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Tri 6 - Tumors > 2. Benign Tumors > Flashcards

2. Benign Tumors Flashcards

1
Q

A round/oval, well circumscribed uniformly opaque calcific radiopacity that arises in membranous bones

A

Osteoma

usually less than 2 cm

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2
Q

MC benign tumor of nose and paranasal sinuses

A

Osteoma

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3
Q

found in paranasal sinuses, inner and outer skull tables

A

Osteoma

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4
Q

Fills the entire sinus

and may cause ocular disturbances, headaches, and sinusitis

A

Giant Osteomas

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5
Q

Mandibular Osteoma will cause

A

Mechanical and cosmetic problems

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6
Q

Osteomas may be associated with what syndrome?

A

Gardner’s Syndrome

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7
Q

Colonic polyposis, soft tissue fibromas, and multiple osteomas that are protuberant, oval, dense.

A

Gardener’s Syndrome:

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8
Q

Discrete area of sclerosis in located anywhere (except skull)

A

Bone Island (Enostoma)

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9
Q

Bone islands are symptomatic or Asymptomatic?

A

Asymptomatic and clinically insignificant

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10
Q

what distinguishes a Bone Island from blastic metastasis?

A

Brush border

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11
Q

bone islands affect what part of the bone?

A

Epiphysis and metaphysis but NOT the diaphysis

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12
Q

A giant bone island is larger than

A

1.0cm

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13
Q

DDx for Bone Island: (Enostoma)

A
  • Blastic metastasis
  • Osteoid osteoma
  • Osteoma
  • Osteopoikilosis
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14
Q

Bone Island are possibly caused by cortical bone that has failed to undergo __________ during the process of endochondral
ossification

A

medullary

resorption

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15
Q

Bone islands typically appear

as

A

round-to-ovoid sclerotic

intramedullary foci

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16
Q

The long axis of the bone
island is aligned ______ to
the long axis of the bone

A

parallel

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17
Q

Bone islands are composed of

cortical bone and appear as what signal intensity?

A

low signal intensity on MRI on all pulse sequences

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18
Q

Do bone islands typically appear “hot”

on bone scans?

A

NO

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19
Q

Radiolucent nidus with surrounding reactive

sclerosis in 10-25 yo.

A

Osteoid Osteoma

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20
Q

Pain from an osteoid osteoma is relieved by

A

aspirin

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21
Q

Gradual severe deep aching pain than can be referred to a nearby joint, worse at night, with Limited ROM, painful limp, stiffness, and weakness

A

Osteoid Osteoma

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22
Q

Painful rigid scoliosis from an Osteoid Osteoma is usually on the ______ side
of curve

A

concave

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23
Q

What bones does an osteoid osteoma affect?

A

50% in tibia and femur and 10% in spine

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24
Q

Osteoid Osteomas are

usually less than

A

1.0 cm

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25
Q

Highly vascularized fibrous connective tissue in osteoid osteomas

A

nidus (may not be seen)

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26
Q

may need what to Dx osteoid osteoma?

A

CT

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27
Q

Intramedullary OO do not produce much sclerosis

except the sclerosis

A

outside of the capsular bone region

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28
Q

Helps show bone edema around the nidus

A

MRI

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29
Q

Very high levels of have _________ been found in the

osteoid osteoma lesion

A

prostaglandins

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30
Q

– Aspirin also relieves pain (worse at night)
– Nidus >1.0 cm in size
– No angiographic vascular blush

A

Brodie’s Abscess

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31
Q

success in 92 % of Osteoid Osteoma cases

A

Thermocoagulation

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32
Q

Osteoid Osteoma spinal lesions in the posterior arch need

A

surgery

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33
Q

Central sclerotic focus in a radiolucent nidus, characteristic
of of

A

osteoid osteoma

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34
Q

a safe and effective method for treatment of osteoid osteoma

at any location

A

Percutaneous thermocoagulation

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35
Q

2-10 cm expansile lesion with a eggshell-thin cortical margin found in 10-20 yo

A

Osteoblastoma

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36
Q

Osteoblastomas are usually located in the?

A

posterior neural arch of the spine

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37
Q

Pain that is usually NOT at night and NOT relieved by aspirin

A

Osteoblastoma

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38
Q

Osteoblastoma my be

A

sclerotic

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39
Q

Osteoblastoma treatment for small and large lesions

A

Excision/curettage for small lesions and Radiation therapy for inoperable spinal lesions

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40
Q

Small percentage of osteoblastomas become

A

malignant

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41
Q

cortical expansion and mass with

ossific matrix

A

Osteoblastoma

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42
Q

Osteoblastoma will show ____ signal intensity in the surrounding soft
tissues consistent with _____

A

high, edema

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43
Q

Arises from residual islands of cartilage left in metaphysis as physis grows away in the hands (50%) and feet in 10-30 yo

A

Solitary Enchondroma

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44
Q

m/c benign tumor of hand

A

Solitary Enchondroma

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45
Q

Usually a painless tumor in the hands (50%) and feet

May see pathologic Fx

A

Solitary Enchondroma

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46
Q

Sudden onset of pain without trauma signals

malignant transformation of a Solitary Enchondroma to a

A

chondrosarcoma

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47
Q

Geographic radiolucent expansile

lesion centrally placed in the metaphysis with ENDOSTEAL SCALLOPING

A

Solitary Enchondroma

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48
Q

50% of Solitary Enchondroma’s have __________ due to

cartilagenous matrix

A

punctate calcification

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49
Q

Neuroarterial lesion in hand causing pressure erosion of tuft

A

Glomus (vascular) tumor

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50
Q

Post trauma introduction of epidermoid tissue into bone

A

Inclusion cyst

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51
Q

skin puncture causes fibrous outer lining and filled with a soft,cheese-like material (keratin)

A

Epidermal Inclusion Cyst

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52
Q

functions to regulate skin circulation

A

normal glomus unit (neuromyoarterial apparatus)

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53
Q

m/c site of glomus tumors is ______ and

75% of the lesions occur in the ____

A

subungual, hand

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54
Q

Solitary Enchondroma malignantly transforms to a Chondrosarcoma when located close to or within

A

axial skeleton

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55
Q

If pathologic Fx of Solitary Enchondroma, treat with…

A

casting, curettage, or replace with bone chips, or cement packing (calciumphosphate)

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56
Q

should benign lesions should be irradiated?

A

no

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57
Q

Expansile, lytic lesion in the proximal phalanx of the fifth digit with a distinct zone of transition, thinning of the cortex, and a
pathologic fracture

A

Solitary Enchondroma

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58
Q

Fluffy calcific matrix within the medullary canal

A

Solitary Enchondroma

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59
Q

Malignant degeneration of Enchondromas are more likely with large lesions and
with endosteal scalloping involving over

A

50% of the cortex

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60
Q

other reported

features of malignant transformation of an enchondroma include

A

Enlarging radiolucent area, pathologic Fx, or

disappearance of preexisting calcification areas

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61
Q

Multiple Enchondromatosis, aka

A

Ollier’s disease

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62
Q

Unpainful, Unossified remnants of cartilage in diaphyses and metaphyses that likes small bones of hands and feet

A

Multiple Enchondromatosis (Ollier’s dz)

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63
Q

MRI is helpful to detect malignant degeneration/transformation of Multiple Enchondromatosis (Ollier’s dz), which occurs at what percent?

A

10-50%

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64
Q

In Multiple Enchondromatosis (Ollier’s dz), when patients have pain or Rapid growth

A

malignant transformation should be suspected

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65
Q

Enchondromas are metabolically active or inactive?

A

ACTIVE

66
Q

Loss of calcification in a focal region suggests what?

A

malignant degeneration with destruction of the

underlying enchondroma by sarcomatous tissue

67
Q

Multiple radiolucent

metaphyseal lesions

A

Multiple Enchondromatosis (Ollier’s dz)

68
Q

Enchondromatosis of bone and soft

tissue cavernous hemangiomas m/c affects hands

A

Maffucci’s Syndrome

69
Q

Maffucci’s Syndrome has a ___ greater incidence of malignant

transformation than Ollier’s Disease

A

25%

70
Q

In Maffucci’s Syndrome, areas of radiolucency

represent _________, and opaque spots represent ________.

A

enchondromas, phleboliths

71
Q

hemangiomas from Maffucci’s may occur in

other organs, including the

A

GI tract

72
Q

A painful primary benign bone tumor of cartilage origin in 10-25 yo

A

Chondroblastoma (Codman’s tumor)

73
Q

Arises from cells of the physis

A

Chondroblastoma (Codman’s tumor)

74
Q

Chondroblastoma (Codman’s tumor) are eccentric in location in the medullary canal of the

A

Femur, proximal tibia and proximal humerus

75
Q

Eccentric, medullary oval/round lytic lesion in epiphysis with a marginal sclerotic rim and short zone of transition

A

Chondroblastoma (Codman’s tumor)

76
Q

Matrix Calcification and possibly solid periosteal reaction

A

Chondroblastoma (Codman’s tumor)

77
Q

DDx of Chondroblastoma (Codman’s tumor)

A

Brodie’s abscess, AVN, and Giant Cell Tumor

78
Q

treatment for Chondroblastoma (Codman’s tumor)

A

surgical curettage and bone chip packing

79
Q

A cartilagenous tumor in 10-30 yo and 50-70 yo composed of chondroid, fibrous, and myxoid tissues

A

Chondromyxoid Fibroma

80
Q

Chondromyxoid Fibroma are usually found on the Proximal Third of the

A

Tibia

81
Q

Eccentric oval/round geographic lesion with endosteal scalloping and sclerosis along medullary side
(Trabeculated/soap bubble)

A

Chondromyxoid Fibroma

82
Q

large, lucent, slightly expansile, eccentric,

metaphyseal lesion with thin sclerotic borders

A

Chondromyxoid Fibroma

83
Q

Fibrous Cortical Defects could be associated with

A

avulsion Fx at a muscle attachment

84
Q

Posterior-medial surface of distal femur

A

Fibrous Cortical Defect

85
Q

a large lesion (>8 cm) due to faulty ossification in 8-20 yo

A

Non-Ossifying Fibroma

86
Q

a thin, lytic, eccentric, and ovoid diametaphyseal lesion (2-7 cm) due to faulty ossification in 8-20 yo

A

Non-Ossifying Fibroma

87
Q

NOF is m/c at the

A

distal tibia

88
Q

Non-Ossifying Fibroma is also called a

A

Fibrous Xanthoma of Bone

89
Q

Dense sclerotic border along medullary side

and periosteal reaction with pathologic fx

A

NOF

90
Q

NOF has high or low uptake on bone scan?

A

high

91
Q

Peripheral sclerotic border with a central lucency

A

NOF

92
Q

Fluid filled cyst lined with thin layer of fibrous tissue in 3-14 yo

A

Simple Bone Cyst

93
Q

Simple bone cyst, Aka

A

unicameral (one house) bone cyst

94
Q

2/3 of Simple Bone cysts undergo

A

pathologic Fx

95
Q

Simple Bone Cyst usually hit the proximal

A

humerus and femur

96
Q

A Simple Bone Cyst that originates in the metaphysis is considered ____
and one in the diaphysis is ____.

A

active, latent

97
Q

Geographic or cystic radiolucency that is broad at the metaphyseal end, and narrower at diaphyseal end with Endosteal scalloping and Light/incomplete septation

A

Simple Bone Cyst

98
Q

Simple Bone Cyst have a truncated __________ appearance

A

cone shaped

99
Q

There is no matrix calcification with a

A

Simple Bone Cyst

100
Q

2 SIGNS of simple bone cyst

A

Fallen Fragment Sign and Hinged Fragment Sign

101
Q

A small, detached, floating bone
fragment that changes position in cyst with
movement

A

Fallen Fragment Sign

102
Q

fragment is attached at one end but opposite end moves with

movement

A

Hinged Fragment Sign

103
Q

Oval, geographic radiolucent lesion in subtalar region of

anterior calcaneus

A

Calcaneal (Simple Bone) Cyst

104
Q

Calcaneal (Simple Bone) Cysts usually occurs at the

A

base of the calcaneal

neck

105
Q

The major DDx for calcaneal cysts are a

A

lipoma and trabecular thinning

pseudotumor

106
Q

Cystic cavity filled with blood in 5-20 yo that is not a true cyst and not an aneurysm but likely post-traumatic

A

Aneurysmal Bone Cyst (ABC)

107
Q

Acute pain with rapid increasing severity in 5-20 with spinal stenosis and epidural mass effect

A

ABC

108
Q

what explains the neuro changes and spinal stenosis in ABC’s?

A

ABCs like the posterior neural arch of the spine

109
Q

Aneurysmal Bone Cysts like what areas?

A

tubular bones and neural arch of T and L spine

110
Q

M/C benign bone tumor of clavicle

A

ABC

111
Q

Expanding cyst

with eggshell and soap bubble appearance around 8-10 cm in size

A

Aneurysmal Bone Cyst

112
Q

Fine septations with thin calcific rim and small flecks of calcification

A

ABC

113
Q

Rarest primary benign bone tumor

A

Intraosseous Lipoma

114
Q

Lytic lesion with well defined/sclerotic border with a calcific radiopacity of central necrosis in wide age range

A

Intraosseous Lipoma

115
Q

Intraosseous Lipomas may be expansile with

A

endosteal scalloping

116
Q

Usually asymptomatic and usually found incidentally

A

Intraosseous Lipoma

117
Q

Intraosseous Lipoma are m/c in

A

metaphyses of long bones (tibia/fibula), calcaneus, and metatarsals

118
Q

Dystrophic calcification in Intraosseous Lipomas is known as

A

Cockade Sign

119
Q

Composed of newly formed capillary, cavernous,

or venous blood vessels usually seen over 40 yo

A

Hemangioma

120
Q

MC benign bone tumor of spine

A

Hemangioma

121
Q

Many hemangioms are not seen on plain film, but seen on

A

MRI

122
Q

neuro symptoms from spinal hemangioma are usually from

A

cord compression

123
Q

Because the spinal canal vs. cord size is smallest, most symptomatic spinal lesions are in the

A

mid thoracic spine

124
Q

may result in death during tooth extraction

due to exsanguination of blood

A

Hemangioma in Maxilla and Mandible

125
Q

75% of Hemangiomas are located in the

A

spine and skull

126
Q

types of hemangiomas

A

Capillary and Cavernous

127
Q

most common type of Hemangiomas

A

Cavernous

128
Q

Large, thin walled blood vessels and sinuses surrounded by resorbed bony trabeculae usually in skull and vertebral body

A

Cavernous Hemangioma

129
Q

Usually solitary with coarse vertical striations in vertebral body separated by
radiolucent zones called Corduroy Cloth Appearance

A

Spinal Hemangioma

130
Q

Corduroy Cloth Appearance

A

Spinal Hemangioma

131
Q

Angiomatous vessels replace resorbed bone rendering the vertebral body osteopenic

A

Spinal Hemangioma

132
Q

Skull Hemangiomas are

m/c located in the

A

frontal bone

133
Q

Sunburst or Spoke-Wheel Appearance

A

Skull Hemangiomas

134
Q

Skull Hemangiomas usually destroy the

A

outer table of skull

135
Q

Palpable soft tissue mass with phleboliths, usually in forearm/lower leg/paravertebral area,

A

Soft Tissue Hemangioma

136
Q

Corduroy Cloth Appearance results in vertebral body being stronger or weaker than neighboring vertebral
bodies

A

STRONGER

137
Q

do we restrict activities due to vertebral hemangioma?

A

NO

138
Q

Polka Dot Appearance on CT

A

Hemangioma

139
Q

Jailhouse Appearance and Corduroy Cloth Appearance on MRI:

A

Hemangioma

140
Q

nonvascular matrix tissues of hemangioma

A
  • Fat
  • smooth muscle
  • bone trabeculae
    fibrous tissue
  • clotted blood products
141
Q

A greater proportion of fat (T1) in vertebral hemangiomas

is associated with a

A

reduced likelihood of symptoms

142
Q

Neural compression in hemangiomas is more likely with a greater
proportion of

A

hypervascular or hemangiomatous

tissue (T2)

143
Q

Low T1 signal and high T2 signal for a vertebral hemangioma indicates

A

more aggressive behavior and common with vertebral collapse

144
Q

MC benign skeletal growth or tumor

A

Solitary Osteochondroma

145
Q

Bony exostosis projecting from external surface and usually has hyaline lined cartilagenous cap

A

Solitary Osteochondroma

146
Q

50% of all neoplasms

and 75% occur before age 20

A

Solitary Osteochondroma

147
Q

Solitary Osteochondromas are asymptomatic unless

A

blood vessels, nerves, or joints are disturbed

148
Q

Solitary Osteochondroma occurs in

A

any bones preformed in cartilage

149
Q

Cortex and medullary cavity blend imperceptibly with host bone

A

Solitary Osteochondroma

150
Q

what indicates malignant degeneration/transformation of a solitary osteochondroma?

A
  • a cartilage cap >2cm in adults and >3cm in children

- Break in cortex or growing soft tissue mass

151
Q

Solitary Osteochondroma point away from the joint due to

A

muscle pull

152
Q

what is m/c affected by a Solitary Osteochondroma?

A

Knee metaphysis

153
Q

Cauliflower and coat hanger Exostoses

A

Solitary Osteochondroma

154
Q

Measures cartilagenous cap thickness

A

MRI

155
Q

Multiple osteochondromas in 2-10 yo

A

Hereditary Multiple Exostoses (HME)

156
Q

Painless lumpy joints that are usually bilateral and symmetric

A

Hereditary Multiple Exostoses (HME)

157
Q
  • Shortening of ulna
  • Outward bowing of radius
  • Subluxation of radioulnar joint
A

Bayonet Hand Deformity

158
Q

Bayonet Hand Deformity

A

Hereditary Multiple Exostoses (HME)

159
Q

– Cauliflower pelvic lesions

A

Hereditary Multiple Exostoses (HME)

160
Q

malignant transformation of HME

A

5-25%, m/c to pelvis and shoulder

161
Q

HME treatment is usually

A

surgical resection for cosmetics rather than for symptoms

Tri 6 - Tumors (12 decks)

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