50/51: Bone Tumors - Mahoney Flashcards
best radiologic test to help diagnose bone lesions, including tumors
x-ray
when do you do a biopsy?
last step
- do not do if you will not be treating the malignancy or the center of biopsy performance will not be performing biopsy
latent
thin sclerotic or radiolucent narrow margin (0.1-1.0 mm), no periosteal reaction, absent soft tissue mass
active
wide (2-10 mm) margin, none or mild periosteal reaction, absent soft tissue mass
aggressive
wide or poorly defined margin, mild or major periosteal reaction, soft tissue mass present
several ill-defined areas of lucency
moth eaten - aggressive
ill-defined pattern of lucency caused by many small irregular holes in the bone
permeative - aggressive infection or malignancy
geographic lesions
lesion grows slowly, bone has time to retreat and lay down new bone around the lesion
lesion grows in fits or starts, periosteum has time to lay down thin shell of new bone before the leion starts another growht sput
lamellate/ onion skin
sun burst/ hair on end
periosteum has no time to lay down bone, but sharpey’s fibers bevome stretched out perpendicular to bone and then ossify
codman’s triangle
only the edges of the raised periosteum will ossify - this little bit of ossification forms a small angle with the surface of bone, but not a complete triangle
non-metastatic diseases the produce periosteal reactions
HEATHV
hypertrophic pulmonary osteoarthropathy endosteal hyperostosis acromegaly thyroid acropachy hypervitaminosis A *** venous stasis
what is bone matrix?
substance in bone produced by osteoblasts AND chondroblasts
speckled
chondroid matrix
cloudy
osseous matrix
ground glass
fibrous, cystic lesion producing little or no calcification
4 cartilage forming tumors
osteochondroma
solitary enchondroma
chondroblastoma
chondrosarcoma
2 bone forming tumors
osteoid osteoma and osteoblastoma
osteogenic sarcoma
benign tumors
enchondroma osteochondroma osteoid osteoma osteoblastoma giant cell tumore (10% malignant) chondroblastoma
malignant tumors
osteogenic sarcoma chondrosarcoma fibrosarcoma ewing's sarcoma metastatic carcinoma
FOG MACHINES
solitary lytic lesions of bone
Fibrous dysplasia
Osteoid osteoma/osteoblastoma
Giant cell tumor
Metastasis, myeloma Aneurysmal bone cyst Chondroblastoma, chondromyxoid fibroma Hyperparathyroidism, hemangioma Infection Non-ossifying fibroma Eosinophilic granuloma, enchondroma Solitary boe cyst, sarcoidosis
long lesion in a long bone
fibrous dysplasia or non-ossifying fibroma (moves into marrow space)
hurts like a b and tough to see
osteoid osteoma
- night pain relieved by ASA or NSAIDS
- produces high amounts of prostaglandins
at the end of a long fast, teens have a blast
osteoblastoma
- most common tumor in teens at the ends of the long bones
osteoid osteoma v osteoblastoma
no surrounding reactive bone sclerosis in osteoblastoma
massive in metaphysis
giant cell tumor
most common primary bone malignancy in body
metastasis/myeloma
metastasis to bone
adult male - lung
adult female - breast
also kidney and thyroid
1 primary metastasis to foot and ankle bone
colorectal CA
most common primary malignatnt tumor of bone in body
myeloma
mosaic glass on MRI
aneurysmal bone cyst
multiple punched out lesions
multiple myeloma
chicken wire matrix
chondroblastoma (also consider osteoblastoma if young age group)
brown tumors
hyperparathyroidism (hemosiderin deposition)
bubbly lesions of bone - NFC GAMES
Non-ossifying fibroma Fibrous dysplasia Chondrosarcoma Giant cell tumor Aneurysmal bone cyst Metastatic CA Enchondroma/Ewing's sarcoma Solitary bone cyst
end of bone, with speckled tone
enchondroma
endosteal scalloping
eosinophilic granuloma
where does solitary bone cyst love to be?
under middle facet in calcaneus
“best bet is middle facet”
fallen fragment sign
solitary bone cyst
multiple lucent bone lesions
HIFEM
Hyperparathyroidism/hemangioma Infection Fibrous dysplasia Enchondroma/eosinophilic granuloma Metastasis/ myeloma
lytic lesions in metaphysis
CAGE ON MUD
Chondroblastoma
Aneurysmal bone cyst
Giant cell tumor
Enchondroma/ewing’s sarcoma
Osteoblastoma/sarcoma/myelitis
Non-ossifying fibroma
Malignant fibrous histiocytoma(fibrosarcoma)
Unicameral bone cyst
Desmoid tumor
malignant lucent bone lesion by age *** less than 1 yo 1-10 yo 10-30 yo 30-40 yo 40+
neuroblastoma ewing's sarcoma osteosarcoma/ ewing's fibrosarcoma, lymphoma metastasis, myeloma, chondrosarcoma
most common primary bone malignancy in foot and ankle
chondrosarcoma
moth-eaten or onion-skin with a soft tissue mss
ewing’s sarcoma
best place to get ewing’s sarcoma
70% survival forefoot
30% survival rearfoot
solitary of multifocal sclerotic lesions of bone
COP BOBS HIP
Chronic osteomyelitis
Osteochondroma
Paget’s disease
Breast metastasis
Osteogenic sarcoma
Bone island
Stress fracture
Hemangioma
Infarct
Prostate metastasis
most common bone tumor in foot and ankle
osteochondroma
develops from epiphysis and ceases growth growing away from the epiphysis
osteochondroma
how is a subungual exostosis different than an osteochondroma?
- more common in females
- has fibrocartilage cap
- does not arise from epiphysis
- from capillary hemangioma
flame-shaped or blades of grass sclerotic lesions of bone
pagets disease
globular bone sclerosis
MOM POO
Melorrheostosis "candle wax dz" Osteopathia striata-linear striations Metastasis Pyknodysostosis- dense and brittle Osteopoikilosis - spotted bones Osteomyelitis
candle wax disease
melorrheostosis
