Benign Tumors Flashcards
osteoma occurs in what type of bone
locations
membranous bones
outer skull and sinuses
how big is an osteoma
< 2cm
describe an osteoma on imaging
round, oval, well circumscribed
uniformly opaque
what is the mc benign tumor of the nose and paranasal sinuses
osteoma
what is gardners syndrome
multiple osteomas
and
colonic polyps
what does osteoma look like on MRI
low intensity on T1 and T2
where do bone islands occur
anywhere
mc in epiphysis and metaphysis
not diaphysis
also not seen in skull
what does bone island look like on imaging
discrete area of sclerosis
brush border - help ddx from blastic mets
round oval well circumscribed
long axis parallel to bone
what is a enostoma
another term for bone island
do bone islands cause any symptoms
no
no pain or chance of malignancy
what does bone island look like on MRI
how about CT
how about on bone scan
low intensity on T1 and T2
bright on CT
cold on bone scan unless in growth period
how big is an osteoid osteoma
< 1cm
osteoid osteoma most commonly occur where
in what part of the bone
mc in tibia or femur
also in neural arch
metaphysis
osteoid osteomas can induce what defect in the spine due to tumor in neural arch
painful rigid scoliosis
which tumor contains radiolucent nidus with surrounding sclerosis or solid periosteal reaction
osteoid osteoma
which tumor contains a vascular blush on MRI
osteoid osteoma
osteoid osteomas occur in what age range
10-25
what are the symptoms of osteoid osteoma
gradual onset of severe deep aching pain
worse at night!
relieved by aspirin!
what do you use to diagnose osteoid osteoma
CT
how do you treat osteoid osteoma
thermoregulation
what does osteoid osteoma show on bone scan
how about MRI
intense uptake
low signal
what is the differential diagnosis for osteoid osteoma
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
where does osteoblastoma occur
common in metaphysis
but loves posterior neural arch
what does osteoblastoma look like on imaging
expansile lesion
egg shell thin cortex and matrix
maybe sclerotic
what is the age range for osteoblastoma
10-20
what are the symptoms of osteoblastoma
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)
what ROM is lost in osteoblastoma
loss of extension
what is the differential diagnosis for osteoblastoma
ABC
can osteoblastomas become malignant
small percentage do
what does osteoblastoma look like on bone scan
how about MRI
HOT
high intensity on T2 due to increase fluid
what is the treatment for osteoblastoma
curettage
radiation if last resort
where does solitary enchondromas occur in the body
common in metaphysis
loves small bones of hands and feet
what do solitary enchondromas look like on imaging
radiolucent expansile lesions
intact but thinning of the cortex
endosteal scalloping
punctate calcification
what may have happened if solitary enchondroma is causing pain
pathological fracture or malignant transformation
usually doesnt cause pain
if enchondroma becomes malignant, where is it located
axial skeleton
turns into chondrosarcoma when metastasizes
what age does solitary enchondromas occur in
10-30
what does solitary enchondroma look like on MRI
low signal
what is treatment of solitary enchondroma
what about if fracture occurs
what if its close to axial spine
packing chips - calcium phosphate packing
implanted human bone morphogenic protein
fracture - casting and curettage
axial spine = malignant - prophylactic surgery to remove
multiple enchondromas is called
olliers disease
are solitary or multiple enchondromas more likely to become malignant
multiple - olliers
10-50%
multiple enchondromas, hemangiomas, and phleboliths is called what
maffuccis syndrome
does solitary enchondromas, olliers, or maffuccis have the highest rate of malignancy transformation
maffuccis syndrome
multiple enchondromas, hemangiomas, phleboliths
transforms into chondrosarcoma
where do chondroblastomas occur
only epiphysis and apophysis
knees, femur, proximal tibia, and humerus
what does chondroblastoma look like on imaging
radiolucent round oval lytic lesion
eccentric - located in medullary canal
internal matrix calcification because cartilaginous matrix
ring of sclerosis
solid periosteal reaction
what age do chrondroblastoma occur in
10-25
what is also called codmans tumor
chondroblastoma
what is the treatment chondroblastoma
curettage and bone chip packing
what does chondroblastomas look like on MRI
what does it look like on bone scan
low signal
hot!
what is the size of chondromyxoid fibroma
1-10 cm
chondromyxoid fibroma looks __ but it is actually __
look malignant
but its benign
chondromyxoid fibroma occurs in what location MC
proximal 1/3 of tibia
what does chondromyxoid fibroma look like on imaging
eccentric oval round lesion
endosteal scalloping
sclerosis on the medullary side of lesion
trabeculated or soap bubble appearance
what age group does chondromyxoid fibroma occur in
10-30
or
50-70
what is treatment for chondromyxoid fibroma
curettage or excision
where do fibrous cortical defects MC occur
posterior medial distal femur**
or LE
metaphysis
what does fibrous cortical defect look like on imaging
< 1cm
lytic lesion
sclerotic rim
eccentric
what age range does fibrous cortical defect occur in
4-8
fibrous cortical defect is symptomatic or asymptomatic
asymptomatic - found by accident
fibrous cortical defect may become what
non ossifying fibroma
non ossifying fibroma MC occurs where
MC in distal tibia
diametaphyseal
what does non ossifying fibroma look like
2-7 cm
multilocular
lytic eccentric ovoid
dense sclerotic border on medullary side of lesion
- peripheral sclerotic border
periosteal reaction
what age range does non ossifying fibroma occur in
8-20
what is a non ossifying fibroma due to
faulty ossification centers - not true neoplasm
does non ossifying fibroma cause symptoms
no
but could cause pain if large enough or causes fracture or stress fracture
non ossifying fibroma may turn malignant? yes or no
no malignant transformation
where does simple bone cysts occur
proximal humerus and femur and calcaneus
metaphysis into diaphysis
what is a bone cyst made up of
fluid filled cyst with thin layer of fibrous tissue - so no matrix calcification
what does a simple bone cyst look like on imaging
truncated cone or bullet shape
broad near metaphysis and narrow in diaphysis - not seen in epiphysis
cystic radiolucency
endosteal scalloping
light or incomplete septation
what age group do bone cysts occur in
3-14
if a simple bone cyst is in the ___ it is an active cysts
if it is in the __ it is an latent cyst
active - metaphysis
latent - diaphysis
2/3 of bone cysts result in what
pathological fracture - result in fallen fragment or hinged fragment sign
what sign is associated with bone cysts
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
what imaging is used to find fluid in the bone cyst
what does it look like on imaging
MRI
high on T2
low on T1
what is the size of an ABC
8-10 cm
where does an ABC occur
metaphysis of long tubular bone (could cross growth plate)
MC in posterior neural arch
what does ABC look like on imaging
eccentric expansile egg shell thinning of cortex soap bubble may cross the growth plate
what age group does ABC occur in
5-20
what is the mc benign bone tumor of the clavicle
ABC
what are the symptoms of ABC
acute rapid progressive pain
RAPIDLY INCREASING PAIN!!!
what is an ABC made up of
blood
NOT A TRUE CYST
not a aneurysm
how to treat an ABC
curettage and packing
what is the size of an intraosseous lipoma
2-13 cm
where does intraosseous lipoma occur
metaphysis of long bones - tibia, fibula, metatarsal, calcaneus
MC in calcaneous
if ABC is found in the posterior neural arch, what does this cause
stenosis and epidural mass effect
what does intraosseous lipoma look like on imaging
lytic
sclerotic border
expansile
endosteal scalloping
calcific radiopaque of central necrosis - looks like doughnut or target
cockade sign - dystrophic calcification
what age do intraosseous lipomas occur in
5-70
what is the rarest benign bone tumor
intraosseous lipoma
does intraosseous lipoma cause symptoms
no symptoms
incidental finding
what is treatment for intraosseous lipoma
curettage and packing
where do hemangiomas occur
MC in spine
skull - maxilla and mandible
soft tissue
what do hemangiomas look like on imaging in the spine skull and soft tissue
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
where do hemangiomas occur in the skull
whats the size
frontal bone MC
1-7 cm round and oval
hemangiomas occur in what age group
> 40
what is the most common benign tumor of the spine
hemangioma
75% of hemangiomas occur where
spine and skull
do hemangiomas produce symptoms
not usually
slow growing, may be slight pain - MOST symptomatic in T spine
if symptomatic, results from cord compression
mandible and maxillary hemangioma can cause what
death by tooth extraction
can you see hemangiomas on plain film
not usually
what is the most common type of hemangioma
capillary or cavernous
cavernous
what is the treatment for hemangiomas
curettage, packing, cryotherapy
solitary osteochondromas are found in what location
MC in the knee
metaphysis
long tubular bones - femur, humerus, scapula, any bone preformed in cartilage
what does solitary osteochondroma look like on imaging
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
75% of solitary osteochondromas occur in what age group
< 20
what is the most common benign skeletal bone tumor
osteochondroma
what tumor makes up 50% of all neoplasm in bone
osteochondroma
which tumor contains a stalk and a cap
what part goes malignant
how do you know if its transforming into malignancy
osteochondroma
cap
cap > 2cm in adults and 3 cm in children indicate transformation
break in cortex of growing soft tissue mass = malignancy
what imaging do you use to assess an malignant transformation of osteochondroma
MRI - to view cap thickness
how do you treat osteochondroma
surgical excision if symptomatic
what tumor occurs bilaterally and symmetrically with 2-100’s of tumors
hereditary multiple exostosis
what is the average number of tumors seen in hereditary multiple exostosis
what kind of tumors are these
2-100s
average 10
osteochondromas
what are some deformities and features of hereditary multiple exostosis
bayonet hand deformity - short ulna, outward bowing of radius, radioulnar joint subluxation
cauliflower pelvic lesions
in what age does hereditary multiple exostosis occur
2-10
what are the symptoms of hereditary multiple exostosis
painless lumpy joints
cauliflower pelvic lesions compress cord and may turn malignant
osteomas are usually what asymptomatic but are a __ complaint
cosmetic
what is gardeners syndrome considered (osteomas)
pre malignant
what is the most common benign tumor of the hand
solitary enchondroma
what does a solitary enchondroma metastisize into
chondrosarcoma
enchondromas are painless but if they become large enough it may cause what
deformities of the hand
where is olliers and maffuccis syndrome most commonly found
hands
maffucci syndrome patients may have a positive __
ulnar variance - leads to TFCC damage
what is a fibrous cortical defect also called
what is a non ossifying fibroma also called
fibrous xanthoma of bone
fibrous xanthoma of bone
what is the size of a non ossifying fibroma
2-7 cm
what is another term for simple bone cyst
unicameral bone cyst
what tumor points away from the joint due to muscle pull
solitary osteochondroma
what are ddx for enostomas
osteoid osteoma
blastic mets
osteopoikilosis
why do osteoid osteomas respond to NSAIDS or aspirin
have analgesic and antipyretic effect on prostaglandins
what is best treatment for osteoid osteoma
thermoregulation
benign flocculated appearance, well defined, expansile, proximal humerus
enchondroma
eccentric, lytic, well circumscribed, benign, hazy matrix in distal femur
fibrous cortical defect
what soft tissue component in high amount indicates a hemangioma is unlikely to be symptomatic
fat
what is the most common benign skeletal tumor
what is the most common benign spine tumor
skeletal - osteochondroma
spine - hemangioma
the closer hereditary mutiple exostosis lesions are to the spine or axial skeleton indicates what
more likely to become malignant
what procedure is used to determine a M spike
protein electrophoresis
should benign tumors be irradiated
no
its more likely to be malignant if ___
hot on bone scan
what are features of malignant transformation
enlarging radiolucent area
fracture
disappearance of pre-existing calcification***
rapid growth of lesion
what is helpful to detect malignant degeneration of multiple enchondromatosis
MRI
when a patient has pain, what should be considered with multiple enchondromatosis even if abscence of radiographic findings
malignant transformation
what are metabolically active and may grow throughout the patients life
enchondromas
what kind of hemangiomas are present in maffuccis syndrome
what do they look like on xray
cavernous hemangiomas
opaque spots
hemangiomas of maffuccis syndrome can occur where
other organs
such as GI tract
how often do simple bone cysts udnergo pathological fracture
2/3 undergo pathological fracture
calcaneal cyst is typically located where
what is the differential diagnosis
simple bone cyst at the base of the calcaneal neck
lipoma
pseudotumor - thinning of trabeculae
aneurysmal bone cyst maybe caused by what
post trauma
what is the mc benign tumor of the clavicle
ABC
which tumor has a high recurrence rate
ABC
what should you do with an intraosseous lipoma thats asymptomatic
leave it alone
dystrophic calcification seen in intraosseous lipoma is known as what
cockade sign
pathognomonic appearance and location of lesion
symptoms from hemangiomas are usually from what
what are the symptoms like
symptoms usually arise from what part of the spine
spinal cord compression
local pain and muscle spasm - radic, spinal steonosis, hyper/hypoesthesia
mid thoracic spine - spinal canal vs cord size is smallest
how do you treat hemangiomas in the skull
spinal stenosis present and cord compression - decompression surgery
symptomatic skull lesions - en bloc excision
inoperable spinal lesion - radiation
corduroy clothe appearance results in vertebral body being ___ than neighboring vertebral bodies
stronger
do you have to restrict activities due to vertebral hemangiomas
do not restrict activities
what does hemangioma look like on CT and MRI
CT - polka dot spine
MRI - jailhouse and corduroy cloth appearance
fat vs blood hemangiomas
what imaging do you see these findings
fat - reduced likelihood of symptoms - T1
blood - increased likelihood of neural compression - T2 - associated with vertebral collapse
osteochondromas produce pain when
when it invades nerves and blood vessels
when do osteochondromas stop growing
after closure of growth plate
large osteochondromas exhibit what
cauliflower exostosis
