Part 10-test 3 Flashcards
-oma
tumor
tumor
lesion followed by an abnormal growth of cells
benign tumor
abnormal tissue masses are are not cancers
malignant tumor
synonymous with cancer and malignant tumors are usually named using -carcinom, -sarcoma or -blastoma
cancer
diseases in which abnormal cells divide without control and are able to invade other tissues
carcinoma
any malignant cancer that arises from epithelial cells
sarcoma
cancer that begins in bone, cartilage, fat, muscle, blood vessels or other connective or supportive tissue
lymphoma/leukemia
malignancies derived from hematopoietic cells
blastoma
tumor (usually malignant) which resembles an immature or embryonic tissue
metastasis
new tumors that appear far from the original tumor
predictive factors for differential diagnosis
age incidence skeletal location interosseous location tumor appearance clinical presentation
metastatic disease
74% of all malignancies in bone
MC malignant tumor in adults
multiple myeloma
MC malignant tumor in kids
osteosarcoma
MC benign osseous tumor
osteochondroma
MC benign spinal tumor
hemangioma
what pattern of bone destruction is least worrysome? most?
least- geographic
most- permative
what are the positions of a lesion in the horizontal plane?
central/medullary eccentric cortical parosteal soft tissues
describe geographic bone desctruction
least aggressive usually solitary lesion <1cm indicative of a slow growing lesion short zone of transition margin is well defined, can be smooth or isolated
describe moth eaten destruction
moderate degree of aggressiveness
numerous small holes (2-5mm) in size
longer zone of transition than geographic
margins are not well defined
describe permeative bone destruction
most aggressive growing lesion
numerous small holes (1mm) in size
wide zone of transition
poorly demarcated or imperceptible borders
what are the big differences between benign and malignant holes in bones?
longer zone of transition=more aggressive
shorter zone of transition= less aggressive
cortical changes that could indicate tumors?
buttressing/thickening endosteal scalloping splitting or tunneling thinning with or without expansion penetration with or without periosteal reaction
differential diagnoses of solitary lucent bone lesions
FOG MACHINES fibrous dysplasia osteoblastoma giant cell tumor metastasis aneurysmal bone cyst chondroblastoma hyperparathyroidism (brown tumor) infection (osteomyelitis) non-ossifying fibroma enchondroma/eosinophilic granuloma simple (unicameral) bone cyst
types of periosteal reactions
laminated codman's hair on end solid complex
describe buttressing/solid periosteal reaction
additional layers of new bone are added to exterior creating an expanded osseous contour
buttressing/solid periosteal reactions are associated with?
slow growing lesions
describe laminated/layered/onion skinned
multiple alternating layers of lucency and opacity with alternating growth
can be thin or thick
can be seen in slow or aggressive lesions
onion skin/layered/laminated are associated with?
Ewing’s sarcoma
describe spiculated
linear radiating spicules of new bone
“hair on end”
describe sunburst
type of spiculated
when bone is radiating from a central focus
spiculated is associated with?
osteosarcoma
describe codman’s triangle
triangular elevation periosteum seen at the peripheral lesion-cortex junction
may be seen also with benign tumors, infections or other disorders
what is one of the most aggressive forms of periosteal reactions?
codman’s triangle
what are the different types of tumor matrices?
osseous fibrus vascular muscular cartilaginous
cartilaginous matrix appearances
ring/arc like flocculent small crystals popcorn like stippled
benign tumors with cartilaginous matrix
enchondroma
osteochondroma
chondroblastoma
chondromyxoid fibroma
malignant tumors with cartilaginous matrix
chondrosarcoma
osseous matrix appearances
variable size radiodense areas
may occupy parts of entire lesion
can be homogenous or inhomogenous increased density changes/sclerosis
solid, cloud like, ivory like
benign tumors with osseous matrix
osteoma
osteoblastoma
osteochondroma
osteoid osteoma
malignant tumors with osseous matrix
osteosarcoma
benign tumors with fibrous dysplasia
fibrous dysplasia desmoplastic fibroma non-ossifying fibroma fibrous cortical defect ossifying fibroma
malignant tumors with fibrous dysplasia
fibrosarcoma
what are the differences between primary and secondary neoplasias?
primary- bone expansion, >6cm in length, periosteal reactions, presence of soft tissue masses
secondary- <6cm in length, number of lesions
what is the most common tumor of bone?
metastasis
most common primary sites for mets?
breast, lung, prostate, kidney, thyroid, bowel
describe MC female tumor
70% breast
80% are lytic
next MC are thyroid, kidney, uterus
describe MC male tumor
60% prostate
80% are blastic
next MC is lung, which is mostly lytic
what are the different pathways of metastasis?
hematogenous dissemination via Batson’s venous plexus
lymphatic dissemination
direct extension
lab values that may be present with metastasis?
ESR serum calcium alkaline phosphatase (blastic) acid phosphatase&/or PSA antigen (prostate) serum protein albumin:globulin ratio protein electrophoresis
clinical features of metastasis
40 or older
recent weight loss, look like death, anemic, fever
initial sign may be pathological fx
pain is usually persistent and nocturnal
MC sites for metastasis
spine ribs and sternum pelvis and sacrum proximal extremities skull
acral metastasis
lytic mets to distal elbow and knees most common to hands and feet
most commonly linked to lung cancer
radiographic signs of metastasis
osteolytic
osteoblastic
mixed
radiographic features of vertebral metastasis
ivory vertebra pedicle descruction pathologic collapse focal osteoporosis of a body malignant schmorl's node formation
most common reason for pathological collapse in adults
lytic mets
multiple myeloma
traumatic fracture (osteoporosis)
most common reason for a pathological collapse in kids
eosinophilic granuloma
what is the name of a flat or pancake vertebra?
vertebra plana
solitary ivory vertebra are MC seen in?
paget’s
Hodgkin’s lymphoma
osteoblastic metastasis
T1 MRI characteristics of metastasis? T2?
T1: most sensitive (shows as a low signal)
metastatic lesion oblique, angled or round
check for pedicular involvement
extradural mass, multiplicity
T2: less sensitive (shows as high signal
