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DI 2201 > Module 6 > Flashcards

Module 6 Flashcards

1
Q
  • Metaphysis/diaphysis
  • 10-25 yrs old; M>F
  • NIGHT PAIN (relieed by asprin)
  • Long bone: Geographic lucent nidus (≤ 1cm) with sclerotic rim; central fleck of calcification, solid periosteal rxn
  • Spine: antalgic scoliosis, lesion on concave side; dense pedicle, TBP, and lamina, ivory vertebra/focal sclerosis
A

• Osteoid Osteoma (OO)

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2
Q
  • Epiphysis/metaphysis in pelvis/hip
  • Intramedullary, round, homogenously opaque
  • Smooth margins/thorn-like radiating spicules
  • DDx: osteoblastic METs, OO, Osteoma
A

• Enostoma (Bone Island)

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3
Q
  • 2-10 y/o
  • Metaphysis
  • Bayonet deformity and Erlenmeyer flask deformity
A

• Hereditary multiple exostosis (HME)

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4
Q
  • F»M
  • Skull (MC benign tumour of nose/paranasal sinuses)
  • Lesion: Homogeneously opaque, round/oval, well-circumscribed, <2cm
  • Ivory/compact osteoma; trabecular/spongy osteoma
A

• Osteoma

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5
Q
  • Metaphysis
  • Most occur <20 y/o
  • Sessile or pedunculated (DDx – supracondylar process)
A

• (Solitary) osteochondroma – bony exostosis

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6
Q
  • 70% occur <20 y/o; M>F
  • Long bones: expansile, lytic, thin cortical rim, > 2cm nidus
  • Spine: neural arch, matrix: lytic > mixed/sclerotic, expansile, w/o reactive sclerosis (thin cortical rim)
A

• Osteoblastoma (giant osteoid osteoma)

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7
Q
  • 10-25 y/o
  • Epiphysis
  • PAINFUL
  • MC: proximal femur, tibia, proximal humerus
  • Medullary, oval/round lytic lesion involving epiphysis
  • Geographic, most are eccentric (especially when the metaphysis is involved), sclerotic rim
  • Calcification (central): punctate or stippled (50%)
  • Periosteal new bone formation on the metaphyseal portions of the bone = metaphyseal periostitis
A

• Chondroblastoma (Codman’s tumour)

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8
Q
  • SAA
  • MC in hands, feet, knee, iliac crest
  • DDx: Maffucci’s
  • Streak-like or vertical bands of radiolucencies - with central metaphyseal lesions, typically in long bones; projecting toward the diaphysis of the bone
  • Soap-bubble lesions
  • Geographic, expansile (ST mass may be present if there is gross expansion of cortex)
  • Punctate/stippled (scattered) calcification may be present
A

• Ollier’s (multiple enchondromatosis)

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9
Q
  • 8-20 y/o
  • Flame-shaped
  • Diametaphyseal
  • LL: distal femur, proximal/distal tibia
  • Solitary, geographic, eccentric, oval, expansile (thinned cortex), scalloped, sclerotic margin, bubbly appearance (multiloculated); multiple lesions in neurofibromatosis
  • NO MALIGNANT POTENTIAL; spontaneous resolution
A

• Fibrous Xanthoma (non-ossifying fibroma – NOF)

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10
Q
  • 10-40 y/o
  • Metaphysis, medullary
  • MC in hands and foot
  • Geographic lytic; EXPANSILE (may deform bone); well-defined margins; central > eccentric
  • Thinned cortex due to expansion & endosteal scalloping
  • Singular lesion, centrally placed, within the metaphysis
  • +/- stippled, punctated, rings of calcification (50%)
A

• Solitary/central Enchondroma

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11
Q
  • <15 y/o (80%); M>F
  • Metaphysis, diaphyis
  • MC: proximal humerus, femur, calcaneus
  • Fallen fragment
  • Geographic, central, elongated lesion, expansile, endosteal scalloping, thin septa within cystic lucency – loculated appearance; NO periosteal rxn
A

• Simple Bone Cyst (SBC)

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12
Q
  • 20-40 y/o; F = benign, M = likely malignant
  • Geographic, eccentric, subarticular, expansile, thin cortex, internal septation (soap-bubble) Spinal (C/L) – expansile, loss of anterior concavity DDx: osteoblastoma, ABC
A

• Giant Cell Tumour (GCT)

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13
Q
  • <25 y/o
  • Glass-like appearance
  • Monostotic (70%): trabeculated/multiloculated, geographic, lucent, smoky, thick sclerotic rim expansile, cortical thinning and scalloping
  • Polyostotic (27%): multiple lesions; deformities: coxa vara, shepherd’s crook, extrapleural sign, protrusio acetabulae
  • McCune-Albright syndrome: polyostotic FD with skin pigmentation; pre-mature menstruation in females
A

• Fibrous Dysplasia

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14
Q
  • 5-20 y/o (75%)
  • Blow-out appearance, inflated spine
  • Metaphysis > diaphysis (MC in long bone - femur and tibia; spine (T/L)
  • PAINFUL
  • Geographic, eccentric, expansile, thin peripheral cortex, light septations, marginal periosteal buttress
A

• Aneurysmal Bone Cyst (ABC)

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15
Q
  • 5-70 y/o
  • Metaphysis
  • MC = tibia, fibula, calcaneus, metatarsals
  • Target or doughnut-shaped sequestrum
  • well-defined, ovoid, lobulated, expanding intramedullary lesion with a central density; well-defined and/or sclerotic border
  • DDx: SBC, pseudocyst
A

• Lipoma

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16
Q
  • > 40 y/o
  • Lower T/upper L spine, frontal bone
  • Corduroy cloth & sunburst appearance
  • Spine: solitary (may have 2-3), coarse vertical striations; overall loss of bone density, primarily affect the VB but may extend to neural arch; rare expansion (associated with stenosis!). DDx: Paget’s, senile/postmenopausal osteoporosis
  • Skull: round, oval radiolunceny (en face), dense, fine spicula radiating from its center; external bulging. DDx: osteosarcoma
  • Soft Tissue: palpable soft tissue mass usually found in forearm, lower leg, or paravertebral area
A

• Hemangioma

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17
Q
  • 20+ & 55+ y/o
  • Vertebral bodies (lower T, upper L)
  • Lytic (75%), Blastic or Mixed
  • 10% periosteal rxn
  • Ivory VB + Scalloping of ant/lat
  • DDx: Paget’s & blastic METs
A

• Hodgkin’s lymphoma

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18
Q
  • <50 y/o
  • Mandible, pelvis, VB, ribs, femur, scapula
  • Lytic, geographic, soap bubbly
  • Highly expansile
  • DDx: FD, GCT, blow-out METs
  • HANDS OFF C-SPINE!!!
A

• Solitary plasmacytoma

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19
Q
  • 50-70 y/o; M>F
  • Diaphysis, vertebral body, pelvis
  • Multiple, lytic, Diffuse, round/oval lesions = Punched out appearance VB compression fx (vertebrae plana) Endosteal scalloping
  • Blastic, may see ivory VB
  • MRI: T1 –low intensity; T2 – high intensity
A

• Multiple myeloma (MM) – MC common primary malignant, 1st sign = osteoporosis

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20
Q
  • 20-40 y/o; M>F
  • Metaphysis & diaphysis
  • MS: knee, humerus > pelvis, ribs
  • Classic: Medullary, permeative, ill-defined lytic
  • Moth-eaten cortical destruction, Minimal periosteal rxn, ST mass
  • DDx: mets and plasmacytoma, Ewing’s sarcoma (relies on AGE)
A

• Non-Hodgkin’s lymphoma

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21
Q
  • 10-25 y/o
  • Metaphysis
  • MC: knee, shoulder
  • Blastic or lytic
  • Periosteal reaction
  • ST involvement
  • 2nd MC 1o malignancy; Metastases: lungs, bones & kidneys
  • Cumulus cloud appearance
A

• Osteosarcoma (Terry Fox) - central

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22
Q
  • 30-50 y/o
  • Blastic
  • Cleavage plan, string sign
  • Chondrosarcoma (central)
A

• Osteosarcoma (Terry Fox) - PAROSTEAL

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23
Q
  • 10-25 y/o; M>F
  • Diaphysis
  • MC: femur, tibia, humerus, pelvis
  • PAINFUL
  • Sunburst periosteal reaction
  • Ill-defined, lytic lesion
  • Permeative, moth-eaten
A

• Ewing’s sarcoma

24
Q
  • > 40 y/o; M>F
  • Metaphysis, diaphysis
  • MC: pelvis, proximal femur, rib, humerus
  • MC primary 1o bone tumor of the HAND & CHEST WALL; 3rd of the pelvis
  • DDx: enchondroma (long bones), osteosarcoma
  • Lytic
  • Soap-bubbly
  • Expanded
  • Endosteal scalloping
  • Laminated spiculated
  • Rings & arcs
A

• Chondrosarcoma (central)

25
Q
  • PAINFUL

* 2o to FD, Paget’s, chronic osteomyelitis and bone infarct; DDx – MM

A

• Fibrosarcoma

26
Q
  • 40-70 y/o; F>M
  • Vertebral column – sacroccygeal, clivus, and VB (C2- MC)
  • TIP: always check arcute lines (ant. Sacral foramina) – eyebrow like lines for possible signs of cortical destruction of sacrum
  • DDx: mets. Myeloma, chondrosarcoma (if calcification is present
  • Sacrococcygeal: lytic destruction, oval/circular with scalloped margins; expansile and widening of sacrum (AP diameter); centrally: incomplete septation and calcification -50%; ST mass common
  • Vertebral: loss of bone density, pathological fx, large ST mass;
  • Suspect this if there is involvement of contiguous (multiple adjacent) VB and disc space
  • May see ivory vertebrae
  • DDx: osteolytic mets, chondrosarcoma, GCT. ABC, and plasmacytoma!
A

• Chordoma (notochord remnant)

27
Q

Solitary, soap bubbly, lytic lesions:

o	F = 
o	O = 
o	G = 
o	M = 
o	A = 
o	C = 
o	H = 
o	I = 
o	N = 
o	E = 
o	S =
A 
o	F = Fibrous Dysplasia
o	O = Osteoblastoma
o	G = Giant Cell Tumour
o	M = Metastasis / Myeloma
o	A = Aneurysmal Bone Cyst
o	C = Chondroblastoma
o	H = Hyperparathyroidism(brown tumours)/ Hemangioma
o	I = Infection
o	N = Non-ossifying Fibroma
o	E = Enchondroma
o	S = Solitary Bone Cyst
28
Q

o Metastatic diseases

 Elevation of…..(4)

A

 Elevation of serum calcium (with lytic METS)–maybe
 Elevation of alkaline phosphatase (with blastic METS)
 Elevation of ESR
 Elevated acid phosphatase (with prostate METS)

29
Q
  • A neoplasm can spread via CSF.
  • Symptoms can be subtle.
  • MRI may show nodular thickening of the meninges.
  • Most common location for METS to “seed” is the L/S due to the presence of gravity.
A

 Drop METS

30
Q
  • Blood stream is the most important and major pathway!!
  • Either arterial or venous (M/C cells penetrate venous system—arterial system seems to be resistant to neoplastic invasion)
  • Batson’s Venous Plexus is the largest source of METS to the spine. Decrease in the intralaminar pressure with no intrathoracic or abdominal pressure creates slow flow, as well as variable direction, favors the likelihood of cell deposition.
A

 Hematogenous dissemination

31
Q

Cancers & METs

Men vs. women

Children (<20 y/o)

A

 Women = breast cancer (70% of osseous METs)
 Men = prostate cancer (60%) and lung cancer (25%)

Children

  • 80% = neuroblastoma
  • 50% = Hodgkin’s lymphoma
32
Q

 Tumor cells will deposit in the bone marrow
 Pressure from proliferating neoplasm on the surrounding bone, causes resorption of trabeculae, creating the lytic appearance.
 Osteoclasts play only a minor role

A

o Lytic METS

33
Q

 The increased density is due to the laying down of new bone (non-neoplastic cause)
 It is osseous reaction to the tumor ———futile attempt to save the body by the bone :( —
 Many benign conditions can simulate blastic METS
 There is generalized sclerotic change of the axial skeleton, including pelvis, spine, and ribs.
 The tumors most likely to metastasize to bone are carcinoma of the: lung, kidney, thyroid, and breast
 Typically seen in C2

A

o Blastic METS

34
Q

 Is a term used to describe a lytic metastatic focus that creates a “soap- bubble” appearance. (remember the ‘M’ in ‘fogmachines’?)
 Usually the only example of a solitary lesion of METS.
 Seen with renal or thyroid cancers.

A

o “Blow Out METS”

35
Q

IVORY VERTEBRAE - 3 DDx

A

HL

Blastic METs

Paget’s

36
Q

MC benign tumour

A

osteochondroma

37
Q

MC primary malignant tumour

A

MM

38
Q

2nd MC primary malignant tumour

A

osteosarcoma

39
Q

3rd MC primary malignant tumour

A

chondrosarcoma

40
Q

4th MC primary malignant tumour

A

Ewing’s

41
Q

MC to MET into other bones

A

Ewing’s sarcoma

42
Q

Many sclerotic lesions in >20 y/o are….

A

healed lytic lesions, ABC, GCT, NOF

43
Q

2 Dx - young (malignant)

A

osteosarcoma and Ewing’s sarcoma

44
Q

3 Dx - old (malignant)

A

MM/myeloma, blastic METs, chondrosarcoma, fibrosarcoma

45
Q

C2 vertebra

A

osteoblastoma

46
Q

Blood test for MM (3)

Blood test for METs (4)

A

CBC, urinalysis, BM autopsy

serum Ca, ESR, acid phosphatase, alkaline phosphataste

47
Q

stippled, spiculated, rings and arcs = all lead you to think

A

chondroid (matrix = cartilage)

48
Q

glassy, or smudgey…

A

fibrous

49
Q

Reed-sternberg cell - related to…

A

in NHL, not HL

differentiate lymphomas

50
Q

6 benign - osseous tumours

A
  • Osseous (6)
  • Osteochondroma – MC benign bone tumor
  • Enostoma (Bone Island)
  • Osteoid Osteoma (OO)
  • Osteoblastoma
  • Osteoma
  • Hereditary multiple exostosis (HME)
51
Q

2 benign - cartilage tumours

A
  • Enchondroma, Ollier’s

* Chondroblastoma

52
Q

2 benign - fibrous tumours

A
  • Fibrous (2)
  • Fibrous Xanthoma (Non-ossifying Fibroma, Fibrous Cortical defect)
  • Fibrous Dysplasia
53
Q

3 benign - cystic tumours

A
  • Aneurysmal Bone Cyst (ABC)
  • Simple Bone Cyst
  • Giant Cell Tumour (GCT)
54
Q

2 benign miscellaneous tumours

A
  • Hemangioma

* Lipoma

55
Q

3 most common malignant tumours

A

METs, MM, lymphoma

56
Q

5 most uncommon malignant tumours

A

Ewing’s sarcoma, osteosarcoma (central), chondrosarcoma, fibrosarcoma, chordoma

57
Q

T or F: NOF heals itself in children

A

T

DI 2201 (1 decks)

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