Bone Tumors 1 /2- Mahoney Flashcards
What is still the single best radiologic test to help diagnose bone lesions, including tumors
The plain radiograph
Soft tissue mass adjacent to a bone tumor is considered ____
malignant (until proven otherwise)
Margins
Narrow: Values
- 1-1.0 mm
- tumor and surrounding normal bone are touching, and you see it surrounded by either a sclerotic or lytic margin
Margins
Wide: Values
2-10 mm
- but in between the two there is an area that is indistinct that looks like it might be partially damaged
Margins
_____ - margin may be several centimeters or it may be impossible to measure the margin
Poorly defined:
-lesions with a distinct margin, whether or not it is sclerotic
geographic lesions
growth is more rapid, there may not be enough time to retreat orderly, and the margin becomes ill-defined
moth-eaten” appearance-usually suggests malignancy
Ill-defined pattern of lucency caused by many, small, irregular holes in the bone
permeative” pattern, usually associated with aggressive infection or malignancy
Moth eating and permeative are all ______
Malignant
If the lesion grows in fits and starts, periosteum may have time to lay down thin shell of calcified new bone before the lesion starts another growth spurt-leads to concentric shells of new bone over the lesion
lamellated or “onion-skin”
- associated with Ewings sarcoma
Rapid growth of bone –> appearance-periosteum has no time to lay down bone, but Sharpey’s fibers become stretched out perpendicular to the bone, and then ossify-lesion is malignant until proven otherwise
“sun-burst” or “hair-on-end”
only the edges of the raised periosteum will ossify-this little bit of ossification forms a small angle with the surface of the bone, but not a complete triangle
Codman’s “triangle
Often caused by the tumor breaking out of cortex into the soft tissue
Codman’s “triangle
The x-ray sign that is least likely to occur with an aggressive bone tumor is:
Codman’s triangle Sunburst appearance Lamellated periosteum Geographic bone matrix Permeative bone matrix
Geographic
Diffuse Periosteal Reaction
Venous stasis
Can cause a psedu osteomyelitis
The substance in bone produced by osteoblasts and chondroblasts
Matrix
______matrix tends to be dense and confluent (“cloudy”)
Osseous
_______ matrix tends to produce small punctate or swirled area of calcification
Chondroid
This bone tumor has a ground glass appearance on x-ray:
Non-ossifying fibroma
- osteochondroma
- solitary enchondroma
- chondroblastoma
- chondrosarcoma
Cartilage-forming tumors (“chondro”)
- Osteoid osteoma and osteoblastoma
2. Osteogenic sarcoma
Bone-forming tumors (“osteo”)
- Osteogenic sarcoma
- Chondrosarcoma
- Fibrosarcoma
- Ewing’s sarcoma
- Metastatic carcinoma
Malignant tumors
Vast majority of bone tumors are going to be in the _____ type
Lytic
FOGMACHINES stands for?
F fibrous dysplasia O osteoid osteoma/osteoblastoma G giant cell tumor M metastasis, myeloma A aneurysmal bone cyst C chondroblastoma, chondromyxoid fibroma H hyperparathyroidism, hemangioma I infection N non-ossifying fibroma E eosinophilic granuloma, enchondroma S solitary bone cyst, sarcoidosis
Solitary lytic lesions of bone
(“long lytic lesion in a long bone”)
Fibrous Dysplasia
Non-ossifying Fibroma –> looks alike
Small <2cm
Occurs in younger
- dervided from bone tissue surrounded by sclerotic tissue
lesion (“hurts like a ‘b’ and tough to see”)
What can help with the pain?
Osteoid osteoma
Night pain relieved by ASA
At the end of a long fast, teens have a blast”
Benign lesion of bone composed of osteoid tissue intermixed with woven bone in a vascular connective tissue stroma
most common tumor in teens at the ends of long bones)
Osteblastoma
Aggressive tumor composed of well vascularized stroma with oval tumor cells and multinucleated tumor giant cells
Giant Cell Tumor
- May metastasize to lungs or transform to fibrosarcoma or osteogenic sarcoma
Most probable cause of osteolytic metastases in a child is _______
neuroblastoma
In an adult male, CA of lung
In an adult female, CA of breast
CA of kidney and thyroid
_________ is most common primary malignant tumor of bone in the body
Myeloma
Arteriovenous or other vascular anomaly resulting from a local circulatory disturbance in bone
Diagnostic: On MRI-”Mosaic glass on MRI”
Aneurysmal Bone Cyst
Expands bone on CT but doesnt break perosteum
(“chicken-wire matrix”)
Chondroblastoma
Chondromyxoid fibroma –> has no chicken wire
“Brown tumors”-hemosiderin deposition in bone matrix that is being rapidly turned-over w/o adequate calcification
Subperiosteal bone resorption is hallmark, especially in phalanges
Hyperparathyroidism
- dont lose osteoblastic activity just much slower
“Long striations with long lucencies
Hemangioma
fibrous cortical defect (FCD) in metaphyseal area of bone caused by periosteal fibroblastic proliferation
Non-ossifying Fibroma
Bubbly lesions of bone***
NFC GAMES
Nonossifying 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”)
Composed of mature hyaline cartilage in the medullary cavity
Enchondroma
Granulomas in a bone that are filled with eosinophils
Eosinophilic Granuloma
(“endosteal scalloping”)
Eosinophilic Granuloma
Almost exclusively in the calcaneus, under the middle facet (“Best bet is middle facet”)
Commonly associated with a “fallen fragment” sign
Solitary bone cyst (Unicameral bone cyst)
Of FOGMACHINES these are the ones that produce more than one.
Multiple Lucent Bone Lesions
H hyperparathyroidism/hemangioma I infection F fibrous dysplasia E enchondroma/eosinophilic granuloma M metastasis/myeloma
Lytic Lesions in Metaphysis
“Cage On Mud”
C chondroblastoma
A aneurysmal bone cyst
G giant cell tumor
E enchondroma, Ewing’s sarcoma
O osteoblastoma, osteosarcoma, osteomyelitis
N non-ossifying fibroma
M malignant fibrous histiocytoma (fibrosarcoma)
U unicameral bone cyst
D desmoid tumor
Best classified by age:
<1
neuroblastoma
Best classified by age:
1-10
Ewing’s sarcoma
Best classified by age:
10-30
osteosarcoma, Ewing’s
Best classified by age:
30-40
fibrosarcoma, lymphoma
Best classified by age:
40+
metastasis, myeloma,
chondrosarcoma
“moth-eaten”
“onion-skin”
soft tissue mass
Ewing’s Sarcoma
forefoot –>survival high
_________ develops in places of active growth
Osteogenic Sarcoma (Osteosarcoma)
Most common malignant BONE tumor in foot and ankle
Chondrosarcoma
When bone lesion is white or scelerotic what pneumonic should be used?
C chronic osteomyelitis
O osteochondroma
P Paget’s disease
B breast metastasis
O osteogenic sarcoma
B bone island*** Most commonly seen
S stress fracture
H hemangioma
I infarct *** Will look sclerotic not lytic
P prostate metastasis
ceases growth at the time of skeletal maturation
Has a cap of hyaline cartilage and projects away from the epiphysis from which it arises
Osteochondroma
“Flame-shaped” or “blades of grass” radiolucent lesions of bone which accentuates the areas of sclerosis
Paget’s Disease
Non-neoplastic tumor-like lesion of bone (heterotopic ossification)
skeletal muscle of extremities following trauma
Myositis Ossificans
This bone lesion is generally sclerotic in appearance, arises from an epiphysis, and grows towards the opposite end of the bone.
Subungual exostosis Bone island Giant cell tumor Bone infarct osteochondroma
osteochondroma
The most likely primary bone malignancy in an adult > 40 is:
Ewing’s sarcoma Chondrosarcoma Osteogenic sarcoma Metastasis from kidney fibrosarcoma
