Primary Malignant Bone Tumors

Question 1

The most common PRIMARY malignancy of bone?

Answer 1

Multiple myeloma

Question 2

What morphological type of anemia will multiple myeloma cause?

Answer 2

Normochromic, normocytic

Question 3

Multiple myeloma usually affects adults over age __

Answer 3

40

Question 4

What part of bone does multiple myeloma begin in?

Answer 4

Bone marrow

Question 5

Name the malignancy with these lab features: hypercalcemia, hyperuricemia, reversed albumin:globulin ratio, elevated blood urea nitrogen (BUN)

Answer 5

Multiple myeloma

Question 6

Multiple myeloma will cause a ____ protein in a urinalysis

Answer 6

Bence-Jones

Question 7

Name 3 key radiographic features of multiple myeloma:

Answer 7

1. Bone destruction multiple areas
2. Punched-out lesions
3. Path fxs
4. Endosteal scalloping
5. “Rain-drop” skull

Question 8

Is vertebra plana a common finding in the spine for multiple myeloma?

Answer 8

Yes

Question 9

T/F: Bone scans are a good diagnostic tool for multiple myeloma

Answer 9

FALSE

Question 10

Confluence of punched-out lesions

Answer 10

Endosteal scalloping

Question 11

Solitary form of multiple myeloma? It is soap-bubbly and expansile.

Answer 11

Plasmacytoma

Question 12

Major DDx of multiple myeloma?

Answer 12

Lytic bone metastasis

Question 13

The most common PRIMARY bone malignancy in CHILDREN

Answer 13

Osteosarcoma

Question 14

___ are affected 2:1 with osteosarcoma (sex)

Answer 14

Boys

Question 15

The bimodal ages for osteosarcoma?

Answer 15

10-25, >50

Question 16

This bone malignancy affects long bones, particularly metaphyseal regions around the knee

Answer 16

Osteosarcoma

Question 17

A classic radiographic feature specific to osteosarcoma is?

Answer 17

“Cumulus cloud” appearance

Question 18

Treatment for osteosarcoma might include ____ chemotherapy

Answer 18

Neoadjuvant

Question 19

Name two lab features associated with osteosarcoma:

Answer 19

1. High alkaline phosphatase

2. High lactate dehydrogenase (LDH)

Question 20

____ is the third most common primary bone malignancy. It usually affects people over 40, and has grades 1, 2, and 3.

Answer 20

Chondrosarcoma

Question 21

This bone malignancy likes to affect flat bones (pelvis, ribs, scapula, etc.) and PROXIMAL long bones

Answer 21

Chondrosarcoma

Question 22

A chondrosarcoma is a lytic lesion with a large soft tissue mass containing scattered calcifications in “________”

Answer 22

Rings and arcs

Question 23

____ strikes people between ages 5 and 30. It is highly malignant and affects red marrow bones (diaphysis of long bones, pelvis, ribs). Hard to distinguish from some other bone tumors

Answer 23

Ewing’s Sarcoma

Question 24

Lab features of this bone malignancy will include leukocytosis, anemia, and an elevated ESR. Classic radiographic findings are periosteal response, onion skin, permeative or moth-eaten bone destruction.

Answer 24

Ewing’s sarcoma

Question 25

What two patterns of bone destruction will Ewing’s sarcoma show?

Answer 25

- Permeative | - Moth-eaten

Question 26

Name three DDX’s for Ewing’s Sarcoma:

Answer 26

1. Osteosarcoma 2. Lymphoma 3. Osteomyelitis

Question 27

What were the former names for primary lymphoma of bone? (2)

Answer 27

Reticulum cell sarcoma, Non-Hodgkin’s lymphoma of bone

Question 28

This malignant bone tumor will be difficult to distinguish from some others. It typically affects the diaphysis of long bones, causes moth-eaten and/or permeative bone destruction, cortical violation, and periosteal response. Can affect ANY age. Often causes path fractures!

Answer 28

Lymphoma (Primary lymphoma of bone)

Question 29

This malignant bone tumor develops in the primitive cell rests of the embryonic notochord! It is very rare.

Answer 29

Chordoma

Question 30

The most commonly affected bone by a chordoma?

Answer 30

Sacrum

Question 31

What bone in the cervical spine is most commonly affected by a chordoma?

Answer 31

C2

Question 32

Radiographic findings of a chordoma would be similar to what other primary bone malignancy?

Answer 32

Chondrosarcoma

Question 33

A bone not often talked about, but often affected by a chordoma (behind the sacrum) is called?

Answer 33

Clivus (in skull)

Question 34

A DDX for a sacral chordoma would be?

Answer 34

Giant cell tumor (benign - also likes sacrum)