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Diagnostic Imaging II Exam Three > Primary Malignancies > Flashcards

Primary Malignancies Flashcards

1
Q

What is the most common primary malignancy?

A

MM (27%) (then osteosarcoma then chondrosarcoma then Ewing’s)

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2
Q

Which primary malignancy is a proliferation of plasma cells which infiltrate the bone marrow?

A

MM

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3
Q

What is the age range for MM?

A

5-8th decade (75% are of ages 50-70 years)

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4
Q

Which gender is more likely to have MM?

A

Males

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5
Q

Which is more common: MM or metastasis?

A

Still metastasis….

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6
Q

Which two bone tumors are the only ones that are more common in females compared to males?

A

Hemangiomas and aneurysmal bone cyst (“bloody ones”)

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7
Q

What is the most common cause of death in patients with MM?

A

Recurrently bacterial infections

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8
Q

What is the primary rad finding for MM?

A

Deossification of bone

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9
Q

What is the usual presentation of a bone scan in those with MM?

A

Negative

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10
Q

What are some laboratory findings that can be seen with MM?

A

Elevated ESR, plasma proteins, serum calcium, and serum phosphorus with thrombocytopenia, and rouleaux formation

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11
Q

What is the rouleaux formation that is commonly seen with MM?

A

Stacks or aggregates of RBCs seen on blood smear

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12
Q

What protein finding is commonly seen in 80-90% of those with MM?

A

Protein electrophoresis with “M-spike”

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13
Q

Detection of which protein in the urine can be found in 40% of MM patients?

A

Bence Jones proteins

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14
Q

What is the best test for MM besides the obvious biopsy?

A

M-spike protein electrophoresis

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15
Q

What are the common locations for a solitary plasmacytoma?

A

Vertebra > pelvis > skull > sternum > ribs

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16
Q

What is the term for a tumor that is a localized form of plasma cell proliferation?

A

Solitary plasmacytoma

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17
Q

How does a solitary plasmacytoma typically present?

A

Soap bubbly, highly expansile lesion

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18
Q

What is unique about the expansion of a solitary plasmacytoma in what it chooses to spare?

A

Posterior elements (of vertebrae)

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19
Q

What radiographic sign on an PA chest film can indicate a possible solitary plasmacytoma?

A

Extrapleural sign

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20
Q

What is an extrapleural sign?

A

Something in the pleural space pushing lungs inward

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21
Q

What type of thoracic spine change can be seen with solitary plasmacytomas of multiple levels?

A

Gibbus formation

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22
Q

What is the Gibbus formation?

A

Acute angular kyphotic thoracic spine changes causing wedges (think multiple solitary plasmacytomas)

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23
Q

“Rain drop skull” is associated with which neoplasm?

A

Multiple Myeloma

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24
Q

What is the best imaging used to detect MM?

A

Conventional radiography

25
Q

How can an MRI help detect MM?

A

Marrow changes (2nd best test)

26
Q

What is the cause of the appearance of a “rain drop skull” seen with MM?

A

Multiple holes of various sizes in the skull

27
Q

In only what specific location of the body is cortical thinning considered a normal pattern of aging?

A

Deltoid tuberosity of the humerus

28
Q

What type of MRI is best to be used for MM detection?

A

STIR (contrast enhanced T1)

29
Q

What is usually the prognosis for MM?

A

Poor (5 year survival 20%)

30
Q

Which tumor is a primary malignant tumor of undifferentiated connective tissue which forms neoplastic osteoid and is also the second most common primary malignant bone tumor overall?

A

Osteosarcoma

31
Q

What is the most common primary malignant bone tumor in children and young adults?

A

Osteosarcoma

32
Q

What is the age range for osteosarcoma?

A

BIMODAL: 10-25 and again after age 60

33
Q

What is the most common form of osteosarcoma?

A

Central

34
Q

Do osteosarcomas grow slowly or quickly?

A

QUICK

35
Q

Osteosarcomas most commonly attack which joint of the body?

A

Knee (50%)

36
Q

What is the most common location for an osteosarcoma?

A

Distal femur (40%) with 75% occurring in metaphysis next to growth plate

37
Q

Are osteosarcomas usually lytic or blastic?

A

Blastic (50%)

38
Q

Where is an osteosarcoma likely to metastasize to?

A

Lungs (cannonball metastasis)

39
Q

What periosteal reaction is associated with an osteosarcoma?

A

Sunburst/Codman’s triangle

40
Q

What is the area of a radiolucent line that can sometimes be seen between the long bone and the present osteosarcoma on X-ray?

A

“String sign” (shows that bone and tumor are not fully attached)

41
Q

Why does the age range for osteosarcoma also include those over 60?

A

Secondly osteosarcomas can arise from Paget’s disease which has the age distribution of over 60

42
Q

What is the third most common primary malignant bone tumor?

A

Chondrosarcoma (10%)

43
Q

Chondrosarcomas can be found anywhere except for what location?

A

SKULL (think about it….skull is made from intramembranous ossification NOT endoCHONDRAL)

44
Q

What is the age range for a chondrosarcoma?

A

Over 50

45
Q

Do chondrosarcomas develop slowly or quickly?

A

SLOWLY

46
Q

What are some common locations of chondrosarcomas?

A

Proximal humerus, femoral neck, ribs/sternum, pelvis

47
Q

What type of calcified appearance is seen with chondrosarcomas?

A

Popcorn matrix with C-shaped calcifications

48
Q

Why must chondrosarcomas be treated by excision only?

A

Cartilage doesn’t typically respond to radiation and/or chemotherapy

49
Q

What is the 4th most common primary malignant bone tumor?

A

Ewing’s sarcoma

50
Q

What is the 2nd most common primary malignant bone tumor in children?

A

Ewing’s sarcoma

51
Q

What is the age range for Ewing’s?

A

10-25 (peak at 15 years)

52
Q

What is the most common location for Ewing’s?

A

Long tubular bones like the femur, tibia, humerus, fibula (60%) but the other 40% is in flat bones like the pelvis

53
Q

Does Ewing’s have a better prognosis in long or flat bones?

A

Long bones

54
Q

How can we differentiate Ewing’s from an osteosarcoma/

A 
Ewing's = diaphysis
Osteosarcoma = metaphysis
55
Q

Is a Ewing’s sarcoma a blastic or lytic lesion?

A

Lytic

56
Q

What is the most identifiable radiographic finding of Ewing’s?

A

Onion-skin periosteal reaction

57
Q

What observational clinical finding is commonly seen with patients who have a Ewing’s sarcoma?

A

Soft tissue mass and swelling (55%)

58
Q

To where does Ewing’s commonly metastasis?

A

Skeleton (lungs would be second most common)

Diagnostic Imaging II Exam Three (4 decks)

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