Bone Tumors Flashcards
What is the best radiographic method to diagnose a bone tumor?
x-ray
What is your first step when diagnosing a bone tumor?
is the lesion latent, active or aggressive?
describe the margin, periosteal reaction and soft tissue mass in a latent bone lesion.
narrow margins
no periosteal reaction
soft tissue mass is absent
describe the margin, periosteal reaction and soft tissue mass in an active bone lesion.
- wide margins
- none or mild periosteal reaction
- soft tissue mass is absent
describe the margin, periosteal reaction and soft tissue mass in an aggressive bone lesion.
- wide or poorly defined margins
- mild or major perisoteal reaction
- soft tissue mass is present
perisoteal reactions occur with what type of lesions?
more active/aggressive lesions
what is considered a narrow margin?
- 1-1.0mm
* tumor and surrounding normal bone are touching
what is considered a wide margin?
2-10mm
*can see where the tumor is and the undamaged bone
what is considered a poorly defined margin?
several cm
*can tell there is a tumor in teh bone or areas that are distinctly abnormal
what is a geographic lesion?
well-defined lesion with a narrow margin
What is a moth-eaten appearance?
ill-defined areas of lucency (rathere than a single discrete lesion)
what is a permeative lesion?
ill-defined pattern of lucency with many small, irregular holes in the bone
*usually associated with aggressive infection or malignancy
what are the 3 descriptions of appearance of lesions?
- geographic
- moth-eaten
- permeative
regarding periosteal reactions, if you see a full layer of solid, uninterrupted perisoteal new bone along the margin of teh affected bone, what does this tell you about the lesion?
it is slow-growing
regarding perisoteal reaction, if you see a lamellated or onion-skin appearance of new bone, what does this tell you about the lesion?
the lesion grows in fits and starts (on/off growing)
if growth of lesion is very rapid, what 2 patterns may develop?
- sun-burst or hair-on-end appearance
2. Codman’s triangle
what is sun-burst apeparance?
periosteum has no time to lay down bone and Sharpey’s fibers become calcified at different lengths
what is hair-on-end appearance?
occurs with rapidly growing lesions because Sharpey’s fibers become calcified at all the same lengths
what is Codman’s triangle?
signifies an aggressive lesion because only the edges of the raised periosteum will ossify
what is step 2 of diagnosing bone tumors?
ask yourself what does the matrix look like?
a speckled matrix is indicative of what cell origin?
chondroid matrix (cartilage cells)
a matrix derived from bone will have what matrix appearance?
cloudy matrix
a matrix derived from fluid-filled cysts or hyaline is indicative of what type of lesion?
ground glass appearance
Name the cartilage-forming tumors.
- osteochondroma
- solitary enchondroma
- chondroblastoma
- chondrosarcoma
Name the bone-forming tumors.
- osteoid osteoma and osteoblastoma
2. osteogenic sarcoma
Which are the benign tumors?
- enchondroma
- osteochodnroma
- osteoid osteoma
- osteoblastoma
- giant cell tumor (also malignant)
- chondroblastoma
Which are the malignant tumors?
- osteogenic sarcoma
- chondrosarcoma
- fibrosarcoma
- Ewing’s sarcoma
- metastatic carcinoma
what is step 3 of diagnosing bone tumors?
is the lesion lytic or sclerotic, solitary or multiple?
What is the mnemonic for solitary lytic lesions of bone?
"FOG MACHINES" 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 ossifiying fibroma E-eosinophilic granuloma, enchondroma S-solitary bone cysts, sarcoidosis
What bone tumor is seen with Albright’s syndrome?
fibrous dysplasia
Which bone tumor appears as a “long lytic lesion in a long bone”?
fibrous dysplasia
Name this bone tumor: night pain that is relieved by aspirin or NSAIDs
“hurts like a b and is tough to see”
osteoid osteoma
Name this bone tumor that attacks the ends of long bones (metaphysis) of teenagers. There is no surrounding reactive bone sclerosis.
osteoblastoma
Name this bone tumor that is massive in the metaphysis and may metastasize to lungs or transform to fibrosarcoma or osteogenic sarcoma?
giant cell tumor (of bone)
What is the most common primary malignant tumor of bone in the body?
multiple myeloma
what does multiple myeloma appear as?
moth-eaten appearance
multiple punched-out lesions
what bone tumor appears as “mosaic glass on MRI”?
aneurysmal bone cyst
Which bone tumor has a “fluffy, cotton wool appearance”?
chondroblasto`ma
Name this bone tumor that has a “chicken-wire matrix”.
chondromyxoid fibroma
what condition produces “brown tumors”
hyperparathyroidism
Name this bone tumor that has “long striations with long lucencies”
hemangiomas
which bone tumor appears very similarly to fibrous dysplasia?
non-ossifying fibroma
which bone tumor appears as “soap bubble appearance”?
non-ossifying fibroma
Which bone tumor loves the ends of long bones and has “speckled tone”?
enchondroma
which bone tumor has “endosteal scallopping”?
eosinophilic granuloma
which bone tumor is almost exclusively in the calcaneus, under the mdidle facet especialy.
solitary bone cysts (unicameral bone cysts)
which malignant lesion affects those <1 y/o?
neuroblastoma
which malignant lesion affects ages 1-10?
Ewing’s sarcoma
Which malignant lesions affects age 10-30?
osteosarcoma
Ewing’s sarcoma
which malignant lesions affect age 30-40?
fibrosarcoma, lymphoma
which malignant lesions affect age 40+?
metastasis, myeloma, chondrosarcoma
which malignant lesion most commonly exhibits onion-skin appearance to the periosteum?
Ewing’s sarcoma
Ewing’s sarcoma affects which part o fthe foot?
1/3 in hindfoot- 30% survival
2/3 in forefoot - 70% survival
where does osteosarcoma like to affect?
rapidly growing bones, esp knees
what is the most common malignant bone tumor of foot and ankle?
chondrosarcoma
what is the mnemonic for solitary or multifocal sclerotic lesions of bone?
COP BOBS HIP
COP
chronic osteomyelitis
osteochondroma
Paget’s disease
BOBS
breast metastasis
osteogenic sarcoma
bone island
stress fracture
HIP
hemangioma
infarct
prostate metastasis
Name this tumor: aberrant proliferation of epiphyseal cartilage cells and ceases growth at time of skeletal maturation
osteochondroma
osteochondroma is similar to subungual exostosis. how do you differentiate this?
subungual exostosis is more common in females and does not arise from epiphysis like osteochondroma does
*subungual exostosis arises from distal phalanx
what is a bone island?
area of sclerotic bone due to increased osteoblastic activity; is benign
what is the “flame-shaped” sclerotic lesions of bone?
Paget’s disease
what looks like “candle wax disease”?
melorrheostosis
what looks like linear striations?
osteopathia striata
what looks like spotted bones?
osteopoikilosis
