Bone Path II Quiz 1 Flashcards
DDX: Young Adult (<40) With Primary Malignant Tumor
Osteosarcoma (10-25) Ewings Sarcoma (10-25)
Giants Cell Tumor (20-40)
Parosteal Osteosarcoma (30-50)
Non-Hodgkins Lympoma (20-50)
Most Common Primary Bone Malignancies
Multiple Myeloma (most)
Osteosarcoma
Chondrosarcoma
Ewings Sarcoma
DDX: >40 Lytic
METS! Multiple Myeloma (multiple)
Is osteosarcoma lytic or blastic?
50% Sclerotic
25% Lytic
25% Mixed
What is the most aggressive form of osteosarcoma?
Lytic
Primary Malignant bone tumors that like the Epiphysis
Giant Cell (metaphysis/diaphysis)
Clear Cell Chondrosarcoma
Fibrosarcoma
Expansile/ Soap Bubbly Lesions
Solitary plasmacytoma
Fibrosarcoma
Giant Cell Tumor
Pt with primary bone maligancy that is 10-25 years old. DDX
Osceosarcoma
Ewings Sarcoma
Pt that is 25-35 DDX
Giant Cell Carcinoma
Hodgkin’s Lymphoma
What is the most common cause of a missing pedicle?
Mets
Where does Mets like to go in bone?
Spine (40%)
Axial skeleton
Skull
Proximal extremities
What labs can you run to check for Mets?
ESR Serum Ca (lytic) Alk Phos (blastic)
DDX for Ivory Vertebra
Osteoblastic Mets
Pagets
Hodgkins
What would you treat with to inhibit osteoclast activity?
Biphosphates
What is the most common symptom of MM?
Bone pain #1
Systemic Symptoms
What is the age group for MM?
50-70
How do you diagnose MM?
Elevated Serum Proteins= Reversed A/G Ratio (G>A)
Where does MM like to go?
Humerus, Femur, Diaphysis, Spine, Skull (same as mets)
What does MM look like on x-ray?
Multiple Punched out lytic lesions.
If its looks like mets, but there is one one lesions, what do you suspect?
Solitary Plasmacytoma
What do Solitary Plasmacytomas look like on x-ray?
Lytic
Expansile
Soap Bubbly
What age group does Osteosarcoma affect?
10-25
Where do you most often see Osteosarcoma in bones?
Metaphysis of long bones.
What does osteosarcoma look like on x-ray?
Cortical disruption Spiculated ST mass Cumulus Cloud Lytic 25% (more aggro) Blastic 50%
What ancillary study do you use to plan treatment in Osteosarcomas?
MRI
What ancillary study do you use to scan for mets with Osteosarcoma?
CT/Bone Scan
Can you use bone scan to look for MM?
No- doesnt show up
Where is mets most common from Osteosarcoma?
Lung (Cannonball mets)
Dense mass with stalk to cortex and no periosteal response. DDX
Parosteal Osteosarcoma
Myositis ossificans (no stalk)
What age group do Parosteal Osteosarcomas affect?
30-50
What is the most common primary malignancy of hand, sternum, scapula?
Chondrosarcoma
Where do you most commonly find Chondrosarcomas?
Pelvis Prox femur Prox humerus Ribs Scapula Knee Craniofascial bones.
What do Chondrosarcomas look like on x-ray?
Large
Lytic
Popcorn stippled calcifications
Can have large ST mass
What age group are chondrosarcomas found in?
40-60
Where is long bones do you find Chondrosarcomas?
Metaphysis (most)
Diaphysis (some)
Where do you find Clear Cell Chondrosarcomas?
Epiphysis
What age groups do Ewing Sarcomas affect?
10-25
What are the symptoms Ewing Sarcomas?
Pain and swelling
Looks like an INFECTION
In what part of bone do you most commonly find Ewing Sarcomas?
Diaphysis
Are Ewing Sarcomas well defined?
No, wide zone of transition
Does Ewing Sarcomas have a good prognosis?
No, often amputation if found
Where do you most commonly find Fibrosarcomas?
Knee (50%)
Do Fibrosarcomas have a periosteal response?
No, but they do have a large ST mass
What is the treatment of choice for Fibrosarcomas?
Amputation
Is the pronosis good for Fibrosarcomas?
No
What is the msot common ST sarcoma in adjults?
Malignant Fibrous Histocytoma (MFH)
What do Malignant Fibrous Histocytomas look similar to on x-ray?
Fibrosarcomas
Where in the body are Chordomas most commonly found?
Sacrococcyggeal and Spheno-occipital regions.
Is mets common with Chordomas?
No
What are the symptoms in Chordomas most often from?
The mass of the tumor affecting surrounding tissues.
Chodomas are lytic/blastic?
Lytic
What age group does Non-Hodgkins Lympomas affect?
20-50
Are Non-Hodgkin’s Lympoma pts healthy?
Usually, Yes
Where is Non-Hodgkins Lympomas usually found?
Femur, Tibia, Humerus
What does Non-Hodgkins Lymphomas look like on x-ray
Permeative (moth eaten)
Lytic
Minimal Periosteal Response
What is the most common symptom of Hodgkins Lympoma?
Pain
Where is Hodgkins Lympomas most common?
Verteba
What does Hodgkins looks like in vertebra?
Ivory Vertebra
Poss exuberant peristeal response
What age group does Synovial Sarcomas affect?
30-50
Are Synovial Sarcomas painful?
Yes
What do Synovial Sarcomas look like on x-ray?
Calcification in 1/3
Speckled
How do you treat Synovial Sarcomas?
Excitation (mod good prognosis)
What ancillary study do you use to check Synovial Sarcomas?
MRI
