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YEAR 4 SEMESTER 1 DIAGNOSTIC IMAGING > Primary Malignant Tumours and Metastatic Spread > Flashcards

Primary Malignant Tumours and Metastatic Spread Flashcards

1
Q

Giant Cell Tumour

Nature?
Incidence?

A

Nature: Neoplasm formed from connective tissue, highly vascular, about 20% malignant

Incidence: 2-5% of all malignancies are GCT
20-40 YOA

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2
Q

Giant Cell Tumor

Location?
Clinical features?

A
  • *Location:** Distal femur, proximal tibia, distal radius, proximal humerus
  • *Clinical Features:** Localised swelling and tenderness. Intermittent aching pain.
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3
Q

Giant Cell Tumor

Radiological appearance?
DDX?

A
  • *Giant Cell Tumor**
  • *Radiological appearance:**
  • (LEFT PHOTO) Eccentrically located, sharply circumscribed lytic lesion (60%) = wide zone of transition
  • Soap bubble appearance (40%) = expansial
  • Thin expanded cortex with wide ZOT at endosteal margins
  • *DDX:**
  • Between benign and malignant (quasimalignant)
  • Osteoblastoma
  • ABC
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4
Q

Multiple Myeloma

Nature?
Incidence?
Location?

A
  • *Nature:** Malignant proliferation of plasma cells
  • *Aeitology:** Most common primary malignant neoplasm
  • 75% 50-70 years of age
  • *Location:** Commonly: Tx. and Lx.
  • Other:* flat bones as skull and ribs
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5
Q

Mulitple Myeloma

Clinical Features?
Radiological Appearance?

A
  • *Clinical Features:**
  • Bone pain intermittent then becoming continuous.
  • Impaired immune system
  • Path #’s
  • Weightloss
  • *Radiological:
  • **Bone scan is cold
  • Osteoporosis, sharply circumscribed
  • Osteolytic defects (punched out lesion)
  • -Rare:* ivory vertebra
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6
Q

What lesion is this?

A

Giant Cell Tumor

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7
Q

Plasmacytoma
Nature?
Location?

A

Nature: Localised plasma cell proliferation
Incidence: 55 yoa common
Location: Common: Mandible, ilium, vertebre, proximal femur, scapula

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8
Q

Plasmacytoma

Radiological appearance?
Differential Diagnosis?

A
  • *Radiological appearance:**
  • Path #’s common
  • Lucent geographic lesion
  • May be high expansile
  • Soap bubble apperance

DDX: Giant Cell Tumor
Brown tumor (hyperparathyroidism)
Blown out Mets

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9
Q

What lesion is this?
Why?

A

Plasmacytoma
Soap bubble lesion is a radiological appearance

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10
Q

What condition is this?
Why?

A

Plasmacytoma
Radiological:
Lucent geographic lesion. May be highly expansile. Soap bubble appearance of lesion.

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11
Q

Osteosarcoma (central)
Nature?

A

Nature: central, multicentric, parosteal, 2ndary to extra osseous

  • *Incidence:** 2nd most common malignancy
  • 20% of all primary malignancies
  • Very young 75%= 10-25

-Occurs in bones affected by paget’s

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12
Q

Osteosarcoma (central)

Location?
Clinical features?

A

Long bones: distal femur most common, proximal tibia and fibula and proximal humerus

Clinical features: Painful sweeling, insidious

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13
Q

Osteosarcoma (central)
Radiological?

A

Radiological appearance:
Metpahyseal lesion: three main apperances:
1. Sclerotic = 50% (dense ivory lesion filling medullary space, may have roughened lobulated margin “cumulous cloud appearance”)
2. Lytic lesion = 25%
3. Mixed mottled permeative lesion= 25%
-See highly irregular periosteal new bone formation (sunburst or sunray)
- +/- Presence of codmans triangle

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14
Q

What condition is this?

A

Radiological appearance:
Metpahyseal lesion: three main apperances:
1. Sclerotic = 50% (dense ivory lesion filling medullary space, may have roughened lobulated margin “cumulous cloud appearance”)
2. Lytic lesion = 25%
3. Mixed mottled permeative lesion= 25%
-See highly irregular periosteal new bone formation (sunburst or sunray)
- +/- Presence of codmans triangle

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15
Q

Chondrosarcoma

A

Nature: May be primary or secondary (degeneration of osteochondroma or enchondroma)

  • *Incidence:** 3rd most common primary malignant tumour (10%)
  • Central more common than peripheral
  • *Location:** Can be central, peripheral or extra-osseous
  • Common in pelvis (50%)
  • Other sites: Ribs, prox. Humerus scapula. distal femur
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16
Q

What is the most common, second most common, third most common, fourth most common primary malignant tumors?

A
  1. Multiple Myeloma
  2. Osteosarcoma
  3. Chondrosarcoma
  4. Ewings Sarcoma
17
Q

Chondrosarcoma
Radiological Appearance?

A
  • Radiological Appearance:*
  • Large lucent, round or oval shaped
  • Poorly defined margins
  • Expansile
  • Endosteal scallopping (focal resorption of the inner margin of cortical bones)
  • Bubbly matrix with mottled appearence
  • Cotton wool appearance
  • laminated or spiculated periosteal response
18
Q

What lesion is this?

A

Chondrosarcoma

19
Q

What is a sessile lesion associated with?
Why is it important?

A
  • An osteochondroma can be either sessile or pedunculated, and is seen in the metaphyseal region typically projecting away from the epiphysis.
  • Sessile lesions are more likely to be associated with abnormalities of tubulation of the underlying bone leading to metaphyseal widening or a “trumpet shaped” deformity on x-ray
20
Q

Ewings Sarcoma
Nature?
Incidence?
Location?

A
  • *Nature:** -Aggressive
  • Frequently early METS
  • *Incidence:** Genetic predisposition
  • 50% <20 peak age 15
  • *Location:** Femur, tibia, fibula, humerus
  • Classically in diaphysis of the above
21
Q

Ewings Sarcoma:
Radiological appearance?

A
  • *Margin:**
  • Diaphyseal permative lesion with wide zone of transition
  • *Periosteum:**
  • Up to 50% are “Onion skin periosteal response” (demonstrates multiple concentric parallel layers of new bone adjacent to the cortex)
  • May see groomed whiskers appearance of periosteum (A pattern characterised by hair-like periosteal projections perpendicular to bony trabeculae)
  • *Cortex:**
  • Saucerisation “scalloped depression in cortex”
  • *Medulla:
  • ** Usually mixed lytic and sclerotic pattern
22
Q

What condition is this?

A

**Ewings Sarcoma

Margin:**

-Diaphyseal permative lesion with wide zone of transition

  • *Periosteum:**
  • Up to 50% are “Onion skin periosteal response” (demonstrates multiple concentric parallel layers of new bone adjacent to the cortex)
  • May see groomed whiskers appearance of periosteum (A pattern characterised by hair-like periosteal projections perpendicular to bony trabeculae)
  • *Cortex:**
  • Saucerisation “scalloped depression in cortex”
  • *Medulla:**
  • Usually mixed lytic and sclerotic pattern
23
Q

Non Hodgkins Lymphoma

A

Location:
Long bones (humerus and femur are the most common)
Radiological Appearance:
Medulla:
-Permeative or punched out lesions (simialr to multiple myseloma)
-Widespeard osteopenia
-Destructive

24
Q

What are some primary malignancies that have permeative or punched out lesions?

A
  • Non-Hodgkins Lymphoma
  • Multiple myeloma
25
Q

Metastatic
Nature?
Incidence?
Location?

A
  • *Nature:** Common B,L,T,K,P BOWEL
  • *Incidence:**
  • 70% of all malignant bone tumours
  • 80% mets from, B,P,L,K
  • *Location:**
  • Spine, ribs, sternum, pelvic and sacrum, long bones
26
Q

Metastasise
Radiological?
DDX?

A
  • *Radiological:**
  • Pelvic bone scan
  • Ostoeblastic or osteosclerotic appearance:
  • Destructive
  • May see winking vertebrae or blown out vertebrae
  • *DDX:**
  • *-Skull:** myeloma
  • *-Spine:** Paget’s, hodgkin’s lymphoma
27
Q

Charcot joint
Location?

A

The involved joint is highly suggestive of the aetiology:

wrist: diabetes, syringomyelia
hip: alcohol, tabes dorsalis
knee: tabes dorsalis, congenital insensitivity to pain

ankle and foot: diabetes

spine: spinal cord injury, diabetes, tabes dorsalis

28
Q

Charcot joint
Definition?
Features?

A

Charcot joint, also known as a neuropathic or neurotrophic joint, refers to a progressive degenerative/destructive joint disorder in patients with abnormal pain sensation and proprioception.

Mnemonic:

increased density (subchondral sclerosis)

destruction

debris (intra-articular loose bodies)

dislocation

distention

disorganisation

YEAR 4 SEMESTER 1 DIAGNOSTIC IMAGING (21 decks)

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