Malignant tumors Flashcards
what is another name for multiple myeloma
kahlers disease
what is the age range of multiple myeloma
50-70 years old
where does multiple myeloma occur
diaphysis of long tubular bones
spine and skull
what are some characteristic features of multiple myeloma
what is the hallmark feature
how is this different from mets
punched out lesions** - HALLMARK
earliest - osteoporosis
moth eaten bone rain drop skull pancake vertebrae - or vertebrae plana unexplained osteoporosis compression fractures spared pedicles
uniform size lesions in MM
non uniform size in mets
what are the symptoms of multiple myeloma
what is the cardinal sign
pain is cardinal sign
pain with increased activity (old man with back pain after shoveling snow)
anemia, weight loss, cachexia, renal disease
pain worse with activity or throughout the day - back pain
is multiple myeloma visible on bone scan
no !
no osteoblast activity
may be present if pathological fracture is present with MM
what is the most common malignant tumor
multiple myeloma
what do you see on lab work with multiple myeloma
m spike on serum elctrophoresis - 90%
IgG myeloma - 50%
bence jones protein
what is best imaging for multiple myeloma
what is seen on MR
MRI is best - shows marrow infiltration
low signal t1
high signal t2
half of the people that get solitary plamocytoma are under the age of
50 years old
what is a solitary plamocytoma look like
single multiple myeloma lesion
expansile and soap bubble like
what does solitary plamocytoma lead to
what percent of cases does that occur
70% develop multiple myeloma in 5 years time
what do multiple myeloma lesions look like
circumscribed osteolytic lesions - uniform in size and shape
osteoporosis
wrinkled vertebrae
pedicle sign- spared pedicles
in what occupations does mutiple myeloma occur in
agriculture - pesticides such as DDT
exposure to wood dust
sheet metal
nuclear industry
what is the most common malignant tumor
multiple myeloma
where do solitary plasmacytoma occur
Mc in mandible, ilium, vertebrae, ribs, proximal femur, scapula
what is a central osteosarcoma
what are the different types of central osteosarcoma
what is most common
undifferentiated connective tissue and forms of neoplastic osteoid
sclerotic - 50%
lytic - 25%
mixed - 25%
what do the different types of central osteosarcoma look like
lytic - focal metaphyseal lesion, permeative, mottled, wide or poor zone of transition
sclerotic - dense ivory or sclerotic medullary lesion, cumulus cloud appearance
where are central osteosarcomas typically located
metaphysis
MC in distal femur
distal femur and proximal tibia - MC around knee
and humerus / shoulder
vertebral body
what tumor is known to stop expanding once it reaches the physis or growth plate so it never enters the epiphysis
central osteosarcoma
what are general features of central osteosarcoma
metaphysis stops at physis wide zone of transition codmans triangle spiculated or sunburst periosteal reaction soft tissue mass cortical disruption dense ivory or sclerotic lesion
what tumor is known to cause cannonball mets and spontaneous pneumothorax
central osteosarcoma (>5cm) - mutiple ossified pulmonary lesions - indicates sacromatous pulmonary bone growth
pneumo - subpleural nodules excavate leading to rupture in pleural space
cannonball mets - lungs mets via blood
what is the age range for central osteosarcoma
10-25 years old
what is the 2nd most common malignant bone tumor
central osteosarcoma
what are the symptoms of central osteosarcoma
85% of time - insidious pain and swelling that cannot be relieved - becomes more severe and persistent
weight loss, cachexia, and fever are all unusual*
how long can it take to diagnose central osteosarcoma
6 months
what is increased in the blood when a patient has a central osteosarcoma
alk phos
if a patient has pagets disease, what will be increased in malignant transformation
alk phos
what does central osteosarcoma look like on bone scan
hot
what does central osteosarcoma look like on MRI and CT
will notice soft tissue mass and marrow infiltration
what is the treatment for central osteosarcoma
excision, amputation, chemo, radiation
what is the most fatal type of central osteosarcoma
lytic
parosteal osteosarcoma occurs at what age
30-50 years old
parosteal osteosarcoma occurs where in the body
on bone surface, juxta cortical
MC on posterior distal femur
is there a periosteal reaction with parosteal osteosarcoma
no
what is the appearance of a parosteal osteosarcoma
slow growing
lobulated, sessile attachment to bone with broad attachment
what do you look for on CT and MRI when looking at a parosteal osteosarcoma
CT - cleavage plane (1-3 mm)
CT or MRI - medullary extension
CT helpful if invades bone - poor prognosis
what are the symptoms of parosteal osteosarcoma
swelling, dull aching pain
what is the ddx for parosteal osteosarcoma
what imaging do you use to clarify
myositis ossificans - if no trauma its probably parosteal osteosarcoma
myositis ossificans is denser around the periphery and shrinks over time
CT
what is the treatment for parosteal osteosarcoma
excision, chemo, radiation
what does multicentric osteosarcoma look like
and where does it occur
looks like multiple independent central osteosarcomas that occur simultaneously
metaphysis
BL symmetrical blastic lesions
at what age does mlticentric osteosarcoma occur at
5-10 years old
what is prognosis for multicentric osteosarcoma
rapidly fatal most often
what is elevated in the blood with multicentric osteosarcoma
alk phos
lesions are blastic so alk phos increases
where does multicentric osteosarcoma metastasize to
lungs - occurs early on in disease
how does a person get secondary osteosarcoma
transformation of other conditions into osteosarcoma
what are some examples that can cause secondary osteosarcoma
BRCA
wilms tumor
radium poisoning - dial painters on watches
how long does it usually take for secondary osteosarcoma to occur
latent period of 5-40 years
(sometimes post radiation)
15 years most common
where is extraosseous osteosarcoma found
not in bone
in soft tissues
MC in the thigh
what does extraosseous osteosarcoma look like
large soft tissue mass adjacent to bone
what is the common age group for extraosseous osteosarcoma
30-50 years old
high incidence of secondary osteosarcoma occurs in what
pagets disease
and
post radiation patients
where do chondrosarcomas occur
metaphysis
MC in pelvis
proximal femur, and flat bones
what do chondrosarcomas look like
large radiolucent lesions with central rings of calcification
expansion of bone
flocculent calcification, cotton wool, or popcorn appearance
laminated and spiculated periosteal reaction
what is the age range for chondrosarcoma
40-60 years old
what is the 3rd most common primary malignant bone tumor
chondrosarcoma
what are symptoms of chondrosarcoma
pain and soft tissue swelling
how do chondrosarcomas spread
spread only by direct extension - not blood
which primary malignant tumor has the best prognosis
chondrosarcoma
what is the treatment for chondrosarcoma
surgery only
chemo and radiation does not work
what does chondrosarcoma look like on bone scan
what about MRI
hot
low on t1
high on t2
where does ewings sarcoma occur
diaphysis of metadiaphysis
long tubular bones and pelvis
MC in femur
what does ewings sarcoma look like
cortical saucerization
permeative lesion with long zone of transition
laminated or onion skin periosteal reaction
codmans triangles
erlenmeyer flask deformity
lytic and sclerotic
extremely undifferentiated and malignant
what age does ewings sarcoma occur at
10-25 years old
peak at age 15
what are symptoms of ewings sarcoma
localized pain and swelling
palpable soft tissue mass
fever and anemia
what is the most common primary malignant to metastasize
where does it metastasize
ewings sarcoma
to the lung
ewings sarcoma appears like what because of the blood panel
whats elevated
looks like infection
increase ESR, WBC
fever and anemia also present
what is treatment for ewings sarcoma
amputation, chemo, radiation
what malignant tumor mimics an infection because of increased ESR and WBC
ewings sarcoma
where do fibrosarcomas occur
young and older
metaphysis
MC in femur, tibia (50%), humerus
young - tubular bones - knee
older - flat bones - pelvis
what do fibrosarcoma lesions look like
eccentric, purely lytic, radiolucent, moth eaten, permeative (destructive)
no calcification and no periosteal reaction and no codmans triangles
extremely large soft tissue masses
expansile lesions with cortex disruption*
wide zone of transition
endosteal scalloping
what age group do fibrosarcomas occur in
30-50 years old
fibrosarcomas can transform into what
how do you treat this transformation
malignant fibrous histicytoma
(undifferentiated pleomorphic osteosarcoma)
highly malignant and destructive so amputate now!
fibrosarcomas occur secondary to what
pagets
radiation
osteomyelitis
what does a fibrosarcoma produce
varying amounts of collagen
1/3 of patients with fibrosarcoma present with what
pathological fracture
where does a fibrosarcoma metastasize to if amputation is not performed
lung and liver
what is a rare primary malignant bone tumor arising from vestigial remnants of the notochord
chordoma
what age group do chordomas occur in
40-70 years old
what are the 3 different types of chordomas
sacrococcygeal chodroma - 50%
spheno-occipital chordoma - 35%
vertebral chordoma - 15%
how do chordomas spread
cross the vertebral disc/joint spaces and spread to adjacent vertebral body segments
what are symptoms of chordomas
sacrococcygeal - presacral tumor (found on rectal exam ), pressure of tumor causes constipation and GI issues, cauda equina symptoms
spheno-occpital chordoma - seen at region of clivus, increased intracranial pressure, headaches, blurred vision, diplopia, nasal obstruction, cerebellar involvement
vertebral - pressure on nerve roots or cord, dysphagia, difficulty breathing, pain, numbness, motor weakness
what is the most common location for a vertebral chordoma
where is it not found
MC - C2
not found in posterior elements
what is treatment of chordoma
resection of tumor is best
radiation therapy
what is another name for non hodgkins lymphoma
reticulum cell sarcoma
or
lymphosarcoma
non hodgkins occurs where
diametaphyseal
metaphysis
knee, femur, tibia, humerus
what does a non hodgkins lymphoma lesion look like
begins in medullary cavity and expands towards cortex
localized lytic moth eaten lesions
laminated periosteal reaction - not always present
soft tissue mass - later stages
may have compression fractures of the spine
what are the symptoms of non hodgkins lymphoma
patient feels good overall, even with large lesions
pathological fracture may be first complaint because patient feels food overall before
intermittent pain
dull aching pain - not relieved by rest
in what age range do you seen non hodgkins lymphoma
20-40 and 40-50 years old
what is the treatment for non hodgkins lymphoma
radiation and chemotherapy
decent prognosis
what are the most common lesions seen in hodgkins lymphoma
what lesions involved in hodgkins lymphoma are more symptomatic
osteolytic 75%
osteoblastic 15%
mixed 10%
lytic > blastic
hodgkins lymphoma can cause what that leads to spinal cord compression
compression fractures and vertebral collapse
what is the primary site of skeletal involvement seen in hodgkins lymphoma
where specifically
vertebral body
lower thoracic
upper lumbar
aka TL junction
what do the lesions involved in hodgkins lymphoma look like
ivory vertebrae
lytic lesions, moth eaten
(maybe periosteal reaction)
anterior vertebral scalloping
what disease causes mediastinal widening on CXR
what causes the mediastinal widening
non hodgkins lymphoma
lymphadenopathy
non hodgkins lymphoma appears as what on bone scan
hot
what does hodgkins lymphoma appear as on MRI
low on t1
high on t2
enhances with GAD
what is treatment for hodgkins lymphoma
radiation and chemo
what does the diagnosis of primary bone lymphoma include
involvement of singe bone with no evidence of disease elsewhere for at least 6 months after diagnosis
in primary lymphoma of bone, signs of systemic disease such as fever, weight loss, and night sweats are __
neuro symptoms are __
absent
maybe present depending on if compression fracture is involved
where are giant cell tumors typically located
what location is there most malignant cases
what is most common spinal site
metaphysis - spreads to epiphysis/subarticular region
distal femur, proximal tibia, humerus, radius, sacrum
most malignant - radius
mc spinal - sarcum
what do giant cell tumors look like
purely lytic lesions with central septations
soap bubble appearance
thinned expanded cortex
cortical breakthrough and soft tissue mass
what is the age range for giant cell tumor
20-40 years old
what are the symptoms of giant cell tumor
intermittent pain, aching, localized, swelling, and tenderness
giant cell tumors originate in the __ of the bone and extend to the __ of the bone
metaphysis
subarticular region
what is a quasimalignant tumor of bone
giant cell tumor
what 3 things do you have to do to diagnose a giant cell tumor
radiologic
clinical
histological
what is treatment for giant cell tumor
removal of tumor
or radiation if it is inoperable
straining may produce pathological compression fracture in multiple myeloma that may result in what
paraplegia
low back pain associated with multiple myeloma may be misdiagnosed as what
disc or sciatic nerve problems
what are the 3 round cell tumors or disorders
multiple myeloma
ewings sarcoma
non hodgkins lymphoma
mutiple myeloma has increased osteoblast or clast activity
osteoclast
people with multiple myeloma usually die of what
pneumonia
respiratory failure
renal failure
where are extraosseous plasmacytomas seen
MC in nasopharynx, nasal cavity, oral cavity, tonsils, larynx, sinuses
MM
plasma cells release ___, therefore __ are deficient in patients and thus a negative bone scan
osteoclastic activating factors
osteoblasts
why is MM often missed on diagnosis
may think its mechanical pain
patient presents with initial finding of osteoporosis and back pain
what is prognosis for MM
BAD
90% die within 3 years
what tumor is seen in affected patients that appear taller than other in the same age group
central osteosarcoma
what acts as a barrier for central osteosarcoma so it doesnt spread
physis
pathological fractures associated with multiple myeloma occur how so
transversely oriented
patients with multiple myeloma usually die from what
pneumonia, respiratory failure, or renal failure
what leads to renal failure in multiple myeloma
bence jones proteins - renal casts with inflammatory infilitrate
what if there are more non uniform size lesions in mutliple myeloma
metastasis disease
why should you be concerned for the future of a patient with a solitary plasmacytoma
70% leads to MM and die in 5 years
MM has occurred 23 years later - long term follow up is important
what is considered in multiple myeloma patients that show more than 50% loss of shaft diameter on xray
prophylatic intramedullary nailing
what is a rare form of multiple myeloma
what does it mean
what is typically seen on xray
POEMS
polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, skin changes
sclerotic lesions on xray
radiographs of treated myeloma patients may show areas of abnormal bone architecture with __
sclerosis
