Malignant Bone And Soft Tissue Tumors Flashcards by Butch Josef Abuel

Four aspects of a lesion to be examined

CPOZ

Cortical destruction,
periostitis,
orientation or axis of the lesion,
zone of transition

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Aspect of lesion that is accurate in detecting malignancy 90% of the time

Zone of transition

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Periosteal reaction of most benign type

Callus formation

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Slow-growing benign tumor will cause what appearance of periostitis because it is a low grade chronic irritation that gives the periosteum time to lay down thick new bone and remodel into more normal cortex

Thick, wavy, uniform or dense periostitis

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Appearance of malignant periostitis

Lamellated (onion-skinned) of amorphous or even sunburst-like

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The only way a benign periostitis can occur in a malignant lesion is if there is a

Concomitant fracture or infection

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Zone of transition is defined as

Border of the lesion with the normal bone

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Zone of transition is narrowed, if it appears

Well-defined

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Zone of transition is wide, if it appears

Imperceptable and cannot be clearly drawn at all

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Permeative lesions are often seen in what malignant tumors (3)

MPE

Multiple myeloma,
primary lymphoma of bone (reticulum cell sarcoma) and
Ewing sarcoma

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Permeative lesions can also be seen in what benign lesions (2)

Infection and EG

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Childhood primary malignant tumors of the bone (2)

Osteosarcoma and Ewing sarcoma

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Malignant tumors after age 40 (3)

MMC

Metastatic disease,
myeloma,
chondrosarcoma

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Malignant bone tumors in ages 30-40 (4)

GPMF

GCT,
parosteal sarcoma,
malignant fibrous histiocytoma,
first degree lymphoma of bone

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Almost all malignant tumors in MRI will present as

Low signal in T1, high signal on T2

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Most common malignant primary bone tumor

Osteosarcoma

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Osteosarcoma in the 6th decade are probably because of (2)

Secondary osteosarcoma in Paget disease and because of prior radiation

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Lytic form of osteosarcoma

Telangiectatic osteosarcoma

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General appearance of osteosarcoma in MR

Large soft tissue component with heterogeneous high and low signal intensities on both T1 and T2

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Form of osteosarcoma that originates from the periosteum of bone and grows outside the bone

Parosteal sarcoma

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Form of osteosarcoma that often wraps around the diaphysis without breaking through the cortex at all

Parosteal osteosarcoma

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Treatment of parosteal osteosarcoma

Shaving the tumor off the bone or wide bloc excision

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Parosteal osteosarcoma are more common in the young or older

Older age group

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Characteristic of parosteal osteosarcoma that if present, will be considered as aggressive as the central osteosarcoma

If it violates the cortex of adjacent bone

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Treatment of central osteosarcoma

Radical excision

Common location from which parosteal osteosarcoma arise

Posterior femur, near the knee

An avulsion injury that is totally benign but can appear somewhat aggressive and can mimic an early parosteal osteosarcoma

Cortical desmoid

Myositis ossificans may be confused with what malignant tumor

Parosteal osteosarcoma

Permeative lesion in the diaphysis of a long bone in a child

Ewing sarcoma

Area of predilection of Ewing sarcoma

40% in diaphysis, the remainder being metaphyseal, diametaphyseal and in flat bones

What benign lesion is usually incomparable in terms of appearance with chondrosarcoma

Enchondroma

Chondrosarcoma may be considered, if a lesion that looks like enchondroma has what other clinical features

Painful, shows periostitis and cortical destruction

If a soft tissue mass or edema is present in an enchondroma-like lesion, what should be considered, enchondroma or chondrosarcoma?

Chondrosarcoma

Appearance of chondrosarcoma in radiographs

Snowflake or popcorn like amorphous calcification

About how many percent of gcts are malignant

15%

Lytic malignant tumors that do not produce osteoid or chondroid matrix

Malignant fibrous histiocytoma or fibrosarcoma

One of the few malignant tumors that can, on occassion have a bony sequestrum

MFH

A half-grade MFH

Desmoid tumor, aka desmoplastjc fibroma or aggressive fibromatosis

These lesions commonly arise in the soft tissue, when in bone, they are lytic but are usually fairly well defined because of their slow growth. Often have benign periostitis present that has thick spicules or spikes, have multilocular appearance with thick bony septa. Do not metastasize by can exhibit inexorable tumor extension into surrounding soft tissues

Desmoid tumor

Neoplasm that has the same appearance as Ewing sarcoma, except that it occurs in older age group

Primary lymphoma of bone or reticulum cell sarcoma

Only malignant tumor that can involve a large amount of bone while being asymptomatic

Primary lymphoma

Multiple sclerotic foci in a man are most likely from

Prostatic metastases

In a woman with sclerotic foci, it is most likely from

Breast metastases

Only primary tumor that never presents with blastic metastatic disease is

Renal cell carcinoma

Classic differential diagnosis for expansile, lytic metastasis is

Renal cell or thyroid carcinoma

Myeloma frequently involves the

Calvarium

One of the malignant bone lesions that is not characteristically hot on radionuclide bone scan, therefore radiologic bone surveys are performed instead

Myeloma

Pathognomonic feature of synovial osteochondromatosis

Presence of calcific loose bodies

Non ossified loose bodies in synovial osteochondromatosis is undistinguishable in what other condition

Pigmented villonodular synovitis

Typical appearance of pigmented villonodular synovitis in MRI

Low signal intensity of synovium on both T1 and T2 that is typical for hemosiderim deposits

2 Tumors now labelled as pleomorphic undifferentiated sarcomas

MFH and liposarcoma

Cortical holes occur almost exclusively in

Radiation and soft tissue hemangioma

Commonly associated finding of hemangioma

Presence of phleboliths

Synovial sarcomas are often seen where

Adjacent to joints, very rarely in a joint

2 Tumors that are typically homogeneously bright on T2 to that extent that they can be mistaken for a fluid collection

Synovial sarcomas and neural tumors

Benign joint lesion that occurs from metaplasia of synovium and leads to multiple calcific loose bodies in a joint

Synovial osteochondromatosis

Benign synovial soft tissue process that causes joint swelling and pain and occassionally, periarticular erosions. It virtually never has calcifications

Pigmented villonodular synovitis

Condition that may mimic PVNS in which there is chronic bleeding in joint

Hemosiderotic arthritis

True permeative pattern of round cell lesions occur in what part of bone

Intramedullary or endosteal part

Pseudopermeative pattern of bone lesion is seen in what part of bone

Cortical

Can present as soft tissue mass, appears homogeneously bright on T2 and often septated, seen around the joint of knee

Atypical synovial cysts such as Baker cysts