Primary Malignancies Flashcards
What is the most common primary malignancy?
MM (27%) (then osteosarcoma then chondrosarcoma then Ewing’s)
Which primary malignancy is a proliferation of plasma cells which infiltrate the bone marrow?
MM
What is the age range for MM?
5-8th decade (75% are of ages 50-70 years)
Which gender is more likely to have MM?
Males
Which is more common: MM or metastasis?
Still metastasis….
Which two bone tumors are the only ones that are more common in females compared to males?
Hemangiomas and aneurysmal bone cyst (“bloody ones”)
What is the most common cause of death in patients with MM?
Recurrently bacterial infections
What is the primary rad finding for MM?
Deossification of bone
What is the usual presentation of a bone scan in those with MM?
Negative
What are some laboratory findings that can be seen with MM?
Elevated ESR, plasma proteins, serum calcium, and serum phosphorus with thrombocytopenia, and rouleaux formation
What is the rouleaux formation that is commonly seen with MM?
Stacks or aggregates of RBCs seen on blood smear
What protein finding is commonly seen in 80-90% of those with MM?
Protein electrophoresis with “M-spike”
Detection of which protein in the urine can be found in 40% of MM patients?
Bence Jones proteins
What is the best test for MM besides the obvious biopsy?
M-spike protein electrophoresis
What are the common locations for a solitary plasmacytoma?
Vertebra > pelvis > skull > sternum > ribs
What is the term for a tumor that is a localized form of plasma cell proliferation?
Solitary plasmacytoma
How does a solitary plasmacytoma typically present?
Soap bubbly, highly expansile lesion
What is unique about the expansion of a solitary plasmacytoma in what it chooses to spare?
Posterior elements (of vertebrae)
What radiographic sign on an PA chest film can indicate a possible solitary plasmacytoma?
Extrapleural sign
What is an extrapleural sign?
Something in the pleural space pushing lungs inward
What type of thoracic spine change can be seen with solitary plasmacytomas of multiple levels?
Gibbus formation
What is the Gibbus formation?
Acute angular kyphotic thoracic spine changes causing wedges (think multiple solitary plasmacytomas)
“Rain drop skull” is associated with which neoplasm?
Multiple Myeloma
What is the best imaging used to detect MM?
Conventional radiography
How can an MRI help detect MM?
Marrow changes (2nd best test)
What is the cause of the appearance of a “rain drop skull” seen with MM?
Multiple holes of various sizes in the skull
In only what specific location of the body is cortical thinning considered a normal pattern of aging?
Deltoid tuberosity of the humerus
What type of MRI is best to be used for MM detection?
STIR (contrast enhanced T1)
What is usually the prognosis for MM?
Poor (5 year survival 20%)
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?
Osteosarcoma
What is the most common primary malignant bone tumor in children and young adults?
Osteosarcoma
What is the age range for osteosarcoma?
BIMODAL: 10-25 and again after age 60
What is the most common form of osteosarcoma?
Central
Do osteosarcomas grow slowly or quickly?
QUICK
Osteosarcomas most commonly attack which joint of the body?
Knee (50%)
What is the most common location for an osteosarcoma?
Distal femur (40%) with 75% occurring in metaphysis next to growth plate
Are osteosarcomas usually lytic or blastic?
Blastic (50%)
Where is an osteosarcoma likely to metastasize to?
Lungs (cannonball metastasis)
What periosteal reaction is associated with an osteosarcoma?
Sunburst/Codman’s triangle
What is the area of a radiolucent line that can sometimes be seen between the long bone and the present osteosarcoma on X-ray?
“String sign” (shows that bone and tumor are not fully attached)
Why does the age range for osteosarcoma also include those over 60?
Secondly osteosarcomas can arise from Paget’s disease which has the age distribution of over 60
What is the third most common primary malignant bone tumor?
Chondrosarcoma (10%)
Chondrosarcomas can be found anywhere except for what location?
SKULL (think about it….skull is made from intramembranous ossification NOT endoCHONDRAL)
What is the age range for a chondrosarcoma?
Over 50
Do chondrosarcomas develop slowly or quickly?
SLOWLY
What are some common locations of chondrosarcomas?
Proximal humerus, femoral neck, ribs/sternum, pelvis
What type of calcified appearance is seen with chondrosarcomas?
Popcorn matrix with C-shaped calcifications
Why must chondrosarcomas be treated by excision only?
Cartilage doesn’t typically respond to radiation and/or chemotherapy
What is the 4th most common primary malignant bone tumor?
Ewing’s sarcoma
What is the 2nd most common primary malignant bone tumor in children?
Ewing’s sarcoma
What is the age range for Ewing’s?
10-25 (peak at 15 years)
What is the most common location for Ewing’s?
Long tubular bones like the femur, tibia, humerus, fibula (60%) but the other 40% is in flat bones like the pelvis
Does Ewing’s have a better prognosis in long or flat bones?
Long bones
How can we differentiate Ewing’s from an osteosarcoma/
Ewing's = diaphysis Osteosarcoma = metaphysis
Is a Ewing’s sarcoma a blastic or lytic lesion?
Lytic
What is the most identifiable radiographic finding of Ewing’s?
Onion-skin periosteal reaction
What observational clinical finding is commonly seen with patients who have a Ewing’s sarcoma?
Soft tissue mass and swelling (55%)
To where does Ewing’s commonly metastasis?
Skeleton (lungs would be second most common)
