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MSK > Fundamentals (Helms) - tumors > Flashcards

Fundamentals (Helms) - tumors Flashcards

1
Q

What are the 4 main periosteal reaction patterns?

A

1 - nonagressive solid periosteal; smooth continous growth

2 - aggressive, lamellated periosteal reaction; onion skinned, periosteal cells dont have enough time to lay down new bone

3 - very aggressive, suburst; pushes periosteal cells outward, hair on end appearance

4 - very very aggressive, codmans triangle; periosteum doesnt have a chance to lay down calcification

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2
Q

What are the types of margin?

A

Sharp/narrow zone of transition - less aggressive

Wide zone of transition - more aggressive

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3
Q

What is lodwick classification relating to bone destruction

A

Type 1 - geographic - thins zone of transition, sclerotic or well defined

Type 2 - moth eaten - difficult to define any border at all

Type 3 - permeative - multiple tiny holes that infiltrate the bone

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4
Q

What is the type of matrix laid down by osteoid vs chondroid lesions?

A

Osteoid - fluffy, cloud like

Chondroid - ring and arc/popcorn

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5
Q

What is the fallen fragment sign seen in?

A

Unicameral bone cyst, fragment represents displaced cortex

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6
Q

What does resorption of the distal clavicle and/or tumoral calcinosis suggest?

A

Brown tumor of hyperparathyroidism

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7
Q

With regards to lytic lesions, what 2 lesions should ALWAYS be considered in patient age >40?

A

> 40 - mets, myeloma

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8
Q

Which lytic lesions is ALWAYS located centrally within the bone?

A

Unicameral bone cyst

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9
Q

What is osteopoililosis?

A

AUto Dom syndrome with multiple bone islands and keloid formation

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10
Q

What is osteopathia striata?

A

Benign, asymptomatic sclerotic dysplasia with linear bands of sclerosis in long bones and fan like sclerosis in flat pelvic bones

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11
Q

What are the lesions in FEGNOMASHIC?

A 
Fibrous dysplasia
Enchondroma/EG
Giant cell tumor
NOF
Osteoblastoma
Mets/myeloma
ABC
SBC
Hyperparathyroidism
Infection
Chondroblastoma/Chondromyxoid fibroma
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12
Q

What are the discriminators for the FEGNOMASHIC lesions?

A

F: no pain or periosteal reaction, mention adamantinoma in tibia
E: calcification (except in phalanges), no pain or periostitis
(EG: 40yo
A:

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13
Q

What lytic lesions are mentioned if

A 
EG
ABC
NOF
Chondroblastoma
SBC

Young people dont need CANES

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14
Q

What lytic lesions are mentioned if no periostitis or pain?

A

FD
Enchondroma
NOF
SBC

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15
Q

What lytic lesions are mentioned if epiphyseal?

A 
Chondroblastoma
GCT
Infection
EG
ABC
Geode
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16
Q

What lytic lesions can be multiple?

A

FEEMHI

FD
EG
Enchondroma (olliers, maffuccis)
Mets
Hpt
Infection
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17
Q

Where does fibrous dysplasia have a predilection for?

What is the classic description?

What is the associated condition?

What is special about an FD in the tibia?

A

Pelvis, proximal femur, ribs, skull. When in pelvis, will always have proximal femur component

Smoky appearing matrix

Polyostotic fibrous dysplasia (cafe au lait spots, Mccune-Albright). Multiple lesions in the jaw give a CHERUB appearance

Adamantinoma, malignant

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18
Q

What is mccune albright syndrome?

A

Polyostotic fibrous dysplasia, precocious puberty, cutaneous cafe au lati spots

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19
Q

What is mazabraud syndrome

A

fibrous dysplasia and intramuscular myxomas

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20
Q

What is the shepered crook appearance seen with?

A

Fibrous dysplasia

appearance caused by bowing deformity of long bone

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21
Q

In the skull base, how does fibrous dysplasia present? what is the main differntial, and differentiating feature between the two?

A

expansile lesion

Pagets, will be in older adults

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22
Q

What is the most common lytic lesion of the phalanges?

A

Enchondroma

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23
Q

What is the makeup of enchondroma

What is the main differentiating feature when trying to include enchondroma?

What is the main differential diagnosis and what are the differentiating features?

What features are suggestive of malignant transformation to chondrosarcoma?

What are the two syndromes associated with enchondromas? T/F they carry a higher risk of malignant transformation?

A

Bening lesion of mature hyaline cartilage rests

Calcified chondroid matrix (except in phlanages), popcorn/ring and arc

Bone infarct; infarct will have well defined, sclerotic, serpiginous border and no endosteal scalloping

Soft tissue mass, cortical destruction, cortical thickening (periostitis)

Olliers - multiple enchondromas

Maffuccis - multiple enchondromas with soft tissue hemangiomas

True

24
Q

What is the main discriminator for EG?

What is the pathophysiology?

What is the appearance in the skull? mandible?
spine?

A
25
Q

What 4 entities give a sequestrum?

A

EG
Infection
Fibrosarcoma
Lymphoma

26
Q

What are the 4 discriminators for GCT?

What is the difference between benign and malignant?

A

1) must have closed epiphyses
2) must be eccentric
3) must be abutting the articular surface
4) Well defined with NONsclerotic borders

Nothing, cannot be differentiated on radiographic imaging

27
Q

What is the difference between FCD and NOF?

What is the radiographic appearance of NOF?

Where do they present?

What is the natural progression?

A

Size; FCD 2cm

thin, sclerotic border with narrow zone of transition and no matrix calcification, +/- expansion

Metaphysis of long bone eminating from cortex

Spontaneous sclerotic involution and disappear (will be hot on bone scan during reparative phase)

28
Q

Most common location of osteoblastoma? appearance?

What other lytic lesion is this mentioned with? When to favor osteoblastoma?

A

Posterior elements of spine

Expansile lytic lesion with soap bubble appearance (internal calcification/mineralization)

ABC; mineralization within lesion

29
Q

What is the differential for expansile lytic lesion in posterior elements of spine

A

Osteoblastoma
TB
ABC

30
Q

What metastatic lesion is always lytic?

A

RCC

31
Q

What is the makeup of ABC?

What is the characteristic MRI appearance?

What are the two types?

What is the usual presenting complaint?

What is the appearance?

What are the discriminators?

A

blood filled sinusoids and solid fibrous elements

Fluid fluid levels

Primary - no known association

Secondary - conjunction with another lesion or trauma

PAIN

Expansile/aneurysmal with smooth periosteal reaction

32
Q

What are the discriminators for SBC?

Where are they usually seen? What is the classic appearance in the calcaneus?

What is the classic sign?

What is the risk?

What is the main difference between ABC?

What is a nonsurgical treatment

A

must be central,

33
Q

What is the discriminator for brown tumor?

What is the pathognomonic finding of HPT that helps aid in diagnosis of brown tumor?

What findings suggests renal osteodystrophy with secondary HPT?

What are the spine findings in HPT?

A

must have other evidence of HPT

Subperiosteal resorption - radial aspect of 2nd/3rd middle phalanges, distal clavicular osteolysis, medial tibias, SI joints

Osteoporosis/osteosclerosis

Rugger jersey spine

34
Q

What are the discriminators for chondroblastoma?

What does it look like?

A

Must be epiphyseal,

35
Q

T/F: the carpal and tarsal bones and calcaneus are considered epiphyseal lesions with regard to lytic lesions?

A

True

36
Q

What is the main discriminator for chondromyxoid fibroma?

What are the differentiating features for this differential?

A

mention when mentioning NOF

Unlike NOF, can be seen in people >30yo and can present with pain

37
Q

What lesions should be considered with a sclerotic focus in a 20-40yo?

A

NOF, SBC, ABC, chondroblastoma

also FD, infection, healing brown tumor, osteoid osteoma

38
Q

What are the 4 main aspects of bone tumor malignancy? Which one is most reliable?

A

Cortical destruction
Periostitis
Orientation to axis of lesion
Zone of transition***

39
Q

Can benign lesions have apparent cortical destruction? Why?

A

Infection
Eosinophilic granuloma
ABC

replacement of cortical bone by noncalcified matrix

40
Q

Which benign processes can have a wide zone of transition and/or aggressive periostitis?

A

Infection
Eosinophilic granuloma
ABC
osteoid osteoma

41
Q

Which tumors have a permeative bone appearance?

A

Myeloma
Lymphoma
Ewings sarcoma
Infection and EG

42
Q

What are the tumors associated with the following ages?

1-30
30-40
>40

A

Ewings, osteosarcoma

Fibrosarcoma, MFH, malignant GCT, lymphoma, parasteal sarcoma

Mets, myeloma, chondrosarcoma

43
Q

What is the most common malignant primary bone tumor?

What is the usual appearance?

What age group? (s)?

What are secondary osteosarcomas arising from?

A

Osteosarcoma

Destructive with sclerosis, but can be lytic

44
Q

Where does the parosteal osteosarcoma arise from? What age group?

What is important to mention?

Where is the common location?

What is a mimic lesion (benign)?

A

Arises from periosteum and grows around bone

30-40

Important to mention any cortical violation

Posterior femur near the knee

Cortical desmoid

45
Q

What is the classic appearance of ewings sarcoma?

Where does it classically present?

A

Permeative lesion in diaphysis of long bone in child. Aggressive periostitis

Long bone diaphysis > metaphyseal, diametaphyseal, flat bones

46
Q

What is the differential for a permative lesion in a child? What can be used to exclude the malignant entity?

A

Ewings
EG
Infection

Benign periostitis or sequestrum eliminates ewings as a possibility

47
Q

What is the age range for chondrosarcoma?

What is the main differentiating feature between enchondroma and chondrosarcoma?

When should chondrosarcoma be considered in the differential?

A

> 40yo

Soft tissue mass or edema on MRI is unlikely to be enchondroma. Pain or definite aggressive characteristics are more likely to be chondrosarcoma

Destructive lytic lesion with amorphous snowflake calcification in older patient

48
Q

When is a GCT considered malignant?

A

any metastatic lesion or recurrence of previously resected tumor

49
Q

What is the appearance of fibrosarcoma?

What is the predominate age? how does it look on T2 MRI?

A

Lytic tumor with variable zone of transition

Predominate in 4th decade

Hypointense

50
Q

What malignant bone tumors are low on T2?

A

Fibrosarcoma, desmoid, and MFH

51
Q

What should be mentioned with fibrosarcoma as a possible alternative diagnosis?

A

MFH

52
Q

What is the appearance of a desmoid bone tumor?

A

Lytic, but can have narrow zone of transition due to indolent growth

Can have benign periostitis with “spike” appearance

MULTILOCULAR WITH THICK SEPTA

53
Q

What is the appearance of bone lymphoma? How is it different from ewings?

A

Permeative moth eaten appearance.

Can be asymptomatic (systemic ewings is usually symptomatic)

54
Q

What is the usual appearance of myeloma? Where does it frequently involve?

How does it appear on radionucleotide scan?

What is the appearance of myeloma/plasamcytoma in the spine?

A

Diffuse permeative appearance that mimics lymphoma or ewings/

Calvarium

Cold on bone scan, thats why radiographs are the usual test of choice

1) swiss cheese appearance
2) dense, thick bony struts like pagets
Plasmacytoma will have minibrain appearance

55
Q

Where are synovial sarcomas?

What is tumefactive synovial osteochondromatosis? why is it important to diagnose on imaging?

A

ADJACENT to the joint, not in it

Conglomeration of loose bodies resembling a solid mass in the joint. Histologically can mimic chondrosarcoma leading to inappropriate amputation

56
Q

How can one tell a soft tissue hemangioma?

A

Can have a permeative appearance of the intramedullary and endosteal bone, but will have intact cortex

57
Q

What two malignant tumors can be confused for cystic lesions on T2?

A

Synovial sarcoma and neural tumors

MSK (8 decks)

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