Bone Tumors 1 /2- Mahoney

Question 1

What is still the single best radiologic test to help diagnose bone lesions, including tumors

Answer 1

The plain radiograph

Question 2

Soft tissue mass adjacent to a bone tumor is considered ____

Answer 2

malignant (until proven otherwise)

Question 3

Margins

Narrow: Values

Answer 3

0. 1-1.0 mm

- tumor and surrounding normal bone are touching, and you see it surrounded by either a sclerotic or lytic margin

Question 4

Margins

Wide: Values

Answer 4

2-10 mm

• but in between the two there is an area that is indistinct that looks like it might be partially damaged

Question 5

Margins

_____ - margin may be several centimeters or it may be impossible to measure the margin

Answer 5

Poorly defined:

Question 6

-lesions with a distinct margin, whether or not it is sclerotic

Answer 6

geographic lesions

Question 7

growth is more rapid, there may not be enough time to retreat orderly, and the margin becomes ill-defined

Answer 7

moth-eaten” appearance-usually suggests malignancy

Question 8

Ill-defined pattern of lucency caused by many, small, irregular holes in the bone

Answer 8

permeative” pattern, usually associated with aggressive infection or malignancy

Question 9

Moth eating and permeative are all ______

Answer 9

Malignant

Question 10

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

Answer 10

lamellated or “onion-skin”

• associated with Ewings sarcoma

Question 11

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

Answer 11

“sun-burst” or “hair-on-end”

Question 12

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

Answer 12

Codman’s “triangle

Question 13

Often caused by the tumor breaking out of cortex into the soft tissue

Answer 13

Codman’s “triangle

Question 14

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

Answer 14

Geographic

Question 15

Diffuse Periosteal Reaction

Venous stasis

Answer 15

Can cause a psedu osteomyelitis

Question 16

The substance in bone produced by osteoblasts and chondroblasts

Answer 16

Matrix

Question 17

______matrix tends to be dense and confluent (“cloudy”)

Answer 17

Osseous

Question 18

_______ matrix tends to produce small punctate or swirled area of calcification

Answer 18

Chondroid

Question 19

This bone tumor has a ground glass appearance on x-ray:

Answer 19

Non-ossifying fibroma

Question 20

1. osteochondroma
   
   2. solitary enchondroma
   3. chondroblastoma
   4. chondrosarcoma

Answer 20

Cartilage-forming tumors (“chondro”)

Question 21

1. Osteoid osteoma and osteoblastoma

2. Osteogenic sarcoma

Answer 21

Bone-forming tumors (“osteo”)

Question 22

1. Osteogenic sarcoma
   
   2. Chondrosarcoma
   3. Fibrosarcoma
   4. Ewing’s sarcoma
   5. Metastatic carcinoma

Answer 22

Malignant tumors

Question 23

Vast majority of bone tumors are going to be in the _____ type

Answer 23

Lytic

Question 24

FOGMACHINES stands for?

Answer 24

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

Question 25

(“long lytic lesion in a long bone”)

Answer 25

Fibrous Dysplasia Non-ossifying Fibroma --> looks alike

Question 26

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?

Answer 26

Osteoid osteoma Night pain relieved by ASA

Question 27

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)

Answer 27

Osteblastoma

Question 28

Aggressive tumor composed of well vascularized stroma with oval tumor cells and multinucleated tumor giant cells

Answer 28

Giant Cell Tumor - May metastasize to lungs or transform to fibrosarcoma or osteogenic sarcoma

Question 29

Most probable cause of osteolytic metastases in a child is _______

Answer 29

neuroblastoma In an adult male, CA of lung In an adult female, CA of breast CA of kidney and thyroid

Question 30

_________ is most common primary malignant tumor of bone in the body

Answer 30

Myeloma

Question 31

Arteriovenous or other vascular anomaly resulting from a local circulatory disturbance in bone Diagnostic: On MRI-”Mosaic glass on MRI”

Answer 31

Aneurysmal Bone Cyst Expands bone on CT but doesnt break perosteum

Question 32

(“chicken-wire matrix”)

Answer 32

Chondroblastoma Chondromyxoid fibroma --> has no chicken wire

Question 33

“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

Answer 33

Hyperparathyroidism - dont lose osteoblastic activity just much slower

Question 34

“Long striations with long lucencies

Answer 34

Hemangioma

Question 35

fibrous cortical defect (FCD) in metaphyseal area of bone caused by periosteal fibroblastic proliferation

Answer 35

Non-ossifying Fibroma

Question 36

Bubbly lesions of bone******* NFC GAMES

Answer 36

``` Nonossifying fibroma Fibrous dysplasia Chondrosarcoma Giant cell tumor Aneurysmal bone cyst Metastatic CA Enchondroma/Ewing’s sarcoma Solitary bone cyst ```

Question 37

End of bone with speckled tone”) Composed of mature hyaline cartilage in the medullary cavity

Answer 37

Enchondroma

Question 38

Granulomas in a bone that are filled with eosinophils

Answer 38

Eosinophilic Granuloma

Question 39

(“endosteal scalloping”)

Answer 39

Eosinophilic Granuloma

Question 40

Almost exclusively in the calcaneus, under the middle facet (“Best bet is middle facet”) Commonly associated with a “fallen fragment” sign

Answer 40

Solitary bone cyst (Unicameral bone cyst)

Question 41

Of FOGMACHINES these are the ones that produce more than one. Multiple Lucent Bone Lesions

Answer 41

``` H hyperparathyroidism/hemangioma I infection F fibrous dysplasia E enchondroma/eosinophilic granuloma M metastasis/myeloma ```

Question 42

Lytic Lesions in Metaphysis “Cage On Mud”

Answer 42

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

Question 43

Best classified by age: <1

Answer 43

neuroblastoma

Question 44

Best classified by age: 1-10

Answer 44

Ewing’s sarcoma

Question 45

Best classified by age: 10-30

Answer 45

osteosarcoma, Ewing’s

Question 46

Best classified by age: 30-40

Answer 46

fibrosarcoma, lymphoma

Question 47

Best classified by age: 40+

Answer 47

metastasis, myeloma, | chondrosarcoma

Question 48

“moth-eaten” “onion-skin” soft tissue mass

Answer 48

Ewing’s Sarcoma forefoot -->survival high

Question 49

_________ develops in places of active growth

Answer 49

Osteogenic Sarcoma (Osteosarcoma)

Question 50

Most common malignant BONE tumor in foot and ankle

Answer 50

Chondrosarcoma

Question 51

When bone lesion is white or scelerotic what pneumonic should be used?

Answer 51

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

Question 52

ceases growth at the time of skeletal maturation Has a cap of hyaline cartilage and projects away from the epiphysis from which it arises

Answer 52

Osteochondroma

Question 53

“Flame-shaped” or “blades of grass” radiolucent lesions of bone which accentuates the areas of sclerosis

Answer 53

Paget’s Disease

Question 54

Non-neoplastic tumor-like lesion of bone (heterotopic ossification) skeletal muscle of extremities following trauma

Answer 54

Myositis Ossificans

Question 55

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 ```

Answer 55

osteochondroma

Question 56

The most likely primary bone malignancy in an adult > 40 is:

Answer 56

``` Ewing’s sarcoma Chondrosarcoma Osteogenic sarcoma Metastasis from kidney fibrosarcoma ```