Malignant Bone Tumors

Question 1

Osteosarcoma radiographic

Answer 1

Ill-defined, mixed sclerotic and lytic

Metaphysis

Periosteal reaction 9Codman’s triangle)

Extra-osseuous mass in soft tissue

Question 2

Osteosarcoma

Ages

Answer 2

Second decade (rapid growth)

Over 60 (Paget’s dz)

Question 3

Causes of ostesarcoma

Answer 3

Growth - metaphysis of taller children

Secondary from radiation

Genetic syndrome

Paget’s in older

Question 4

Genetic syndrome and osteosarcoma

Answer 4

Retinoblastoma (RB)
Rothmund-Thomson (RecQL4)
Li-Fraumeni Syndrome (TP53)

Question 5

Presentation of osteosarcoma

Answer 5

Pain at tumor site (typically steady)

Swelling and limp will develop

Fever, weight loss, etc. uncommon

Question 6

Locations of osteosarcoma

Answer 6

Metaphysis of long bones

Distal femur (most common) or promximal tibia

Proximal ghumeorus 3rd most

Question 7

Eval of osteosarcoma

Answer 7

Plain film of - ill-efined mixed, periosteal rxn, wide zone of transition

Then MRI of entire bone

Search for bone metastases with bone scan or PET

Search for lung with chest CT

Question 8

Most important prognostic factor of osteosarcoma

Answer 8

Lung metastases

Question 9

Diagnosiing osteosarcoma

Answer 9

Biopsy always required (core biopsy or surgery)

Question 10

Hallmark osteosarcoma on a slide

Answer 10

Lamignant osteoid

Question 11

Tx of osteosarcoma

Answer 11

Use chemo and surgery….oragnepeel strategy

Question 12

Ewing sarcoma radiographic/in a slide

Answer 12

Moth eaten superoir pelvic ramus

Lots of small blue cells

Question 13

Ewing sarcoma

Age, sx,

Answer 13

25% in soft tissues

Diagnosed in first 3 decases

Could have the fever, weight loss etc.

Persistnet pain

Question 14

Ewing sarcoma areas affected

Answer 14

Axial and appendicular skeleton

Typically from diaphysis but also some from metaphysis

Single most common in plevis

Question 15

Metastatic spread of Ewing

Answer 15

Most have micrometastatic

Lungs are common, followed by bone and bone marrow (no bone marrow in osteosarcoma)

Question 16

Tx difference for Ewing

Answer 16

Radiation can be used

Question 17

Chondrosarcoma

Pathology, age, sites

Answer 17

Production of cartialge matri

Develop within normal bone

Middle-age to older adults

Pelvis and proximal femur are common

Question 18

Chondrosarcoma

Most common type, mutations, management

Answer 18

Most are primary arising in meduallry canal

IDH2 and IDH1

Managmeent surgical onlyy

Question 19

Chondrosarcoma on a slide

Answer 19

CHondrocytes and matrix

Question 20

Radiograph appearance of chondrosarcoma

Answer 20

Arcs and rings with ossification

Question 21

OS

Age
Sx
Common primary site
Location in bone 
X-ray 
Pathology
Tx

Answer 21

Teenage, elderly
Pain 
Femur, tibia, humerous 
Metaphysis
Lytic/slerotic
Malignant osteoid production
Surg and chemo

Question 22

ES 
Age
Sx
Common site
Location in bone 
X-ray 
Partho tx

Answer 22

Teenage/young adults 
Pain, fever, WL
Axial=appendicular
Diaphysis
Onion skin/moth eaten
SMall round blue cells, EWS-FLI-1 translocation
Surgery/RT and chemo

Question 23

CS 
Age
sx
common site
Location in bone 
X ray 
patho
Tx

Answer 23

30-70
Pain
Pelvis, femur
Often central
Arcs and rings 
Chondroid matrix...IDH 1 and IDH2 
Surgery