Metastatic Lesions

Question 1

What is the prevelence of metastatic bone disease (in autopsy pts)

Answer 1

M/c malignency of bone

- 20-35% of autopsy pts have osseous mets

Question 2

the source of 80% of metastatic bone disease is from

Answer 2

80% from Breast, Lung, Prostate and kidney carcinoma

Question 3

what is the main source of metastatic bone disease in women (+%)

Answer 3

Breast cancer 70%

Question 4

what is the main source of metastatic bone disease in men (+%)

Answer 4

Prostate 60%

Lung 25%

Question 5

what is the age range for metastatic bone disease

Answer 5

> 40 years old

Question 6

In kids with metastatic bone disease what is the typical causes (2, + %)

Answer 6

80% due to neuroblastoma

50% due to hodgkins lymphoma

Question 7

Where is the loc, margin/matrix/rxn of metastatic disease

Answer 7

Loc- 80% axial (40% spine)

Imaging- 75% lucent that is moth eaten to permeative, rarley a paresoteal rxn

Question 8

What is the clinical picture of a pt with metastatic disease (age, pain, symptoms)

Answer 8

age- >40
Bone pain (worse @ night + awake)
Symptoms- unintentional weight loss, anemia, fever

Question 9

Lab- what would be elevated w/ lytic mets

Answer 9

Serum calcium

Question 10

Lab- What would be elevated w/ blastic mets

Answer 10

Alkaline phosphatase

Question 11

Lab- What would be elevated w prostatic mets

Answer 11

Acid phosphatase

Question 12

What are the 4 pathways of tumor dissemination (+ m/c)

Answer 12

1. Direct extension- to bone from adjacent soft tissue tumor (natural path/surgery)
2. Lymphatic
3. Hematogenous- thru blood (usually venous)
4. Drop mets- Spread thru CSF (usually seeds in lumbar)

Question 13

What is the most common path for mets in spine

Answer 13

Batsons venous plexus

Question 14

why is the main look of mets lytic

Answer 14

Pressure from proliferating neoplasm/surrounding bone causes reabsorbtion of trabeculea, creating lytic appearence

Question 15

Imaging wise what does metastatic disease usually have less of compared to primary bone tumors

Answer 15

• less pareosteal rxn, cortex destruction or soft tiss mass

Question 16

Why does blastic mets occur

Answer 16

Increased density due to laying down of new bone (osseous rxn to the tumor)

Question 17

What is a way to differentiate a begin bone tumor from blastic mets

Answer 17

There will be no brush border in blastic mets

Question 18

What is the mc location for blastic mets

Answer 18

Axial skeleton (pelvis/spine/ribs)

Question 19

What is the imaging findings in blow out mets and what type of cancer is it seen in

Answer 19

Lytic mets that creats a soap bubbly appearence

seen in renal/thyroid cancers