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NYCC MSP > Multiple Myeloma, Chondrosarcoma & Metastasis > Flashcards

Multiple Myeloma, Chondrosarcoma & Metastasis Flashcards

1
Q

Chondrosarcomas are comprised of ____

A

Hyaline cartilage

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2
Q

The more aggressive a chondrosarcoma is, the (more/less) cartilage is produced

A

less

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3
Q

What are the 2 classifications of chondrosarcomas by location?

A
  • central (intramedullary)
  • juxtacortical (peripheral)
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4
Q

Most chondrosarcomas are (primary/secondary)

A

primary

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5
Q

Where do secondary chondrosarcomas originate?

A

form in pre-existing cartilage tumors:
- enchondromas: solitary 1%, Ollier 25%, Mafucci 50%
- osteochondromas: solitary <1%, HME 25%

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6
Q

Chondrosarcomas are very ____ growing

A

Slow
(low grade tumor)

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7
Q

Describe the histological appearance of a chondrosarcoma

A
  • malignant chondrocytes
  • necrosis
  • hemorrhage
  • stippled calcifications
  • cystic change
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8
Q

What is the preferential location of chondrosarcoma?

A
  • pelvis
  • long bones (femur & humerus)
  • ribs
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9
Q

What common location of chondrosarcomas may have a mass effect on nearby structures?

A

pelvis

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10
Q

What age group is primarily affected by chondrosarcomas?

A

40-60 years
(exception: clear & mesenchymal subtypes = teens-20s)

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11
Q

What is the etiology of chondrosarcoma?

A

multiple genes implicated

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12
Q

Where do chondrosarcomas typically metastasize to?

A

lungs, liver, kidneys, brain
(rare, very late stage)

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13
Q

Chondrosarcomas have a tendency to extend ____ bone

A

along (instead of beyond)

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14
Q

What causes the white appearance of chondrosarcomas on x-ray?

A

cartilage attracts Ca2+ –> calcification
(similar appearance to enchondroma)

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15
Q

How would a patient with a chondrosarcoma present clinically?

A
  • insidious onset (up to 2 yrs)
  • pain at affected site
  • possible palpable soft tissue mass
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16
Q

What are the radiographic characteristics of a chondrosarcoma?

A
  • localized bone destruction
  • poorly-defined borders with cortex perforation
  • radiopacities due to calcification or endochondral ossification
  • soft tissue masses may be visible
    (buzz word: “large calcified soft tissue mass”)
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17
Q

What pattern of destruction is seen in an chondrosarcoma?

A

motheaten lytic

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18
Q

What type of matrix calcification is seen in a chondrosarcoma?

A

stippled

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19
Q

Why are drug and radiation therapy less effective in treating chondrosarcomas than other malignant bone tumors?

A

low grade tumor –> less blood supply

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20
Q

What is another name for multiple myeloma?

A

Plasma cell myeloma

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21
Q

What is the most common primary malignant bone tumor?

A

Multiple myeloma

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22
Q

What age group is primarily affected by multiple myeloma?

A

50-70 years

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23
Q

What is the etiology of multiple myeloma?

A

Unknown

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24
Q

Multiple myeloma is a tumor of uncontrolled proliferation of ____ which produces ____

A

B-lymphocyte marrow
B-lymphocytes
(single cell lineage of B-lymphocytes)

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25
Q

What do B-lymphocytes produce?

A

Antibodies/immunoglobulins (Ig’s)

26
Q

What is unique about immunoglobulins produced by multiple myeloma?

A

selectively make short chain only (no long chain)

27
Q

What are Bence-Jones proteins?

A

Short chain of immunoglobulin proteins selectively produced by B-lymphocytes of multiple myeloma

28
Q

What are the 2 major proteins in blood?

A

albumin
globulin

29
Q

What is a normal A:G ratio?

A

albumin > globulin in blood

30
Q

What happens to the A:G ratio with multiple myeloma and why?

A
  • globulin > albumin
  • reverses due to overproduction of Ig’s
31
Q

What would you include in your differential diagnosis if you see aggressive activity on a radiograph of an older patient?

A
  • metastasis (usually older)
  • multiple myeloma (usually older)
  • lymphoma (any age)
32
Q

Multiple myeloma cells secrete ____ that recruit ____

A

cytokines
osteoclasts

33
Q

What would alkaline phosphatase levels be in a patient with multiple myeloma and why?

A

normal
tumor releases hormone that is osteoblast-inhibiting –> less osteoblastic activity, no alk phos. released

34
Q

What is the appearance of lesions in multiple myeloma?

A
  • multiple 1-5mm lesions (lytic)
  • histologically consist of sheets of plasma cells w/ varying degrees of differentiation
  • large nuclei > cytoplasm
35
Q

What is the preferential location of multiple myeloma?

A
  • skull
  • spine
  • ribs
  • pelvis
  • femur
36
Q

How would a patient with multiple myeloma present clinically?

A
  • lack of cardinal signs
  • weight loss, cachexia (wasting)
  • variable bone pain presentation (intermittent –> continuous; rapid onset following trauma; worse during day/activity/wt bearing)
  • hypercalcemia
  • anemia (manifests as fatigue)
  • amyloidosis (10%)
  • Bence-Jones proteins
37
Q

Why would a patient with multiple myeloma present with fatigue?

A
  • loss of white & red marrow (replaced by B-lymphocyte lineage) causes anemia
38
Q

What would you suspect in a patient who says they chew ice a lot, have been progressively fatigued lately, and has pale mucous membranes inside their cheeks and under their tongue?

A

iron deficiency anemia
(need labs to diagnose; pale mucous membranes instead of pink)

39
Q

What causes renal failure in a patient with multiple myeloma?

A
  • overproduction of immunoglobulins which are destructive to kidneys
  • results in altered GFR, creatinine, and presence of protein in urine
40
Q

What is the prognosis of multiple myeloma?

A
  • treatment options poor
  • avg survival rate of 5 yrs
  • infection or renal failure common causes of death (less normal marrow to produce functioning WBCs)
41
Q

Metastatic bone tumors are also called ____

A

secondary bone tumors

42
Q

What is the most common malignant tumor of bone?

A

metastatic disease

43
Q

What is metastatic bone disease?

A

neoplasias (usually carcinomas) that metastasize to bone from any tissue in the body

44
Q

What are the most common primary origins of metastasis to bone?

A
  • breast
  • prostate
  • kidney
  • lung
45
Q

What is the most common pathway of metastatic spread to bone and why?

A

hematogenous
- vascular neogenesis (angiogenesis)
- tumor cells not sticky, shed easily into blood

46
Q

Metastatic bone tumors are considered a ____-replacing disease

A

marrow (mostly red marrow)

47
Q

What cancer has the highest mortality rate?

A

lung & bronchus

48
Q

What are the common sites of metastasis in the skeletal system?

A
  • lower thoracic spine to lumbar spine & pelvis due to gravity & Batson’s venous plexus
  • proximal femur > proximal humerus
49
Q

How does hematogenous metastatic spread commonly occur to the skeleton?

A

Batson’s vertebral plexus –> red marrow spaces (more vascular than yellow marrow)

50
Q

What is Batson’s vertebral plexus also referred to as?

A

Basivertebral vv

51
Q

What bones is red marrow found in?

A
  • skull
  • spine
  • pelvis
  • proximal humerus
  • proximal femur
52
Q

Primary breast cancer often metastasizes via what route?

A

lymphatic

53
Q

A pancoast tumor that metastasizes to the upper ribs and thoracic spine spreads via what route?

A

direct extension

54
Q

What are the 2 most common clinical manifestations of metastasis to bone?

A
  1. unexplained weight loss
  2. anemia manifesting as fatigue
54
Q

What symptom is likely to develop due to the high glucose demand and angiogenesis of a metastatic tumor?

A

unexplained weight loss

55
Q

What are the clinical manifestations of metastasis?

A
  • unexplained weight loss
  • anemia (fatigue)
  • pain
  • fever (night sweats) with late stage
  • abnormal labs
56
Q

What are the possible radiographic characteristics of metastasis to bone?

A
  • osteoblastic, osteolytic, or mixed activity
  • no soft tissue mass (rare)
57
Q

What bone pathologies would you include in your differential diagnosis specific to a 50-year-old patient?

A
  • fibrous xanthoma (20+)
  • Paget disease (>50)
  • secondary osteosarcoma (predisposing + >50)
  • chondrosarcoma (40-60)
  • multiple myeloma (50-70)
58
Q

What bone pathologies would you include in your differential diagnosis specific to a 7-year-old patient?

A
  • fibrous cortical defect (<8)
  • polyostotic fibrous dysplasia (<10)
  • simple bone cyst (<20)
  • aneurysmal bone cyst (<20)
  • primary osteosarcoma (<20)
  • enchondroma (<20)
  • ewing sarcoma (<20)
  • osteochondroma (<20)
  • chondroblastoma (5-25)
  • osteoid osteoma (5-35)
59
Q

What bone pathologies would you include in your differential diagnosis specific to a 22-year-old patient?

A
  • fibrous xanthoma (20+)
  • chondroblastoma (5-25)
  • osteoid osteoma (5-35)
  • giant cell tumor (20-40)

NYCC MSP (32 decks)

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