p. 1169 Bone tumors

Benign

Generally not painful (benign or malignant)

Benign

Often incidental findings (benign or malignant)

Malignant

Can be painful (benign or malignant)

Malignant

Can have associated soft tissue masses (benign or malignant)

Malignant

Have have constitutional symptoms (benign or malignant)

X-ray

What imaging do you always start with for bone tumors

What is the lesion doing to the bone? How is the bone responding to the lesion?

2 important questions when dealing with bone tumors

Benign

Narrow zone of transition (benign or malignant)

Benign

Well-marginated (benign or malignant)

Benign

Sclerotic border (benign or malignant)

Malignant

Wide zone of transition (benign or malignant)

Malignant

Permeative (benign or malignant)

Malignant

Aggressive (benign or malignant)

Malignant

+/- soft tissue extension (benign or malignant)

Benign

Osteochondroma (benign or malignant)

Benign

Enchondroma (benign or malignant)

Benign

Non-ossifying fibroma (NOF) (benign or malignant)

Benign

Unicameral bone cyst (benign or malignant)

Benign

Aneurysmal bone cyst (benign or malignant)

Osteochondroma

Outgrowth of cartilage from peripheral physeal plate that then undergoes enchondral ossification

Distal femur

Most common location of osteochondroma

Cut off the bone bump

What is exostectomy

Observation, exostectomy

Treatment for osteochondroma

Enchondroma

Benign cartilage lesion, remnants of hyaline cartilage from growth plate that failed enchondral ossification

Hand, femur, humerus

Most common location of enchondroma

Inside the bone, medullary lesion

Radiologic feature of enchondroma

Observation

Treatment for enchondroma

Non-ossifying fibroma

Developmental error in remodeling

Distal femur, tibia

Common locations of non-ossifying fibroma

Inside the bone, eccentric, metaphyseal, expansile, well-marginated

Radiological features of non-ossifying fibroma

Observation, activity modification

Treatment of non-ossifying fibroma

Most in long bones, esp. proximal humerus, femur, tibia

Most common locations of unicameral bone cyst

Active

Type of unicameral bone cyst that abuts the physis

Latent

Type of unicameral bone cyst that is separated from physis

Fallen fragment, leaf sign

Radiological sign of unicameral bone cyst

No consensus

Treatment for unicameral bone cyst

Femur, tibia, vertebra

Common locations of aneurysmal bone cyst

Female

Most common gender that gets aneurysmal bone cyst

Pain/swelling, or pathologic fracture

Clinical presentation of aneurysmal bone cyst

Lytic, eccentric, expansile (soap bubble)

Radiographic appearance of aneurysmal bone cyst

Intra-lesional curettage + adjuvant + bone grafting

Treatment for aneurysmal bone cyst

Malignant

Osteosarcoma (benign or malignant)

Malignant

Ewings sarcoma (benign or malignant)

Malignant

More rare (benign or malignant)

Sarcoma

Cancer arising from cells of mesenchymal origin (bone, cartilage, fat, muscle, vascular, neural, hematopoietic tissue)

Carcinoma

Cancer arising from epithelial cells (breast, lung, colon)

Osteosarcoma

The most common malignant tumor of bone

Pain, swelling, decreased ROM, pathologic fracture

Clinical signs of osteosarcoma

Knee!, proximal humerus

Most common locations of osteosarcoma

Codman's triangle, wide zone of transition

Radiographic appearance of osteosarcoma

Pre-op chemotherapy, surgery, post-op chemotherapy

Treatment for osteosarcoma

Chemotherapy

Most important part of treatment for osteosarcoma that will give the best survival rate

Ewings sarcoma

Second most common primary malignant tumor or bone

Fever, malaise, weight-loss, anemia, elevated ESR, leukocytosis

What are some constitutional symptoms of ewings sarcoma

Diaphysis (tibia, fibula), spine

Most common locations of ewings sarcoma

Onion-skinning (layering of the periosteum), Codman's triangles

Radiographic findings of ewings sarcoma

Codman's triangles

What is the radiologic name for periosteal new bone

Pre-op chemotherapy, surgery, post-op chemotherapy

Treatment for ewings sarcoma

Lung, renal, prostate, breast, thyroid

5 most common sources of metastatic lesions to bone

Batson vertebral plexus

Network of valve-less connecting veins hypothesized to be source of osseous spread of metastases

Pain, limp, gait change, weight loss, pathologic fracture

Presentation of metastatic bone disease

Metastatic disease

If you see a lytic lesion in a patient over 40, what do you suspect until proven otherwise

Radiation or surgical stabilization with radiation

Treatment for metastatic bone disease

Bimodal distribution, 2nd decade then 4th-5th decade)

Most common age for osteosarcoma

Primarily before 25

Most common age for aneurysmal bone cyst

20 or younger

Most common age for unicameral bone cyst

2nd decade

Most common age for non-ossifying fibroma

2nd decade

Most common age for enchondroma

2nd decade

Most common age for osteochondroma