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CORE > MSK Bone Tumors > Flashcards

MSK Bone Tumors Flashcards

1
Q

Lodwick classification of bone destruction?

A

Type:

  • 1: geographic
  • 2: moth-eaten
  • 3: permeative
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2
Q

Lodwick classification of bone destruction –> Type 1: geographic –> 3 subtypes?

A
  • 1A: thin sclerotic margin –> almost always non-agg
  • 1B: well-defined margin –> usu non-agg
  • 1C: partially indistinct
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3
Q

Lodwick classification of bone destruction –> type 3: permeative –> can be seen with what conditions? (3)

A
  • lymphoma
  • leukemia
  • Ewing sarcoma
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4
Q

bone lesion –> fluffy, cloud-like matrix –> what matrix type?

A

Osteoid

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5
Q

bone lesion –> ring&arc, popcorn-like matrix –> what matrix type?

A

Chondroid

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6
Q

bone lesion –> groundglass matrix –> what matrix type?

A

fibrous

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7
Q

what is fallen fragmt sign?

A

simple bone cyst –> path fx –> fx fragmt inside bone cyst

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8
Q

bone island (enostosis) –> bone scan?

A

normal

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9
Q

osteopoikilosis –> synd? (2)

A

AD:

  • mult bone island
  • keloid
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10
Q

what is osteopathia striata?

A

benign asympt dysplasia: long bone, flat pelvic bone –> linear bands of sclerosis

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11
Q

osteopathia striata –> bone scan?

A

normal

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12
Q

osteoma –> location?

A

cortex:
- skull
- frontal, ethmoid sinus

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13
Q

Gardner synd –> synd? (3)

A

AD:

  • mult osteoma
  • intestine polyps
  • soft tissue –> desmoid tumor
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14
Q

melorheostosis –> imaging appearance?

A

cortex –> thick & irreg –> “candle-wax” appear

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15
Q

melorheostosis –> assoc soft tissue finding?

A

overlying scleroderma-like skin lesion

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16
Q

melorheostosis –> location?

A

unilat LE –> single sclerotome distribution

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17
Q

melorheostosis –> bone scan?

A

intense uptake

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18
Q

osteoid osteoma –> classic clinical presentation?

A

teen/YA –> night pain –> relieve by ASA

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19
Q

osteoid osteoma –> XR/CT appearance?

A
  • lucent nidus –> surrounding sclerosis

- central calc

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20
Q

osteoid osteoma –> bone scan?

A

“double density” sign:

  • nidus –> intense uptake
  • sclerosis –> adj reactive uptake
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21
Q

osteoid osteoma –> tx?

A
  • IR radiofreq ablation
  • surgical curettage
  • resect
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22
Q

what is osteoblastoma?

A

osteoid osteoma –> >2cm

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23
Q

differentiate: osteoid osteoma vs osteoblastoma –> clinical presentation?

A

osteoid osteoma:

  • teen/YA
  • pain
  • relieve w ASA

osteoblastoma:
- teen/YA
- pain
- NOT relieve w ASA

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24
Q

osteoblastoma –> MC location?

A

spine –> post elements

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25
Q

YA –> spine post element –> lytic lesion –> ddx? (2)

A
  • osteoblastoma

- aneurysmal bone cyst

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26
Q

osteoblastoma –> MC imaging appearance?

A

lucent lesion –> mineralized

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27
Q

2ary osteosarcoma –> etiology? (2)

A
  • Paget dz

- radiation

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28
Q

osteosarcoma –> general imaging hallmarks? (4)

A
  • bony destruct
  • osteoid matrix
  • agg periosteal rxn
  • assoc ST mass
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29
Q

osteosarcoma –> 4 MC subtypes?

A
  • # 1 conventional (intramedullary)
  • telangiectatic
  • parosteal
  • periosteal
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30
Q

osteosarcoma –> conventional (intramedullary) subtype –> MC location?

A

knee –> metaphysis:

  • femur
  • tibia
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31
Q

osteosarcoma –> telangiectatic subtype –> can look like what bone lesion?

A

benign ABC

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32
Q

differentiate: telangiectatic osteosarcoma vs other osteosarcomes

A

telang: no matrix

other ostesarcomas: osteoid matrix

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33
Q

osteosarcoma –> parosteal subtype –> arise from what part of bone?

A

outer periosteum

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34
Q

osteosarcoma –> parosteal subtype –> MC location?

A

distal femoral metaphysis –> post aspect

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35
Q

osteosarcoma –> parosteal subtype –> imaging appearance?

A

cauliflower-like exophytic –> lucent line separate from cortex

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36
Q

osteosarcoma –> parosteal subtype –> epidemiology?

A

30s-40s

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37
Q

osteosarcoma –> least malig subtype

A

parosteal

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38
Q

osteosarcoma –> periosteal subtype –> arise from what part of bone?

A

inner periosteum

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39
Q

osteosarcoma –> periosteal subtype –> MC location?

A

femur/tibia –> diaphysis

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40
Q

osteosarcoma –> periosteal subtype –> epidemiology?

A

<20yo

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41
Q

osteosarcoma –> MC mets location? appearance?

A

lungs –> calcify

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42
Q

what is synovial osteo/chondromatosis?

A

non-neoplastic –> synovial metaplasia –> intra-articular cartilag nodules

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43
Q

synovial osteo/chondromatosis –> MC location?

A

knee

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44
Q

mult round intra-articular bodies –> ddx? (2)

A
  • synovial chondromatosis

- OA –> intra-articular bodies

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45
Q

MRI –> mult intra-articular foci –> low signal –> ddx? (2)

A
  • synovial chondromatosis –> ossified

- pigmented villonodular synovitis (PVNS)

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46
Q

what is enchondroma?

A

benign –> lesion of mature hyaline cartilage rests

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47
Q

enchondroma –> matrix?

A

long bone –> chondroid

hand –> no visible matrix –> lytic lesion

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48
Q

enchondroma –> ddx? (2)

A
  • medullary bone infarct

- chondrosarcoma

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49
Q

enchondroma –> tx?

A

curettage

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50
Q

what is osteochondroma?

A

benign –> bone growth projecting outward –> cartilage-cap

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51
Q

osteochondroma –> location?

A

metaphysis –> grow away from epiphysis

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52
Q

osteochondroma –> key imaging finding?

A

cortex & medulla continuous w host bone

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53
Q

osteochondroma –> potenial comp?

A

malig transform –> chondrosarcoma

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54
Q

mult osteochondromas –> what condition?

A

familial osteochondromatosis (mult hereditary exostoses)

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55
Q

chondroblastoma –> age?

A

skeletally immature –> 5-25yo

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56
Q

chondroblastoma –> location?

  • long vs flat bone?
  • dia/meta/epi-physis?
  • MC bone?
  • centric vs eccentric?
A
  • long bone –> epiphysis –> eccentric

- knee/prox humerus

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57
Q

chondroblastoma –> T2 signal?

A

T2 –> low-interm

most chondroid lesions –> T2 hyper

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58
Q

chondroblastoma –> tx?

A
  • curettage
  • cryosurg
  • radiofreq ablation
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59
Q

chondroblastoma –> benign or malig?

A

benign

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60
Q

what is chondromyxoid fibroma?

A

very rare –> benign cartilage tumor

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61
Q

chondromyxoid fibroma –> location?

A

knee –> femur/tibia metaphysis –> ecc

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62
Q

chondromyxoid fibroma –> imaging appearance:

  • XR
  • MR
A

XR –> sclerotic margins

MR –> T2 hyper

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63
Q

2ary chondrosarcoma –> etiology? (3)

A
  • enchondroma
  • Paget dz
  • osteochondroma
64
Q

osteochondroma –> what finding is highly sugg of chondrosarcoma?

A

cartilage cap >2cm

65
Q

chondrosarcoma –> MC subtype?

A

conventional (intramedullary)

66
Q

chondrosarcoma –> MC imaging appearance?

A
  • medulla –> expansile lesion –> chondroid matrix
  • cortex –> thick –> endosteal scallop
  • assoc ST mass
67
Q

chondrosarcoma –> dedifferentiated subtype –> aggressive –> can contain elements of what other bone lesions?

A
  • fibrosarcoma

- osteosarcoma

68
Q

nonossifying fibroma (fibroxanthoma) –> epidemiology?

A

child & adol

69
Q

differentiate: nonossifying fibroma vs fibrous cortical defect

A

NOF = FCD:

  • > 2cm
  • sympt
70
Q

nonossifying fibroma (fibroxanthoma) –> MC location?

A

long bone –> leg

71
Q

nonossifying fibroma (fibroxanthoma) –> XR appearance?

A
  • narrow zone of transition –> sclerotic margin

- no matrix calc

72
Q

nonossifying fibroma (fibroxanthoma) –> natural progression?

A

adult –> spont sclerotic involution

73
Q

undifferentiated pleomorphic sarcoma not otherwise specified (malig fibrous histiocytoma) –> epidemiology?

A

middle age - older

74
Q

undifferentiated pleomorphic sarcoma not otherwise specified (malig fibrous histiocytoma) –> locations? (3)

A
  • thigh
  • retroperitoneum
  • bone
75
Q

undifferentiated pleomorphic sarcoma not otherwise specified (malig fibrous histiocytoma) –> bone –> imaging appearance?

A

aggressive lytic lesion

76
Q

what is fibrous dysplasia?

A

congenital –> benign non-neoplastic –> normal cancellous bone –> replace abnormal fibrous tissue

77
Q

fibrous dysplasia –> epidemiology?

A
  • child

- YA

78
Q

fibrous dysplasia –> MC comp?

A

femoral neck –> path fx

79
Q

fibrous dysplasia –> long bone –> location?

A

metadiaphysis –> central

80
Q

fibrous dysplasia –> femur –> deformity?

A

shepherds crook

81
Q

YA –> pelvis –> supra-acetabulum –> cystic lesion –> ddx? (2)

A
  • fibrous dysplasia

- unicameral bone cyst

82
Q

McCune-Albright synd –> synd? (3)

A
  • polyostotic fibrous dysplasia
  • precocious puberty
  • cafe au lait spots
83
Q

Mazabraud synd –> synd? (2)

A
  • fibrous dysplasia

- intramusc myxoma

84
Q

vertebral hemangioma –> MRI appear?

A

fat –> T1/T2 bright

85
Q

vertebral hemangioma –> XR/CT –> sign?

A

reactive thicken trabeculae:

  • “corduroy” striation
  • “polka dot”
86
Q

angiosarcoma –> mets location?

87
Q

giant cell tumor –> epidemiology?

A

skeletal mature –> 20-40yo

88
Q

giant cell tumor –> location?

A

long bone –> metaphysis/epiphysis –> articular surface –> eccentric

89
Q

multifocal giant cell tumor –> can be see in what condition? (2)

A
  • Paget dz

- hyperPTH

90
Q

giant cell tumor –> tx?

A
  • curettage

- wide resect

91
Q

Ewing sarcoma –> epidemiology?

A

child & adol –> male predominance

92
Q

child –> aggressive lytic lesion –> ddx? (4)

A
  • Ewing sarcoma
  • osteomyelitis
  • LCH
  • neuroblastoma mets
93
Q

Ewing sarcoma –> XR appearance?

A

agg lesion:

  • permeative bone destruct
  • agg periosteal rxn
  • assoc ST mass
94
Q

mult myeloma (plasmacytoma) –> MC appearance?

A

mult lytic lesions

95
Q

what is sclerosing myelomatosis?

A

uncommon variant of mult myeloma (plasmacytoma)

96
Q

sclerosing myelomatosis –> assoc synd?

A

POEMS synd

97
Q

POEMS synd –> synd? (5)

A
  • polyneuropathy
  • organomeg –> liver/spleen
  • endocrine disturb –> amenorrhea/gynecomastia
  • monoclonal gammopathy
  • skin change –> hirsutism, hyperpig
98
Q

adult –> mult lytic lesion –> ddx? (2)

A
  • mult myeloma

- mets

99
Q

mult myeloma (plasmacytoma) –> originating tissue?

A

red marrow

100
Q

differentiate: mult myeloma vs mets (2)

A

mult myeloma:

  • not involve areas w minimal red marrow –> pedicles
  • bone scan –> can be neg
101
Q

what is plasmacytoma?

A

mult myeloma –> solitary tumor

102
Q

primary bone lymphoma –> epidemiology?

103
Q

vertebral body –> diffusely sclerotic “ivory” –> ddx? (1)

104
Q

lymphoma –> typical imaging appearance?

A
  • agg lytic lesion

- assoc ST mass

105
Q

intraosseous lipoma –> MC locations? (4)

A
  • calcaneus
  • femur –> subtrochanteric
  • distal tibia/fibula
  • metatarsal
106
Q

intraosseous lipoma –> calc appearance?

A

central or ring-like calc

107
Q

lipoma –> contain non-adipose tissue –> ddx? (2)

A
  • benign lipoma

- well-differentiated liposarcoma (atypical lipoma)

108
Q

well-differentiated liposarcoma (atypical lipoma) –> imaging features that suggest liposarcoma? (4)

A
  • > 10cm
  • thick septat
  • globular/nodular soft tissue
  • <75% fat
109
Q

what is chordoma?

A

notochord remnant –> malig lesion

110
Q

chordoma –> location?

A

axial skeleton –> midline:

  • spheno-occipital
  • C2 body
  • sacro-coccyx
111
Q

chordoma –> appearance?

A

high destruct lesion –> irreg scallop border

112
Q

chordoma –> calc or no calc?

A

can have calc (d/t necrosis)

113
Q

simple bone cyst (unicameral bone cyst) –> MOA?

A

child/adol –> bone growth –> local disturb –> benign

114
Q

simple bone cyst (unicameral bone cyst) –> location?

  • MC bone?
  • epi/meta/dia-physis?
  • central vs ecc?
A

humerus/femur –> prox diaphysis –> central

115
Q

differentiate: simple bone cyst (unicameral bone cyst) vs aneurysmal bone cyst:

  • periosteal rxn
  • central vs ecc
A

SBC:

  • no periosteal rxn
  • central

ABC:

  • periosteal rxn
  • central or ecc
116
Q

simple bone cyst (unicameral bone cyst) –> location –> which bones? (5)

A
  • humerus
  • femur
  • tibia
  • calcaneus
  • iliac
117
Q

what bone lesions demonstrate fluid-fluid levels? (4)

A
  • simple bone cyst
  • aneurysmal bone cyst
  • giant cell tumor
  • telangiectatic osteosarcoma
118
Q

pediatric –> proximal humerus –> fallen fragmt sign –> dx?

A

simple bone cyst

119
Q

simple bone cyst –> tx?

A

intra-lesion inject –> methylprednisolone –> osteogenesis

120
Q

what’s inside simple bone cyst?

A
  • fluid

- nothing

121
Q

what is aneurysmal bone cyst?

A

blood-filled sinusoids & solif fibrous element –> expansile multicystic lesion

122
Q

aneurysmal bone cyst –> epidemiology?

A

child & adol

123
Q

agg lesion –> bx –> pathology shows aneurysmal bone cyst –> what does this indicate?

A

true lesion not bx

124
Q

adamantinoma –> what bone?

125
Q

adamantinoma –> ddx? (1)

A

fibrous dysplasia

126
Q

adamantinoma –> imaging feature?

A

“soap bubble” appearance

127
Q

differentiate: mets vs osteoporosis –> compression fx

A

mets –> can involve:

  • pedicle
  • post elements
128
Q

breast cancer –> solitary bone lesion –> high predictive for mets –> what location?

129
Q

bony mets –> lytic –> what primary cancers? (3)

A
  • lung
  • thyroid
  • kidney
130
Q

bony mets –> blastic –> what primary cancers? (5)

A
  • prostate
  • seminoma
  • transitional cell CA
  • mucinous tumor
  • carcinoid
131
Q

bony mets –> lytic and/or blastic –> what primary cancers? (3)

A
  • breast
  • stomach
  • colon
132
Q

what is myositis ossificans?

A

trauma –> skeletal muscle –> heterotopic bone formation

133
Q

myositis ossificans –> MC locations? (2)

A
  • elbow

- thigh

134
Q

myositis ossificans –> ddx? (1)

A

parosteal osteosarcoma

135
Q

differentiate: myositis ossificans vs parosteal osteosarcoma –> calc?

A

myositis ossificans –> peripheral calc

parosteal osteosarcoma –> central calc

136
Q

myositis ossificans –> appearance –> natural progression?

A
  • wk 1-2: soft tissue mass
  • wk 3-4: form amorphous osteoid matrix –> adj bone periosteal rxn (can look like early osteosarcoma)
  • wk 5-8: peripheral –> mature into compact bone
  • <6mo: ossification –> progress to mature
  • > 6mo: decrease in size
137
Q

myositis ossificans –> bx or no bx? why?

A

no bx –> path may resemble sarcoma –> unnecess surg

138
Q

what is brown tumor?

A

hyperPTH –> inc osteoclast activation –> benign lytic lesion

139
Q

brown tumor –> ddx? (1)

A

giant cell tumor

140
Q

hyperPTH –> imaging features? (4)

A
  • brown tumor
  • osteopenia
  • subperiosteal bone resorb
  • ST calc
141
Q

hyperPTH –> subperiosteal bone resorb –> MC location? (2)

A
  • 2nd/3rd middle phalanx –> radial aspect

- clavicle –> acromion

142
Q

2ary hyperPTH –> etiology? (1)

A

renal fail

143
Q

renal fail –> renal osteodystrophy (2ary hyperPTH) –> spine appearance?

A

“rugger jersey” spine

144
Q

epiphysis –> lucent lesion –> ddx? (5)

A

GEIChA:

  • giant cell tumor
  • eosinophilic granuloma
  • infx
  • chondroblastoma
  • aneursymal bone cyst
145
Q

malig tumor at epiphysis –> dx?

A

clear cell chondrosarcoma

146
Q

ABC –> epidemiology?

147
Q

ABC –> MC bone?

148
Q

classic sclerotic mets? (3)

A
  • prostate
  • carcinoid
  • medulloblastoma
149
Q

classic lytic mets? (2)

A
  • renal

- thyroid

150
Q

diffuse ostepenia –> malig ddx? (1)

A

mult myeloma

151
Q

ant tibia –> lesion that looks like non-ossifying fibroma –> assoc ant tibial bowing –> dx?

A

osteofibrous dysplasia

152
Q

pleomorphic undifferentiated sarcoma (malig fibrous histiocytoma) –> T2 signal?

A

dark to interm

153
Q

pleomorphic undifferentiated sarcoma (malig fibrous histiocytoma) –> MC location?

A

prox extremities

154
Q

spine –> post element –> bone lesion –> ddx? (5)

A
  • osteoblastoma
  • ABC
  • osteoid osteoma
  • myeloma
  • mets
155
Q

spine –> vertebral body –> bone lesion –> ddx? (7)

A
  • GCT
  • chordoma
  • LCH
  • Ewing
  • lymphoma
  • myeloma
  • mets

CORE (33 decks)

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