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Tumors > Metastatic Diseases > Flashcards

Metastatic Diseases Flashcards

1
Q

What is the most common malignant tumor of the skeleton?

A

METs

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2
Q

How is drop metastasis spread?

A

hematogenous route

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3
Q

What kind of bone are predisposed to develop osseous metastases?

A

rich in red bone marrow

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4
Q

At what age does METs usually occur after?

A

40yo

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5
Q

What are Metastatic osseous lesions in children <5 yo

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

A 
<5 = neuroblastoma
10-20 = Ewing’s and Osteosarcoma
20-35 = Hodgkin’s lymphoma
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6
Q

What kind of METs will increase alkaline phosphatase?

A

Blastic metastasis

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7
Q

What will elevate if prostate capsule is disrupted?

A

acid phosphatase

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8
Q

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

A

lungs, liver and axial skeleton

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9
Q

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

A

Implantation/Seeding Metastasis

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10
Q

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

A

Ascites

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11
Q

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

A

Batson’s Venous Plexus

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12
Q

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

A

Bypass liver and lungs and go straight to bone

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13
Q

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?

A

Spinal METs

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14
Q

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

A

Bone pain at night

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15
Q

What is an Osteoblastic Tumor invading L1 typically associated with?

A

METs of the prostate gland

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16
Q

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

A

30%

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17
Q

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

A

osteoclast stimulating cytokines secreted by tumor cells

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18
Q

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

A

Osteoclasts

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19
Q

What is a grave clinical sign of Blastic METs?

A

Enlargement of existing lesions and development of new lesions

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20
Q

What are 4 benign conditions that stimulate Blastic Metastasis?

A

Paget’s disease
Osteopoikilosis
Osteopetrosis
Sarcoidosis

21
Q

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

A

18 months

22
Q

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

A

CT

23
Q

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

A

MRI

24
Q

What type of images on MRI are lesions hyperintense?

A

T2

25
Q

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

A

STIR images

26
Q

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

A

Motheaten/permeative pattern

27
Q

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

A

Osteoblastic

28
Q

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

A

Blow-Out Metastatic Lesions

29
Q

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

A

Solitary
Bubbly
Expansile

30
Q

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

A

focal osteoporosis

31
Q

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

A 
T1 = decreased signal
T2 = Intermediate to increased signal
32
Q

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

A

Blind Vertebra

33
Q

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

A

Vertebral body METs

34
Q

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

A

Ivory Vertebra

35
Q

What are the 3 causes of Ivory Vertebra?

A

Blastic METs
Paget’s Disease
Hodgkin’s Lymphoma

36
Q

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

A 
Myeloma = uniform sized radiolucent circles
METs = Both small and large sized radiolucent circles
37
Q

What is the most significant sign of Rib METs?

A

Extrapleural sign

38
Q

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

A

METs of the distal phalanx of finger

39
Q

What is the most common complication of METs?

A

pathological fracture

40
Q

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

A

Hemorrhage

41
Q

What kind of therapy is essential for METs?

A

Palliative

42
Q

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

A

Sclerosis

43
Q

What is the most common abdominal neoplasm in children?

A

Wilm’s tumor

44
Q

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

A

Neuroblastoma

45
Q

What organ does 75% of Neuroblastomas arise from?

A

adrenal gland

46
Q

What age is typically affected by neuroblastoma?

A

<5yo

47
Q

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

A

Lytic lesions
Widening of sutures
Sunburst periosteal reaction
plaques on brain

48
Q

What are the clinical features of Pulmonary Hypertrophic Osteoarthropathy?

A

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

49
Q

Is Pulmonary Hypertrophic Osteoarthropathy usually primary or secondary?

A

secondary

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