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CASE 1: OSTEOSARCOMA
o 13 year old male who first noted onset of pain in his left proximal tibial metaphysis 4 months prior to X-rays. No history of trauma o X-rays: Destructive process within L. proximal tibial fo metaphysis. o Tc99 bone scan revealed uptake in same general area. o CT of the chest was normal. o Labs Normal o Diagnosis: Osteosarcoma Most common primary malignant bone tumor Bimodal age distribution (75% occur in pts < 20 yo) Mutations in the genes encoding p53 and RB o Pts with hereditary retinoblastomas at 1,000x more likely to develop osteosarcoma Bone infarcts, chronic osteomyelitis, Paget disease, radiation, also associated with a bone neoplasia Develop at sites of greatest bone growth (metaphysis)
CASE 2: CHONDROSARCOMA
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72 year old black female with aching discomfort in her right shoulder, worse at night. Duration of approximately six months. X-ray: expansile lesion replacing the head of the right humerus, with characteristic punctate calcifications. Bone scan shows intense uptake in region of tumor. Lab: no abnormal values Diagnosis: Chondrosarcoma 40 years or older Central skeleton pelvis, shoulder, ribs Malignant hyaline and myxoid cartilage
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Multiple Myeloma Summary: o 50-60 year olds o More common in blacks than whites o Excess IgGk o Bone pain due punched out lytic lesions Production of osteoblast inhibitor Release IL-1 (osteoclast activating factor) o Ribs, vertebrae, skull, pelvis
46 year old male with a Hx of renal cell carcinoma Presents w/ right hip pain, 10 pound weight loss X-ray: large lesion in right proximal femur that is worrisome for a fracture 1.2 million patients present with cancer each year in the United States. Of these, approximately 600,000 persons have metastases to bone. In contrast, 2,700 patients per year develop primary bone sarcoma. The age range of patients with sarcoma is different from that of individuals with carcinoma of bone; most metastatic bone lesions occur in adults older than 50 years Most sarcomas occur in adolescents or young adults (< 30 y) A bone-occupying mass in an adult is much more likely to be a focus of metastatic carcinoma than to be a primary sarcoma of bone Females: Breast and Lung Male: Prostate and Lung Others: Thyroid and Renal cell carcinoma
Hip Lesion
More on Metastatic Carcinoma: Tumor cells up-regulate osteoclasts through production of RANK ligand potent stimulator of osteoclastic activity RANK ligand 1) recruits & 2) activates osteoclasts which degrade bone, producing pockets or holes in bone for tumor cells to grow Parathyroid hormone related peptide (PTHrP) Breast carcinoma cells small cell carcinoma of the lung Potent stimulant of osteoclasts