8. Skeletal Metastasis Flashcards
almost all tumors have reported incidences of metastases to bone except tumors of
central nervous
system and basal cell carcinoma of the skin
Leptomeningeal Metastasis from primary Medulloblastoma of brain
Drop Metastasis
“sugar coating” enhancement
Drop Metastasis
4-year-old with medulloblastoma
presents with
morning vomiting and ataxia
responsible for ~70% of all bony metastases
Female breast cancer
results in ~60% of skeletal metastases
Prostate carcinoma
Metastatic osseous lesions in children <5 yo are usually due to
neuroblastoma
Metastatic Bone Tumors between 10-20 yo
Ewing’s and Osteosarcoma
Metastatic Bone Tumors Between 20 and 35 yo
Hodgkin’s lymphoma
May have increased serum calcium in
extensive lytic
metastasis
Blastic metastasis will increase
alkaline phosphatase
PSA and/or acid phosphatase will elevate if what is disrupted?
prostate
capsule
drop metastasis in CSF is an example of what type of mets?
Implantation or Seeding Metastasis
Valveless epidural vertebral veins that function as a venous lake or pool
Batson’s Venous Plexus
provides the
pathophysiological basis for early metastasis of
prostate cancer to pelvis, lumbar spine, and
remainder of axial skeleton
Prostatic venous plexus may drain directly into
vertebral venous plexus
Approximately 90% of patients present with Spinal metastasis present with
bone and/or back pain followed by radicular pain
most ominous symptom in patients with metastatic disease to the spine
Bone pain at night
Destruction due to osteoclast stimulating cytokines secreted by tumor cells.
Lytic Metastasis
Contrast is inserted into the thecal sac (subarachnoid space) via fluoroscopic
control
MYELOGRAPHY
Osteoid reacts to tumor cells by laying down nonneoplastic bone as a futile attempt at bone repair
Blastic Metastasis
Bone Scan will detect what percent of metabolic activity alteration?
3-5%
Radiation emitting substance, with low radiation dose a convenient half life for clinical use, is taken up and concentrated in
regions of high metabolic activity in bone
99mTc-MDP
bone scan with be positive how long before you see disease on plain film?
18 months
Useful for cortical bone involvement and presence of soft
tissue mass formation
Computed Tomography (CT, CAT):
Better than CT for detecting bone lesions and assessment of
soft tissue mass formation
MRI
Replacement of fatty bone marrow by tumor cells results in
loss of normal bright signal intensity on T1 weighted images
75% of metastatic bone tumors are
lytic
Motheaten or permeative pattern is classic in metastatic bone tumors and occurs mc with
breast and lung carcinoma metastasis
Primary tumors of thyroid and kidney may
produce
blow-out metastatic patterns
favors primary tumors
- Periosteal reactions
- Soft tissue mass
- Long lesions >6cm
- Most tumors that expand bone
- usually solitary, whereas metastatic lesions are usually multiple
Earliest and most subtle sign of metastasis to vertebral body is
focal osteoporosis compared to adjacent bodies
due to disc herniation into vertebral body from destruction and weakening of
vertebral body
Malignant Schmorl’s Nodes
Regarding neural arch, the _____ is mc involved by metastasis
pedicle
winking owl sign
Bilateral pedicle destruction, known as
Blind Vertebra
When a single vertebral body is involved with a diffuse homogeneous radiopacity
Ivory Vertebra
3 mc causes of ivory vertebra
Blastic Metastasis, Paget’s Disease, and Hodgkin’s Lymphoma
mc cause of extrapleural sign is
rib metastasis
Blow out rib lesions are from
thyroid and renal metastasis
description of the extrapleural Sign
- Smooth contour
- Convex towards lung
- Edges taper
Predilection for distal phalanx of finger to be affected by metastasis from
primary bronchogenic carcinoma
Periosteal Reactions are very rare in metastatic lesions, with
the exception of
neuroblastoma
Complications of bone metastasis
- pathologic fracture
- Damage to physis
- Extradural compression of spinal cord
- AVN
mc complication of bone metastasis is
pathologic fracture
Greater chance for pathologic fracture when > 50% of the
cortex is destroyed
Soft tissue masses typically accompany metastatic disease to small bones such as ribs, and is usually due to
hemorrhage
ribs are commonly affected by
expansion
Presence of sclerosis in a lytic lesion may be a sign of
healing
what seem to be most reliable to measure
response to therapy?
Bone scans
Second mc abdominal neoplasm in childhood
Wilm’s is mc
neuroblastoma
(75% arise in adrenal gland)
Adrenal neuroblastomas are highly fatal and mc prior to age
5
neuroblastomas have a ________ of calcification in 2/3 of cases
Granular pattern
- Typically osteolytic and fairly symmetric
- Vertebral compression fractures with widening of paravertebral
stripe
Neuroblastoma
- Lytic lesions
- Widening of sutures
- Sunburst periosteal reaction
- Metastatic lesions to brain produce plaques on brain that may
widen sutures
pathognomonic Skull changes from a neuroblastoma
most common pediatric malignancy in infancy
Neuroblastoma
Hypertrophic Osteoarthropathy (HOA) may occur secondary to
pulmonary lesions
in children cyanotic congenital heart disease is a potential
cause of
Hypertrophic Osteoarthropathy (HOA)
- Clubbing of Fingers
- Periostitis in the distal tibial diaphyses
- “Double stripe or
railroad track” appearance
Pulmonary
Hypertrophic
Osteoarthropathy
periosteal proliferation and right upper lobe perihilar mass
Pulmonary Hypertrophic Osteoarthropathy
