Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSK Radiology > MSK - Bony Lesions > Flashcards

MSK - Bony Lesions Flashcards

1
Q

Causes of osteoblastic mets

A
  • Prostate
  • Breast - often mixed lytic and sclerotic
  • Mucinous tumours
  • Carcinoid
  • Treated lytic mets
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is Ollier’s Disease?

What is Mafucci disease?

A
  • Multiple enchondromatosis, asymmetric distribution, hands, skeletal deformity, predisposed to fracture
  • Non-hereditary
  • Mean age 13 yo
  • Malignant transformation to chondrosarcoma (<5%), by age 40
  • Mafucci = enchondromas + vascular calcifications
  • Higher rate of malignant transformation (up to 25-50%)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Imaging features and location of juxtacortical chondroma (periosteal chrondromas)

A

Chondroid tumours arising from periosteum of tubular bones (#1 proximal humerus/distal femur, #2 phalanges)

Soft tissue mass +/- calcification (chondroid matrix), “saucerisation” of bony cortex with periosteal reaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What percentage of osteochrondromas in HME/diaphyseal aclasia demonstrate malignant transformation to chondrosarcoma? Inheritance pattern? what features are associated with malignant transformation?

A 
Approx. 3-5 % (up to 25%)
NB: each lesion has same risk of transformation as solitary osteochondroma
AD
GLAD-PAST:
G: growth after skeletal maturity
L: lucency (new)
A: additional scintigraphic activity
D: destruction (cortical)
P: pain after puberty
A: and
S: soft tissue mass
T: thickened cartilage cap >1.5 cm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Features of BPOP? What other entity is in the differential diagnosis?

A

Bizarre parosteal osteochondromatous proliferations
(AKA Nora lesions)
- Benign, exophytic osteochrondral lesions
- Hands and feet (proximal, middle phalanges)
- Ddx: osteochrondromas - BPOP arises from cortical bone with lack of medullary involvement and does not point away from physis
- Can recur after surgical excision
- On MRI: hypointense on T1-weighted images, hyperintense on T2-weighted images, and uniformly enhancing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Differentiating feature between glomus tumours and intraosseous epidermal inclusion cysts

A

Location!

  • Glomus - subungal hypervascular nodule
  • EIC - fingertips (tufts) - usu hx of trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which systemic disease typically manifests as lace-like osteolysis in the hands?

A

Sarcoidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Most common primary malignant bony tumour of the hands?

A

Chondrosarcoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Classic epiphyseal lesions (3)

A

GCT (>20 years), chondroblastoma (<20), infection

Rarely clear cell chondrosarcoma in older patient**

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

List the polyostotic bone lesions in kids

A

FEEMHI:

  • Fibrous Dysplasia
  • Enchondromas (Ollier Disease or Maffucci)
  • Eosinophilic Granuloma
  • Mets
  • HyperPTH (Browns Tumours)
  • Infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Causes of secondary ABCs

A

Fibrous dysplasia
Chondroblastoma
GCT
Osteosarcoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Syndrome associated with multiple NOFs

A
  • Jaffe-Campanacci Syndrome (cafe au lait, axillary freckles, and some features of NF 1)
  • High risk for pathologic fracture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Conditions associated with polyostotic fibrous dysplasia

A

McCune-Albright, isolated endocrinopathies, Mazabraud syndrome (fibrous dysplasia + intramuscular myxomas)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Most common primary bone tumours affected the patella

A

Epiphyseal equivalent
Benign: GCT, Chondroblastoma
Malignant: Mets (#1), lymphoma and hematologic malignancies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Features of Trevor disease

A

Male**, osteochondroma formation around joints (at epiphysis), or in epiphyseal equivalents including carpal bones, usu ankle and knee, causes pain and malalignment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Most likely causes of aggressive lytic bone lesion in patient over 40

A

Mets
Myeloma
Lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Most likely causes of aggressive lytic bone lesion in patient under 20

A

LCH
Ewings
Infection**

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Imaging findings osteopoikilosis

A

Multiple bone islands + keloid scars

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Imaging findings osteopathic striata

A

Asymptomatic skeletal dysplasia

Linear bands of sclerosis in long bones (fan like in the pelvis)

20
Q

Osseous findings in Gardner syndrome

A
  • AD Familial polyposis syndrome

- Multiple skull/sinus osteomas, desmoid tumors, fibromatoses

21
Q

Most common location of osteoid osteoma

A

Long bones - femur and tibia**

20% occur in the spine (painful scoliosis, will be on CONCAVE side)

22
Q

DDx. for lytic lesion in posterior elements in young pt

A

Osteoblastoma or ABC

Could also include GCT (can extend into posterior elements, LCH, and mets)

23
Q

Least malignant subtype of osteosarcoma

A

Parosteal sarcoma (90% 5 yr survival)

24
Q

Differences b/w periosteal and paraosteal osteosarcoma

A

PARosteal - arises from OUTER periosteum, post distal femur METAPHYSIS most common, cauliflower like exophytic, best prognosis, older (30-40)

PERIosteal - arises from INNER periosteum, DIAPHYSIS of femur or tibia, broad-based soft tissue mass causing erosion/thickening of cortex, aggressive periosteal reaction, may have high T2 signal (predominantly contains chondroid matrix), younger pt (<20 years)
- on MR, may see reactive marrow changes but frank bony invasion is uncommon

  • ddx: conventional osteosarcoma (but this usually has medullary invasion, and involves entire circumference)
25
Q

Most commonly affected joint in synovial osteochondromatosis

A

Knee (80%) > hip > elbow > shoulder (large joints!)

26
Q

Differentiating features between primary and secondary synovial osteochondromatosis

A

Primary: older age, underlying OA, few bodies, variable sizes
Secondary: numerous fragments, similar in size, variable signal intensity on MR

27
Q

Most common location of enchondromas

A

Small tubular bones of hands and feet (proximal phalanx most common)
Tubular long bones (femur, tibia, humerus)
Rarely, in pelvis, ribs, scapula - consider chondrosarcoma in these locations!

28
Q

Features suggestive of chondrosarcoma over enchondroma and risk of transformation

A

1% risk of transformation in solitary enchondroma
25-30% in multiple enchondromatoses (higher in Maffucci)

  • Cortical breech/thickening
  • Deep endosteal scalloping
  • ST mass
  • Pain
  • Large size >5 cm
  • Permeative/destructive pattern
  • Location (much more likely to be a chondrosarcoma outside hands and feet)
  • Patient age (older = chondrosarcoma)
29
Q

Imaging findings chondroblastoma

A
  • Eccentric, epiphyseal, usually around knee or proximal humerus
  • Skeletally immature!
  • May not see matrix on radiographs, but can on CT
  • Unique bc has low to int signal on T2 unlike other chondroid lesions!!
  • Lots of surrounding bone and ST edema
30
Q

Imaging findings chondromyxoid fibroma

A
  • Eccentric, tibial and femoral metaphysis at the knee
  • Lobulated lesion, rarely demonstrates chondroid matrix
  • Classic sclerotic margin
  • Will have high T2 signal on MR
  • Usually before age 30
  • DDx: ABC, GCT, NOF, chondroblastoma (usually epicentre of this lesion is epiphyseal)
31
Q

Subtypes of chondrosarcoma and distinguishing features

A

Conventional (intramedullary, met/diaphysis long bones)

Juxtacortical (surface lesion arises under periosteum, long bones, posterior distal femur most common; ddx: juxtacortical chondroma, periosteal ostesarcoma)

Clear cell (epiphyseal, proximal femur and humerus, well circumscribed sclerotic margination, slow growing, better prognosis; ddx: chondroblastoma)

Myxoid (most common extra-skeletal chondrosarcoma; occur in deep soft tissue most commonly in the thigh)

Mesenchymal (also both intra and extra-skeletal, younger adults than myxoid for soft tissue involvement, has both small round blue cells and cartilaginous component)

32
Q

Most common adult soft tissue sarcoma

A

Undifferentiated pleomorphic sarcoma (previously MFH)

33
Q

Imaging findings in fibrous dysplasia

A

Lucent lesion, ground glass matrix (sometimes cystic)
Metadiaphyseal, long bones
Also occurs in ribs, pelvis and skull base (ddx: Paget’s - age matters)
Associated with bowing deformity (i.e. Shepherd’s crook)
Risk of fracture

34
Q

Features of McCune-Albright

A

Polyostotic fibrous dysplasia, precocious puberty, cafe au lait spots

35
Q

Features of Mazabraud syndrome

A

Fibrous dysplasia + intramuscular myxomas

36
Q

Findings in LCH

A

Lytic lesion children 5-10 years
Skull: lytic lesion with beveled edge (inner table involved more than outer table)
Mandible/maxilla: bony resorption - floating tooth
Spine: vertebra plana
Long bones: destructive permeative lesion with aggressive periosteal reaction (often lamellated); metadiaphyseal - going to be in ddx with Ewings

37
Q

Most common paediatric primary bone tumours

A

1) Osteosarcoma

2) Ewings

38
Q

Imaging findings in Ewings

A

Permeative, destructive lesion, large ST component, aggressive periosteal reaction (onion-skin, codmans), sclerosis
Most often in long bones (femur/tib/humerus); 40% flat bones including ribs and scapula
Older age group than LCH - 10-20 years (teenagers)
Almost always metaphyseal or diaphyseal

If outside knee, the consider Ewings over osteosarcoma unless there is clear osteoid matrix

DDx: infection, LCH, mets, osteosarcoma, hematologic malignancy (lymphoma, leukemia)

39
Q

Most common primary bone tumour in patient over 40

A

Multiple myeloma

40
Q

What is POEMS syndrome?

A 
Paraneoplastic syndrome related to plasma cell dyscrasia
POLYNEUROPATHY
ORGANOMEGALY
ENDOCRINOPATHY
MONOCLONAL GAMMOPATHY
SKIN CHANGES

Associated with SCLEROTIC myeloma

41
Q

Primary bone lymphoma findings

A

Long segment of involvement; most often permeative, can be sclerotic
Often has adjacent ST mass
In ddx. for ivory vertebra

42
Q

Most common location of intraosseous lipoma

A

Calcaneus, subtrochanteric region of femur, distal tibia/femur, metatarsals

43
Q

Imaging features of SBC

A

Usually central, prox diaphysis of humerus or femur (other locations tibia, calcaneus, iliac bone)
Fallen fragment
May have fluid fluid levels

44
Q

Imaging features ABC

A

Eccentric, often within the metaphysis of long bones and 20% post elements
Buttressing smooth periosteal reaction
Fluid fluid levels

45
Q

Causes of lytic metastases

A
  • Lung (most often purely lytic)
  • Breast (lytic or blastic)
  • Hypervascular tumours (renal, thyroid, etc.)
  • Stomach, colon (lytic or blastic)
46
Q

DDx for fluid fluid levels on MRI

A

ABC (primary, secondary), GCT, simple bone cyst after fracture, chrondroblastoma, telangiectactic osteosarcoma

47
Q

Ddx lytic lesion anterior tibial cortex

A

Adamantinoma - aggressive, intramedullary extension

Osteofibrous dysplasia - less aggressive, may be multiple and have gg matrix

MSK Radiology (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions