MS: Ganglion Cysts and Bone Tumors

What imaging is best for visualizing cortical continuity?

CT

What imaging is useful when the primary site of metastatic tumor is unknown?

CT and bone scan

What imaging is best for visualizing soft tissue and marrow infiltrative processes?

MRI

It is filled with:

thick, clear, mucous

What imaging is helpful in determining if a known primary cancer has metastasized to the bone?

bone scan

Most malignant bone lesions are metastases from another site, esp. in older patients. What five primary sites account for 85% of skeletal metastases?

breast lung kidney thyroid prostate

Example of notochordal tumor:

chordoma

When a patient desires to avoid surgical excision of a non-mucous ganglion, what less invasive treatments can be tried that have the potential to provide permanent resolution?

dorsal wrist: aspiration tendon sheath at base of finger: needle rupture followed by massage ankle: pierce the wall of the ganglion 3-4 times with 18 gauge needle to release gelatinous core and promote complete collapse of the cyst

"Common" ganglions are usually associated with which locations on the hands/wrists and feet/ankles?

dorsum of wrist volar radial aspect of wrist base of finger lateral aspect foot ro ankle

Example of neuro-ectodermal boen tumor:

ewing sarcoma

Examples of fibrogenic bone tumors:

fibrous cortical defect/non-ossifying fibromas fibrous dysplasia fibrosarcomas

Examples of tumors of unknown origin:

giant cell tumor unicameral and aneurysmal bone cysts

Classification of primary bone tumors can be separated into the following types:

hematopoietic osteogenic chondrogenic fibrogenic tumors of unknown origin neuro-ectodermal notochordal

What helps you distinguish a ganglion from other soft-tissue tumors?

history of variation in size is a key factor to distinguish it

What role do corticosteroids have in the treatment of ganglia?

injecting corticosteroid has not been shown to influence the recurrence rate and is NOT recommended

A ganglion is a cystic structure that arises from either a:

joint capsule or a tendon synovial sheath

Mucous cysts are usually located on the:

lie to one side of the extensor tendon at the DIP joint

Osteosarcoma:

mc primary malignant bone tumor, most commonly at distal femur or proximal tibia xray has poor definition with "moth eaten" appearance and extension into soft tissue

Osteoid osteoma:

most common site is femur classic xray finding is lucent nidus with sclerotic margin

Osteoblastoma:

most common site is spine varibale xray findings

What hematologic disease should be included in your differential of a bone lesion?

multiple myeloma

Examples of hematopoietic bone tumors:

myeloma, leukemia, lymphoma

Examples of chondrogenic bone tumors:

osteochondroma chondroblastomas chondromyxoid fibroma chondrosarcoma

Examples of osteogenic bone tumors:

osteoid osteoma osteoblastoma osteosarcoma

What imaging is the single most valuable imaging study?

plain radiographs

Notochordal bone tumor:

resemble embryologic notochord occurs along spine, progresses over many years

Neuro-ectodermal bone tumors:

resemble skin cells properties of nerves

What physical exam technique can be used to differentiate between a prominent ganglion and a solid tumor?

shine a penlight through it, it will transilluminate

Hematopoietic bone tumors:

tissue: blood cells many have fatigue, weight loss, night sweats, lymphadenopathy

Osteogenic bone tumors:

tissue: bone or osteoid linear arrangement of cells changes to haphazard pattern. SLight male predominance, < 30 years. Localized pain; spine or legs

Chondrogenic bone tumors:

tissue: cartilage wide variance, but usually associated with long bones

Fibrogenic bone tumors:

tissue: fibrous tissue predominance in children fibrous displacement of osseous tissue within a bone

Tumors of unknown origin:

varied. All are considered benign, however recurrence rate can be high after treatment

A tumor that causes pain that is exacerbated with activity is indicative of what?

weakened structural integrity of the bone

Neuro-ectodermal bone tumors have a predominance in:

young females mimics ostemyelitis with fever, pain and leukocytosis