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NYCC Bone & Joint > MOCE > Flashcards

MOCE Flashcards

1
Q

What are the 4 most common primary malignancies of bone from most to least common?

A

MOCE:
- multiple myeloma
- osteosarcoma
- chondosarcoma
- Ewing sarcoma

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2
Q

Which of the 4 most common primary malignancies of bone occur in older populations?

A

Multiple Myeloma & Chondrosarcoma
(MOCE)

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3
Q

Which of the 4 most common primary malignancies of bone occur in younger populations?

A

Osteosarcoma & Ewing sarcoma
(MOCE)

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4
Q

What is the most common primary malignancy of bone?

A

Multiple myeloma

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5
Q

What is the second most common primary malignancy of bone in elderly patients?

A

Chondrosarcoma

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6
Q

What is the second most common primary malignancy of bone in kids?

A

Ewing sarcoma

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7
Q

What is the most common malignancy of bone?

A

metastatic disease

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8
Q

What is your list of differential diagnoses for a 55 year old patient with an aggressive radiographic lesion?

A
  1. mets
  2. multiple myeloma
  3. lymphoma
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9
Q

What is on your list of differential diagnoses for a 55 year old patient with an aggressive radiographic lesion, and raindrop skull?

A
  1. Multiple myeloma
  2. mets
  3. lymphoma
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10
Q

What is on your list of differential diagnoses for a 55 year old patient with an aggressive radiographic lesion, and a serum M-protein spike on serum protein electrophoresis?

A
  1. Multiple myeloma
  2. mets
  3. lymphoma
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11
Q

What are the clinical findings that may or may not be present in a patient with multiple myeloma?

A
  • age 50-70
  • patho Fx
  • bone pain
  • weakness & fatigue (anemia)
  • fever & weight loss
  • bleeding & bruising
  • neuro signs
  • ^bacterial infections (especially lung)
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12
Q

What age group is primarily affected by multiple myeloma?

A

50-70 years

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13
Q

Multiple myeloma cells secrete ____ that recruit ____

A

cytokines
osteoclasts

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14
Q

What is the preferential location of multiple myeloma?

A
  • vertebrae
  • skull
  • ribs
  • pelvis
  • femur
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15
Q

Why would a patient with multiple myeloma present with fatigue?

A
  • loss of white & red marrow (replaced by B-lymphocyte lineage) causes anemia
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16
Q

What is the prognosis of multiple myeloma?

A
  • treatment options poor (radiation, chemo, marrow transplant)
  • 90% die within 3 yrs (++ aggressive)
  • infection or renal failure common causes of death (less normal marrow to produce functioning WBCs)
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17
Q

Multiple myeloma is a tumor of uncontrolled proliferation of ____ which produces ____

A

B-lymphocyte marrow
B-lymphocytes
(single cell lineage of B-lymphocytes)

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18
Q

What do B-lymphocytes produce?

A

Antibodies/immunoglobulins (Ig’s)

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19
Q

What is unique about immunoglobulins produced by multiple myeloma?

A

selectively make short chain only (no long chain)

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20
Q

What are Bence-Jones proteins?

A

Short chain of immunoglobulin proteins selectively produced by B-lymphocytes of multiple myeloma

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21
Q

What are the 2 major proteins in blood?

A

albumin
globulin

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22
Q

What is a normal A:G ratio?

A

albumin > globulin in blood

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23
Q

What happens to the A:G ratio with multiple myeloma and why?

A
  • globulin > albumin
  • reverses due to overproduction of Ig’s
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24
Q

What would you suspect in a patient who says they chew ice a lot, have been progressively fatigued lately, and has pale mucous membranes inside their cheeks and under their tongue?

A

iron deficiency anemia
(need labs to diagnose; pale mucous membranes instead of pink)

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25
Q

What are the early stage imaging findings of multiple myeloma?

A
  • normal radiographs
  • diffuse/generalized osteopenia (1st radiographic sign)
  • possible insufficiency/fatigue Fx
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26
Q

What are the late stage imaging findings of multiple myeloma?

A
  • permeative or moth-eaten osteolysis (as osteoblasts are inhibited)
  • vertebral collapse
  • sparing of pedicles (no winking owl or blind vertebra)
  • bone scan often normal
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27
Q

What is the term for the radiographic sign that is characteristic of multiple myeloma in the skull?

A

raindrop skull

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28
Q

What is the first radiographic sign of multiple myeloma?

A

generalized osteopenia

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29
Q

What is the term for the solitary form of multiple myeloma?

A

plasmacytoma

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30
Q

What age group is primarily affected by plasmacytomas?

A

40-75 yrs

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31
Q

What is the mnemonic for differential diagnoses of geographic lytic lesions?

A

FEGNOMASHIC

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32
Q

What is the prognosis of a plasmacytoma?

A

70% develop into multiple myeloma

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33
Q

What are the radiographic characteristics of a plasmacytoma?

A
  • geographic lytic
  • soap bubble appearance
  • highly expansile
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34
Q

Where do osteosarcomas frequently metastasize to?

A

Lungs, other bones

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35
Q

What is the term for large soft tissue masses in the lung due to metastasis of an osteosarcoma?

A

Cannon ball mets

36
Q

Which pattern of destruction is linked to a more aggressive type of osteosarcoma?
A) mixed
B) blastic
C) lytic

A

lytic
(more aggressive builds less bone)

37
Q

What general pattern of destruction may be seen in an osteosarcoma?

A

Can be blastic or lytic or both

38
Q

Which primary malignancies of bones prefer to metastasize to other bones?

A

1 MC: Ewing sarcoma
2 MC: Osteosarcoma

39
Q

Most osteosarcomas are (blastic/lytic/mixed)

40
Q

What is the common treatment for an osteosarcoma?

A
  • amputation + chemo/radiation therapy
  • limb salvage surgery
41
Q

What population is primarily affected by osteosarcomas?

A

Bimodal:
- 10-25 years (75%; primary)
- Older adults with predisposing conditions (secondary)

42
Q

What is the most common primary bone tumor in children?

A

Primary osteosarcoma

43
Q

What conditions can predispose older adults to developing a secondary osteosarcoma?

A
  • malignant degeneration of benign process (Pagets, fibrous dysplasia, osteochondroma)
  • Hx of radiation therapy (20 yr latency period)
44
Q

What is the most common primary malignancy of bone in kids?

A

osteosarcoma

45
Q

What is the second most common primary malignancy of bone?

A

Osteosarcoma

46
Q

An osteosarcoma presents on an x-ray as a densely blastic mass. Is this more or less aggressive than an osteosarcoma that appears purely lytic?

47
Q

What are the 5 types of primary osteosarcomas?

A
  • central/conventional
  • multicentric
  • parosteal
  • telangiectatic
  • extraosseous
48
Q

How might a patient with an osteosarcoma present clinically?

A
  • age 10-25 yrs
  • painful swelling of involved limb (typically LE)
  • typically complains of jt pain
49
Q

What are the preferential locations of primary osteosarcomas?

A
  • metaphysis
  • tubular long bones (LE; only 3.5-7% in spine)
  • femur
  • tibia
  • humerus
  • pelvis
  • spine
50
Q

What radiographic appearance is associated with a primary osteosarcoma?

A

cumulus cloud appearance
(blastic lesion)

51
Q

What are the radiographic findings specific to an osteoblastic osteosarcoma?

A
  • cumulus cloud appearance
  • lobulated ossified soft tissue mass
52
Q

What are the radiographic findings of a primary osteosarcoma?

A
  • osteoblastic or permeative osteolytic
  • cortical destruction
  • aggressive periosteal Rxn
  • soft tissue mass not always ossified
53
Q

How can you tell the difference between a parosteal osteosarcoma and myositis ossificans?

A

Zonal phenomenon:
- parosteal osteosarc. ossifies inside out
- myositis oss. ossifies outside in

(use CT if no previous imaging to compare)

54
Q

Chondrosarcomas are comprised of ____

A

Hyaline cartilage

55
Q

What are the 2 classifications of chondrosarcomas by location?

A
  • central (intramedullary)
  • peripheral (surface of bone)
56
Q

What is the preferential location of chondrosarcoma?

A
  • metaphyseal or diaphyseal
  • pelvis
  • long bones (femur & humerus)
  • ribs
57
Q

What age group is primarily affected by chondrosarcomas?

58
Q

What causes the white appearance of chondrosarcomas on x-ray?

A

cartilage attracts Ca2+ –> calcification (NOT ossification)
(similar appearance to enchondroma)

59
Q

What pattern of destruction is seen in a chondrosarcoma?

A

permeative or motheaten lytic

60
Q

What type of matrix calcification is seen in a chondrosarcoma?

A
  • 66% stippled (popcorn, flocculent, or arc & rings)
  • 33% purely osteolytic (no calcification)
61
Q

Where do secondary chondrosarcomas originate?

A

form in pre-existing cartilage tumors:
- enchondromas:
- osteochondromas

62
Q

Primary chondrosarcomas arise ____

63
Q

Secondary chondrosarcomas arise ____

A

from malignant degeneration

64
Q

What is the 3rd most common malignant bone tumor?

A

chondrosarcoma

65
Q

What are the clinical features of a chondrosarcoma?

A
  • age 40-60yrs
  • asymptomatic initially, pain in late stage
  • large soft tissue mass
  • severe pain after patho Fx
66
Q

What periosteal reaction is seen in a chondrosarcoma?

A

laminated or spiculated

67
Q

What are the radiographic characteristics of a chondrosarcoma?

A
  • permeative/motheaten osteolysis
  • stippled calcification or pure osteolysis
  • **large (calcified) soft tissue mass)
  • laminated/spiculated periosteal Rxn
68
Q

Where do chondrosarcomas commonly metastasize to?

69
Q

What is the mnemonic for differential diagnoses of stippled calcification?

A

ICE
(infarct, chondrosarc., enchondroma)

70
Q

What are the possible treatments for chondrosarcomas?

A
  • local excision
  • segmental resection
  • amputation
71
Q

What age group is primarily affected by Ewing sarcomas?

A

10-25 years

72
Q

What is the preferential location of Ewing sarcoma?

A

mid-diaphysis of long bones:
- femur
- pelvis
- tibia
- humerus
- fibula

73
Q

What is the most common primary malignancy of bone to metastasize to other bones?

A

Ewing sarcoma

74
Q

How would a patient with Ewing sarcoma present clinically?

A
  • age 10-25 yrs
  • localized pain & swelling
  • may mimic infection (fever, ^ESR, anemia)
75
Q

What is the treatment for Ewing sarcoma?

A

chemo/radiation therapy & limb-sparing surgery

76
Q

What are the radiographic characteristics of Ewing sarcoma?

A
  • permeative/motheaten lytic destruction
  • long ZoT
  • cortical disruption (saucerization - rare)
  • laminated/spiculated periosteal Rxn
  • may extend to soft tissues
  • patho Fx
    (can look like osteomyelitis –> send to ER)
77
Q

What bone pathologies would you include in your differential diagnosis if you see aggressive bone destruction radiographically in a patient under 25 years old?

A

OLEO:
- osteosarcoma (aggressive kid tumor)
- Ewing sarcoma (aggressive kid tumor)
- lymphoma (any age)
- osteomyelitis (appears same; more common in kids)

78
Q

What rare radiographic sign is pathognomonic for Ewing sarcoma?

A

cortical saucerization
(thin whittled edge, like teacup saucer; d/t soft tissue mass)

79
Q

What is on your list of differential diagnoses in order from most to least likely?

A
  1. Mets
  2. Multiple myeloma
  3. Lymphoma
80
Q

What would prompt you to put multiple myeloma at the top of your list of differential diagnoses?

A
  • lab findings (M spike)
  • raindrop skull
81
Q

What is on your list of differential diagnoses from most to least likely?

A
  1. Multiple myeloma
  2. Mets
  3. Lymphoma
82
Q

10 year old boy with lower leg pain and swelling. What is on your list of differential diagnoses in order from most to least likely?

A

Aggressive in kid = OLEO
1. Osteosarcoma (metaphyseal)
2. Ewing sarcoma
3. Lymphoma
4. Osteomyelitis

83
Q

18 year old with pain and swelling of the lower leg. What is on your list of differential diagnoses in order from most to least likely?

A

Aggressive in kid = OLEO
1. Osteosarcoma (metaphyseal)
2. Ewing sarcoma
3. Lymphoma
4. Osteomyelitis

84
Q

80 year old female with pain and swelling in the right knee. What is on your list of differential diagnoses in order from most to least common?

A

Stippled calcification = ICE
1. Chondrosarcoma
2. Enchondroma
3. Infarct

85
Q

Give a list of differentials in order from most to least likely.

A
  1. Chondrosarcoma (large calcified soft tissue mass)
  2. Enchondroma
  3. Infarct
86
Q

Give a list of differentials in order from most to least likely.

A

Aggressive in kid = OLEO
1. Ewing sarcoma (diaphyseal)
2. Osteosarcoma
3. Lymphoma
4. Osteomyelitis

NYCC Bone & Joint (52 decks)

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