Radiology 3

Question 1

tumors most likely in children

Answer 1

benign: ABC, SBC, osteoid osteoma
malignant: osteosarcoma, Ewing sarcoma, lymphoma

Question 2

tumors most likely in young adults

Answer 2

benign: giant cell, osteochrondroma
malignant: lymphoma, osteosarcoma

Question 3

tumors most likely in older adults

Answer 3

benign: non usually newly found in this group
malignant: metastasis, myeloma, chondrosarcoma, lymphoma

Question 4

tumors in epiphyseal or bone end

Answer 4

giant cell tumor

chondroblastoma

Question 5

tumors in diaphyseal bones

Answer 5

ewing sarcoma
lymphoma
advancing/enlarging metaphyseal lesions

Question 6

what do tumors look like in bone?

Answer 6

dense, white, “hard” appearance

Question 7

what do tumors look like in cartilage?

Answer 7

stippled, punctate, speckled, dotted calcifications

Question 8

what do tumors look like that are fibrous?

Answer 8

hazy, smokey, cloudy, ground glass

Question 9

what do tumors look like that are lytic/lucent?

Answer 9

pure “empty” hole in the bone, punched out, moth-eaten

Question 10

which 3 primary cancers are most likely to lead to metastasis?

Answer 10

lung
breast
prostate

Question 11

where in the body will metastasis usually been seen?

Answer 11

highly vascular tissue (pedicles, metaphyses)

Question 12

what’s the difference between lytic metastasis and blastic metastasis?

Answer 12

lytic- holes in bone

blastic- random increased densities

Question 13

metastasis key possible findings

Answer 13

absent pedicle
polyostotic locations, multiple sized lesions, less well-defined margins
lytic, blastic, or mixed densities
usually no periosteal reaction or soft tissue mass
ivory vertebra
pathological collapse of vertebrae, could be vertebra plana

Question 14

metastasis management (labs)

Answer 14

blood: hypercalcemia, elevated alkaline phosphatase, ESR, CRP

Question 15

metastasis (imaging)

Answer 15

CT best for defining degree of bony destruction at each site
MRI best for evaluating marrow destruction
radionuclide scintigraphy- best for searching for multiple sites of involvement
chest films for evaluating common metastatic site

Question 16

metastasis referral

Answer 16

oncologist
primary allopath
orthopedist

Question 17

primary malignant tumors (from most common to least common)

Answer 17

multiple myeloma
osteosarcoma
chondrosarcoma
ewing sarcoma
lymphoma

Question 18

multiple myeloma key possible findings

Answer 18

punched out lesions
raindrop skull
usually no soft tissue mass or periosteal reaction
pathological collapse of vertebrae, could be vertebra plana

Question 19

multiple myeloma management (labs)

Answer 19

blood: M spike on protein electrophoresis, hyperglobinemia with reversed A/G ratio, normocytic normochromic anemia, thrombocytopenia, elevated creatine and BUN levels
urine: bence jones proteins, hypercalciuria

Question 20

multiple myeloma management (imagins)

Answer 20

CT best for defining degree of bony destruction at each site
MRI best for evaluating marrow destruction
bone scan best for searching for multiple sites of involvement, but could be cold
chest films for evaluating common metastatic site

Question 21

multiple myeloma referral

Answer 21

oncologist
primary allopath
orthopedic

Question 22

osteosarcoma key possible findings

Answer 22

second most common primary malignant tumor overall, but most common for children
ages 10-25 and >60 due to malignant degeneration of “osteo” tumors
location: usually metaphysis, usually knee or humerus
aggressive and metastatic
periosteal reactions (spiculated, sunburst, laminated, codman’s triangle possible)

Question 23

chondrosarcoma key possible findings

Answer 23

3rd most common primary malignancy
50-70 years
mostly located in pelvis, metaphysis
aggressive and metastatic
stippled, punctate, speckled, dotted

Question 24

ewing sarcoma key possible findings

Answer 24

4th most common primary malignancy overall, 2nd most common in children (10-25)
aggressive and malignant
located in leg bones, pelvis, anywhere
lytic, moth-eaten appearance, with laminated periosteum

Question 25

key location for ewing sarcoma

Answer 25

diaphysis

Question 26

lymphoma of bone key possible findings

Answer 26

5th most common primary malignancy
any age for non-hodgkin’s, 20-40 for hodgkin’s (reed-sternberg cells)
spine: ivory vertebra, compression fractures
extremities: lytic diaphysis location (mimics Ewing)