Diagnosis Tips Flashcards
What is the age range for Ewing’s sarcoma?
10-25
What is the age range for osteosarcoma?
10-25
What is the age range for giant cell tumor?
20-40
What is the age range for chondrosarcoma?
55-70
What is the age range for myeloma?
50-70
What is the most common overall cancer in those aged 0-14 yeas old?
Leukemia
What is the general cause of 75% of all malignancies?
Metastatic disease
What is the most common primary malignant tumor in adults?
Multiple myeloma
What is the most common primary malignant tumor in children?
Osteosarcoma
What is the most common benign osseous tumor?
Osteochondroma (50%)
What is the most common benign spinal tumor?
Hemangioma
At what age do we reach skeletal maturity?
25 ish
What predictive factor to diagnosis bone tumors could possibly be considered the most important of them all?
Skeletal location
Where is the body does the conversion from red to yellow marrow begin?
Distal extremities
Do children have more red or yellow marrow?
Red
Why are extremity tumors less common in adults?
Red to yellow marrow conversion occurs first in the distal extremities
What is the order of marrow conversation in the parts of long bones?
1 epiphysis 2 midshaft 3 metaphyseal ends
What are the patterns of bone destruction in order from least to most invasive?
1 geographic 2 moth-eaten 3 permeative
Is the geographic pattern of bone destruction normally benign or malignant?
Benign
Does the geographic pattern of bone destruction typically appear as a solitary or multiple lesion?
Solitary
When a lesion is well-defined with borders, is it more likely to be benign or malignant?
Benign
Which has a longer zone of transition: geographic or moth-eaten pattern of bone destruction?
Moth-eaten
What is the term for a radiolucent line seen in the middle of the cortex of bone?
Tunneling
Which pattern of bone destruction tends to have the smallest sized lesions?
Permeative (1 mm)
Why is permeative bone destruction difficult to see?
Lesions are similar in size to normal trabeculae because they’re so small
What is the term for increased cortical thickening of long bones?
Buttressing
Are periosteal reactions more commonly seen in adults or children?
Children
At what location of bone is the periosteum tight?
At metaphyseal corners by the growth plates
What type of periosteal reaction is characterized by additional layers of bone being added to the exterior creating an expanded osseous contour?
Buttressing/solid periosteal reaction
Is buttressing more commonly seen with fast or slow growing lesions?
Slow
What type of periosteal reaction is characterized by alternating layers of lucency and opacity with a alternating growth of new layers of bone?
Laminated/layered/onion skin
Onion skin periosteal reactions are commonly associated with what tumor?
Ewing’s sarcoma
What type of periosteal reaction is characterized by linear radiating areas of bone growth that appear perpendicular to the bone?
Spiculated (“hair on end”)
What type of periosteal reaction is characterized by linear radiating areas of bone growth that stem from a central focus of the bone?
Sunburst
Sunburst appearance is commonly associated with which tumor?
Osteosarcoma
Which periosteal reaction is characterized by a triangular elevation of periosteum seen at the peripheral lesion-cortex junction?
Corman’s triangle
Which is considered the most aggressive of the periosteal reactions?
Codman’s triangle
What are the three possible appearances for cartilaginous matrix of tumors?
1 ring/C-shaped 2 flocculent (popcorn ball like) 3 small crystals (hole with dots)
Which is more common: primary or secondary lesion?
Secondary (75%)
Is bone expansion more likely to occur with a primary or secondary lesion?
Primary
Do periosteal reactions tend to occur with primary or secondary lesions?
Primary
What are the most common primary sites of metastatic disease?
Breast, lung, prostate, kidney, thyroid, bowel
If lytic metastasis is seen in the hands of a female, what is most likely the primary site?
Lungs
What is probably the #1 cause of lytic metastasis in males?
Lungs
What is probably the #1 cause of lytic metastasis in females?
Breast
What is probably the #1 cause of blastic metastasis in males?
Prostate
What is the most common type of metastasis pathway and how is it accomplished?
Hematogenous dissemination (blood) via Batson’s venous plexus
Does the Batson’s venous plexus revolve around the axial skeleton or extremities?
Axial skeleton (explains location of spine for many secondary tumors)
What are some laboratory measurements that can be done for metastatic disease?
ESR, serum calcium, alkaline phosphatase, acid phosphatase, PSA antigen
What would elevated acid phosphatase and/or PSA antigen levels indicate?
Ruptured capsule of prostate
What would elevated alkaline phosphate levels indicate?
Bony productive disease (blastic disease)
What is usually the age range for those with metastasis?
Over 40 (past the 4th decade)
What is the most common area for metastasis and why?
Spine (area of red marrow in adults)
What is the order of frequency for common locations of metastasis?
Spine, ribs/sternum, pelvis/sacrum, proximal extremities, skull
Metastasis to the hands or feet is rare, but if it happens..what primary site should be considered?
Lungs
What is more common: blastic or lytic metastasis?
Lytic (75%)
If a “blow out” metastasis occurs, what primary sites should be considered?
Thyroid/kidney (maybe hepatocellular carcinoma)
What is the name of the radiographic sign when a vertebral body becomes solid white due to blastic metastasis?
Ivory vertebra
What are the two differentials for a missing pedicle?
Congenital defect or metastasis
What is the radiographic finding called when there is a missing pedicle?
Winking owl sign
What are the 3 causes of pathological collapse?
1 osteoporosis
2 metastasis
3 multiple myeloma
What conditions are most commonly seen to involve solitary ivory vertebra?
Paget’s disease, Hodgkin’s lymphoma, osteoblastic metastasis
What is the age range for Hodgkin’s lymphoma?
20-40
What is the age range for Paget’s disease?
Over 60
What is the age range for osteoblastic metastasis?
Over 40
If a 50 year old patient presents with a solitary ivory vertebra, what is the most likely cause?
Osteoblastic metastasis
If a 30 year old patient presents with a solitary ivory vertebra, what is the most likely cause?
Hodgkin’s lymphoma
If a 70 year old patient presents with a solitary ivory vertebra, what is the most likely cause?
Paget’s disease
Can yellow marrow ever covert to red marrow?
Yes, sometimes in times of crisis when blood is needed
When mixed metastasis presents in a female, what is the likely primary site?
Still breast
When mixed metastasis presents in a male, what is the likely primary site?
Prostate (because the majority is blastic)
What is the name of the congenital anomaly that presents as multiple bone islands (insult compacta) with increased whitened density that also appear inactive on bone scan?
Osteopoikilosis
In what location do we commonly seen degeneration due to aging that takes on the appearance of a long bone pseudotumor?
Proximal humerus
Can bone scans differentiate between lytic and blastic metastasis?
No (simply detect metabolic activity)
Which is more common: blow out metastasis from kidney or thyroid or primary blow out lesion?
Metastasis ALWAYS
How can you differentiate between a congenital pedicle defect or an absent pedicle due to metastasis?
Old films OR if sclerosis is not present = metastasis
Which parameter of MRI is most sensitive to metastasis?
T1
How does metastasis appear on T1 weighted MRI? T2?
T1 = low signal (dark) T2 = slightly high signal
