3e. Other Primary Neoplasms Flashcards
What is a Fibrosarcoma (FS)?
A RARE sarcoma in which the predominant cell type is a malignant fibroblast.
MC age group for FS?
4-83…but not usually common in kids
FS usually occurs where?
Major long bones (50% at knee)
What is the average length of time of symptoms in FS before diagnosis?
2 years! Pain and swelling
FS Plain film findings?
- Highly destructive, expanding, lytic lesion
- HUGE soft tissue mass
- Usually NO periosteal reaction
FS Prognosis?
Poor prognosis, mets late to lung, liver, lymph, and brain
Treatment of choice?
AMPUTATION
What is Malignant Fibrous Histiocytoma (MFH)?
- MC soft tissue sarcoma in adults
- Indistinguishable from Fibrosarcoma
- Primitive mesenchymal cells
- Mets to lungs
- Painless, solid mass
Where is MFH more common?
Lower extremity (50%)
What is a Chordoma?
Rare, notochordal remnant neoplasm
Where do Chordoma’s usually happen?
Spinal column (85% sacrococcygeal or spheno-occipital)
Age range of Chordoma?
Any age, but 40-70 MC
MC in lads or lasses?
Lads
T or F: Metastasis is uncommon in Chordoma’s
T
What are symptoms from a Chordoma usually from?
Mass effect
Other than the Sacrococcygeal, what other places commonly have Chordoma’s?
Clivus, Vertebra (especially C2).
What is the only primary malignancy to cross IVD?
Chordoma
Prognosis for Chordoma?
It varies, many of the lesions can be difficult to resect (spinal column)
Plain film findings for Chordoma?
- Lytic destruction
- Cortical expansion (may increase AP diameter of sacrum)
- Calcification in 50%
- Soft tissue mass common
- Ddx: lytic mets, chondrosarcoma, GCT, ABC, plasmacytoma
What is Non-Hodgkins Lymphoma (NHL)?
A rare extranodal lymphoma, initially appearing as a solitary bone lesion
Age range for NHL? (not the hockey league)
20-50
…NHL is more common in guys, okay?
Why did you flip this card over?
Prognosis for NHL?
Better than most bone primary malignancies
Pain pattern for NHL?
- Local, intermittent pain
- Dull aching, not relieved by rest
Are most patients with NHL healthy or unhealthy?
Generally healthy, but over 50% will have symptoms in a year (palpable mass or swelling)
Plain film findings for NHL?
- Permeative destruction
- Minimal periosteal response
- Pathological Fx is very common
- Femur, tibia, and humerus MC affected
- Could have soft tissue mass
What is Hodgkins Lymphoma of Bone (HLB)?
- Usually secondary to systemic Hodgkin’s (10-20% of patient’s with Hodgkin’s)
- Rarely primary in bone
MC symptom of HLB?
- Pain
Prognosis of HLB?
Treatment and prognosis related to stage of systemic disease
What is Hodgkin’s Lymphoma (HL)?
A type of lymphoma, which is generally believed to result from white blood cells of the lymphocyte kind
Where is HL MC?
In the vertebral body (“ivory vertebrae”, anterior scalloping possible)
Are sclerotic or lytic HL lesions MC?
Lytic (especially in tubular bones)
Periosteal response in HL?
Possible exuberant periosteal response
What is Synovial Sarcoma (SS)?
An uncommon soft tissue sarcoma
MC age range for SS?
30-50
Where is SS MC?
Knee, hip, and ankle
SS Plain film findings?
- Fine granular calcification in 1/3rd
- Secondary bone destruction in 10-20%
SS Prognosis?
Moderately good
Most useful imaging for SS?
MRI
Treatment for SS?
Excision and/or radiation
