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Bone Path II > Quiz 1 - malignancies of bone > Flashcards

Quiz 1 - malignancies of bone Flashcards

1
Q

Most common malignant tumors of bones?

A

Mets (25x MC than 1˚)

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2
Q

What are the MC primary malignancy sites?

A

Lung
Breast
Renal
Prostate cancer

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3
Q

Mets targets what are?

A

Axial skeleton, skull, proximal extremities (blood)

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4
Q

What is acral metastasis

A

The rare occurrence of mets distal to the knee or elbow

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5
Q

What is primary malignancy in women vs men?

A

Breast = women, then thyroid, kidney, uterus

Prostate = men, then lung

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6
Q

Most patients are how old?

A

Over 40

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7
Q

Malignancy under 5 yo is usually what malignancy?

A

Neuroblastoma

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8
Q

Malignancy under age 10-20 yo is usually?

A

Ewing sarcoma

Osteosarcoma

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9
Q

Malignancy age 200-35 is usually what disease?

A

Hodgkin lymphoma

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10
Q

What % of people have bone pain?

A

70%

Insidious, remission/exacerbation, persistent, nocturnal

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11
Q

Patients with suspected metastasis should get what lab studies

A

ESR
CBC
Chem screen
UA

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12
Q

What are the 3 routes of mets?

A
  • Hematogenous is MC via arteries
  • Direct invasion soft tissues
  • Lymph dissemination (unusual)
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13
Q

What imaging is needed for mets? (4)

A

Plain radiograph
CT
MRI
Bone scan (nuclear imaging)

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14
Q

What does mets look like on radiograph?

A

75% osteolytic (moth-eaten, permeative)

15% osteoblastic

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15
Q

What is a “blow-out” pattern?

A

Large, very expansile, solitary

Suggests renal or thyroid primary

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16
Q

40% of mets occurs in what location?

A

Spine

Thoracic and lumbar MC

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17
Q

What is the MC cause of missing pedicle?

A

Osteolytic mets

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18
Q

3 MC causes of ivory vertebra

A

Osteoblastic mets
Paget’s disease (cortical thickening, expansion)
Lymphoma (Hodgkin) (anterior body scalloping)

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19
Q

MC cause of extrapleural sign?

A

Rib mets

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20
Q

Skeletal metastasis is most common where?

A

28% ribs and sternum

12% pelvis
10% skull
10% long tubular bones

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21
Q

Management plan for mets?

A

Identify primary site
Identify extent of mets
Manage P and bone loss

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22
Q

What are 3 meds commonly for managing mets.

A

Steroids and NSAIDS

Bisphosphonates to manage osteoblastic activity

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23
Q

What are the 4 MC primary malignancies of bone? And MC ages of people to get them? (Hint: MOCE)

A

Multiple myeloma (50-70 y.o.)
Osteosarcoma (10-25 y.o.)
Chondrosarcoma (40-60 y.o.)
Ewing’s sarcoma (10-25 y.o.)

In order of age:
O + E = 10-25 yo
C = 40-60 yo
MM = 50-70 yo

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24
Q

What age group gets Multiple myeloma?

A

50-70 y.o.

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25
Q

What age group gets Osteosarcoma?

A

10-25 y.o.

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26
Q

What age group gets Chondrosarcoma?

A

40-60 y.o.

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27
Q

What age group gets Ewing’s sarcoma?

A

10-25 y.o.

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28
Q

Where is MM located usually?

A

Similar as mets (axial skeleton, proximal femur and humerus, skull) PLUS long bones: the whole humerus, femur, tibia, fibula, radius, ulna.

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29
Q

What are signs and Sx of MM?

A 
Bone pain (worse with activity and weight bearing, pathologic fx)
Anemia
Proteinuria
Renal disease
Weight loss/cachexia
Osteoporosis
Amyloidosis
Bacterial infections (esp. respiratory)
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30
Q

How do you dx MM?

A

Blood screening:

  • anemia
  • thrombocytopenia
  • elevated ESR
  • hyperuricemia, hypercalcemia
  • elevated serum proteins
  • -> M spike with electrophoresis is diagnostic
  • Benjones protein in urine
  • bone marrow aspirate shows increased number of bone marrow plasma cells
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31
Q

Multiple, well-defined, round osteolytic defects: “punched out” defects and endosteal scalloping

Severe generalized osteopenia

High incidence pathologic Fx

This suggests what disease?

A

MM

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32
Q

Where does MRI, bone scan, CT play a role in detecting MM?

A

MRI very sensitive to marrow changes
Bone scan is usually negative
CT does not play a major role

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33
Q

What is the Prognosis of MM?

A

Prognosis is poor

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34
Q

Complications of MM? (3)

A

Pathologic fx
Renal failure
Respiratory infection

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35
Q

Tx for MM?

A

Targeted drug therapy
Chemotherapy
Bone marrow transplant

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36
Q

What is the concern with a solitary plasmacytoma?

A

70% develop MM within 5 years

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37
Q

Geographic
Lytic
Highly expansile
“Soapy bubbly”

If this is seen on radiograph, what do you think it might be?

A

solitary plasmacytoma

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38
Q

What location does solitary plasmacytoma favor?

A

MC Thoracic Spine

20% Rib, sternum, classical, scapula

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39
Q

Median age for solitary plasmacytoma

A

55

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40
Q

What is solitary plasmacytoma

A

Localize plasma cell neoplasm

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41
Q

What is a malignant neoplasm which forms osteoid called?

A

Osteosarcoma

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42
Q

Where are Osteosarcoma usually located?

A

80% Intramedullary (knee)
10-15% Surface/juxtacortical
5% extra skeletal

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43
Q

What percentage of Osteosarcoma are primary vs secondary?

A

75% primary in 10-20 yo

25% secondary = older patients d/t malignant degeneration of benign lesion or Paget’s

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44
Q

What are signs and Sx of Osteosarcoma?

A
  • Painful swelling
  • Pain increases with activity
  • Pathologic Fx possible
  • Onset of Sx to Dx often >6months
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45
Q

“Cumulus cloud” appearance
Cortical destruction, aggressive periosteal response, soft tissue mass
Location: metaphysis of long bone (75% of them)
Appearance: sclerotic (50% of the time)

If you saw this on plain film, what would you think?

A

Osteosarcoma

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46
Q

What is the role of MRI, CT, bone scan with Osteosarcoma?

A

MRI is used in planning Tx (determine extend of lesion and relationship to vessels and nerves)

Chest CT and Bone scan detects metastasis

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47
Q

What is the prognosis for Osteosarcoma

A

Mets to lungs common, mets to other bones possible

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48
Q

To for Osteosarcoma

A

Aggressive surgical resection often includes amputation

Mets to lung “cannonball metastasis”

Radiation therapy

Chemotherapy

49
Q

“Cannonball mets”

A

Osteosarcoma

Ewing sarcoma

50
Q

What kind of Osteosarcoma accounts for 5% all Osteosarcoma?

A

Parosteal Osteosarcoma

51
Q

How fast does Parosteal Osteosarcoma grow?

A

Slow

52
Q

What are the symptoms of Parosteal Osteosarcoma?

A

Similar to osteosarcoma:

  • Painful swelling
  • Pain increases with activity
  • Pathologic Fx possible
53
Q

Age range of Parosteal Osteosarcoma?

A

30-50yo

54
Q

Dense, juxtacortical mass with stalk to cortex and NO periosteal response

A

Parosteal Osteosarcoma

DDx: myositis ossificans (MO) because they looks so similar (see slide 60)

55
Q

How do you know its Parosteal Osteosarcoma and not MO?

A

PO: stalk attaches to cortex. Central portion is more dense and less dense at periphery, grows over time

MO: separated from the bone. Less dense in the middle. Gets smaller over time.

56
Q

What is secondary Osteosarcoma?

A

Malignant degeneration of benign lesion

57
Q

What are the 4 most common benign lesions to turn into secondary osteosarcoma if they undergo malignancy? (3 + 1 special one)

A

Paget’s disease
Fibrous dysplasia
Osteochondroma —> osteosarcoma

Enchondroma —> chondrosarcoma THEN osteosarcoma

(—> signifies malignant changes)

58
Q

What is the age range of chondrosarcoma?

A

40-70 yo MC

Though 20-90 possible

59
Q

What gender gets chondrosarcoma?

A

M>F 2:1

60
Q

chondrosarcoma is what % of primary bone malignancies

A

25% primary bone malignancies are chondrosarcoma

61
Q

Cartilaginous matrix?

A

Think chondrosarcoma

62
Q

It’s possible for these 2 lesions, when they undergo malignancy, to become chondrosarcoma:

A

Enchondroma

Osteochondroma

63
Q

Signs and Sx of chondrosarcoma?

A

Deep, dull, achy pain
Sometimes mild limp, limited ROM
Soft tissue swelling/ mass possible
Hx of 2-5 years

64
Q

Lab findings for chondrosarcoma?

A

Typically WNL

65
Q

What is the MC location for chondrosarcoma? (2)

Where else can you find it? (6)

A

Any bone preformed in cartilage.
MC: pelvic, proximal femur

Also: proximal humerus, ribs, scapula, distal femur, proximal tibia, craniofacial bones

Metaphyseal or diaphyseal; clear-cell in epiphysis (<2%)

66
Q

What is the MC benign tumor of the hand?

A

Enchondroma

67
Q

What is the MC primary malignancy of hand, sternum, scapula?

A

Chondrosarcoma

68
Q

Large, lytic, poorly defined
Calcification in 70% “popcorn,” “stippled,” “arcs and rings”
Large soft tissue mass
Endosteal scalloping

Plain film findings for?

A

Chondrosarcomaa

69
Q

Chondrosarcoma and Enchondroma look very similar. What is the main difference?

A

[answer here]

70
Q

What is the prognosis for chondrosarcoma?

A

Slow progression
High 5-year survival rate w/ early Tx

Grade 1 = 90% survival rate
Grade 3 = 30% survival rate

71
Q

Tx for chondrosarcoma?

A

Surgical resection

Radiation and chemo have limited use

72
Q

Are mets common with chondrosarcoma?

A

No

73
Q

What is an uncommon subtype of chondrosarcoma?

A

clear cell chondrosarcoma

74
Q

Where is clear cell chondrosarcoma located? What does it look like?

A

Epiphysis

Round, sharply marinated lytic lesion

75
Q

What bones is clear cell Chondrosarcoma MC found in?

A

Proximal long bones

76
Q

Will clear cell chondrosarcoma have sclerosis or calcification/

A

Maybe

77
Q

How do you distinguish clear cell chondrosarcoma from chondroblastoma?

A

Cannot.

78
Q

Who gets Ewing sarcoma?

A

10-25 yo

M>F

79
Q

Ewing sarcoma is what % of primary malignancies?

A

7%

80
Q

Marrow cell tumor
“Round cell”

What kind fo tumor is this?

A

Ewing sarcoma

81
Q

Signs and Sx of Ewing sarcoma

A

Localized P and swelling, local warmth, tenderness, dilated veins

Palpable soft tissue mass

Systemic signs: fever, anemia, leukocytosis, increased ESR

82
Q

Location of Ewing sarcoma

A

70% Long bones (Femur, tibia, humerus: and diaphysis is classic location)

25% Flat bones (pelvis, ribs, scap)

5% spine

83
Q

What long bones does Ewing sarcoma MC show up in

A

Humerus
Femur
Tibia
Fibula

84
Q

Permeative lytic destruction w/ wide zone of transition

Aggressive periosteal response (25-50%): sunburst, laminated, codman

Sclerosis seen in up to 40%

What problem do these plain film findings suggest?

A

Ewing sarcoma

85
Q

Prognosis for Ewing sarcoma

A

Poor

86
Q

Tx for Ewing sarcoma

A

Chemotherapy is mainstay

  • radiation
  • surgical resection/amputation

Commonly mets to lungs “cannonball mets”

87
Q

What is the MC primary malignant bone tumor to mets to bone?

A

Ewing sarcoma

88
Q

What is a rare <2% primary bone malignancy?

A

Fibrosarcoma

89
Q

Fibrosarcoma is MC in what age group

A

30-50 yo

90
Q

Where is Fibrosarcoma located commonly

A

Major long bones

50% at knee

91
Q

What is Sx for Fibrosarcoma

A

Pain, swelling

Ave 2 yrs before Dx

92
Q

Highly destructive, expanding, lytic lesion

Large soft tissue mass

No periosteal reaction

What do these radiograph findings suggest?

A

Fibrosarcoma

93
Q

What is prognosis for Fibrosarcoma

A

Poor

Frequent local recurrence up to 80%

94
Q

What is Tx for Fibrosarcoma

A

Amputation

95
Q

When and where does Fibrosarcoma metastasize?

A

Mets late to Lung, liver, lymph, brain

96
Q

What is the MC soft tissue sarcoma in adults?

A

Malignant fibrous histiocytoma (MFH)

97
Q

What is histologically similar to fibrosarcoma?

A

Malignant fibrous histiocytoma (MFH)

98
Q

What location does Malignant fibrous histiocytoma (MFH) affect?

A

50% Lower extremity

20% upper extremity

99
Q

Sx of Malignant fibrous histiocytoma (MFH)?

A

Painless, solid mass usually

100
Q

Where does Malignant fibrous histiocytoma (MFH) mets?

A

Lungs

101
Q

What is a rare <1% primary bone malignancy?

A

Chordoma

102
Q

What originates from notochord remnants?

A

Chordoma

103
Q

What age group is Chordoma

A

30-70 yo

M>F

104
Q

What is the only primary malignancy to cross the IVD?

A

Chordoma

105
Q

Prognosis of Chordoma?

A

Poor

Difficult surgical resection

106
Q

What vertebra is Chordoma MC in?

A

C2

107
Q 
Midline lesions
Lytic destruction
Cortical expansion
Calcification in 50%
Soft tissue mass

What do these findings suggest?

A

Chordoma

DDx: lytic mets, chondrosarcoma, GCT, ABC, plasmacytoma

108
Q

What is 3-4% of primary bone malign?

A

Lymphoma of bone

109
Q

What is the prognosis for Lymphoma of bone

A

Better than most primary bone malignancies

110
Q

Age and gender of Lymphoma of bone?

A

20-50 yo

M>F

111
Q

What is rare, extranodal lymphoma?

A

Lymphoma of bone

112
Q

Signs and sx of Lymphoma of bone

A 
Local intermittent pain
Dull, aching, not relieved by rest
Generally healthy pt
Over 50% have Sx > 1 year
Palpable mass or swelling
113
Q

MC location for Lymphoma of bone

A

Lower extremities, pelvis, spine

114
Q

Permeative, moth-eaten lytic destruction
Minimal periosteal response
Soft tissue mass
Pathologic Fx common

These radiograph findings suggest?

A

Lymphoma of bone

115
Q

What is usually secondary to systemic Hodgkin?

A

Hodgkin Lymphoma of bone

10-20% patients with Hodgkin develop skeletal involvement

116
Q

What is the MC sx of Hodgkin Lymphoma of bone

A

Pain

117
Q

MC location for Hodgkin Lymphoma of bone?

A

Vertebral body

“Ivory vertebra”

118
Q

Hodgkin Lymphoma of bone is polyostotic in

A

2/3

Bone Path II (9 decks)

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