Metastatic Diseases Flashcards
What is the most common malignant tumor of the skeleton?
METs
How is drop metastasis spread?
hematogenous route
What kind of bone are predisposed to develop osseous metastases?
rich in red bone marrow
At what age does METs usually occur after?
40yo
What are Metastatic osseous lesions in children <5 yo
usually due to? 10-20yo? 20-35yo?
<5 = neuroblastoma 10-20 = Ewing’s and Osteosarcoma 20-35 = Hodgkin’s lymphoma
What kind of METs will increase alkaline phosphatase?
Blastic metastasis
What will elevate if prostate capsule is disrupted?
acid phosphatase
What parts of the body are a common hematogenous pathway for METs to spread?
lungs, liver and axial skeleton
What kind of METs is spread through fluids in a body cavity?
Implantation/Seeding Metastasis
What is it called when tumors form large quantities of fluid?
Ascites
What are valveless epidural vertebral veins that function as a venous lake or pool known as?
Batson’s Venous Plexus
What does Batson’s venous plexus allow cancer cells to do?
Bypass liver and lungs and go straight to bone
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?
Spinal METs
What is the most ominous symptom in patients with metastatic disease to the spine?
Bone pain at night
What is an Osteoblastic Tumor invading L1 typically associated with?
METs of the prostate gland
How much bone destruction of appendicular skeleton must happen before being seen on plain film in regards to Lytic Metastasis?
30%
In regards to Lytic METs, what is the destruction due to?
osteoclast stimulating cytokines secreted by tumor cells
What plays a large role in formation of lytic lesions in metastatic disease?
Osteoclasts
What is a grave clinical sign of Blastic METs?
Enlargement of existing lesions and development of new lesions
What are 4 benign conditions that stimulate Blastic Metastasis?
Paget’s disease
Osteopoikilosis
Osteopetrosis
Sarcoidosis
How much longer would you see a + bone scan before you see the disease on regular plain film?
18 months
What kind of imaging is useful for cortical bone involvement and presence of soft tissue mass formation?
CT
What kind of imaging is Better than CT for detecting bone lesions and assessment of soft tissue mass formation?
MRI
What type of images on MRI are lesions hyperintense?
T2
What kind of MR imaging includes fat suppression (heavily weighted T1 images) and detects metastatic bone lesions up to 91%?
STIR images
What kind of METs pattern is the most common with breast and lung carcinoma metastasis?
Motheaten/permeative pattern
What kind of lesions represent 15% of lesions and are most common from prostate, breast, cecum and bronchial carcinoid tumors?
Osteoblastic
What kind of lesion is most commonly seen in Primary tumors of thyroid and kidney?
Blow-Out Metastatic Lesions
What are significant features of a Blow-Out METs lesion?
Solitary
Bubbly
Expansile
What is the earliest and most subtle sign of METs of the vertebral body?
focal osteoporosis
How are Vertebral body METs shown on T1 and T2 images?
T1 = decreased signal T2 = Intermediate to increased signal
With Vertebral body METs, what is also known as Bilateral pedicle destruction?
Blind Vertebra
If you see no pedicle on one side and the other pedicle is NOT bigger than normal or sclerotic, what should you suspect?
Vertebral body METs
What is it called when a single vertebral body is involved with a diffuse homogeneous radiopacity?
Ivory Vertebra
What are the 3 causes of Ivory Vertebra?
Blastic METs
Paget’s Disease
Hodgkin’s Lymphoma
What is the difference between multiple myeloma and METs of the skull radiographically?
Myeloma = uniform sized radiolucent circles METs = Both small and large sized radiolucent circles
What is the most significant sign of Rib METs?
Extrapleural sign
What is a possible predilection if someone has primary bronchogenic carcinoma?
METs of the distal phalanx of finger
What is the most common complication of METs?
pathological fracture
Soft tissue masses typically accompany metastatic disease to small bones such as ribs, and is usually due to what?
Hemorrhage
What kind of therapy is essential for METs?
Palliative
Presence of what may be a sign of healing in a lytic lesion?
Sclerosis
What is the most common abdominal neoplasm in children?
Wilm’s tumor
What is the 2nd most common abdominal neoplasm in children?
Neuroblastoma
What organ does 75% of Neuroblastomas arise from?
adrenal gland
What age is typically affected by neuroblastoma?
<5yo
What are the key clinical features of Neuroblastoma in the skull?
Lytic lesions
Widening of sutures
Sunburst periosteal reaction
plaques on brain
What are the clinical features of Pulmonary Hypertrophic Osteoarthropathy?
joint swelling with clubbing of digits
Periostitis
“railroad track” appearance on bone scan
Is Pulmonary Hypertrophic Osteoarthropathy usually primary or secondary?
secondary
