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CORE MSK > Bone Tumors > Flashcards

Bone Tumors Flashcards

1
Q

Lucent Epiphyseal Lesions

A

AIG“the evil” Company

  • ABC
  • Infection
  • Giant cell
  • Chondroblastoma
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2
Q

What bones are epiphyseal equivalents?

A
  • Carpals
  • Patella
  • Greater Trochanter
  • Calcaneus
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3
Q

Differential diagnosis for lucent bone tumors in patients that are:

  1. Less than 30
  2. Any age
  3. Over 40
A

Less than 30 = EG, ABC, NOF, Chondroblastoma, and Solitary Bone Cyst

Any age = Infection

Greater than 40 = mets and myeloma

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4
Q

Classic appearnce of Fibrous Dysplasia

A

Long lesion in a long bone with a ground glass matrix

No periosteal reaction or pain

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5
Q

What is the difference between McCune Albright and Mazabraud Syndrome?

A

Both are polyostotic fibrous dysplasia syndromes

McCune Albright

  • Girl
  • Cafe au lait spots
  • Precocious puberty

Mazabraud

  • Woman (middle aged)
  • Soft tissue myxomas
  • Increased risk for osseous malignant transformation
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6
Q

What is Jaffe-Campanacci Syndrome?

A

***Low yield

  • NOFs
  • Cafe au lait spots
  • Mental retardation
  • Hypogonadism
  • Cardiac malformations
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7
Q

How do you differentiate an enchondroma from a low grade chondrosarcoma?

A

Pain: Low grade chondrosarcomas can be painful

Size: Enchondroma (1-2 cm) vs low grade chondrosarcoma (>4-5cm)

Changes: Archs and ring pattern may move around with low grade chondrosarcoma but will not change with an enchondroma

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8
Q

Name two multiple enchondroma syndromes

A

Ollier and Maffuci

Maffuci has More - Cancer risk and vascular malformations

If you see phleboliths or hemangiomas (lucent centered calcifications) think Maffuci

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9
Q

3 classic Eosinophilic Granuloma (EG) appearances

A
  1. Vertebral plana in a kid
  2. Skull with lucent beveled edge (also in a kid)
  3. “Floating Tooth” with lytic lesion in alveolar ridge – differential case
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10
Q

Classic DDx for Osseous Sequestrum

A
  • Osteomylitis
  • Lymphoma
  • Fibrosarcoma
  • EG

*Osteoid Osteoma can mimic a sequestrum

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11
Q

Classic DDx for vertebra plana

A

MELT

  • Mets / Myeloma
  • EG
  • Lymphoma
  • Trauma / TB
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12
Q

Facts about Giant Cell Tumor (GTC)

A
  • Physis must be closed
  • Non sclerotic border
  • Abuts the articular suface

Things to know

  • Most common in the knee - abuting articular surface
  • Most common at age 20-30
  • Association with ABCs (can turn into them)
  • They are “quasi-malignant” - 5% can mets to the lung
  • Fluid levels on MRI
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13
Q

What is typical apperance of an osteoid osteoma?

A

Oval lytic lesion (“lucent nidus”) surrounded by dense sclerotic bone

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14
Q

Classic DDx for lucent lesion in the posterior elements

A
  • Osteoblastoma
  • ABC
  • TB
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15
Q

Typical age and location for a solitatry bone cyst

A

Less than 30 years old

Proximal humerus > femur > calcaneus

Fallen fragment sign = bone fragment in the dependent portion of a lucent bone lesion

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16
Q

Lytic or sclerotic lesion with history of hyperparathyroidsm think…

A

Brown tumor

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17
Q
A
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18
Q

Classic blastic mets are

A

Prostate, carcinoid, and medulloblastoma

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19
Q

Classic lytic mets are

A

Renal and Thyroid

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20
Q

Test to differentiate a bone island from a prostate met

A

Bone scan

Bone Island should be mild or not active

Prostate met should be HOT

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21
Q

Multiple myeloma typically spares

A

Posterior elements

22
Q

Multiple myeloma can manifest as

A

Diffuse osteopenia

23
Q

Classics: Long lesion in a long bone

A

Fibrous dysplasia

24
Q

Classics: Ground glass

A

Fibrous dysplasia

25
Q

Classics: Lytic lesion with a hazy matrix

A

Fibrous dysplasia

26
Q

Classics: Chondroid matrix in the proximal humerus or distal femur

A

Enchondroma

27
Q

Classics: Lucent lesion in the finger or toes

A

Enchondroma

28
Q

Classics: Epiphyseal tibial lesion in a teenager

A

Chondroblastoma

29
Q

Classics: Epiphyseal equivalent lesion

A

Chondroblastoma or GCT

*Technically GCT grows into the epiphysis

30
Q

Classics: Lucent lesion with a fracture (fallen fragment) in the humerus

A

Solitary (Unicameral) bone cyst

31
Q

Classics: Lucent lesion in the greater trochanter

A

Chondroblastoma

32
Q

Classics: Calcaneal lesion with a central calcification

A

Intraosseus lipoma

33
Q

Classics: Lucent lesion in the skull

A

EG

34
Q

Classics: Vertebra planna in a kid

A

EG

35
Q

Classics: Vertebra plana in an adult

A

Mets (or myeloma)

36
Q

Classics: Sequestrum / nidus in the tibia or femur

A

Osteoid osteoma

37
Q

Classics: “Painful Scoliosis”

A

Osteoid osteoma

38
Q

Classics: Calcified lesion in the posterior elements of the C-Spine

A

Osteoblastoma

39
Q

Malignant Fibrous Histocyoma (aka Pleomorphic Undifferentiated Sarcoma)

A
  • Old people and central location (proximal arms and legs)
  • Dark to intermediate on T2
  • Assocated with spontanous hemmorhage
  • Bone infarcts can turn into MFH
  • Radiation is a risk factor
40
Q

Synovial sarcoma

A
  • Young
  • Peripheral (knee, foot)
  • T2 triple sign (bowl of grapes)

Random trivia

  • Most sarcomas don’t attack bones; synovial sarcoma can
  • Most sarcomas present as a painless mass; synovial sarcomas can hurt
  • Soft tissue calcifications and bone erosions are highly suggestive
  • Slow growing and small in size can trick people into thinking it is B9
41
Q

Myxiod Liposarcoma

A
  • Most common liposarcoma in patients younger than 20
  • Can look like a cyst (T2 bright and T1 dark) - confusing
  • Need gad to differentiate
42
Q

Soft tissue myxoma signal characteristics

A
  • T2 bright
  • T1 iso to dark

Multple soft tissue myxomas + polyostotic fibrous dysplasia = Mazabraud Syndrome

43
Q

Treatment Trivia

Osteosarcoma

A

Chemo first (to kill micro mets) followed by wide excision

44
Q

Treatment Trivia

Ewings

A

Both chemo and radiation followed by wide excision

45
Q

Treatment Trivia

Chondrosarcoma

A

Usually wide excision (low grade and major concern is local recurrence)

46
Q

Treatment Trivia

Giant Cell Tumor

A

Because it extends to the articular surface it will require arthroplasty

47
Q

PVNS versus Synovial Chondromatosis

A
  • PVNS is associated with hemarthrosis (blooming on GRE)
  • PVNS never calcifies
  • Synovial chondromatosis may calcify (see on plainfilm below)
48
Q

Lipoma arborescens appearance

A
  • “Frond like”
  • Behaves like fat (T1 bright, T2 bright, response to fat saturation)
  • Associated with OA, chronic RA, or prior trauma

Tricks:

  • Shown on gradient and need to appreciate fat-fluid interface
  • Shown on US with “frond-like hyperechoic mass”
49
Q

Cortical Desmoid

A
  • DO NOT TOUCH LESION
  • Location = posteriomedial epicondyle of the distal femur
  • Tug lesion
  • Can be hot on bone scan
50
Q

Synovial Herniation Pit / Pitt’s Pit

A
  • Characteristic location in the anterosuperior femoral neck
  • Lytic appearing lesions
  • Associated with femoral acetabular syndrome?

DO NOT TOUCH LESION

CORE MSK (1 decks)

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