Final: Tumors and Tumor Like Processes

Question 1

What is the most common source of osteoblastic metastatic carcinoma in adult females?

Answer 1

Breast CA

Question 2

The 3 common causes of solitary sclerotic vertebral body/ivory vertebra

Answer 2

IHOP:
I: Ivory
H: Hodgkin's lymphoma
O: Osteoblastic mets
P: Paget's dz

Question 3

Is it common to find a tumor involving a joint?

Answer 3

No

Question 4

Is multiple myeloma more common in the vertebral body or neural arch?

Answer 4

Vertebral body

Question 5

What malignancy demonstrates as a cold bone scan?

Answer 5

Multiple Myeloma

Question 6

What is the common age range of primary osteosarcoma?

Answer 6

10-25 y/o

Question 7

What is the most dense (white on x-ray) primary malignant tumor?

Answer 7

Multiple Myeloma

Question 8

What is the difference between sunburst and onion skin appearance?

Answer 8

Sunburst: spoked wheel –> osteosarcoma

Onion skin: Ewing’s sarcoma

Question 9

Which part of the long bone is commonly involved in osteosarcoma?

Answer 9

Metaphysis

Question 10

What is codman’s triangle?

Answer 10

A periosteal rxn seen w/ aggressive bone lesions. Periosteum does not have time to ossify w/ shells of new bone so only edge of raised periosteum will ossify.

Question 11

Why is Ewing’s sarcoma commonly found in the dyaphysis of long bone?

Answer 11

It is a marrow cell tumor.

Question 12

What is a geographic lytic appearance and does it suggest more benign or aggressive neoplasms? What are the other two lytic appearances of tumors?

Answer 12

Destructive lytic bone lesions. Benign.

Motheaten/permeative
Blowout

Question 13

Which condition presents as a solitary exostosis that points away from the nearest joint?

Answer 13

Osteochondroma. MC benign bone tumor.

Question 14

Incidence of malignant transformation in osteochondroma and hereditary multiple exostosis

Answer 14

Osteochondroma = 1%

Hereditary multiple exostosis: 20%

Question 15

What is a corduroy vertebra?

Answer 15

Vertical lines in vertebral bodies

–> Ddx with Paget’s dz

Question 16

Is spinal hemangioma commonly solitary or polyostotic?

Answer 16

Solitary

Question 17

Which is the most common benign bone tumor of the spine?

Answer 17

Hemangioma

Question 18

Is a bone island symptomatic?

Answer 18

Usu asx

DDx: osteoblastic mets, osteoid osteoma

Question 19

Which benign tumor cassically demonstrates as pain worst at night and easily relieved by aspirin?

Answer 19

Osteoid osteoma

Question 20

Which part of the bone is usu involved with osteoid osteoma?

Answer 20

Cortical

Question 21

What is the appearance of the tumor matrix in the endochondroma?

Answer 21

Geographic lytic, expansile, thinned cortex, endosteal scalloping, most central, calcification in 50%

Question 22

What is multiple endochondromatosis called?

Answer 22

Ollier’s dz

Question 23

What is the most common location of fibrous cortical defect?

Answer 23

Lower extremity

Question 24

What is a fallen fragment sign associated with?

Answer 24

Piece of cortex breaks off and falls into the fluid of the cyst (Assoc w/simple bone cyst)

Question 25

Which benign bone tumor is named according to its appearance rather than its histological composition?

Answer 25

Aneurysmal bone cyst: acute onset w/pain and rapid progression. MC tumor of posterior arch

Question 26

Radiographic appearance of endochondroma

Answer 26

``` Enchondroma: Stippled calcification • Geographic lytic • Expansile • Thinned cortex, endosteal scalloping • Metaphyseal-diaphyseal • Most central • Calcification in 50% • No periosteal reaction; no soft tissue mass ```

Question 27

Radiographic appearance of simple bone cyst

Answer 27

Simple bone cyst: • Geographic; lytic; maybe loculated (multiple pockets) • Broad based at physis, narrows toward diaphysis • Bone expansion, but not beyond physis diameter • “Fallen fragment” sign with fracture

Question 28

Radiographic appearance of aneurysmal bone cyst

Answer 28

``` Aneurysmal bone cyst: • Expansile • Lytic, septated • Eccentric • Markedly thinned cortex • Metaphyseal, may extend to epiphysis (only benign tumor to cross growth plate) • Periosteal response more common ```

Question 29

Radiographic appearance of osteochondroma

Answer 29

``` Osteochondroma: • Bony exostosis: cortex continuous with host bone; normal trabeculae • Cartilaginous cap may calcify • Project away from joint • Sessile produces asymmetric widenin ```

Question 30

Is giant cell tumor painful? Is it malignant?

Answer 30

Yes, painful Benign

Question 31

Is Paget's dz monostotic or polyostotic?

Answer 31

Polyostotic, many bones involved

Question 32

Radiographic features of Paget's dz in a long bone

Answer 32

Ivory vertebrae, opaque or lucent (increased or decreased density), thick cortex, coarsened trabeculae, subarticular extension, pseudofractures, deformities, saber shin deformity, bone expansion, polyostoic, R side > L side Femur and Tibia: Blade of grass or candle flame appearance; V lesion