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radiology > MSK neoplasms > Flashcards

MSK neoplasms Flashcards

1
Q

MC 1˚ osseous malignancies

A

MM/plasmacytoma (27%), OS (20%), CS (20%)

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2
Q

how much trabecular bone is destroyed before you can see it?

A

70%

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3
Q

what demonstrates permeative & moth eaten app?

A

myelin, lymphoma, ewings, OM, hyperPTH

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4
Q

4 main subtypes OS to know

A

1) conventional intramedullary (85%, higher grade than surface types)
2) parosteal (4%)
3) periosteal (1%)
4) telangiectatic (rare)

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5
Q

Difference btw trabecular vs cortical bone loss

A

Trabecular more rapidly but noticed later bc cortical bones more smooth & orgz

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6
Q

conventional intramedullary-1˚ vs 2˚, where, bf’s, classic met

A
  • 1˚ 10-20 yr old
  • femur (40%), prox tibia (15%)
  • skip lesions, lung (occult PTX)
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7
Q

class OS PW

A

xray –> bone scan + Chest CT –> MRI (entire bone for skip lesions, bx planning) –> bx –> neoadjuvant chemo –> restage, re biopsy –> surgery –> adjuvant chemo –> f/u (2 yrs)

  • re-biopsy: predicts outcome (90% tumor death = good)
  • 2 yr f/u: 80% relapse –> lung. 20%–> bone
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8
Q

Parosteal OS

A

low grade, bulky/big

  • pst distal femur (mimic cortical dermoid tug lesion early on )
  • meatphyseal 90%
  • string sign-radiolucent line sep bulky tumor from cortex.
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9
Q

sunburst pattern

A

aggressive periosteal run looks like sunburst

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10
Q

“reverse zoning phenomenon”

A

denser mature matrix in center, less peripherally (opposite of myositis ossificans)

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11
Q

BWs aggressive periosteal reactions

A
  • Sunburst
  • Reverse zoning phenomenon
  • Lamellated
  • Codman triangle
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12
Q

“lamellated”/onion skin rxn

A

multi layers of parallel peritoneum

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13
Q

Codman triangle

A

edge of raised periosteum ossifies creating appearance of triangle

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14
Q

parosteal vs periosteal osteosarcomas- who, where, marrow ext, grade/outcome

A
  • Parosteal: early adult/middle age, metaphyseal, pst distal femur, marrow ext 50%, low grade, extends OUTWARD
  • Periosteal: 15-25 yo, diaphysial, medial distal femur, no marrow extension, intermediate grade (worse outcome)
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15
Q

Telangiectatic OS-classic app

A
  • 15% narrow zone
  • Rgx: cystic
  • MR: F/F levels, T1+ (methemoglobin)
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16
Q

Order of OS grade/outcome

A 
Parosteal
Periosteal
Telangectatic
Classic
2˚
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17
Q

Ewing’s

A
  • 2nd MC 1˚bone malignancy in peds. ~15 yo. Rare in AA
  • metadiaphysis –> diaph –> metaph
  • permeative, moth eaten. +lamellated, ST 80% (Ca-)
  • met –> bone (spine) (MC), lung
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18
Q

MC sarcoma to met to bone

A

Ewings

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19
Q

chondrosarcoma-what, RFs, where, met, matrix

A
  • low grade tumor in older adults (40-70), M > F
  • RFs: Paget’s, anything cartilaginous (OC, Maffucci), etc)
  • proximal tubular bones (more abundant cartilage) & limb girdles (triradiate cartilage in pelvis)
  • central (intramedullary) or peripheral (at end of osteochondroma)
  • met –> lung
  • “changing matrix”-vs enchondroma
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20
Q

chordoma

A
  • adults 30-60 yr old
  • sacrum (slightly older), clivus (slightly younger), VB (C2)
  • midline, T2+++
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21
Q

MC 1˚ malignancy of spine

A

chordoma

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22
Q

MC 1˚ malignancy of sacrum

A

chordoma

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23
Q

where in spine does chordoma occ

A

VB C2

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24
Q

Enchondroma vs low grade chondrosarcoma-what favors chondrosarcoma?: pain, cortex, size, matrix

A
  • Pain
  • Cortical destruction (scalloping >2/3),
  • > 5cm
  • changing matrix
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25
Q

Lucent Lesions: FOGMACHINES

A
  • Fibrous dysplasia
  • OB
  • GCT
  • Mets
  • ABC
  • CB
  • hyper PTH
  • inf
  • NOF
  • Enchondroma/eusinphilic granuloma
  • Simple (unicameral) bone cyst
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26
Q

Lucent lesions based on age

A
  • <30 yo: EG, ABC, NOF, CB, UBC
  • any age: inf
  • > 40 yo: mets/myeloma (unless NB met)
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27
Q

Epiphyseal equivalents

A
  • carpals
  • patella
  • greater trochanter
  • calcaneus
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28
Q

Epiphyseal lesions: AIGC

A
  • abc (after GP closes it ext from metaph)
  • Inf
  • GCT
  • CB & clear cell CS
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29
Q

malignant epiphyseal lesion

A

-clear cell chondrosarcoma

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30
Q

what part of bone do mets go

A

metaph (greatest bs) –> diaphysis

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31
Q

fibrous dysplasia-what, phases, app, where

A

-skeletal developmental anomaly of OB-failure of normal maturation & differentiation–> repl N medullary space

  • phases: lytic, mixed, blastic
  • polyostotic & monoostotic (rib mc)
  • long lesion, gg matrix. PR-, pain
  • polyostotic: skull, face (lion-like faces); <10 yr old. mangled face, syndromic
  • long bones, ribs, pelvis –> IL femur (shepherd crook deformity)

T1: heterogeneous signal, usually intermediate
T2: heterogeneous signal, usually low, but may have regions of higher signal
T1 C+ (Gd): heterogeneous contrast enhancement 4

Tc MDP+

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32
Q

shepherd crook

A
  • coxa varus angulation

- FD (classic), Paget, OI

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33
Q

monostotic vs polyostotic FD

A
  • monastic (20-30 yos)

- multiple lesion=<10 yr old, syndromes (McCune Albright_

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34
Q

McCune albright

A
  • polyostotic FD
  • Cafe Aurait spots
  • precocious puberty
  • girl
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35
Q

Mazabraud

A
  • polyostocic FD
  • ST myxoma
  • (+) risk osseous malignant transformation
  • middle aged F
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36
Q

adamantinoma-what, where, app

A
  • v rare, low grade malignant tibial lesion
  • soap bubble
  • resembles FD (mixed lytic & sclerotic)
  • mal pot
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37
Q

non ossifying fibroma (NOF), fibrous cortical defect- what, who, where, app (before regression), mx

A
  • non-neoplastic fibrous org
  • children (Rare before walking)
  • knee
  • app: eccentric, thin sclerotic border
  • spon’t regress (more sclerotic bf disappearing)
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38
Q

Bone forming (osteo-) lesions

A
  • Enostosis
  • osteoma
  • melorheostosis
  • osteoid osteoma
  • OB
  • OS
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39
Q

Cartilage forming (Chondo-) lesions

A
  • synovial chondromatosis/osteochondromatosis
  • endochondroma
  • osteochondroma
  • CB
  • chondromyxoid fibroma
  • CS
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40
Q

Fibrous origin lesions

A
  • fibroxanthomas: NOF, FCD
  • Malignant fibrous histiocytoma
  • FD
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41
Q

lesions of unknown cell org

A
  • SBC/UBC
  • ABC
  • adamantinoma
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42
Q

lesions of vascular org

A
  • hemangioma

- angiosarcoma of bone

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43
Q

lesions of hematopoietic orgn

A
  • GCT/osteoclastoma)
  • eusinophilic granuloma (Langerhands)
  • Ewing sarcoma
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44
Q

fibroxanthomas

A

waste basket term for NOF (>2-3cm) & FCD (<2cm)

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45
Q

Jaffe-campanacci syndrome

A

multiple NOFs, cafe-au-lait spots, MR, hypogonadism, cardiac malformations

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46
Q

enchondroma

A
  • tumor of medullary cavity composed of hyaline cartilage
  • MC w/ age (peak: 10-30 yo)

-metaphysis long bones. Skull/spine spared

  • app
    • fingers/toes: lytic
    • humerus, femur: arcs & rings
    • chondroid comp = T1-, T2+ lobular lesions
  • multiple? (esp hands)-syndromes: Ollier dx & maffucci syndrome
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47
Q

mc cystic lesions in hands/feet

A

enchondroma

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48
Q

Ollier disease

A

-multiple enchondromas (3+)

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49
Q

Maffucci syndrome

A
  • multiple enchondromas
  • hemangiomas
  • greater risk CS than older
  • Marfucci has More (CA & vascular malform)
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50
Q

syndromes ass w/ multiple enchondromas

A
  • Ollier disease

- Maffucci syndrome

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51
Q

Eusinophilic granuloma/LCH

A

benign prol of histiocytes

  • <30 yo (peak 5-10 yo)
  • var appearance
    • solitary (mc), mult
    • lytic, blastic
    • +/- sclerotic border
    • +/- periosteal resp
    • +/- osseous sequestrum
  • bone –> skin –> CNS, HB/spleen, lungs, LN/ST, BM, SG, GI
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52
Q

3 classic appearances eusinophilic granuloma

A

1) vertebra plana
2) beveled edge
3) floating tooth w/ lytic lesion in alveolar ridge

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53
Q

Ddx vertebra plana (MELT)

A
  • Mets/Myeloma
  • EG
  • Lymphoma
  • Trauma/Tb
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54
Q

Ddx osseous sequestrum

A

OM
Lymphoma
Fibrosaroma
EG

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55
Q

Giant cell tumor (GCT)

A
  • 20-30 yo; physis MUST be closed
  • knee
  • non sclerotic border (vs NOF), abuts articular surface
  • locally invasive, pulm met (5%)
  • ass w/ ABC (
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56
Q

osteoid osteoma-who, app, loc

A
  • adolescent (10-25%)
  • Lucent nidus surr by dense sclerotic cortical bone
  • Loc
    • meta/diaphysis long bone (femora neck=MC)
    • pst spine (L > C > T)
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57
Q

associations of osteoid osteoma

A
  • painful scoliosis, convexity pointed away from lesion
  • growth deformity-increased length & girth of long bones
  • synovitis- if intra-articular, JE
  • arthritis- from 1˚synovitis or altered joint mechanics
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58
Q

“large amount of edema for size of lesion”

A
  • osteoid osteoma

- edema can involve ST

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59
Q

osteoid osteoma nuclear med sign

A

“double density sign”-cnetral activity surr by less intense reactive bone

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60
Q

OO vs stress fx on nuc medicine

A

stress fx= linear

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61
Q

Rx OO-CI/relative CI

A

percutaneous radio frequency ablation

  • can’t be w/I 2 cm of nerve or other vital structure
  • typically avoided in hands, spine, pregnant pts
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62
Q

osteoblastoma-what, who, where

A

OO > 2cm

  • <30 yo
  • pst elements MC
  • long bones 35% (diaphysis 75%)
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63
Q

Ddx Lucent lesion in pst element spine

A

OB
ABC
Met

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64
Q

abc-who, where, app

A
  • 1˚ or 2˚(classically GCT, other benign lesions)
  • anuerysmal lesion of bone w/ thin wall, blood filled space
  • <30 yr old
  • Tib > Vert> femur> humerus
  • img: T2+, septal enh, F/F
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65
Q

solitary (unicameral) bone cyst

A
  • CENTRAL in tubular bone
  • fallen fragment sign
  • <30 yo
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66
Q

brown tumor (hyperPTH)-what, who, where

A
  • accumulation giant cells and fibrous tissue
  • lytic or sclerotic
  • subperiosteal bone resorption
  • side of finger, edge of clavicle, rib
  • difference stages healing/sclerosisL resorb –> sclerotic when healed
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67
Q

chondroblastoma-who, where, app, mx

A
  • epiphyseal lesion 5-25 yo
  • femur (greater trochanter) > humerus > tibia
  • thin sclerotic rim, ext across physical plate (25-50%), periostitis (30%)
  • bmarrow & ST edema-misleading for bad thing
  • ONE OF ONLY TUMORS THAT”S NOT T2+
  • mx-resection (reocc 30%)
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68
Q

chondromyoid fibroma

A
  • rare bening cartilagenous tumor
  • <30 yo
  • tibia metaphysis
  • osteolytic, elongated, eccentric, cortical expansion _ bite like configuration
  • looks like NOF
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69
Q

what is special about chondroblastoma

A

one of only tumors that’s not T2+

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70
Q

least common benign lesion of cartilage

A

Chondromyoxid fibroma

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71
Q

avulsion fracture lesser trochanter

A

pathologic fx

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72
Q

pathology of intertrochanteric region

A

lipoma
SBC
FD (monostotic)

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73
Q

POEMS

A

rare medical syndrome w/ plasma cell proliferation (typically myeloma), neuropathy, organomegaly

  • Polyneuropathy
  • Organomegaly
  • endocrinopathy
  • M-protein
  • Skin lesions
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74
Q

liposclerosing myxofibroma-most classic location, app, malignant degeneration

A

-benign fibro-osseous lesion made of a mixture of histo elements (lipoma, myxoma, myxofibroma, fibroxanthoma, FD-like features, cyst formation, ischemic ossifications, cartilage)

  • intertrochanteric region
  • geographic lytic lesion, sclerotic margin

-10% malignant degeneration-follow

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75
Q

osteochondroma/exostosis what, malignant potential (based on what?)

A
  • cartilagenous forming developmental anomaly/tumor pointing away from joint
  • MC benign tumor.
  • bmarrow flows into it
  • mal pot very small-cap >1.5 cm
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76
Q

exostosis and enostosis

A
  • exostosis=cartilagenous forming bony protrusion

- bone island

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77
Q

only benign tumor associated with radiation

A

exostosis

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78
Q

multiple hereditary exostosis

A

AD condition w/ multiple osteochondromas

  • sessile or pedunculated
  • (+) risk malignant transformation
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79
Q

Trevor Disease/Dysplasia epiphyseal hemimelica (DEH)-what, who, where, app, mx

A

osteochondromas at epiphysis –> joint deformity

  • ankle, knee (bad soccer players)
  • young children
  • cartilagenous irregular mass, point INTO joint
  • mx-surgical excision
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80
Q

supracondylar spur (Avian spur)

A
  • Aunt minnie, normal variant
  • osseous process at medial supracondylar humerus
  • point into joint
  • compress median n if ligament of strutters smashes it
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81
Q

peripsteal chondroma (juxxta-cortical chondroma)

A
  • rare cartilagenous lesion in finger of child

- saucerization of adj cortex w/ sclerotic periosteal rxn

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82
Q

osteofibrous dysplasia

A
  • developmental tumor-like, fibroosseous condition
  • benign lesion in tib/fib of child <10 yo
  • spon’t regression

-almost exclusively in ANT TIB DIAPH

  • ant tibial bowing
  • char sclerotic band
  • can occ with adamantinoma, looks like NOF

-indis from NOF, FD, adamantinoma

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83
Q

NOF in anterior tibia w/ anterior bowing

A

osteofibrous dysplasia

84
Q

distal femoral metaphyseal irregularity/cortical desmoid-what, where, mx, Mao, bw

A
  • lucency at pst lat distal femoral metaph (BL).
  • incidental- Do not touch. No further img
  • BW: “scoop like defect”
  • likely MOA: chronic tug lesion from adductor magnus
85
Q

“scoop like defect”

A

distal femoral metaphyseal irregularity/cortical desmoid

86
Q

most pathologic calcification in the body

A

calcium hydroxyapatite

87
Q

most abundant form of calcium in bone

A

calcium hydroxyapatite

88
Q

calcific tendinitis

A

-Ca hydroxyapatite deposition disease. 1˚or 2˚

89
Q

MC locs calcific tendinitis

A
  • MC=supraspinatus tenon at insertion near greater tuberosity
  • longus colli m (ant to atlas–> T3)
90
Q

2˚ causes calcific tendinitis

A
  • chronic renal dx
  • collagen vascular dx
  • tumoral calcinosis
  • hypervitaminosis D
91
Q

osteopoikilosis

A
  • mult bone islands in epiphyses
  • inherited (AD) or sporadic
  • joint centered (vs mets)
  • keloid formers
92
Q

osteopathic striata

A
  • linear, parallel and long lines in metaph of long bones

- +/- pain

93
Q

engelmann’s disease/progressive diaphysial dysplasia (PDD)

A
  • fusiform bony enlargement + sclerosis long bones
  • childhood
  • BL, symmetric
  • bone scan hot
  • loc
    • tibia-MC
    • skull –> optic n compression
94
Q

thalassemia vs sickle cell

A

Thalassemia will obliterate sinuses, SCD will not

95
Q

thalassemia buzzwords

A
  • hair on end
  • rodent faces
  • jail bars
96
Q

Causes AVN hip

A

Perthes

  • SCD
  • Gaucher’s
  • steroids
  • trauma (femoral neck fx-degree of risk related to degree of displacement & disruption reticular less’)
97
Q

where does avn hip usually start

A

superoant articular surface

98
Q

double line sign AVN hip

A

inner T2+ (granulation tissue) + outer dark (sclerotic border)

99
Q

rim sign AVN hip

A

T2+ sandwiched btw two T2(-)=fluid btw sclerotic borders of osteochondral fragmentation ==> instab

100
Q

crescent sign AVN hip

A

Xray subchondral lucency in anterolat aspect of proximal femoral head. indicates imminent collapse

101
Q

plain film stages osteonecrosis

A 
0=N
1= Xray N. MRI edema
2= mixed lytic & sclerotic
3= crescent sign, articular collapse, joint space preserved
4= 2˚ OA
102
Q

Paget’s dx/osteitis deformans-incidence, epidemiology

A
  • 4% at 40, 8% at 80

- M > F

103
Q

paget’s 3 phases

A

1) lytic
2) mixed (reparative)
3) sclerotic (latent inactive)

104
Q

“wide bones with thick trabecular”

105
Q

sgx’s and syx’s ass w/ paget phases

A

1) lytic-usually asyx
2) mixed (reparative)- ALP+ 20x, fx
3) sclerotic-hydroxyproline+, fx+, sarcomas

106
Q

blade of grass sign

A

Paget’s. Lucent leading edge in a long bone

107
Q

osteoporosis circumscripta

A

Paget’s. Lucent leading edge in frontal/occipital skull

108
Q

picture frame vertebra

A

Paget’s. Cortex expanded on all sides

109
Q

Cotton wool bone

A

Paget’s. Thick disorganized trabeculae

110
Q

Banana fracture

A

Paget’s. Insufficiency fx of bowed soft bone (femur or tibia)

111
Q

tam o’shanter sgx

A

Paget’s. Thick skull w/ front aspect “falling over the facial bones”

112
Q

Saber shin

A

Paget’s. Bowing of tibia.

113
Q

Ivory vertebra

A

Paget’s & mets. Pagets=expansile

114
Q

Paget’s complications

A

Deafness-mc

  • spinal stenosis-characteristic
  • cortical stress fx
  • CN paresis
  • CHF (high output)
  • 2˚hyperPTH (10%)
  • 2˚OS (1%), GCT
115
Q

paget’s on bone scan

A

hyper vascular, 5˚ hotter than other bone

116
Q

what part of skull does Paget’s involve

A

inner and outer tables (vs FD)

117
Q

MC bone involved in Pagets. Compl’s

A

Pelvis

  • always involves iliopectineal line on pelvic brim
  • 2˚ OA, acetabular protrusion
  • classic look on scan
118
Q

rugger jersey spine

A

top and bottom VB

-renal osteodystrophy, oteopetrosis

119
Q

osteopetrosis

A

genetic dx w/ impaired osteoclastic resorption

  • thick cortical bone w/ diminished marrow
  • rugger jersey or sandwich vertebra
  • dark T1 (loss of normal marrow)
120
Q

“widening of disc space” aka

A

“h-shaped vertebrae”

121
Q

Paget’s different phases MRI appearance

A

1) lytic/eary mixed-T2 hetero. T1 iso w/ speckled app
2) late mixed-T1/2+ (fatty)
3) sclerotic-T1/2-

122
Q

Paget active dx vs malignant transformation

A
  • loss of T1 signal w/ cancer

- both T2+, enh

123
Q

paget’s nuclear medicine

A

-hot on all 3 phase bone scan

124
Q

Why are soft tissue masses not accurately diagnosed on MRI?

A

20-30% bc almost all are T2+, enh

125
Q

soft tissue masses to know

A
  • Malignant fibrous histiocytoma (MFH)
  • synovial sarcoma
  • lipoma, atypical lipoma, liposarcoma
  • hemangioma
  • myxoma
126
Q

malignant fibrous histiocytoma/pleomorphic undifferentiated sarcoma-who, where, app, ass, RFs

A

Undifferentiated pleomorphic sarcoma (UPS), previously known as malignant fibrous histiocytoma (MFH), is considered the most common type of soft tissue sarcoma. It has an aggressive biological behavior and a poor prognosis.

  • older
  • central loc (proximal arm & leg)
  • T2- (50%) (“fibrous”
  • spon’t hem (outgrow bs)
  • 2˚=bone infarcts, radiation
127
Q

“sarcomatous transformation of infarct”

A

malignant fibrous histiocytoma (MFH)/Pleomorphic undifferentiated sarcoma (“pus”)

128
Q

synovial sarcoma-who, where, img, translocation

A
  • 20-40 yos (mc malignancy in teens/young adults of foot/ankle/LE)
  • translocation of X18 (90%)
  • peripheral LEs, close to joint; foot, ankle, LE (knee)
  • 2˚ invasion into joint (10%)-just remember they never involve joint
  • img: small (slow growing), ST mass, Ca+, bone erosion
    • triple sign-T2 high, medium, low signal in same mass (probably at knee)
    • bowl of grapes-fluid levels in mass (probably in knee)
    • xray ST mass + Ca
129
Q

synovial sarcoma vs baker’s cyst

A

sarcoma. ..
- complex
- blood flow

130
Q

Synovial sarcoma vs other sarcomas

A

attacks bone, causes pain

131
Q

“ball like tumor” in extremity of young adult

A

synovial sarcoma

132
Q

ST tumor in food of young adult

A

synovial sarcoma

133
Q

MFH (PUS) vs synovia sarcoma

A
  • MFH-old, central, T2 variable

- SS-young, per, T2 triple sign

134
Q

MC liposarcoma <20 yo

A

myxoid liposarcoma

135
Q

spectrum fat containing ST masses

A

lipoma –> atypical lipoma –> liposarcoma

136
Q

lipoma vs atypical lipoma/low grade liposarcoma vs high grade liposarcoma

A
  • lipoma-Super. Completely fat sat, no sept
  • AL/LGL- may incomp fat sat, thick chunky sept
  • HGL- Deep. Incompl/no fat sat/, thick nodular complex enhancing content. +/- fat. Deep
137
Q

T/F: hemangiomas respect fascial boundaries

138
Q

mazabraud syndrome

A
  • polyostotic fibrous dysplasia

- mult ST myxomas

139
Q

myoma

A

T2+, T1-

-ass w/ mazabraud syndrome

140
Q

mx GCT

A

arthroplasty (bc ext to articular surf)

141
Q

pigmented villonodular synovitis (PVNS)-what, who, where, app, rx, recurrence rate

A
  • small nodules lining synovium, synovial proliferation + hemosiderin dep (via tendency to bleed)
  • adults (polyarticular in kids)
  • focal or diffuse
  • intraarticular, knee 65-80%
  • osseous erosion w/ preservation of joint space and normal mineralization
  • tendency to bleed –> hemosiderin –> blooming, low sign
  • T1/T2(-), blooming
  • (+) large hemorrhagic joint effusion
  • Ca (late)
  • rx=synovectomy
  • recurr 20-50%
142
Q

GCT of the tendon sheath/PVNS of the tendon

A

hand (palmar)
2nd MC ST mass of hand/wrist (after ganglion)

  • T1/T2(-)
  • diffusely/avid enh

-vs glomus tumor: T1(-), *T2+, enh

143
Q

1˚ synovial chondromatosis

A
  • 1˚ or 2˚(from OA). Non-inflamm metaplastic/true Neo
  • mult cartilaginous nodules in synovium of joints, tendon sheaths, bursae–> loose bodies. +/- Ca
  • knee (70%)
  • 40s-50s
  • rx-removal LBs +/0 synovectomy
144
Q

PVNS vs synovial chondromatosis

A
  • PVNS-hemarthosis, never Ca

- SC-no hemarthosis, +/- Ca

145
Q

1˚ vs 2˚ synovial chodnromatosis

A

2˚ loose bodies fewer, larger; extensive degen

146
Q

diabetic myonecrosis-who, where, app, bx?

A
  • muscle infarction in poorly controlled DM 1
  • thigh (80%), calf (20%)
  • edema, enh, irregular m necross
  • no bx-delays recovery, compl++
147
Q

lipoma arborescents

A

frond-like depo fatty tissue in synovial lining of joints, bursa

  • suprapatellar bursa knee. Normal knee or ass w/ OA, chronic RA, trauma. UL
  • 50-70s
  • img=fat
148
Q

tumoral calcinosis

A
  • Hereditary phosphate metabolism (Ca normal, P isn’t.)
  • big lobular/cystic Ca near joint.
  • Layering fluid/Ca levels. No erosion/destruction joint.
  • Hip (greater trochanteric bursa), elbow, shoulder (knee rare)
149
Q

tumoral calcinais vs metastatic Ca

A

look sim but labs different

150
Q

what to avoid when biopsying pelvis

A

-gluteal m’s (may need for reconstruction)

151
Q

what to avoid when biopsying knee

A
  • crossing joint space via supra patellar or other communicating bursae
  • quadriceps tendon (unless involved)
152
Q

what to avoid when biopsying shoulder

A

pst 2/3 (axillary n courses pst –> ant== may denervate ant 1/3 of nerve)

153
Q

don’t touch lesions

A
  • myositis ossificans
  • avulsion injury
  • cortical desmoid
  • synovial herniation pit (“Pitt’s pit)
154
Q

synovial herniation pit (“Pitt’s pit)

A

lytic appearing lesion ass w/ femoral acetabular impingement syndrome

155
Q

metastatic Ca

A
  • MOA=hypercalcemia

- fine and diffuse ST Ca + renal/lung Ca

156
Q

non ossifying fibroma aka

A

fibrous cortical defect

fibroxanthoma

157
Q

mx NOF

A

curettage and bone graft-if indicated (ex: patho fx)

158
Q

chondroid matrix

A

Calcifications in chondroid tumors have many descriptions: rings-and-arcs, popcorn, focal stippled or flocculent.

159
Q

osteoid matrix

A

trabecular ossification pattern in benign bone-forming lesions and as a cloud-like or ill-defined amorphous pattern in osteosarcomas.

160
Q

plasmacytoma

A

proliferation of plasma cells

-lytic lesions + ST mass

161
Q

myxoma

A
  • intramuscular tumor, mc in thigh, butt, shoulder girdle
  • char T2+, T1 (-)/~
    • hypointense sept, nods
    • hetero enh
162
Q

Gorham disease/ Gorham massive osteolysis/ gorham-stout syndrome/ disappearing bone disease

A
  • rare vascular disorder of lymphatic etiology
  • bone resorption + ST change at skel site + splenic cysts

Bone:

  • spon’t, progressive resorption of bone
  • MC=skull, shoulder, pelvis
  • usually single bone –> regional (no regard for boundaries)
  • hx trauma
  • +patho fx

-splenic lesions/cyst

ST change at site of skeletal involvement

163
Q

plantar fibromatosis

A
  • fibroblastic and myofibroblastic tumor
  • plantar fascia of foot, BL 20-50%
  • M>F

MR:

  • T1 (-)/~
  • T2 hetero
  • enh+ hetero

-US: hetero hypoecho

164
Q

paraosteal osteochondromatous proliferation/ “Nora lesion”

A
  • rare, exophytic growths from osseous cortical surfs,
  • bone, cartilage & fibrous tissue
  • post reparative vs benign neoplastic
165
Q

parosteal osteosarcoma vs myositis ossificans

A
  • PS: centrally most dense

- MO: peripherally most dense

166
Q

telangiectatic OS vs ABC

A

OS:

1) thick nodular separations, surrounding ST comp (best demonstrated on contrast+ CT or MRI
2) matrix mineralization in the lesion
3) aggr fx’s, ex: cortical destruction

167
Q

glomus tumor

A

benign sublingual tumor (hamartoma) developing from neuromyoarterial gloms bodies)

  • T2+, T1-, richly vascular (MRI/MA)
  • mx- surgical excision (complete resolution of syx’s after!)
168
Q

patellar lesions

A
  • end of bone
  • benign (usually)

-CB –> GCT

169
Q

sclerotic MM ass

A

rare

-ass w/ POEMS

170
Q

periosteal chondroma/ juxtacortical chondroma

A
  • benign cartilage tumor arising on surface of bone deep to periosteum
  • metaph of long bones
  • saucerization of cortex, sclerotic margination, dense periosteal rxn
  • +matrix

-T1, T2- (chondroid composition)

171
Q

hemangiopericytoma/ solitary fibrous tumor

A
  • heterog group of benign and malignant spindle cell neoplasms
  • staghorn branching pattern
  • hypoglc and osteomalacia
172
Q

bx shoulder lesion

173
Q

bx prox tvb metaph

174
Q

Pannus Rheumatoid Arthritis

A

synovial inflammatory mass posterior to C2 and surrounding the dens in association with odontoid erosion.

175
Q

Typical patient age range for tumors

A

<20 yo
20-40
40

176
Q

typical skel loc descriptors for tumors

A
  • flat vs tubular
  • epiphyseal vs metaphyseal vs diaphyseal
  • medullary vs cortical
177
Q

True of false: the margin of lesion and type of periosteal reaction indicate benign vs malignant

A

False. It indications lesion aggression

178
Q

Bone lesions with age predilection <20: benign & mal

A

Benign:

  • fibrous cortical defect, NOF, SBC, ABC
  • LCH
  • OB, OO
  • osteofibrous dysplasia
  • chondromyxoid fibroma
  • fibrous dysplasia
  • enchondroma

Malignant:

  • leukemia, ES, HL
  • OS (conventional, periosteal, telangiectatic.)
  • mets (rare)
  • NB, RB
  • rhabdomyosarcoma
179
Q

Bone lesions with age predilection 20-40: benign & mal

A

Benign:

  • enchondroma
  • GCT
  • OB, OO
  • chondromyxoid fibroma
  • FD

Mal:

  • OS (periosteal)
  • adamantinoma
180
Q

Bone lesions with age predilection >40: benign & mal

A

Benign:

  • FD
  • Paget disease
  • NHL
  • chondrosarcoma
  • malignant fibrous histiocytoma
  • osteosarcoma (secondary to Paget disease and radiation)

Mal:

  • mets (MC)
  • MM
181
Q

The specific radiographic features that should be evaluated

A

tumor location, margins and zone of

transition, periosteal reaction, mineralization, size and number of lesions, and presence of a soft-tissue component.

182
Q

the most important piece of clinical information

when assessing a bone tumor

183
Q

why does OS have predilection for metaph and why does ES have predilection for red marrow?

A 
some
tumors (eg, osteosarcoma) have a predilection for sites of rapid bone growth,
usually the metaphyseal region, while
other tumors (eg, Ewing sarcoma) tend
to follow the distribution of red marrow
184
Q

Apophysis

A

(a growth center that
does not contribute to the length of a
bone) is the equivalent of an epiphysis

185
Q

Describing margins

A

Focal & discrete=
Type 1= “geographic”
-1a-well defined border with sclerotic rim
-1b-focal lytic lesion with ill-defined border

Infiltrative=

  • Type 2: “moth-eathen”
  • Type 3: “permeative”

-from least to most aggressive appearing

186
Q

benign but aggressive appearing lesions

187
Q

well defined margin but mal

188
Q

Why are they called “ small round blue cell group”

A

histologic appearance on hematoxylin and eosin stained specimens
*OM and LCH also look “blue”

189
Q

classic “permeative” lesions

A

small round blue cell grp (ES, lymphoma)-small enough to fit through the haversian canals

190
Q

patterns of periosteal rxn

A

1) solid, unilamellated- nonaggressive.
- Slow growing allowing bone to wall it off
2) multilamellated (onionskin)-intermediately aggressive
- Wax & wane such that bone continually trying to wall off but cannot.
3) Interruption (regional disruption)-aggressive
- Has broken through the periosteum
4) spiculated, hair-on-end (T to cortex), sunburst-most aggressive

191
Q

codman triangle-what, what lesions

A
  • elevation of periosteum away from cortex with angle formed where elevated periosteum and bone come togehter
  • conventional OS
  • inf, subperiosteal hematoma
192
Q

How does sequestrum form

A

diestructive process caues fragment of bon e(sequestrum) to become stuck in lytic region

193
Q

trabecular patterns of:

  • ABC, desmoplastic fibroma
  • PD
  • hemangioma
A
  • ABC, DF: honeycomb
  • PD: coarse
  • hemangioma: Sunburst/spoke-and-wheel in long bone. “Corderoy” (vertically oriented, coarsened) in VB
194
Q

matrix

A

type of tissue of tumor:

  • osteoid
  • chondral
  • fibrous
  • adipose
195
Q

mineralization

A

calcification of matrix

196
Q

mineralized chondral tissue/cartilate

A

punctate, flocculent, comma-shaped, arclike/ringlike

197
Q

mineralization of bone

A

fluffy
amorphous
cloudlike

198
Q

mets vs osteopoikolosis

A

OPK=same size, centered around joints

199
Q

mult lytic lesions >40 yo

A
  • mets
  • mm
  • NHL
  • brown tumors
200
Q

pathophys of lytic expansile/”soap bubble” appearanc

A

slow growing medullary process grows outward but bone has time to lay down new periosteum

201
Q

endosteal scalloping vs saucerization

A
  • Endo scall: in to out

- sauce: out to in

202
Q

tumors with ST components

A
  • OS
  • ES
  • lymphoma
203
Q

“end of bone” sites

A
  • epiphyses
  • aphophyses
  • patella
  • sm bones of wrist
  • mid/hindfoot
  • subarticular portions of flat bones (SI joints, acetabuli, glenoid)
204
Q

Specific sites for tumors:

  • adamantinoma, OFD
  • epidermal inclusion cyst, glomus tumor
  • periosteal desmoid, parosteal OS
  • chordoma
  • hemangioma
  • SBC, intraosseous lipoma
  • OB, ABC
A
  • adamantinoma, OFD: tib ant cortex
  • epidermal inclusion cyst, glomus tumor
  • periosteal desmoid, parosteal OS-pst cortex of distal femur
  • chordoma-clivus, VB, sacrum
  • hemangioma-VB
  • SBC, intraosseous lipoma-calcaneus
  • OB, ABC-pst elements of spine
205
Q

Specific sites for tumors:

  • adamantinoma, OFD
  • epidermal inclusion cyst, glomus tumor
  • periosteal desmoid, parosteal OS
  • chordoma
  • hemangioma
  • SBC, intraosseous lipoma
  • OB, ABC
A
  • adamantinoma, OFD: tib ant cortex
  • epidermal inclusion cyst, glomus tumor
  • periosteal desmoid, parosteal OS-pst cortex of distal femur
  • chordoma-clivus, VB, sacrum
  • hemangioma-VB
  • SBC, intraosseous lipoma-calcaneus
  • OB, ABC-pst elements of spine

radiology (31 decks)

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