Lab: Cysts & Neoplasia Flashcards
(82 cards)
1
Q
What type of bone response is common in the first stage of Paget disease?
How does this appear radiographically?
A
Osteoclastic/osteolytic response appears radiolucent
2
Q
What type of bone response is common in the second stage of Paget disease?
How does this appear radiographically?
A
Osteoclastic and osteoblastic bone response (mixed) appears radiolucent and radiopaque
3
Q
What type of bone response is common in the third stage of Paget disease?
How does this appear radiographically?
A
“Burn out”; won’t see much activity, everything that has already happened is still radiographically visible
4
Q
What are the signs/symptoms of a simple bone cyst vs an aneurysmal bone cyst?
A
Simple bone cyst: asymptomatic, incidental finding, fracture possible
Aneurysmal bone cyst: pain, swelling, fracture, palpable
5
Q
What is the radiographic appearance of a simple bone cyst?
A
- Radiolucent
- Sclerotic border
- Eucentric
- Non-expansile
- Unilocular
6
Q
What is the radiographic appearance of an aneurysmal bone cyst?
A
- Radiolucent
- Sclerotic border
- Eccentric
- Expansile
- Multilocular (soap bubble)
7
Q
What is found histologically in biopsy of a simple bone cyst vs an aneurysmal bone cyst?
A
Simple bone cyst: serous fluid
Aneurysmal bone cyst: blood
8
Q
What are the signs/symptoms of a benign bone tumor?
A
- No pain
- Slow growing
- Palpable/swelling possible
osteoid osteomas are benign but very painful
9
Q
What are signs/symptoms of a malignant bone tumor?
A
- Cardinal signs of inflammation
- Abnormal blood work
- Fast growing/changing
- Unexpected weight loss
- Hypercalcemia
10
Q
What is the radiographic appearance of a benign bone tumor?
A
- Short zone of transition (defined border)
- No cortical/periosteal disruption
- No soft tissue effects
11
Q
What is the radiographic appearance of a malignant bone tumor?
A
- Long zone of transition
- Cortical/periosteal disruption
- Soft tissue effects
12
Q
What are some benign bone forming tumors found in bone?
A
- Osteoma
- Osteoid osteoma
- Osteoblastoma
13
Q
What are some benign cartilage forming tumors found in bone?
A
- Osteochondroma
- Chondroma
14
Q
What is a benign tumor of unknown origin found in bone?
A
Giant cell tumor
15
Q
What is a malignant primary bone forming tumor found in bone?
A
Osteosarcoma (primary)
16
Q
What is a malignant cartilage forming tumor found in bone?
A
Chondrosarcoma
17
Q
What are some malignant primary tumors of unknown origin found in bone?
A
- Ewing sarcoma
- Multiple myeloma
18
Q
This condition may be mistaken for a tumor-like condition.
What pathology is present?
A
Paget disease
19
Q
What is an important lab result found in this patient?
A
Increased alkaline phosphatase
Paget disease
20
Q
What are some manifestations of this pathology?
A
- Osteoporosis circumscripta
- Bone enlargement
- Localized pain
- Pagetic steal (ischemia from vascular compression in spinal arteries)
- Hearing impairment
Paget disease
21
Q
What is the name for this deformity?
What is seen at the green arrow?
A
Sabre shin
Banana fracture/insuffiency pathological fracture
Paget disease
22
Q
Is this bone tumor likely benign or malignant?
A
Benign
23
Q
Notice the radiolucent radiopaque mixed appearance in this enlarged bone with cortical thickening.
What pathology is present?
A
Paget disease
sabre shin
24
Q
What is the appearance of this lesion?
What pathology is present?
A
Unicameral/unilocular osteolytic
Simple bone cyst with fracture
fibrous lining filled with serous fluid
25
What is the typical location of this lesion?
How large will it grow?
Typically in **eucentric metaphysis**
Grows **no larger than width of bone** (non-expansile)
| simple bone cyst
26
What is the typical age and sex of a patient with this presentation?
<20-year-old male
| simple bone cyst
27
This lesion has led to what consequence shown in this radiograph?
Complete humeral fracture (pathological)
| simple bone cyst
28
What is the appearance of this lesion?
What pathology is present?
Appears multilocular with visible fibrous septa, widening cortex (expansile)
**Aneurysmal bone cyst**
29
What is the typical age of those with monostotic fibrous dysplasia vs those with polyostotic fibrous dysplasia?
Monostotic: **10-30 years**
Polyostotic: **early childhood**
30
What is the distribution of sex amongst those with monostotic fibrous dysplasia vs those with polyostotic fibrous dysplasia?
Monostotic: **Males = Females**
Polyostotic: **Females > Males**
31
What is the nature of lesions in monostotic fibrous dysplasia vs those in polyostotic fibrous dysplasia?
Monostotic: **focal expanding lesion**
Polyostotic: **lesions in multiple bones**
32
What are the locations of monostotic fibrous dysplasia vs polyostotic fibrous dysplasia?
Monostotic: **(proximal) femur, ribs, tibia, facial bones**
Polyostotic: **more than 50% of skeleton affected**
33
What are the effects of **monostotic** fibrous dysplasia on bone?
* Enlargement or deformation
* Pathologic fracture
34
What are the effects of **polyostotic** fibrous dysplasia on bone?
* Enlargement or deformation
* Limb length discrepancies
* Spine alignment issues
* Pathologic fracture
35
What are the syndromes associated with polyostotic fibrous dysplasia?
* Mazabraud syndrome
* Mcune-Albright syndrome
36
With fibrous dysplasia, failure to form ___ bone leads to ___ lesions
**mature lamellar bone** leads to **osteolytic/radiolucent lesions**
37
What is within the well defined lesions of fibrous dysplasia?
* Fibroblasts
* Collagen
* Irregular trabeculae
* Cystic degeneration
* Slight hemorrhage
38
A well defined lesion is biopsied and finds the following contents:
* Fibroblasts
* Collagen
* Irregular trabeculae
* Cystic degeneration
* Slight hemorrhage
What bone pathology is present?
Fibrous dysplasia
39
How does soft tissue involvement differ between benign and malignant neoplasia of bone?
Benign: **no soft tissue involved**
Malignant: **soft tissue may be involved**
40
How does cortex and periosteum involvement differ between benign and malignant neoplasia of bone?
Benign: cortex remains intact, periosteum unaffected
Malignant: cortex can be disrupted, periosteum can be perforated or lifted
41
How does the zone of transition differ between benign and malignant neoplasia of bone?
Benign: **short** (well-defined)
Malignant: **long** (poorly defined or irregular)
42
Is this bone neoplasia likely benign or malignant?
Malignant
43
A 6-year-old male presents for an annual physical. The parent explains that the child has been experiencing upper right thigh pain for 4 months. Previous doctor's visits revealed no abnormalities upon a physical exam. The parent is seeking a second opinion. The physical exam does not indicate any issues and a radiograph is taken.
How would you describe the location of the lesion indicated by the green arrow?
How does it affect the cortex and periosteum?
Metaphysis medullary cavity location
Cortex and periosteum unaffected
| osteoid osteoma
44
A 6-year-old male presents for an annual physical. The parent explains that the child has been experiencing upper right thigh pain for 4 months. Previous doctor's visits revealed no abnormalities upon a physical exam. The parent is seeking a second opinion. The physical exam does not indicate any issues and a radiograph is taken.
Does soft tissue appear to be affected by the lesion?
Is the zone of transition short or long?
Soft tissues unaffected
Short zone of transition
| osteoid osteoma
45
A 6-year-old male presents for an annual physical. The parent explains that the child has been experiencing upper right thigh pain for 4 months. Previous doctor's visits revealed no abnormalities upon a physical exam. The parent is seeking a second opinion. The physical exam does not indicate any issues and a radiograph is taken.
Is this lesion consistent with a non-aggressive or aggressive lesion?
Non-aggressive (likely benign)
| osteoid osteoma
46
What pathologies have we discussed that share a similar radiographic presentation of a radiolucency with a sclerotic border?
* Brodie abscess
* **Osteoid osteoma**
* Simple bone cysts
* Benign cartilaginous tumor
47
A 6-year-old male presents for an annual physical. The parent explains that the child has been experiencing upper right thigh pain for 4 months. Previous doctor's visits revealed no abnormalities upon a physical exam. The parent is seeking a second opinion. The physical exam does not indicate any issues and a radiograph is taken.
Which condition most closely aligns with this case?
Osteoid osteoma
48
A 6-year-old male presents for an annual physical. The parent explains that the child has been experiencing upper right thigh pain for 4 months. Previous doctor's visits revealed no abnormalities upon a physical exam. The parent is seeking a second opinion. The physical exam does not indicate any issues and a radiograph is taken.
Why would aspirin relieve this patient's pain?
Aspirin is a vasoconstrictor
| osteoid osteoma
49
Is this lesion osteolytic or osteoblastic?
How would it appear on a radiograph?
Osteolytic
Would appear radiolucent likely with sclerotic border
| simple bone cyst
50
Is this lesion eucentric or eccentric?
Is it singular or multilocular?
Eucentric
Unilocular
| simple bone cyst
51
Note the appearance of this lesion.
What is the likely diagnosis?
Simple bone cyst
| benign
52
What is the appearance of this pathology?
Eucentric, unilocular, radiolucent lesion with sclerotic border
| simple bone cyst
53
Is this lesion likely expansile?
Non-expansile
| simple bone cyst
## Footnote
typically in metaphysis, but has a tendency to diaphysis as maturity continues
54
What type of fluid would be found in this patient's lesion in a tissue biopsy?
Serous fluid
| simple bone cyst
55
How might this patient present clinically?
Asymptomatic, or a fracture leads to incidental finding
| simple bone cyst
56
Is this lesion eccentric or eucentric?
Unilocular or multilocular?
Expansile or non-expansile?
Eccentric
Multilocular
Expansile
| aneurysmal bone cyst
57
What type of fluid would fill this lesion?
Blood
| aneurysmal bone cyst
58
How will this bone cyst appear on a radiograph?
* Multilocular
* Radiolucent
* Sclerotic border
* Expansile
* Eccentric
| aneurysmal bone cyst
59
A 35-year-old female presents with knee pain. When asked, the patient states that the pain began several months prior and has gotten worse. Radiographs are taken.
What is the location of this lesion?
Has the cortex been disrupted?
Located in epiphysis, metaphysis, and metadiaphysis medullary cavity
Cortex has not been disrupted
| giant cell tumor
60
A 35-year-old female presents with knee pain. When asked, the patient states that the pain began several months prior and has gotten worse. Radiographs are taken.
Is this lesion singular or multiloculated?
Is it aggressive?
Is it benign or malignant?
Multiloculated
Non-aggressive
Benign
| giant cell tumor
61
A 35-year-old female presents with knee pain. When asked, the patient states that the pain began several months prior and has gotten worse. Radiographs are taken.
Note this radiolucent lesion with a sclerotic border. It is multiloculated with a short zone of transition, not disrupting the cortex.
What pathologies share a similar radiographic presentation?
* **Giant cell tumor**
* Aneurysmal bone cyst
| benign
62
You are working at an off-campus sporting event at a local high school when you feel a lump on the thigh of a 15-year-old male. You ask him how long the lump has been present and he says "a while" and says it might have gotten bigger recently. He doesn't feel pain. This is his radiograph.
What is the location of the lesion?
Metaphysis extending from the cortex
Pointing away from joint
| osteochondroma
63
You are working at an off-campus sporting event at a local high school when you feel a lump on the thigh of a 15-year-old male. You ask him how long the lump has been present and he says "a while" and says it might have gotten bigger recently. He doesn't feel pain. This is his radiograph.
Does the lesion have a short or long zone of transition?
Is it likely aggressive?
Short zone of transition
Likely non-aggressive
| osteochondroma
64
You are working at an off-campus sporting event at a local high school when you feel a lump on the thigh of a 15-year-old male. You ask him how long the lump has been present and he says "a while" and says it might have gotten bigger recently. He doesn't feel pain. This is his radiograph.
This lesion is extending from the cortex without disrupting it. Is the periosteum intact? Is soft tissue affected?
Periosteum is not lifted
Lesion is not invading soft tissues
| osteochondroma
65
You are working at an off-campus sporting event at a local high school when you feel a lump on the thigh of a 15-year-old male. You ask him how long the lump has been present and he says "a while" and says it might have gotten bigger recently. He doesn't feel pain. This is his radiograph.
What specific term could you use to describe the shape of this lesion?
Pedunculated
| osteochondroma
66
You are working at an off-campus sporting event at a local high school when you feel a lump on the thigh of a 15-year-old male. You ask him how long the lump has been present and he says "a while" and says it might have gotten bigger recently. He doesn't feel pain. This is his radiograph.
What would you expect this patient's lab results to be?
ESR:
Alkaline phosphatase:
ESR: **normal**
Alkaline phosphate: **increased**
| osteochondroma
67
You are working at an off-campus sporting event at a local high school when you feel a lump on the thigh of a 15-year-old male. You ask him how long the lump has been present and he says "a while" and says it might have gotten bigger recently. He doesn't feel pain. This is his radiograph.
What is the most likely diagnosis for this individual?
Pedunculated osteochondroma
## Footnote
points away from joint
68
Label the image shown.
Green arrows:
Purple arrows:
Red arrows:
Green arrows: **perichondrium** (fibrous tissue lining)
Purple arrows: **hyaline cartilage**
Red arrows: **bone**
| osteochondroma
69
John is a teenage male experiencing knee pain for over a month. When you ask about the pain, he says it is deep, right above his knee. Sometimes it keeps him awake at night. He doesn't recall any injuries. This is his radiograph.
What is the location of this lesion?
Is it disrupting the cortex? The periosteum?
Metaphysis, diaphysis, medullary cavity
Disrupting the cortex and affecting the periosteum
| osteosarcoma
70
John is a teenage male experiencing knee pain for over a month. When you ask about the pain, he says it is deep, right above his knee. Sometimes it keeps him awake at night. He doesn't recall any injuries. This is his radiograph.
Does this lesion have a short or long zone of transition?
Is it likely aggressive?
Long zone of transition
Likely aggressive
| osteosarcoma
71
John is a teenage male experiencing knee pain for over a month. When you ask about the pain, he says it is deep, right above his knee. Sometimes it keeps him awake at night. He doesn't recall any injuries. This is his radiograph.
Is this primarily an osteoblastic or osteolytic pathology?
Osteoblastic; sunburst appearance (Sharpey's fibers) of spiculated periosteum
72
John is a teenage male experiencing knee pain for over a month. When you ask about the pain, he says it is deep, right above his knee. Sometimes it keeps him awake at night. He doesn't recall any injuries. This is his radiograph.
Is soft tissue likely to be affected by this neoplasia?
Is it benign or malignant?
Soft tissue likely affected because of cortex and periosteal involvement
Malignant
| osteosarcoma
73
John is a teenage male experiencing knee pain for over a month. When you ask about the pain, he says it is deep, right above his knee. Sometimes it keeps him awake at night. He doesn't recall any injuries. This is his radiograph.
What would be this patient's lab results?
ESR:
CRP:
Alkaline phosphatase:
ESR: elevated
CRP: elevated
Alkaline phosphatase: increased
| osteosarcoma
74
John is a teenage male experiencing knee pain for over a month. When you ask about the pain, he says it is deep, right above his knee. Sometimes it keeps him awake at night. He doesn't recall any injuries. This is his radiograph.
What is the most likely diagnosis for this patient?
Osteosarcoma
## Footnote
spiculated radiopaque mass, deep bone pain keeping patient up at night
75
A 57-year-old man presents with long-standing, painful deformation of the right tibia. He reported increased volume of the right leg since late adolescence and three low-impact fractures in the fourth decade of life. He was treated 15 years before presentation with calcitonin for 6 months, without symptomatic relief. Physical examination revealed a prominent deformity of the tibia and superficial venous circulation related to chronic venous insufficiency.
What pathologies have we discussed that could cause tibial bowing?
Which of these cause bowing unilaterally vs bilaterally?
Unilateral bowing: **Pagets disease**
Bilateral bowing: Syphilis, Rickets
76
A 57-year-old man presents with long-standing, painful deformation of the right tibia. He reported increased volume of the right leg since late adolescence and three low-impact fractures in the fourth decade of life. He was treated 15 years before presentation with calcitonin for 6 months, without symptomatic relief. Physical examination revealed a prominent deformity of the tibia and superficial venous circulation related to chronic venous insufficiency.
These are radiographs of his right tibia.
What observations can you make about the changes in this bone? Are these changes osteoblastic, osteolytic, or mixed?
Coarse trabecular expansion (highly vascular); bone enlargement with cortical thickening
Mixed blastic and lytic response
| Pagets disease
77
A 57-year-old man presents with long-standing, painful deformation of the right tibia. He reported increased volume of the right leg since late adolescence and three low-impact fractures in the fourth decade of life. He was treated 15 years before presentation with calcitonin for 6 months, without symptomatic relief. Physical examination revealed a prominent deformity of the tibia and superficial venous circulation related to chronic venous insufficiency.
These are radiographs of his right tibia.
Based on the number of bones affected in this clinical presentation and the radiograph, what term could you use to describe this condition?
Monostotic
| Pagets disease
78
What could increased alkaline phosphatase indicate about bone metabolism?
Increased osteoblastic activity
79
What do increased type I collagen byproducts (P1NP and b-CTX) indicate about bone metabolism?
Increased bone turnover (decreased bone quality, increased fracture risk)
80
A 57-year-old man presents with long-standing, painful deformation of the right tibia. He reported increased volume of the right leg since late adolescence and three low-impact fractures in the fourth decade of life. He was treated 15 years before presentation with calcitonin for 6 months, without symptomatic relief. Physical examination revealed a prominent deformity of the tibia and superficial venous circulation related to chronic venous insufficiency.
These are radiographs of his right tibia.
What pathology do you think this patient is most likely experiencing?
Pagets disease
81
What term describes the anterior bowing of the tibia in this patient's case?
Sabre shin
| Pagets disease
82
How is the pathogenesis of this anterior bowing different from that seen in syphilis?
**Pagets disease**: physical tibial bowing with coarse trabecular expansion
**Syphilis**: periosteal reaction creates appearance of tibial bowing without actual bowing
