Ganglion Cysts and Bone Tumors
CT
Best for visualizing cortical continuity Useful when the primary site of a metastatic tumor is unknown
MRI
Best for visualizing soft tissue and marrow infiltrative processes
What re the most common primary sites for skeletal mass metastasis?
Breast, lung, kidney, thyroid and prostate
Test of choice to determine if osteosarcoma has metastasized to lungs
CT
Bone Scan
Helpful in determining if a known primary cancer has metastasized to bone
Myeloma
Hematologic disease that should be included in your d/dx of a bone lesion
What HPI clue would point to a ganglion cyst?
History of variation in size
Common physical exam findings in osteosarcoma
Local tenderness Swelling, mass, deformity Limp, muscle atrophy, decreased joint motion pathologic fracture
What role do corticosteroids have in the tx of ganglia?
No role - they have not been proven to be effective
Lungs
Organ to which osteosarcoma usually metastasizes to first
Who does a biopsy for osteosarcoma?
Orthopedic oncologist
A ganglion is filled with _______
synovial fluid
What might you have on your d/dx in a possible osteosarcoma with enlarged regional lymph nodes?
Osteomyelitis
What PE technique can be used to differentiate between a ganglion and a solid tumor?
Transillumination with a pen-light
Ganglion cyst
cystic structure that arises from either a joint capsule or tendon synovial sheath
"Common" ganglion cysts are associated with which joints/locations?
dorsoradial wrist, lateral aspect of foot/ankle
Mucuous ganglions are usually located where?
extensor tendon of DIP
Mucous ganglion
ganglion that develop from an arthritic interphalangeal joint
What can serve as treatment for ganglion cysts if patient wants to avoid excision?
immobilization, aspiration
How frequently should CT be repeated in the first two years post treatment for osteosarcoma?
q 3-6 months
Common history features of patients with osteosarcoma
5-30 years (most common 20-30) Dull, aching pain Night time "growing pains" Hx of minor trauma or injury
Plain Radiographs
Single most valuable study in evaluating bone tumors
A tumor that causes pain that is exacerbated with activity is indicative of what?
Weakened integrity of bone
What characteristic differentiates growing pains and possible osteosarcoma?
unilateral pain
How does metastasis affect the prognosis of osteosarcoma?
worsens it dramatically