Metastatic Diseases

Question 1

What is the most common malignant tumor of the skeleton?

Answer 1

METs

Question 2

How is drop metastasis spread?

Answer 2

hematogenous route

Question 3

What kind of bone are predisposed to develop osseous metastases?

Answer 3

rich in red bone marrow

Question 4

At what age does METs usually occur after?

Answer 4

40yo

Question 5

What are Metastatic osseous lesions in children <5 yo

usually due to? 10-20yo? 20-35yo?

Answer 5

<5 = neuroblastoma
10-20 = Ewing’s and Osteosarcoma
20-35 = Hodgkin’s lymphoma

Question 6

What kind of METs will increase alkaline phosphatase?

Answer 6

Blastic metastasis

Question 7

What will elevate if prostate capsule is disrupted?

Answer 7

acid phosphatase

Question 8

What parts of the body are a common hematogenous pathway for METs to spread?

Answer 8

lungs, liver and axial skeleton

Question 9

What kind of METs is spread through fluids in a body cavity?

Answer 9

Implantation/Seeding Metastasis

Question 10

What is it called when tumors form large quantities of fluid?

Answer 10

Ascites

Question 11

What are valveless epidural vertebral veins that function as a venous lake or pool known as?

Answer 11

Batson’s Venous Plexus

Question 12

What does Batson’s venous plexus allow cancer cells to do?

Answer 12

Bypass liver and lungs and go straight to bone

Question 13

What kind of METs causes about 90% of patients present with bone and/or back pain followed by radicular pain and 50% of these patients have sensory and motor dysfunction, and more than 50% have bowel and bladder dysfunction?

Answer 13

Spinal METs

Question 14

What is the most ominous symptom in patients with metastatic disease to the spine?

Answer 14

Bone pain at night

Question 15

What is an Osteoblastic Tumor invading L1 typically associated with?

Answer 15

METs of the prostate gland

Question 16

How much bone destruction of appendicular skeleton must happen before being seen on plain film in regards to Lytic Metastasis?

Answer 16

30%

Question 17

In regards to Lytic METs, what is the destruction due to?

Answer 17

osteoclast stimulating cytokines secreted by tumor cells

Question 18

What plays a large role in formation of lytic lesions in metastatic disease?

Answer 18

Osteoclasts

Question 19

What is a grave clinical sign of Blastic METs?

Answer 19

Enlargement of existing lesions and development of new lesions

Question 20

What are 4 benign conditions that stimulate Blastic Metastasis?

Answer 20

Paget’s disease
Osteopoikilosis
Osteopetrosis
Sarcoidosis

Question 21

How much longer would you see a + bone scan before you see the disease on regular plain film?

Answer 21

18 months

Question 22

What kind of imaging is useful for cortical bone involvement and presence of soft tissue mass formation?

Answer 22

CT

Question 23

What kind of imaging is Better than CT for detecting bone lesions and assessment of soft tissue mass formation?

Answer 23

MRI

Question 24

What type of images on MRI are lesions hyperintense?

Answer 24

T2

Question 25

What kind of MR imaging includes fat suppression (heavily weighted T1 images) and detects metastatic bone lesions up to 91%?

Answer 25

STIR images

Question 26

What kind of METs pattern is the most common with breast and lung carcinoma metastasis?

Answer 26

Motheaten/permeative pattern

Question 27

What kind of lesions represent 15% of lesions and are most common from prostate, breast, cecum and bronchial carcinoid tumors?

Answer 27

Osteoblastic

Question 28

What kind of lesion is most commonly seen in Primary tumors of thyroid and kidney?

Answer 28

Blow-Out Metastatic Lesions

Question 29

What are significant features of a Blow-Out METs lesion?

Answer 29

Solitary Bubbly Expansile

Question 30

What is the earliest and most subtle sign of METs of the vertebral body?

Answer 30

focal osteoporosis

Question 31

How are Vertebral body METs shown on T1 and T2 images?

Answer 31

``` T1 = decreased signal T2 = Intermediate to increased signal ```

Question 32

With Vertebral body METs, what is also known as Bilateral pedicle destruction?

Answer 32

Blind Vertebra

Question 33

If you see no pedicle on one side and the other pedicle is NOT bigger than normal or sclerotic, what should you suspect?

Answer 33

Vertebral body METs

Question 34

What is it called when a single vertebral body is involved with a diffuse homogeneous radiopacity?

Answer 34

Ivory Vertebra

Question 35

What are the 3 causes of Ivory Vertebra?

Answer 35

Blastic METs Paget's Disease Hodgkin's Lymphoma

Question 36

What is the difference between multiple myeloma and METs of the skull radiographically?

Answer 36

``` Myeloma = uniform sized radiolucent circles METs = Both small and large sized radiolucent circles ```

Question 37

What is the most significant sign of Rib METs?

Answer 37

Extrapleural sign

Question 38

What is a possible predilection if someone has primary bronchogenic carcinoma?

Answer 38

METs of the distal phalanx of finger

Question 39

What is the most common complication of METs?

Answer 39

pathological fracture

Question 40

Soft tissue masses typically accompany metastatic disease to small bones such as ribs, and is usually due to what?

Answer 40

Hemorrhage

Question 41

What kind of therapy is essential for METs?

Answer 41

Palliative

Question 42

Presence of what may be a sign of healing in a lytic lesion?

Answer 42

Sclerosis

Question 43

What is the most common abdominal neoplasm in children?

Answer 43

Wilm's tumor

Question 44

What is the 2nd most common abdominal neoplasm in children?

Answer 44

Neuroblastoma

Question 45

What organ does 75% of Neuroblastomas arise from?

Answer 45

adrenal gland

Question 46

What age is typically affected by neuroblastoma?

Answer 46

<5yo

Question 47

What are the key clinical features of Neuroblastoma in the skull?

Answer 47

Lytic lesions Widening of sutures Sunburst periosteal reaction plaques on brain

Question 48

What are the clinical features of Pulmonary Hypertrophic Osteoarthropathy?

Answer 48

joint swelling with clubbing of digits Periostitis "railroad track" appearance on bone scan

Question 49

Is Pulmonary Hypertrophic Osteoarthropathy usually primary or secondary?

Answer 49

secondary