Systems Path Exam 2

T/F Metastasis to bone is MC than primary bone tumors

True

What are the diverse features of primary bone tumors?

1. Asymptomatic

2. Pathologic fractures

3. Fever, fatigue, cachexia

What are the categories of bone tumors?

1. Bone-forming tumors

2. Cartilage-forming tumor

3. Tumors of uncertain origin

What are the bone forming tumors?

1. Osteoid osteoma

2. Osteoblastoma

3. Osteosarcoma

What is the difference between osteoid osteoma and osteoblastoma?

Size

What is a osteoid osteoma?

Small benign tumor

dark area in center is a “nidus”

rim around is rim of sclerosis

near cortex of long bones (metaphysis of femur and tibia)

Osteoid osteoma can be relieved by ___

NSAIDS

Both osteoid osteoma and osteoblastoma are MC in ___

younger males (10-20)

What is an osteoblastoma? (TQ)

larger tumor

grows in vertebral processes

unrelieved by aspirin

What is an osteosarcoma?

malignant tumor and agressive

affects 10-20 year males

If older than 40, osteosarcoma is associated with ____

Paget disease

What is the most common primary bone cancer?

Osteosarcoma

What is codman triangle?

periosteal reaction- aggressive lesion of bone

associated with osteosarcoma

What is periosteal reaction?

aggressive lesion of bone

A mixed pattern of tumor is MC in ___

osteosarcoma

Osteosarcomas tend to develop where? (TQ)

metaphysis of distal femur, tibia, and humerus

Around what area do osteosarcomas mostly develop?

knee (60%)

What is a major concern with osteosarcoma?

20% have metastasis to lungs at diagnosis

What is the treatment for osteosarcoma?

1. amputation

2. chemotherapy

   good prognosis (60-70% survivial)

What are the three main types of cartilage forming tumors?

1. Osteochondroma (exostosis)

2. Chondroma (enchondroma)

3. Chondrosarcoma

What makes up cartilage?

hyaline

T/F Cartilage forming tumors are benign

true

Osteochondromas are MC in who?

Males ages 10-30

Where do osteochondroma’s typically grow?

Long bone metaphysis near growth plate

knee MC

Most osteochondromas are ____

solitary- sporadic

What is the most common shape of osteochondroma?

pedunculated (narrow base)

What is sessile?

wide base

What is an enchondroma? (TQ)

benign tumor of hyaline cartilage

MC in hands and feet (proximal phalanges)

What age is at risk for enchondromas?

20-50 years

What is multiple enchondromas referred to as?

Ollier’s disease

How is enchondromas normally found?

MC asymptomatic

incidental diagnosis with fractures

What is a chondrosarcoma?

malignant cartilage tumor

2nd MC primary bone cancer

What age group is at risk for chondrosarcomas?

40-60 years old

Males

Where are chondrosarcomas most common?

Pelvic and shoulder gurdles

Chondrosarcomas can be identified as a ___

“glistening” mass

What is companion feature of chondrosarcomas?

stippled or “popcorn"" calcifications

What is a low-grade chondrosarcoma?

MC, slow growing

thickens cortex

What is a high grade chondrosarcoma?

large mass, erodes thin cortex

poor prognosis

What are fibrous cortical defect and nonossifying fibroma?

small= FCD

large= NOF

reaction to periosteal injury

fibroblasts and macrophages accumulate

Common, self-resolve in childern

T/F FCD and NOF self resolve in childern

True

What is the common location of FCD and NOF?

knee and ankle

MC asymptomatic

T/F fibrous dysplasia is a tumor

False

What is fibrous dysplasia?

Failed bony differentiation

What causes fibrous dysplasia

mutation that causes failed osteoblast differention

Is the fibrous dysplasia mutation inherited?

No- occurs spontaneously

Monostotic fibrous dysplasia vs Polyostotic fibrous dysplasia?

Monostotic- single bone

Polystotic- multiple bones

McCune-Albright syndrome is a combination of ___

polyostotic + cafe-au- lait spots and endocrinopathy

Which FD is more common?

Monostotic FD →stops growing at time of growth plate closure

Does polyostotic stop with growth plate closure?

No→ likely to progress into adulthood

more severe→ leads to more issues

What is McCune-Albright syndrome?

fibrous dysplasia

more widespread

skeletal

skin→ cafe au lait spots

endocrinopathy→ hyperfunctioning

What is ewing sarcoma?

malignant tumors

2nd MC pediatric bone cancer

Who is most at risk for Ewing sarcoma?

caucasian males

10-20 years

Where is ewing sarcoma most common?

Diaphysis of long bone

“onion-skinning”→enlarging mass

What type of cells are associated with Ewing sarcoma?

small round cell

What is giant-cell tumor of bone (Osteoclastoma)?

promotes ostoeclast differentiation

Epiphsis/metaphysis of bone

What is a companion feature of giant cell tumor of bone?

soap bubble appearance

thin “shell” of cortex

T/F Secondary metastasis to bone is MC than primary bone cancer?

True

Where is metastasis of bone most common?

spine is MC spot

Where is metastasis of bone MC?

axial skeleton, proximal femur/humerus

What is lytic, blastic, and mixed (MC)?

Lytic- radiolucent

Blastic- radioplaque

Mixed- combination

In adults prostate cancer causes __ apperance

blastic

In adults, breast cancer causes a __ appearance

lytic

In adults, lung cancer causes a __ appearance

mixed

What are the red flags with low back pain of cancerous origin? (TQ)

1. over 50 years old

2. history of cancer

3. cachexia

What is a ganglion cyst?

common, asymptomatic

occurs in joints that have substained previous injuries

myxoid degenrative connective tissue

favors posterior wrist

T/F There is no communication with synovium with a ganglion cyst

True

What is a synovial cyst?

TRUE CYST

synovial herniation- fluid filled extension of synovium

associated with joint degeneration

Where is synovial cysts located most commonly?

popliteal= Baker cyst

spinal synovial cyst

What are soft tissue tumors?

cellular origin of adipose, fibrous, muscle, vessels, PNS

RARE- deadly

What is the most common soft tissue tumor?

lipoma

What is a lipoma?

benign adipocytes tumor

What is a liposarcoma?

malignant adipocyte tumor

MC adults age 50-70

Where are liposarcoma’s most commonly found? (TQ)

deep retroperitoneum and thigh

What is a nodular fasciitis?

proliferation of fibroblasts

benign tumor

What is the common location of nodular fasciitis?

palm side of the arm

rapid growth but self-limited

What is myositis ossificans?

repair process lays down bone

reaction to trauma

fibroblasts transition into osteoprogenitor cells

MC in athletes

What are fibromatoses?

benign tumor of fibroblasts

invasive and painful

What is the difference between superficial and deep fibromatoses?

Superficial fibromatoses= less aggressive

Deep fibromatoses (desmoid tumors)=

What is an example of superifical firbomatoses?

Dupuytren Contracture→ MC in palms of hands at 4-5 digit

What are deep fibromatosis (desmoid tumors)?

more aggressive than superficial

MC in abdominal wall

What is a fibrosarcoma?

malignant tumor of fibroblasts

MC in deep thigh and retroperitoneum

What is the appearance features of fibrosarcoma?

1. herringbone pattern

2. originates in fibrous tissue- may invade into bone

What is a rhabdomyosarcoma?

aggressive malignancy of skeletal muscle

MC pediatric soft tissue sarcoma

What is the MC pediatric soft tissue sarcoma? (TQ)

Rhabdomyosarcoma

What is a leiomyoma?

benign uterine fibroids

What is leiomyosarcoma?

malignant tumor in deep retroperitoneum (IVC)

MC in adult females

What is a synovial sarcoma?

soft tissue cancer- aggressive, deadly

MC age 20-40

Where are synovial sarcoma most commonly found?

MC near the knee

What should we look for if there is a peripheral nerve injury? (TQ)

Muscle weakness

flaccidity

decreased DTR’s (deep tendon reflex)

sensory abnormalites

What is a common way to assess peripheral nerve function?

NCV (nerve conduction velocity) test

What does NCV test for? (TQ)

both velocity and amplitude

What is neuropraxia?

mild compression/traction injury

What is axonotmesis?

axons severed

regeneration expected

What is neurotmesis?

nerve completely severed

poor regeneration capacity

When the distal end of the axon degenerates it is called __

Wallerian degeneration

If regrowth and remyelination of axons takes place, what are the consequences? (TQ)

1. decreased axon density

2. decreased amplitude on a NCV test

What is demyelinating neuropathy?

random or segmental demyelination

results of repair is decreased velocity on NCV test

What is mononeuropathy?

isolated nerve injury

carpel tunnel syndrome is example

trauma

What is polyneuropathy? (TQ)

systemic issues

widespread pattern

Stocking and glove paresthesia→ distal areas affected first

What is guillain-barre syndrome?

acute motor neuron deymyelination

ascending flaccid paralysis