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NYCC MSP > Multiple Myeloma, Chondrosarcoma & Metastasis (DRAFT) > Flashcards

Multiple Myeloma, Chondrosarcoma & Metastasis (DRAFT) 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

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

20
Q

What is another name for multiple myeloma?

A

Plasma cell myeloma

21
Q

What is the most common primary malignant bone tumor?

A

Multiple myeloma

22
Q

What age group is primarily affected by multiple myeloma?

A

50-70 years

23
Q

What is the etiology of multiple myeloma?

A

Unknown

24
Q

What do multiple myeloma cells secrete and what is the result of this?

A
  • cytokines (Ig’s) that recruit osteoclasts –> lytic activity
  • hormone that inhibits osteoblasts
    (check note on this)
25
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
26
Q

What is the preferential location of multiple myeloma?

A
  • skull
  • spine
  • ribs
  • pelvis
  • femur
27
Q

A:G ratio???

A

check note

28
Q

How would a patient with multiple myeloma present clinically?

A
  • lack of cardinal signs
  • weight loss, cachexia (wasting)
  • bone pain (intermittent –> continuous; rapid onset following trauma; worse during day/activity/wt bearing)
  • hypercalcemia
  • anemia (manifests as fatigue)
  • amyloidosis (10%)
  • Bence-Jones proteins
29
Q

Why would a patient with multiple myeloma present with fatigue?

A
  • loss of white & red marrow causes anemia
  • need labs to diagnose
  • pale mucus membranes
30
Q

What are Bence-Jones proteins and what do they indicate?

A
  • serum & urinary proteins
  • overproduction of Ig’s in multiple myeloma
  • causes renal failure (check note)
31
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
32
Q

Metastatic bone tumors are also called ____

A

secondary bone tumors

33
Q

What is the most common malignant tumor of bone?

A

metastatic disease

34
Q

What is metastatic bone disease?

A

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

35
Q

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

A
  • breast
  • prostate
  • kidney
  • lung
36
Q

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

A

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

37
Q

What cancer has the highest mortality rate?

A

lung & bronchus

38
Q

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

A
  • vertebrae (l/s due to gravity)
  • pelvis
  • ribs
  • skull
  • sternum
39
Q

How does hematogenous metastatic spread commonly occur to the skeleton?

A

Baxon’s vertebral plexus –> red marrow spaces

40
Q

Primary breast cancer often metastasizes via what route?

A

lymphatic

41
Q

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

A

direct extension

42
Q

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

A
  1. unexplained weight loss
  2. anemia manifesting as fatigue
43
Q

What are the clinical manifestations of metastasis?

A
  • unexplained weight loss
  • anemia (fatigue)
  • pain
  • fever (night sweats) with late stage
  • abnormal labs
44
Q

What are the possible radiographic characteristics of metastasis to bone?

A

osteoblastic, osteolytic, or mixed activity

NYCC MSP (22 decks)

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