MSS8

Question 1

How do you stage a bone lesion?

Answer 1

x-ray of entire affected bone
Whole body bone scan
CT Chest, abd, pelvis
Serum protein electrophoresis
Urine protein eletrophoresis
Prostatic specific antigen

Question 2

What is a classical radiologic sign for multiple myeloma?

Answer 2

multiple lytic punched out lesions

Question 3

What should you r/o for a young pt with bone pain?

Answer 3

Lymphoma

Question 4

What are common cancers that metastasize to bone?

Answer 4

Breast, kidney, lung

Question 5

What labs should you get for multiple myeloma or plasmacytoma?

Answer 5

Serium protein eletrophoresis, urine protein electrophoresis, serum free light chains

Question 6

What is a good screening measure for prostate adeno?

Answer 6

PSA. Blastic lesions

Question 7

Multiple myeloma

Answer 7

Common lymphoid malignancy where cells produce monoclonal immunoglobuins IgG. Involves bone marrow and causes lytic lesions through skeleton.

Question 8

What will you see in a biopsy of B cell lymphoma?

Answer 8

Most common type of lymphoma. CD20 + on biopsy

Question 9

How do you diagnose an osteosarcoma?

Answer 9

Biopsy–> pathology shows malignant cells that produce osteoid.

Question 10

How can you determine a primary vs metastatic lesions in bone?

Answer 10

Pathology. Bone tumors don’t form glands. TTF1: positive in adno from lung. Cytokeritain + in carcinoma

Question 11

What is a unicameral bone cyst?

Answer 11

Benign solitary bone cyst that occurs in metaphysis. Filled with clear, yellowish fluid. usually present with fractures. Tx: let them heal.

Question 12

What is an aneurysmal bone cyst?

Answer 12

Benign neoplasm. Honey comb blood filled mass. Aggessive and expansile. Painful. Cystic spaces filled with blood but no endothelial lining. Usually in Metaphysis, <20 yrs

Question 13

What does a fluid/fluid level on MRI indicate?

Answer 13

Aneurysmal bone cyst.

Question 14

What are some chracteristics of giant cell tumor?

Answer 14

Giant cells on pathology. No mineralization. Purely lytic in epiphysis. Can have soft tissue masses

Question 15

What are some characteristics of osteosarcoma?

Answer 15

MRI: Soft tissue mass with mineralization. Pathology shows: cells producing osteoid

Question 16

What are some radiologic and pathological charactertistics of Ewing’s?

Answer 16

Radiology: destructive lesion, poorly defined, no mineralization. Pathology: CD99, Large blue cells. T(11,22)

Question 17

Is fat on T1 weighted image on MRI dark or bright?

Answer 17

Bright

Question 18

What are some pathological characteristics of desmoid fibromatosis?

Answer 18

Pathology: dense spindle cells with no pleomorphism. Beta catenin positive

Question 19

Characteristics of Soft tissue sarcoma

Answer 19

Pathology: highly pleomorphic

Question 20

What does cartilage look like on MRI?

Answer 20

T1: dark
T2: brighter (fluid)
enhancing peripherally, center non-enhancing
Looks lobular

Question 21

What are some characteristics of Enchondromas?

Answer 21

Radiology: Sclerotic rim, no expansion or thinning of cortex. Localized. No soft tissue mass
Pathology: benign, bi-nucleated, not a lot of crowding

Question 22

Chondrosarcoma

Answer 22

Pathology: Atypical cartilage cell (little matrix, pleomorphism)
Radiology: arcs/swirls (mineralization), thinning of cortex, expansion. Peripheral enhancement

Question 23

Which bone or soft tissue tumrs produce osteoid?

Answer 23

Cartilage: Enchondroma, ostechondroma, chondrosarcoma. Osteosarcoma