Watkins Ch.12 Bone Tumors

Multiple myeloma

..... is more common than osteogenic sarcoma but is often considered a marrow cell tumor

Ewing's Sarcoma

Radiographic evaluation: Looks very aggressive, permeative or motheaten, osteolytic lesion with cortical erosions, periostitis

Osteoblastoma (Giant Osteoid Osteoma)

Rapidly growing benign bone forming tumor; rarely becomes malignant Occurs in the second and third decades of life More common in males Most commonly seen in the spine, skull, and the diaphysis of long bones Mild pain worse at night not relieved by aspirin

Chondromyxoid Fibroma

Rare, benign cartilage forming tumor Occurs during the second and third decades of life More common in males (2:1) Occurs in the metaphysis of long tubular bones (esp. tibia) Symptoms include slowly progressing pain, tenderness, and swelling.

Fibrosarcoma

Secondary to Paget's Disease Malignant connective tissue tumor Occurs during the third, fourth, fifth, and sixth decades of life. Distribution of males to females is equal. Usually found in the metaphysis of long tubular bones (esp. femur, tibia) Symptoms can include pain, swelling, and limited motion with possible pathologic fracture.

Osteoid Osteoma

Symptoms are pain, worse at night, relieved by aspirin or NSAIDs.

Breast, lung, prostate, kidney, and thyroid

THE MOST COMMON SOURCES OF METASTATIC BONE TUMORS

99-Tc MDP

This can estimate the local intramedullary extent of the tumor and screen for other skeletal areas of involvement

Soap bubble appearance

This is a hallmark radiographic feature of aneurysmal bone cysts

Codman Triangle

elevation of the periosteum seen in osteogenic sarcoma and other condition including hemorrhage and acute osteomyelitis

Hair on end

rays are all parallel. Rays of periosteal bone project in a perpendicular direction to the underlying bone. Seen in Ewing sarcoma

Permeative

Poorly defined lesion margins with a wide zone of transition; the lesion boundaries are not easily discerned from normal bone. Aggressive, rapidly growing lesion seen in malignant bone tumors

Aneurysmal Bone Cyst

Benign blood-filled cyst Not a true neoplasm; may be secondary to vascular injury Occurs during the first, second, third decades of life More common in females (2:1)

Osteoma

Benign bone forming tumor Most common in the sixth decade of life More common in females (3:1) Occurs in bone that is formed from the periosteum (membranous bone) Although more common in the skull (specifically the sinuses), they also

Chondroblastoma

Benign cartilage forming tumor Occurs during the second and third decades of life More common in males Located in the epiphysis of long tubular bones (esp. femur, tibia, and humerus); when found in the foot, it is usually in the talus or calcaneus

Chondroma

Benign cartilage forming tumor Occurs in third and fourth decades of life Male to female distribution is equal.

Osteochondroma

Benign cartilage-covered osseous protuberance Occurs during the first, second, and third decades of life More common in males (1.5:1) Occurs in the metaphysis of long tubular bones (esp. femur, humerus, and tibia) Most common benign tumor; however, there is a 1% change of malignant degeneration

Non-ossifying Fibroma

Benign connective tissue tumors Occurs during the first and second decades of life Affects the metaphysis of long tubular often around the knee Self-limiting: heals over time

Giant Cell Tumor

Benign fibrohistiocytic tumors composed of connective tissue, stromal cells, and giant cells Occurs during the third and fourth decades of life More common in females, the cortex can be eggshell thin. Recurrence is high in Children

Unicameral Bone cyst

Benign fluid-filled tumors of unknown origin Occurs during the first and second decades of life More common in males (2:1)

Enchondroma

May occur in any age group, but mostly during the second decade of life Male to female distribution is equal. Humerus and femur are usually affected and to a lesser extent the hands and feet.

Bone biopsy

Definitive diagnosis requires a ____________

Sunburst

Delicate rays of periosteum bone formation separated by spaces containing blood vessels. Seen with Ewing sarcoma, osteogenic sarcoma, chondrosarcoma, fibrosarcoma, leukemia, and acute osteomyelitis

Poor prognosis, Caucasian

Ewing Sarcoma has this prognosis and affects this race more than others

MRI

For potentially active and aggressive lesions, an ________ is useful

Periostitis (onion-skin)

Hallmark sign of Ewing Sarcoma

Moth eaten

Less well-defined lesion margins and a wider zone of transition between normal and abnormal bone More aggressive pattern than geographic and indicates a faster growing lesion Seen in aggressive tumors and in osteomyelitis

Less

MORE/LESS aggressive lesions have a narrow zone of transition, a geographic pattern of destruction, and no periostitis of adjacent soft tissue involvement

Osteochondroma

MOST COMMON BENIGN PRIMARY BONE TUMOR

Osteogenic sarcoma

MOST COMMON MALIGNANT PRIMARY BONE TUMOR

Osteosarcoma

Malignant bone forming tumor Age 10 to 25 years and >40 years Male to female distribution is equal. Most commonly found in the metaphyseal region around the knee (distal femur or proximal tibia) Usually occurs in teenagers during rapid growth spurts or in patients over 40 who have a preexisting condition most notably Paget disease Symptoms: Pain, swelling, and fever (R/O osteomyelitis); the osteoidproducing nature of the tumor often yields an elevated alkaline phosphatase level.

Chondrosarcoma

Malignant cartilage forming tumor More common over age 60 Males are affected more often than females (1.5:1). Lesions can occur almost anywhere, the most commonly affected bone being the femur.

Ewing Sarcoma

Malignant tumors of miscellaneous/unknown origin Usually occurs between the ages of 7 and 20 years More common in males (3:2) Metadiaphysis, metaphysis

Maffucci's

Multiple enchondromas associated with soft tissue hemangiomas Occurs in the first decade of life 30% of cases become malignant.

Onion Skin

Multiple layers of new periosteal bone Seen in Ewing sarcoma, eosinophilic granuloma, lymphoma of bone, osteogenic sarcoma, and acute osteomyelitis

Osteoma Osteochondroma Enchondroma Chondroblastoma Chondromyxoid fibroma

Name benign tumors

Benign Osteoid Ostoma

Occurs in the first and second decades of life More common in males (2:1) Occurs in the diaphysis of long bones (esp. tibia and femur)

metaphysis of tubular bones

Unicameral Bone Cysts appear in this region of the bone to those under 20 yo

Pathological

Unicameral bone cysts are usually asymptomatic unless associated with a this type of fracture

pelvis or calcaneus

Unicameral bone cysts lesions in patients over 20 years of age generally occur in the _____________

Geographic

Well-defined margins with a narrow zone of transition from normal to abnormal bone. Indicative of a slow growing, less aggressive lesion

Chondrosarcoma, Fibrosarcoma

What are malignant tumors that affect 20-50 yo?

Chondrosarcoma, Osteosarcoma

What are malignant tumors that affect those over 50 yo?

primary or metastatic

What are the two types of bone tumors

Ewing Sarcoma, Osteosarcoma

What are two malignant tumors that affect those under 20 yo?

Interosseous Lipoma

When the calcaneus is involved (15% of the time), lesions are usually in the neutral triangle (as with simple bone cysts) and there is often a central calcified nidus.

Fallen fragment sign

pathologic fractures cause bone fragments to fall into the cyst and migrate to the dependent position