Primary Malignant Tumours and Metastatic Spread Flashcards
Giant Cell Tumour
Nature?
Incidence?
Nature: Neoplasm formed from connective tissue, highly vascular, about 20% malignant
Incidence: 2-5% of all malignancies are GCT
20-40 YOA
Giant Cell Tumor
Location?
Clinical features?
- *Location:** Distal femur, proximal tibia, distal radius, proximal humerus
- *Clinical Features:** Localised swelling and tenderness. Intermittent aching pain.
Giant Cell Tumor
Radiological appearance?
DDX?
- *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
Multiple Myeloma
Nature?
Incidence?
Location?
- *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
Mulitple Myeloma
Clinical Features?
Radiological Appearance?
- *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
What lesion is this?
Giant Cell Tumor
Plasmacytoma
Nature?
Location?
Nature: Localised plasma cell proliferation
Incidence: 55 yoa common
Location: Common: Mandible, ilium, vertebre, proximal femur, scapula
Plasmacytoma
Radiological appearance?
Differential Diagnosis?
- *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
What lesion is this?
Why?
Plasmacytoma
Soap bubble lesion is a radiological appearance
What condition is this?
Why?
Plasmacytoma
Radiological:
Lucent geographic lesion. May be highly expansile. Soap bubble appearance of lesion.
Osteosarcoma (central)
Nature?
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
Osteosarcoma (central)
Location?
Clinical features?
Long bones: distal femur most common, proximal tibia and fibula and proximal humerus
Clinical features: Painful sweeling, insidious
Osteosarcoma (central)
Radiological?
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
What condition is this?
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
Chondrosarcoma
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
What is the most common, second most common, third most common, fourth most common primary malignant tumors?
- Multiple Myeloma
- Osteosarcoma
- Chondrosarcoma
- Ewings Sarcoma
Chondrosarcoma
Radiological Appearance?
- 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
What lesion is this?
Chondrosarcoma
What is a sessile lesion associated with?
Why is it important?
- 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
Ewings Sarcoma
Nature?
Incidence?
Location?
- *Nature:** -Aggressive
- Frequently early METS
- *Incidence:** Genetic predisposition
- 50% <20 peak age 15
- *Location:** Femur, tibia, fibula, humerus
- Classically in diaphysis of the above
Ewings Sarcoma:
Radiological appearance?
- *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
What condition is this?
**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
Non Hodgkins Lymphoma
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
What are some primary malignancies that have permeative or punched out lesions?
- Non-Hodgkins Lymphoma
- Multiple myeloma
Metastatic
Nature?
Incidence?
Location?
- *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
Metastasise
Radiological?
DDX?
- *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
Charcot joint
Location?
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
Charcot joint
Definition?
Features?
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
