue extension

• Destruction

Can you locate the findings that you described previously?

<p>Can you locate the findings that you described previously?</p>
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To look for cannonball metastasis

Why did they do a chest CT?

<p>Why did they do a chest CT?</p>
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- Location: metaphyseal of distal femur

- Matrix: flocculent cartilaginous

- Non-aggressive

- Dx: Enchondroma

- What is the exact location?

- What type of matrix is demonstrated?

- At this point, is this aggressive or non-aggressive?

- Diagnosis at this point?

<p>- What is the exact location?</p><p>- What type of matrix is demonstrated?</p><p>- At this point, is this aggressive or non-aggressive?</p><p>- Diagnosis at this point?</p>
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Refer to orthopedist (non-aggressive)

Next step at this point?

<p>Next step at this point?</p>
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- Cortical thinning

- Tumor more sclerotic - grew in size

- More lucency around tumor

- Aggressive

These x-rays were taken 3.5 years later:

- List at least 3 new findings

- At this point, is this aggressive or non-aggressive?

<p>These x-rays were taken 3.5 years later:</p><p>- List at least 3 new findings</p><p>- At this point, is this aggressive or non-aggressive?</p>
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Chondrosarcoma

Diagnosis?

<p>Diagnosis?</p>
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- Refer to oncologist

- Would not adjust patient's knee

- Next step?

- Would you adjust this patient's knee?

<p>- Next step?</p><p>- Would you adjust this patient's knee?</p>
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Humerus

Bone

<p>Bone</p>
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- Longitudinal: metaphysis

- Eccentricity: eccentric

- Transverse: medullary

Location

<p>Location</p>
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Monostotic

Mono/polyostotic

<p>Mono/polyostotic</p>
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>1 cm

Size

<p>Size</p>
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- Lytic

- Permeative/motheaten

- Long zone of transition

Behavior

<p>Behavior</p>
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- Cortical thinning

- Cortical destruction

Cortex

<p>Cortex</p>
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Nothing visible

Matrix

<p>Matrix</p>
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Laminated

Periosteal reaction

<p>Periosteal reaction</p>
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Soft tissue swelling

Soft tissue involvement

<p>Soft tissue involvement</p>
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None

Joint involvement

<p>Joint involvement</p>
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Aggressive

Aggressive or non-aggressive?

<p>Aggressive or non-aggressive?</p>
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- Osteosarcoma

- Ewing's Sarcoma*

What is your differential diagnosis?

<p>What is your differential diagnosis?</p>
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Soft tissue swelling

Is there soft tissue extension/involvement?

<p>Is there soft tissue extension/involvement?</p>
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To check for metastasis to another bone

Why do you think they did a bone scan?

<p>Why do you think they did a bone scan?</p>
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- Left proximal femur

- Left ilium

Bone

<p>Bone</p>
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- Longitudinal: metaphysis

- Eccentricity: central, some eccentric lesions

- Transverse: medullary

Location

<p>Location</p>
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Polyostotic

Mono/polyostotic

<p>Mono/polyostotic</p>
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Non-uniform

Uniform or non-uniform?

<p>Uniform or non-uniform?</p>
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>1 cm

Size

<p>Size</p>
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- Lytic

- Permeative/motheaten

- Long zone of transition

Behavior

<p>Behavior</p>
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Cortical thinning

Cortex

<p>Cortex</p>
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Nothing visible

Matrix

<p>Matrix</p>
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None

Periosteal reaction

<p>Periosteal reaction</p>
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None

Soft tissue involvement

<p>Soft tissue involvement</p>
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None

Joint involvement

<p>Joint involvement</p>
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Aggressive

Aggressive or non-aggressive?

<p>Aggressive or non-aggressive?</p>
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Non-Hodgkin's Lymphoma

What is your differential diagnosis?

<p>What is your differential diagnosis?</p>
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- Both femurs

- Both ilia

- Everywhere

What bone(s) is/are involved?

<p>What bone(s) is/are involved?</p>
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Refer to oncologist

Next step?

<p>Next step?</p>
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- Sacral destruction (arcuate line, foramina)

- S3-S5 involved

Findings?

<p>Findings?</p>
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Chordoma

Most likely diagnosis?

<p>Most likely diagnosis?</p>
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Distal sacrum (sacrococcygeal)

What is the exact lesion of the lesion?

<p>What is the exact lesion of the lesion?</p>
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- Spheno-occipital

- Vertebral

Where else do these occur?

<p>Where else do these occur?</p>
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Right distal femur

Bone

<p>Bone</p>
55
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- Longitudinal: metaphysis

- Eccentricity: central

- Transverse: medullary

Location

<p>Location</p>
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Monostotic

Mono/polyostotic

<p>Mono/polyostotic</p>
57
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>1 cm

Size

<p>Size</p>
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- Blastic

- Long zone of transition

Behavior

<p>Behavior</p>
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- Cortical thinning

- Cortical destruction

Cortex

<p>Cortex</p>
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Osseous

Matrix

<p>Matrix</p>
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Spiculated

Periosteal reaction

<p>Periosteal reaction</p>
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- Soft tissue swelling

- Soft tissue extension

- Soft tissue calcification

Soft tissue involvement

<p>Soft tissue involvement</p>
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Patellofemoral joint

Joint involvement

<p>Joint involvement</p>
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- Osteosarcoma*

- Ewing's Sarcoma

What is your differential diagnosis?

<p>What is your differential diagnosis?</p>
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Pediatric oncology referral

Next step?

<p>Next step?</p>
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Calcification

What do you see?

<p>What do you see?</p>
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Arc and ring cartilaginous

Matrix

<p>Matrix</p>
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Chondrosarcoma

Most likely diagnosis?

<p>Most likely diagnosis?</p>
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Humerus

Bone

<p>Bone</p>
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- Longitudinal: diaphysis

- Eccentricity: central

- Transverse: medullary

Location

<p>Location</p>
71
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Monostotic

Mono/polyostotic

<p>Mono/polyostotic</p>
72
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>1 cm

Size

<p>Size</p>
73
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- Blastic

- Long zone of transition

Behavior

<p>Behavior</p>
74
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Cortical thinning

Cortex

<p>Cortex</p>
75
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Osseous

Matrix

<p>Matrix</p>
76
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- Laminated

- Spiculated

Periosteal reaction

<p>Periosteal reaction</p>
77
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- Soft tissue swelling

- Soft tissue extension

Soft tissue involvement

<p>Soft tissue involvement</p>
78
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None

Joint involvement

<p>Joint involvement</p>
79
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- Osteosarcoma

- Ewing's Sarcoma*

What is your differential diagnosis?

<p>What is your differential diagnosis?</p>
80
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Refer to pediatric oncologist

Next step?

<p>Next step?</p>