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Tri 6 - Tumors > Malignant Skeletal Tumors > Flashcards

Malignant Skeletal Tumors Flashcards

1
Q

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

A

Multiple Myeloma

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2
Q

• 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

A

Multiple Myeloma

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3
Q

• 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

A

Multiple Myeloma

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4
Q

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

A

Multiple Myeloma

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5
Q 
• Unexplained Osteoporosis 
• Spine is m/c affected along with other red marrow
containing bones such as flat bones
• Weight loss 
• Cachexia 
• Anemia
A

Multiple Myeloma

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6
Q

Assessment of Multiple of Myeloma

A

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

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7
Q

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

A

Multiple Myeloma

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8
Q

proteinacious renal casts with
surrounding inflammatory infiltrate leading to renal
failure

A

Bence Jones

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9
Q

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

A

TRUE

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10
Q

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

A

Extraosseous Plasmacytoma

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11
Q

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

A

Multiple Myeloma

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12
Q 
Punched Out Lesions
– Multiple round lytic lesions
– Raindrop skull
– Uniform size of lesions in MM, and more
nonuniform size in metastatic disease
A

Multiple Myeloma: Radiologic Hallmark

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13
Q

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

A

Multiple Myeloma

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14
Q

earliest radiographic sign of Multiple Myeloma

A

Osteoporosis

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15
Q

______ is highly sensitive to marrow infiltration by

myeloma

A

MRI

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

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16
Q

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

A

multiple myeloma

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17
Q
  • LOCALIZED form of plasma cell proliferation
  • Less common than MM
  • ~50% are <50 yo
  • Localized pain
A

Solitary Plasmacytoma

18
Q

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

A

Solitary Plasmacytoma

19
Q

Solitary Plasmacytoma is typically seen in what bone

A

tibia

20
Q

Multiple punched-out lesions in a patient with multiple myeloma

A

Multiple Myeloma:

Raindrop Skull

21
Q

POEMS

A

(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

22
Q

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

A

Central Osteosarcoma

23
Q

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

A

Central Osteosarcoma

24
Q

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

A

Central Osteosarcoma

25
Q

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

A

TRUE

26
Q

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

A

Secondary Osteosarcoma

27
Q

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

A

paget’s disease which may involve secondary osteosarcoma

28
Q

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

A

Central Osteosarcoma:

Cannonball Metastases

29
Q

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

A

Central Osteosarcoma:

Spontaneous Pneumothorax

30
Q 
Common Presentation:
– Focal lesion in metaphysis
– Mottled, permeative lesion
– Poorly defined zone of transition
OR:
– Dense ivory or sclerotic lesion filling medullary
space
A

Central Osteosarcoma

31
Q

_____ imaging is best for marrow and soft tissue dz

A

MRI

32
Q

what signal does central osteosarcoma come up as on STIR

A

high signal (fluid filled)

33
Q

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

A

TRUE

34
Q
  • 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
A

Multicentric Osteosarcoma

35
Q

• 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

A

Parosteal Osteosarcoma

36
Q

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

A

TRUE

37
Q

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

A

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

38
Q 
• 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
A

Parosteal Osteosarcoma

39
Q 
– Paget’s disease
– Polyostotic fibrous dysplasia
– HME
– Ollier’s
Are all related to...
A

Secondary Osteosarcoma

Malignant degeneration of benign disorders to osteosarcoma

40
Q

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

A

Secondary Osteosarcoma:

Postradiation Sarcoma

Tri 6 - Tumors (5 decks)

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