Snapshot A 31-year-old man presents to his primary care provider with left knee pain. He noted a bulge on his left knee 6 months ago that has gradually grown in size. A radiograph of the left knee is shown demonstrating a large lytic tumor in the fibular head. The patient is diagnosed with a giant cell tumor. Osteoma Definition benign bone tumor (osteogenic) derived from osteoblasts Presentation location skull mandible symptoms painless mass associated conditions Gardner syndrome Associated findings histology proliferating osteoblasts with active intramembranous ossification radiography radiodense and smooth bony mass Treatment surgical resection for symptomatic masses Osteoid Osteoma Definition benign bone tumor (osteogenic) derived from osteoblasts small (< 2 cm) Presentation location proximal femur (most common) tibial diaphysis vertebrae symptoms focal pain that resolves with NSAIDs if arising in the spine, may cause painful scoliosis Associated findings histology nidus of osteoid and immature osteoblasts surrounded by a rim of reactive bone formation radiography radiolucent nidus (< 2 cm) surrounded by reactive bone Treatment observation and NSAIDs Osteoblastoma Definition benign but locally aggressive bone tumor (osteogenic) derived from osteoblasts larger than an osteoid osteoma (> 2 cm) Presentation location vertebrae (most common) long bone diaphyses symptoms focal pain that is not relieved by NSAIDs if arising in the spine, may cause neurologic symptoms Associated findings histology nidus of osteoid and immature osteoblasts surrounded by a rim of reactive bone formation radiography radiolucent nidus (> 2 cm) surrounded by reactive bone large lesions may extend into neighboring soft tissues Treatment observation and NSAIDs Giant Cell Tumor (Osteoclastoma) Definition benign but locally aggressive tumor derived from stromal cells with accompanying giant cells stromal cells resemble interstitial fibroblasts and are neoplastic cells giant cells are derived from monocyte/macrophage lineage and have similar characteristics to osteoclasts Presentation location metaphyseal regions of long bones distal femur (most common) proximal tibia distal radius symptoms focal pain may be referred to nearby joint Associated findings histology 3 cells types may be seen stromal cells resembling fibroblasts neoplastic cells monocyte/macrophage cells recruited from peripheral blood precursors to giant cells giant cells multiple nuclei similar to osteoclasts resorb bone radiography eccentric lytic metaphyseal lesion that may extend into the distal epiphysis characteristic "double bubble" or "soap bubble" appearance increased activity of osteoclasts results in a cavitary lesion Treatment curettage or marginal excision with bone grafting Osteochondroma (Exostosis) Definition benign cartilage-derived tumor (chondrogenic) containing bone and a cartilage cap arises as a lateral projection of the growth plate most common cartilage-derived tumor two forms solitary osteochondroma may be caused by Salter-Harris fracture, surgery, or radiation therapy syndromatic osteochondromas multiple hereditary exostosis (MHE) Presentation location metaphyseal regions of long bones distal femur proximal tibia proximal humerus symptoms painless mass Associated findings histology normal bony trabeculae with a thin cartilaginous cap radiography sessile (broad base) or pedunculated (narrow stalk) lesions found on the surface of bones Treatment medical bisphosphonates denosumab surgical curettage and reconstruction Enchondroma Definition benign cartilage-derived (chondrogenic) tumor arises when chondroblasts and epiphyseal cartilage escape from the physis, enter the metaphysis, and proliferate second most common cartilage-derived tumor two forms solitary enchondroma syndromatic enchondromas Ollier disease Maffucci syndrome Presentation location medullary cavity in the metaphyseal or diaphyseal regions hand (most common) feet distal femur symptoms most often asymptomatic pathologic fracture Associated findings histology bland mature hyaline cartilage radiography well-defined lucent medullary lesion Treatment observation
QUESTIONS 1 of 2 1 2 Previous Next Lab Values Blood Hematologic Cerebrospinal Sweat, Urine, and BMI Blood, Plasma, Serum Reference Range ALT 8-20 U/L Amylase, serum 25-125 U/L AST 8-20 U/L Bilirubin, serum (adult) Total // Direct 0.1-1.0 mg/dL // 0.0-0.3 mg/dL Calcium, serum (Ca2+) 8.4-10.2 mg/dL Cholesterol, serum Rec: < 200 mg/dL Cortisol, serum 0800 h: 5-23 μg/dL //1600 h: 3-15 μg/dL 2000 h: ≤ 50% of 0800 h Creatine kinase, serum Male: 25-90 U/LFemale: 10-70 U/L Creatinine, serum 0.6-1.2 mg/dL Electrolytes, serum Sodium (Na+) 136-145 mEq/L Chloride (Cl-) 95-105 mEq/L Potassium (K+) 3.5-5.0 mEq/L Bicarbonate (HCO3-) 22-28 mEq/L Magnesium (Mg2+) 1.5-2.0 mEq/L Estriol, total, serum (in pregnancy) 24-28 wks // 32-36 wks 30-170 ng/mL // 60-280 ng/mL 28-32 wk // 36-40 wks 40-220 ng/mL // 80-350 ng/mL Ferritin, serum Male: 15-200 ng/mLFemale: 12-150 ng/mL Follicle-stimulating hormone, serum/plasma Male: 4-25 mIU/mL Female: premenopause: 4-30 mIU/mL midcycle peak: 10-90 mIU/mL postmenopause: 40-250 pH 7.35-7.45 PCO2 33-45 mmHg PO2 75-105 mmHg Glucose, serum Fasting: 70-110 mg/dL2-h postprandial:<120 mg/dL Growth hormone - arginine stimulation Fasting: <5 ng/mLProvocative stimuli: > 7ng/mL Immunoglobulins, serum IgA 76-390 mg/dL IgE 0-380 IU/mL IgG 650-1500 mg/dL IgM 40-345 mg/dL Iron 50-170 μg/dL Lactate dehydrogenase, serum 45-90 U/L Luteinizing hormone, serum/plasma Male: 6-23 mIU/mL Female: follicular phase: 5-30 mIU/mL midcycle: 75-150 mIU/mL postmenopause 30-200 mIU/mL Osmolality, serum 275-295 mOsmol/kd H2O Parathyroid hormone, serume, N-terminal 230-630 pg/mL Phosphatase (alkaline), serum (p-NPP at 30° C) 20-70 U/L Phosphorus (inorganic), serum 3.0-4.5 mg/dL Prolactin, serum (hPRL) < 20 ng/mL Proteins, serum Total (recumbent) 6.0-7.8 g/dL Albumin 3.5-5.5 g/dL Globulin 2.3-3.5 g/dL Thyroid-stimulating hormone, serum or plasma .5-5.0 μU/mL Thyroidal iodine (123I) uptake 8%-30% of administered dose/24h Thyroxine (T4), serum 5-12 μg/dL Triglycerides, serum 35-160 mg/dL Triiodothyronine (T3), serum (RIA) 115-190 ng/dL Triiodothyronine (T3) resin uptake 25%-35% Urea nitrogen, serum 7-18 mg/dL Uric acid, serum 3.0-8.2 mg/dL Hematologic Reference Range Bleeding time 2-7 minutes Erythrocyte count Male: 4.3-5.9 million/mm3Female: 3.5-5.5 million mm3 Erythrocyte sedimentation rate (Westergren) Male: 0-15 mm/hFemale: 0-20 mm/h Hematocrit Male: 41%-53%Female: 36%-46% Hemoglobin A1c ≤ 6 % Hemoglobin, blood Male: 13.5-17.5 g/dLFemale: 12.0-16.0 g/dL Hemoglobin, plasma 1-4 mg/dL Leukocyte count and differential Leukocyte count 4,500-11,000/mm3 Segmented neutrophils 54%-62% Bands 3%-5% Eosinophils 1%-3% Basophils 0%-0.75% Lymphocytes 25%-33% Monocytes 3%-7% Mean corpuscular hemoglobin 25.4-34.6 pg/cell Mean corpuscular hemoglobin concentration 31%-36% Hb/cell Mean corpuscular volume 80-100 μm3 Partial thromboplastin time (activated) 25-40 seconds Platelet count 150,000-400,000/mm3 Prothrombin time 11-15 seconds Reticulocyte count 0.5%-1.5% of red cells Thrombin time < 2 seconds deviation from control Volume Plasma Male: 25-43 mL/kgFemale: 28-45 mL/kg Red cell Male: 20-36 mL/kgFemale: 19-31 mL/kg Cerebrospinal Fluid Reference Range Cell count 0-5/mm3 Chloride 118-132 mEq/L Gamma globulin 3%-12% total proteins Glucose 40-70 mg/dL Pressure 70-180 mm H2O Proteins, total < 40 mg/dL Sweat Reference Range Chloride 0-35 mmol/L Urine Calcium 100-300 mg/24 h Chloride Varies with intake Creatinine clearance Male: 97-137 mL/minFemale: 88-128 mL/min Estriol, total (in pregnancy) 30 wks 6-18 mg/24 h 35 wks 9-28 mg/24 h 40 wks 13-42 mg/24 h 17-Hydroxycorticosteroids Male: 3.0-10.0 mg/24 hFemale: 2.0-8.0 mg/24 h 17-Ketosteroids, total Male: 8-20 mg/24 hFemale: 6-15 mg/24 h Osmolality 50-1400 mOsmol/kg H2O Oxalate 8-40 μg/mL Potassium Varies with diet Proteins, total < 150 mg/24 h Sodium Varies with diet Uric acid Varies with diet Body Mass Index (BMI) Adult: 19-25 kg/m2 Calculator ( ) xy AC 7 8 9 ÷ 4 5 6 × 1 2 3 - 0 . = + Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK
All Videos (1) Podcasts (0) Login to View Community Videos Login to View Community Videos Osteoid Osteoma vs. Osteoblastoma Oncology - Benign Bone Tumors 3/18/2019 18 views (1)