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