Ganglion Cysts & bone tumors

X ray of an osteosarcoma

"moth-eaten" appearance and extension into the soft tissue

What is it called when a ganglion develops from an *arthritic interphalangeal joint*?

(digital) mucus cyst

______ is the key step in the diagnosis of an osteosarcoma

Biopsy

Imaging study helpful in determining if a known primary cancer has metastasized to bone

Bone scan

Imaging study that is best for visualizing *cortical continuity*

CT

Imaging study useful when the primary site of a metastatic tumor is *unknown*

CT

What is the test of choice to determine if metastasis to this organ has occured?

CT chest

Name the type of primary bone tumor: -tissue: *Cartilage* -traits: Wide variance, but usually associated with *long bones*

Chondrogenic

X-ray finding of osteoid osteoma

Classic x-ray finding is lucent nidus with sclerotic margin

Where are *mucous cysts* usually located?

DIP joint

Describe a malignant bone tumor pattern

Destructive ill-defined Lytic cortical destruction

How frequently should a CT be repeated in the first two years after treatment?

Every 3-6 months

Type of neuroectodermal primary bone tumor

Ewing sarcoma

Name the type of primary bone tumor: -tissue: *fibrous tissue* -traits: predominance in children, fibrous displacement of osseous tissue within the bone

Fibrogenic

Examples of fibrogenic primary bone tumor

Fibrous cortical defect/non-ossifying fibromas fibrous dysplasia fibrosarcoma

Difference during HPI b/n a ganglion and a soft-tissue tumor

Ganglion will vary in size based on activity

Examples of tumors of unknown origin

Giant cell tumor Unicameral and aneurysmal bone cysts

Name the type of primary bone tumor: -tissue: blood cells -traits: fatigue, wt. loss, night sweats, lymphadenopathy

Hematopoietic

__________ has a reduced rate of amputation

Induction chemotherapy

How does induction chemo reduce the rate of amputation?

It is given pre-operatively, and induces tumor necrosis and treats early metastatic disease

Common PE of a patient with *osteosarcoma*

Localized tenderness restricted ROM of adjacent joint muscle atrophy; referred pain

An osteosarcoma usually metastasizes to which organ first?

Lungs

Best imaging study for visualizing soft tissue and marrow infiltrative processes

MRI

How does metastasis of an osteosarcoma affect the prognosis?

Much poorer if pulmonary mets present

Hematologic disease should be included in your differential diagnosis of a bone lesion

Multiple Myeloma

Examples of Hematopoietic bone tumors

Myeloma leukemia lymphona

Name the type of primary bone tumor: -tissue: resemble skin cells with properties of nerves -traits: *young females* predominance. Mimics osteomyelitis, with fever, pain, and leukocytosis

Neuroectodermal

Do corticosteroids have a role in treating ganglia?

No

Name the type of primary bone tumor: -tissue: resembel embryologic notochord -traits: occurs along the spine, progresses over many years

Notochordal

Who should obtain a biopsy sample?

Orthopedic oncologist

In *wichita*, if we suspect osteosarcoma, who should we refer to for a second opinion? (b/c specialist is only in KC)

Orthopedic surgeon

What is a ganglion cyst filled with?

synovial fluid

Name the type of primary bone tumor: -tissue: bone or osteoid (uncalcified bone) -traits: linear arrangement of cells, changes to a haphazard pattern. Slight male predomeincance, <30 years. Localized pain; *spine or legs*

Osteogenic

Osteogenic tumor where the most common site is *femur*.

Osteoid osteoma

Teenage boy presents with leg pain that is progressively increasing and worse at night. No history of trauma, fatigue, wt loss. X ray appears benign. What is it likely?

Osteoid osteoma

If a patient who presents with all the s/s of an osteosarcoma, but has *enlarged, tender regional lymph nodes on physical exam,* what differential diagnosis would you consider?

Osteomyelitis

Osteogenic tumor that is the most common primary malignant bone tumor

Osteosarcoma

Example of notochordal primary bone tumor

chordroma

Most common site of an osteosarcoma

distal femur proximal tibia

Whenever *sarcoma* is a part of a tumor's name, it is __________

malignant

Most bone tumors are ____________, especially in *older patients*

metastases from another site

Osteogenic tumor where the most common site is the *spine*.

osteoblastoma

Chondrogenic bone tumor that is a frequent benign bone tumor, appears as a *mushroom shaped protruberance*

osteochondroma

Examples of chondrogenic primary bone tumor

osteochondroma chondroblastomas chondromyxoid fibroma chondrosarcoma

Single most valuable imaging study

plain radiographs

Physical exam technique you can use to differential between a prominent ganglion and a solid tumor

transilluminate ganglion from the side, and the *ganglion will light up*

A patient wants to avoid surgical excision of a non-mucous ganglion. What are *less invasive* treatments that could provide permanent resolution?

1. Aspiration and needle rupture 2. Anesthetic injection to pop ganglion

What five primary sites account for 85% of skeletal metastases?

1. Breast 2. Lung 3. Kidney 4. thyroid 5. Prostate

Examples of Osteogenic bone tumors

1. Osteoid osteoma 2. Osteoblastoma 3. Osteosarcoma

Common ganglions are usually associated with what joints/locations?

1. Wrist (dorsum & volar) 2. Lateral aspect of foot & ankle 3. Subtalor/ankle joint 4. Base of finger

Common history of a patient with *osteosarcoma*

10-20 yrs of age dull, aching pain for several months may become severe hx of frequent injury, sprain, or muscle pull *night pain* that awakens the patient

Tumor that causes pain that is *exacerbated* with activity - what does it indicate?

A lesion that has weakened the structural integrity of the bone

Where does a ganglion cyst arise from?

Tendon synovial sheath joint capsule

A 13-year-old boy presents with dull aching pain in his right knee that is worse at night for the past 3 months. *What characteristic heightens your suspicion so that you do not dismiss it as growing pains?"*

Unilateral

Traits of tumors of unknown origin

Varied. All are benign recurrence rate can be high after treatment

Describe a benign bone tumor pattern

well-defined without cortical destruction