Essentials of Orthopedic Surgery, third edition / 04-Tumors of the Musculoskeletal System

166 M. Malawer and K. Kellar-Graney

3.Dahlin DC. Bone Tumors: General Aspects and Data on 6221 Cases, 3rd ed. Springfield: Thomas, 1978.

4.Enneking WF, Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop 1980;153:106–120.

5.Sim FH, Bowman W, Chao E. Limb salvage surgery and reconstructive techniques. In: Sim FH (ed) Diagnosis and Treatment of Bone Tumors: A Team Approach. A Mayo Clinic Monograph. Thorofare, NJ: Slack, 1983.

6.Mankin HJ, Lange TA, Spanier SS. The hazards of biopsy in patients with malignant primary bone and soft tissue tumors. J Bone Joint Surg [Am] 1982;64(8):1121–1127.

7.Marcove RC, Mike V, Hajek JV, Levin AG, Hutter RV. Osteogenic sarcoma under the age of twenty-one. A review of one hundred and forty-five operative cases. J Bone Joint Surg [Am] 1970;52(3):411–423.

8.Rougraff BT, Simon MA, Kneisl JS, Greenberg DB, Mankin HJ. Limb salvage compared with amputation for osteosarcoma of the distal end of the femur. A long-term oncological, functional, and quality-of-life study. J Bone Joint Surg [Am] 1994;76(5):649–656.

9.Edeiken J. Bone tumors and tumor-like conditions. In: Edeiken J (ed) Roentgen Diagnosis and Disease of Bone, 3rd ed. Baltimore: Williams & Wilkins, 1981:30–414.

10.Marcove RC. Chondrosarcoma: diagnosis and treatment. Orthop Clin North Am 1977;8(4):811–820.

Review Questions

1.—and — are the two most commonly diagnosed primary malignant bone tumors in children and adolescents.

a.Osteoid osteoma and osteoblastoma

b.Giant cell tumor and osteochondroma

c.Liposarcoma and angiosarcoma

d.Osteosarcoma and Ewing’s sarcoma

2.Carcinomas tend to grow in an invasive manner, infiltrating surrounding soft tissues. Sarcomas —

a.Grow in a ball-like manner and typically compress surrounding tissues

b.Behave exactly like carcinomas and always grow invasively

c.Immediately spread to the lymph nodes and metastasize through the lymphatic system

d.None of the above

3.When performing a biopsy, the preferred approach would include:

a.An open or incisional biopsy to obtain a large amount of tumor

b.A fine-needle aspirate of the fluid surrounding the tumor

c.Biopsy is typically not indicated for sarcomas because typically radiographs and staging studies are conclusive

d.A core-needle biopsy in the same anatomic planes as any planned surgical resection

4. Tumors of the Musculoskeletal System

167

4.When evaluating a plain radiograph of a patient with a suspected osteosarcoma, the following characteristics may be seen with regard to the affected bone:

a.Intramedullary sclerosis and/or cortical destruction

b.Periosteal elevation

c.Extraosseous extension with ossification

d.a, b, and c

5.The most common location of origin of an osteosarcoma is:

a.The distal femur

b.The acetabulum

c.The spine

d.The ribs

6.Which of the following diagnoses should be included in a differential diagnosis for a 61-year-old patient with pain and a pathologic fracture of the pelvis?

a.Chondrosarcoma

b.Multiple myeloma

c.Metastatic carcinoma to bone

d.All of the above

7.Batson’s plexus refers to:

a.The neurovascular bundle located in the axilla

b.The valveless venous plexus that permits retrograde blood flow to the spine, pelvis, and shoulder-girdle

c.A condition wherein the patient describes a ‘pins and needles’ sensation

d.None of the above

8.Benign bone tumors should be surgically removed under which of the following circumstances?

a.There is a pathologic fracture

b.They are painful

c.They have the potential to undergo malignant transformation or have recurred

d.All of the above

9.Which of the following modalities is utilized in the treatment of highgrade soft tissue sarcomas?

a.Surgery

b.Chemotherapy (preand/or postoperative)

c.Radiation therapy

d.All of the above

10.The appearance of an intramuscular lipoma, when viewed on aT1- weighted MRI, would be described as:

a.Heterogeneous and bright on T1 sequence

b.Homogeneous and bright on T1 sequence

c.Cystic and dark on T2 sequence

d.Hemorrhagic and both bright and dark on T1 as well as T2 sequence

168 M. Malawer and K. Kellar-Graney

Suggested Readings

1.Malawer M, Sugarbaker PH (eds) Musculoskeletal Cancer Surgery: Treatment of Sarcomas and Allied Diseases, 1st ed. Dordrecht: Kluwer, 2001. (Note: The best general overview of musculoskeletal cancer imaging, pathology, radiology and surgery.)

2.Enneking WF, Spanier SS, Malawer MM. The effect of the anatomic setting on the results of surgical procedures for soft parts sarcoma of the thigh. Cancer (Phila) 1981;47(5):1005–1022. (Classic article of surgical anatomy and soft tissue muscle resections in lieu of amputations.)

3.Dahlin DC. Bone Tumors: General Aspects and Data on 6221 Cases, 3rd ed. Springfield: Thomas, 1978. (Classic text reviewing pathology and radiology of bone tumors.)

4.Enneking WF, Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop 1980;153:106–120. (The classic article describing the system of musculoskeletal cancer staging.)

5.Sim FH, Bowman W, Chao E. Limb salvage surgery and reconstructive techniques. In: Sim FH (ed) Diagnosis and Treatment of Bone Tumors: A Team Approach. A Mayo Clinic Monograph. Thorofare, NJ: Slack, 1983. (A general review of limb-salvage techniques.)

6.Mankin HJ, Lange TA, Spanier SS. The hazards of biopsy in patients with malignant primary bone and soft-tissue tumors. J Bone Joint Surg [Am] 1982;64(8):1121–1127. (The classic article describing the importance and risks of the initial biopsy in the overall treatment of musculoskeletal tumors.)

7.Marcove RC, et al. Osteogenic sarcoma under the age of twenty-one. A review of one hundred and forty-five operative cases. J Bone Joint Surg [Am] 1970;52(3):411–423. (The original article describing the high risk and survival of osteosarcoma.)

8.Rougraff BT, et al. Limb salvage compared with amputation for osteosarcoma of the distal end of the femur. A long-term oncological, functional, and quality- of-life study. J Bone Joint Surg [Am] 1994;76(5):649–656. (This article compares the clinical differences of an amputation versus an endoprosthetic limb-sparing procedure.)

9.Edeiken J. Bone tumors and tumor-like conditions. In: Edeiken J (ed) Roentgen Diagnosis and Disease of Bone. Baltimore: Williams & Wilkins, 1981. (Textbook and review of all bone tumors.)

10.Marcove RC. Chondrosarcoma: diagnosis and treatment. Orthop Clin North Am 1977;8(4):811–820. (The classic article on the treatment of chondrosarcoma; the second most common primary bony sarcoma.)