Malignant Skeletal Tumors

Question 1

• Malignant proliferation of plasma cells that infiltrate bone
marrow
• aka Kahler’s disease
• m/c primary malignant bone tumor

Answer 1

Multiple Myeloma

Question 2

• 50-70 yo
• Anemia due to diseased hematopoietic tissue by
proliferating plasma cells (FATIGUED)
• Osteopenia in bones with red bone marrow
• Abnormal serum and urinary proteins
• Renal disease

Answer 2

Multiple Myeloma

Question 3

• Pain is the cardinal symptom
• Back pain
• At first pain is intermittent, then becomes more constant
• Pain worse during day, and aggravated by activity
• Low back pain may be initially misdiagnosed as disc
or sciatic nerve problems
• Pain becomes more severe and prolonged

Answer 3

Multiple Myeloma

Question 4

Slight strain may produce pathologic compression fractures that may result in
paraplegia

Answer 4

Multiple Myeloma

Question 5

• Unexplained Osteoporosis 
• Spine is m/c affected along with other red marrow
containing bones such as flat bones
• Weight loss 
• Cachexia 
• Anemia

Answer 5

Multiple Myeloma

Question 6

Assessment of Multiple of Myeloma

Answer 6

Aspiration and Biopsy of bone marrow usually of sternum and ilium ****

Question 7

Round cell disorder which reflects microscopic
appearance of nuclei
increased osteoclastic activity

Answer 7

Multiple Myeloma

Question 8

proteinacious renal casts with
surrounding inflammatory infiltrate leading to renal
failure

Answer 8

Bence Jones

Question 9

T/F: w/ Multiple Myeloma: Patients usually die of pneumonia and
respiratory failure, however may also die of renal
failure

Answer 9

TRUE

Question 10

– mc seen in nasopharynx, with nasal cavity, oral cavity, tonsils, sinuses and larynx also affected
– May erode into adjacent bony structures

Answer 10

Extraosseous Plasmacytoma

Question 11

Plasma cells release osteoclastic activating factor, therefore osteoblasts are deficient in ______ patients, and thus a negative bone scan since a bone scan depends upon osteoblastic activity

Answer 11

Multiple Myeloma

Question 12

Punched Out Lesions
– Multiple round lytic lesions
– Raindrop skull
– Uniform size of lesions in MM, and more
nonuniform size in metastatic disease

Answer 12

Multiple Myeloma: Radiologic Hallmark

Question 13

Wrinkled Vertebrae: pathologic fx, vertebra plana, spinal cord compression
Pedicle Sign:
– Pedicles spared due to deficiency of red marrow
– Pedicle sign is not a reliable sign for MM

Answer 13

Multiple Myeloma

Question 14

earliest radiographic sign of Multiple Myeloma

Answer 14

Osteoporosis

Question 15

______ is highly sensitive to marrow infiltration by

myeloma

Answer 15

MRI

T1: Low signal intensity lesions T2: High signal intensity lesions

Question 16

There are multiple variably-sized white nodules within the bone marrow. These are accumulations of malignant plasma cells in this case of

Answer 16

multiple myeloma

Question 17

• LOCALIZED form of plasma cell proliferation
• Less common than MM
• ~50% are <50 yo
• Localized pain

Answer 17

Solitary Plasmacytoma

Question 18

Geographic radiolucent lesion, often highly expansile, with a soap bubble appearance

Answer 18

Solitary Plasmacytoma

Question 19

Solitary Plasmacytoma is typically seen in what bone

Answer 19

tibia

Question 20

Multiple punched-out lesions in a patient with multiple myeloma

Answer 20

Multiple Myeloma:

Raindrop Skull

Question 21

POEMS

Answer 21

(polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) syndrome may demonstrate sclerotic lesions on radiographs, but this is responsible for fewer than 1% of myeloma cases

RARE

Question 22

Second mc primary malignant bone tumor
20% of all primary bone tumors
10-25 yo

Answer 22

Central Osteosarcoma

Question 23

Undifferentiated connective tissue and forms of
neoplastic osteoid
Likes long bones, primarily knee and shoulder
58% occur around knee

Answer 23

Central Osteosarcoma

Question 24

Painful swelling at site of lesion (85%)
• May have previous trauma to area
• Pain is initially insidious and transitory, but eventually becomes more severe and persistent
• May take 6 months or longer to DX tumor

Answer 24

Central Osteosarcoma

Question 25

T/F: Weight loss, fever, cachexia are UNUSUAL in Central Osteosarcoma

Answer 25

TRUE

Question 26

Incidence arising in Paget’s bone is high 44% for what sarcoma

Answer 26

Secondary Osteosarcoma

Question 27

Elevation of Alkaline Phosphatase is positive for a pt with what dz

Answer 27

paget's disease which may involve secondary osteosarcoma

Question 28

– Pulmonary metastasis via hematogenous route – Usually see multiple ossified pulmonary lesions – Represents sarcomatous pulmonary bone growths

Answer 28

Central Osteosarcoma: | Cannonball Metastases

Question 29

Subpleural nodules that have undergone excavation lead to rupture into pleural space

Answer 29

Central Osteosarcoma: | Spontaneous Pneumothorax

Question 30

``` Common Presentation: – Focal lesion in metaphysis – Mottled, permeative lesion – Poorly defined zone of transition OR: – Dense ivory or sclerotic lesion filling medullary space ```

Answer 30

Central Osteosarcoma

Question 31

_____ imaging is best for marrow and soft tissue dz

Answer 31

MRI

Question 32

what signal does central osteosarcoma come up as on STIR

Answer 32

high signal (fluid filled)

Question 33

T/F: Radiograph of the femur in a patient with osteosarcoma shows a typical Codman triangle

Answer 33

TRUE

Question 34

* Rare * Independent lesions occur simultaneously * Probably not metastatic lesions * Probably are all primary lesions * 5-10 yo * Rapidly fatal course * Lesions are blastic, thus increase alkaline phosphatase * Pulmonary metastasis occurs early

Answer 34

Multicentric Osteosarcoma

Question 35

• Located on bone surface in juxtacortical location within periosteum • Well-differentiated osteosarcoma • Slow growing • Swelling, mass formation, dull, aching pain • 30-50 yo • No significant laboratory findings

Answer 35

Parosteal Osteosarcoma

Question 36

T/F: 50% of Parosteal Osteosarcoma's are located posterior surface of distal femur

Answer 36

TRUE

Question 37

What separates Parosteal Osteosarcoma versus Myositis Ossificans Traumatica (MOT)?

Answer 37

Sarcomas are denser CENTRALLY and less dense around periphery of lesion – MOT is more dense around its periphery, and less dense centrally

Question 38

``` • Average size of 10 cm • Lobulated, sessile, bony mass • Broad based attachment to bone • Cleavage plane (1-3mm in width) • If invades bone, poorer prognosis – CT is extremely helpful • No periosteal reaction ```

Answer 38

Parosteal Osteosarcoma

Question 39

``` – Paget’s disease – Polyostotic fibrous dysplasia – HME – Ollier’s Are all related to... ```

Answer 39

Secondary Osteosarcoma Malignant degeneration of benign disorders to osteosarcoma

Question 40

may develop after irradiation of breast cancer, Wilm’s tumor, other primary tumors – Latent period of 5-40 years, with 15 years average latent period

Answer 40

Secondary Osteosarcoma: | Postradiation Sarcoma