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Radiology Tumors > Benign Tumors > Flashcards

Benign Tumors Flashcards

1
Q

osteoma occurs in what type of bone

locations

A

membranous bones

outer skull and sinuses

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2
Q

how big is an osteoma

A

< 2cm

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3
Q

describe an osteoma on imaging

A

round, oval, well circumscribed

uniformly opaque

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4
Q

what is the mc benign tumor of the nose and paranasal sinuses

A

osteoma

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5
Q

what is gardners syndrome

A

multiple osteomas
and
colonic polyps

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6
Q

what does osteoma look like on MRI

A

low intensity on T1 and T2

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7
Q

where do bone islands occur

A

anywhere

mc in epiphysis and metaphysis

not diaphysis

also not seen in skull

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8
Q

what does bone island look like on imaging

A

discrete area of sclerosis

brush border - help ddx from blastic mets

round oval well circumscribed

long axis parallel to bone

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9
Q

what is a enostoma

A

another term for bone island

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10
Q

do bone islands cause any symptoms

A

no

no pain or chance of malignancy

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11
Q

what does bone island look like on MRI

how about CT

how about on bone scan

A

low intensity on T1 and T2

bright on CT

cold on bone scan unless in growth period

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12
Q

how big is an osteoid osteoma

A

< 1cm

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13
Q

osteoid osteoma most commonly occur where

in what part of the bone

A

mc in tibia or femur

also in neural arch

metaphysis

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14
Q

osteoid osteomas can induce what defect in the spine due to tumor in neural arch

A

painful rigid scoliosis

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15
Q

which tumor contains radiolucent nidus with surrounding sclerosis or solid periosteal reaction

A

osteoid osteoma

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16
Q

which tumor contains a vascular blush on MRI

A

osteoid osteoma

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17
Q

osteoid osteomas occur in what age range

A

10-25

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18
Q

what are the symptoms of osteoid osteoma

A

gradual onset of severe deep aching pain

worse at night!

relieved by aspirin!

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19
Q

what do you use to diagnose osteoid osteoma

A

CT

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20
Q

how do you treat osteoid osteoma

A

thermoregulation

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21
Q

what does osteoid osteoma show on bone scan

how about MRI

A

intense uptake

low signal

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22
Q

what is the differential diagnosis for osteoid osteoma

A

brodies abscess

  • infection (osteomyelitis) with same signs and symptoms but NO vascular blush and nidus > 1cm

osteoid osteoma is < 1cm

also brodies is cold on bone scan to differentiate

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23
Q

where does osteoblastoma occur

A

common in metaphysis

but loves posterior neural arch

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24
Q

what does osteoblastoma look like on imaging

A

expansile lesion

egg shell thin cortex and matrix

maybe sclerotic

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25
Q

what is the age range for osteoblastoma

A

10-20

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26
Q

what are the symptoms of osteoblastoma

A

gradual onset of pain

painful scoliosis if in posterior neural arch

pain not relieved by aspirin and not worse at night (compared to osteoid osteoma)

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27
Q

what ROM is lost in osteoblastoma

A

loss of extension

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28
Q

what is the differential diagnosis for osteoblastoma

A

ABC

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29
Q

can osteoblastomas become malignant

A

small percentage do

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30
Q

what does osteoblastoma look like on bone scan

how about MRI

A

HOT

high intensity on T2 due to increase fluid

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31
Q

what is the treatment for osteoblastoma

A

curettage

radiation if last resort

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32
Q

where does solitary enchondromas occur in the body

A

common in metaphysis

loves small bones of hands and feet

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33
Q

what do solitary enchondromas look like on imaging

A

radiolucent expansile lesions

intact but thinning of the cortex

endosteal scalloping

punctate calcification

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34
Q

what may have happened if solitary enchondroma is causing pain

A

pathological fracture or malignant transformation

usually doesnt cause pain

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35
Q

if enchondroma becomes malignant, where is it located

A

axial skeleton

turns into chondrosarcoma when metastasizes

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36
Q

what age does solitary enchondromas occur in

A

10-30

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37
Q

what does solitary enchondroma look like on MRI

A

low signal

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38
Q

what is treatment of solitary enchondroma

what about if fracture occurs

what if its close to axial spine

A

packing chips - calcium phosphate packing

implanted human bone morphogenic protein

fracture - casting and curettage

axial spine = malignant - prophylactic surgery to remove

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39
Q

multiple enchondromas is called

A

olliers disease

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40
Q

are solitary or multiple enchondromas more likely to become malignant

A

multiple - olliers

10-50%

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41
Q

multiple enchondromas, hemangiomas, and phleboliths is called what

A

maffuccis syndrome

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42
Q

does solitary enchondromas, olliers, or maffuccis have the highest rate of malignancy transformation

A

maffuccis syndrome

multiple enchondromas, hemangiomas, phleboliths

transforms into chondrosarcoma

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43
Q

where do chondroblastomas occur

A

only epiphysis and apophysis

knees, femur, proximal tibia, and humerus

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44
Q

what does chondroblastoma look like on imaging

A

radiolucent round oval lytic lesion

eccentric - located in medullary canal

internal matrix calcification because cartilaginous matrix

ring of sclerosis

solid periosteal reaction

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45
Q

what age do chrondroblastoma occur in

A

10-25

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46
Q

what is also called codmans tumor

A

chondroblastoma

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47
Q

what is the treatment chondroblastoma

A

curettage and bone chip packing

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48
Q

what does chondroblastomas look like on MRI

what does it look like on bone scan

A

low signal

hot!

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49
Q

what is the size of chondromyxoid fibroma

A

1-10 cm

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50
Q

chondromyxoid fibroma looks __ but it is actually __

A

look malignant

but its benign

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51
Q

chondromyxoid fibroma occurs in what location MC

A

proximal 1/3 of tibia

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52
Q

what does chondromyxoid fibroma look like on imaging

A

eccentric oval round lesion

endosteal scalloping

sclerosis on the medullary side of lesion

trabeculated or soap bubble appearance

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53
Q

what age group does chondromyxoid fibroma occur in

A

10-30
or
50-70

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54
Q

what is treatment for chondromyxoid fibroma

A

curettage or excision

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55
Q

where do fibrous cortical defects MC occur

A

posterior medial distal femur**

or LE

metaphysis

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56
Q

what does fibrous cortical defect look like on imaging

A

< 1cm

lytic lesion
sclerotic rim
eccentric

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57
Q

what age range does fibrous cortical defect occur in

A

4-8

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58
Q

fibrous cortical defect is symptomatic or asymptomatic

A

asymptomatic - found by accident

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59
Q

fibrous cortical defect may become what

A

non ossifying fibroma

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60
Q

non ossifying fibroma MC occurs where

A

MC in distal tibia

diametaphyseal

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61
Q

what does non ossifying fibroma look like

A

2-7 cm

multilocular

lytic eccentric ovoid

dense sclerotic border on medullary side of lesion
- peripheral sclerotic border

periosteal reaction

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62
Q

what age range does non ossifying fibroma occur in

A

8-20

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63
Q

what is a non ossifying fibroma due to

A

faulty ossification centers - not true neoplasm

64
Q

does non ossifying fibroma cause symptoms

A

no

but could cause pain if large enough or causes fracture or stress fracture

65
Q

non ossifying fibroma may turn malignant? yes or no

A

no malignant transformation

66
Q

where does simple bone cysts occur

A

proximal humerus and femur and calcaneus

metaphysis into diaphysis

67
Q

what is a bone cyst made up of

A

fluid filled cyst with thin layer of fibrous tissue - so no matrix calcification

68
Q

what does a simple bone cyst look like on imaging

A

truncated cone or bullet shape

broad near metaphysis and narrow in diaphysis - not seen in epiphysis

cystic radiolucency

endosteal scalloping

light or incomplete septation

69
Q

what age group do bone cysts occur in

A

3-14

70
Q

if a simple bone cyst is in the ___ it is an active cysts

if it is in the __ it is an latent cyst

A

active - metaphysis

latent - diaphysis

71
Q

2/3 of bone cysts result in what

A

pathological fracture - result in fallen fragment or hinged fragment sign

72
Q

what sign is associated with bone cysts

A

fallen fragment sign - small detached floating fragment that changes position with movement

hinged fragment sign - fragment attached at one end but the other end moves with movement

  • indicates fluid on imaging
  • associated with fracture
73
Q

what imaging is used to find fluid in the bone cyst

what does it look like on imaging

A

MRI

high on T2
low on T1

74
Q

what is the size of an ABC

A

8-10 cm

75
Q

where does an ABC occur

A

metaphysis of long tubular bone (could cross growth plate)

MC in posterior neural arch

76
Q

what does ABC look like on imaging

A 
eccentric 
expansile 
egg shell thinning of cortex 
soap bubble 
may cross the growth plate
77
Q

what age group does ABC occur in

A

5-20

78
Q

what is the mc benign bone tumor of the clavicle

A

ABC

79
Q

what are the symptoms of ABC

A

acute rapid progressive pain

RAPIDLY INCREASING PAIN!!!

80
Q

what is an ABC made up of

A

blood

NOT A TRUE CYST
not a aneurysm

81
Q

how to treat an ABC

A

curettage and packing

82
Q

what is the size of an intraosseous lipoma

A

2-13 cm

83
Q

where does intraosseous lipoma occur

A

metaphysis of long bones - tibia, fibula, metatarsal, calcaneus

MC in calcaneous

84
Q

if ABC is found in the posterior neural arch, what does this cause

A

stenosis and epidural mass effect

85
Q

what does intraosseous lipoma look like on imaging

A

lytic
sclerotic border
expansile
endosteal scalloping

calcific radiopaque of central necrosis - looks like doughnut or target

cockade sign - dystrophic calcification

86
Q

what age do intraosseous lipomas occur in

A

5-70

87
Q

what is the rarest benign bone tumor

A

intraosseous lipoma

88
Q

does intraosseous lipoma cause symptoms

A

no symptoms

incidental finding

89
Q

what is treatment for intraosseous lipoma

A

curettage and packing

90
Q

where do hemangiomas occur

A

MC in spine
skull - maxilla and mandible
soft tissue

91
Q

what do hemangiomas look like on imaging in the spine skull and soft tissue

A

spine - corduroy cloth appearance (thickening of horizontal trabeculae with thinning of vertical trabeculae), polka dot spine (CT or MRI)

skull - sunburst or spoke wheel appearance in skull

soft tissue - phleboliths

92
Q

where do hemangiomas occur in the skull

whats the size

A

frontal bone MC

1-7 cm round and oval

93
Q

hemangiomas occur in what age group

A

> 40

94
Q

what is the most common benign tumor of the spine

A

hemangioma

95
Q

75% of hemangiomas occur where

A

spine and skull

96
Q

do hemangiomas produce symptoms

A

not usually

slow growing, may be slight pain - MOST symptomatic in T spine

if symptomatic, results from cord compression

97
Q

mandible and maxillary hemangioma can cause what

A

death by tooth extraction

98
Q

can you see hemangiomas on plain film

A

not usually

99
Q

what is the most common type of hemangioma

capillary or cavernous

A

cavernous

100
Q

what is the treatment for hemangiomas

A

curettage, packing, cryotherapy

101
Q

solitary osteochondromas are found in what location

A

MC in the knee

metaphysis

long tubular bones - femur, humerus, scapula, any bone preformed in cartilage

102
Q

what does solitary osteochondroma look like on imaging

A

hyaline lined cartilaginous cap - calcified

sessile (looks like a hill- broad proximally and narrow distally) and peducnulated (cauliflower stalk - narrow proximally and broad distally)

points away from joint because of muscle pull

cortex and medulla cavity blend with host bone

coat hanger exostosis

large lesions exhibit cauliflower exostosis

103
Q

75% of solitary osteochondromas occur in what age group

A

< 20

104
Q

what is the most common benign skeletal bone tumor

A

osteochondroma

105
Q

what tumor makes up 50% of all neoplasm in bone

A

osteochondroma

106
Q

which tumor contains a stalk and a cap

what part goes malignant

how do you know if its transforming into malignancy

A

osteochondroma

cap

cap > 2cm in adults and 3 cm in children indicate transformation

break in cortex of growing soft tissue mass = malignancy

107
Q

what imaging do you use to assess an malignant transformation of osteochondroma

A

MRI - to view cap thickness

108
Q

how do you treat osteochondroma

A

surgical excision if symptomatic

109
Q

what tumor occurs bilaterally and symmetrically with 2-100’s of tumors

A

hereditary multiple exostosis

110
Q

what is the average number of tumors seen in hereditary multiple exostosis

what kind of tumors are these

A

2-100s

average 10

osteochondromas

111
Q

what are some deformities and features of hereditary multiple exostosis

A

bayonet hand deformity - short ulna, outward bowing of radius, radioulnar joint subluxation

cauliflower pelvic lesions

112
Q

in what age does hereditary multiple exostosis occur

A

2-10

113
Q

what are the symptoms of hereditary multiple exostosis

A

painless lumpy joints

cauliflower pelvic lesions compress cord and may turn malignant

114
Q

osteomas are usually what asymptomatic but are a __ complaint

A

cosmetic

115
Q

what is gardeners syndrome considered (osteomas)

A

pre malignant

116
Q

what is the most common benign tumor of the hand

A

solitary enchondroma

117
Q

what does a solitary enchondroma metastisize into

A

chondrosarcoma

118
Q

enchondromas are painless but if they become large enough it may cause what

A

deformities of the hand

119
Q

where is olliers and maffuccis syndrome most commonly found

A

hands

120
Q

maffucci syndrome patients may have a positive __

A

ulnar variance - leads to TFCC damage

121
Q

what is a fibrous cortical defect also called

what is a non ossifying fibroma also called

A

fibrous xanthoma of bone

fibrous xanthoma of bone

122
Q

what is the size of a non ossifying fibroma

A

2-7 cm

123
Q

what is another term for simple bone cyst

A

unicameral bone cyst

124
Q

what tumor points away from the joint due to muscle pull

A

solitary osteochondroma

125
Q

what are ddx for enostomas

A

osteoid osteoma
blastic mets
osteopoikilosis

126
Q

why do osteoid osteomas respond to NSAIDS or aspirin

A

have analgesic and antipyretic effect on prostaglandins

127
Q

what is best treatment for osteoid osteoma

A

thermoregulation

128
Q

benign flocculated appearance, well defined, expansile, proximal humerus

A

enchondroma

129
Q

eccentric, lytic, well circumscribed, benign, hazy matrix in distal femur

A

fibrous cortical defect

130
Q

what soft tissue component in high amount indicates a hemangioma is unlikely to be symptomatic

A

fat

131
Q

what is the most common benign skeletal tumor

what is the most common benign spine tumor

A

skeletal - osteochondroma

spine - hemangioma

132
Q

the closer hereditary mutiple exostosis lesions are to the spine or axial skeleton indicates what

A

more likely to become malignant

133
Q

what procedure is used to determine a M spike

A

protein electrophoresis

134
Q

should benign tumors be irradiated

A

no

135
Q

its more likely to be malignant if ___

A

hot on bone scan

136
Q

what are features of malignant transformation

A

enlarging radiolucent area

fracture

disappearance of pre-existing calcification***

rapid growth of lesion

137
Q

what is helpful to detect malignant degeneration of multiple enchondromatosis

A

MRI

138
Q

when a patient has pain, what should be considered with multiple enchondromatosis even if abscence of radiographic findings

A

malignant transformation

139
Q

what are metabolically active and may grow throughout the patients life

A

enchondromas

140
Q

what kind of hemangiomas are present in maffuccis syndrome

what do they look like on xray

A

cavernous hemangiomas

opaque spots

141
Q

hemangiomas of maffuccis syndrome can occur where

A

other organs

such as GI tract

142
Q

how often do simple bone cysts udnergo pathological fracture

A

2/3 undergo pathological fracture

143
Q

calcaneal cyst is typically located where

what is the differential diagnosis

A

simple bone cyst at the base of the calcaneal neck

lipoma
pseudotumor - thinning of trabeculae

144
Q

aneurysmal bone cyst maybe caused by what

A

post trauma

145
Q

what is the mc benign tumor of the clavicle

A

ABC

146
Q

which tumor has a high recurrence rate

A

ABC

147
Q

what should you do with an intraosseous lipoma thats asymptomatic

A

leave it alone

148
Q

dystrophic calcification seen in intraosseous lipoma is known as what

A

cockade sign

pathognomonic appearance and location of lesion

149
Q

symptoms from hemangiomas are usually from what

what are the symptoms like

symptoms usually arise from what part of the spine

A

spinal cord compression

local pain and muscle spasm - radic, spinal steonosis, hyper/hypoesthesia

mid thoracic spine - spinal canal vs cord size is smallest

150
Q

how do you treat hemangiomas in the skull

A

spinal stenosis present and cord compression - decompression surgery

symptomatic skull lesions - en bloc excision

inoperable spinal lesion - radiation

151
Q

corduroy clothe appearance results in vertebral body being ___ than neighboring vertebral bodies

A

stronger

152
Q

do you have to restrict activities due to vertebral hemangiomas

A

do not restrict activities

153
Q

what does hemangioma look like on CT and MRI

A

CT - polka dot spine

MRI - jailhouse and corduroy cloth appearance

154
Q

fat vs blood hemangiomas

what imaging do you see these findings

A

fat - reduced likelihood of symptoms - T1

blood - increased likelihood of neural compression - T2 - associated with vertebral collapse

155
Q

osteochondromas produce pain when

A

when it invades nerves and blood vessels

156
Q

when do osteochondromas stop growing

A

after closure of growth plate

157
Q

large osteochondromas exhibit what

A

cauliflower exostosis

Radiology Tumors (11 decks)

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