Spinal Tumors Flashcards
Most common spinal benign neoplasms ?
Enostoma, hemangioma, osteoid osteoma, osteoblastoma, ABC, GCT and osteochondroma
Common spinal malignant tumors?
Typically uncommon (5% of cases).
Chordoma, chondrosarcoma, lymphoma, Ewing’s sarcoma (or PNET) and osteosarcoma
Osteoid osteoma age range and gender?
5-25yrs
M:F (2:1 to 3:1)
What % of O.O. patients get a painful scoliosis?
70%
T/F – spine is M/C location of O.O.?
F. Only 10% (post elements).
Femur & tibia M/C locations.
What % of O.O are partially calcified?
50% (20% are fully)
Age and gender for osteoblastomas?
90% < 30yrs;
M:F (2:1)
What are the clinical differences btwn osteobalstomas (OB) vs osteoid osteomas (OO)?
OO - nocturnal pain relieved by salicylates;
stability in growth;
predominantly long bone tumors
OB - slow growth;
malignant transformation to osteosarcoma; more aggressive overall
higher rate of recurrence compared to OO;
30-40% in spine;
What are the histological differences between OB and OO?
Virutally indistinguishable;
OB > 2cm nidus
What are 3 types of appearances of OB on imaging?
1) similar to OO w/ radiolucent center & surrounding sclerosis
2) more expansile w/ prominent sclerotic rim and multiple Ca2++ – M/C appearance
3) aggressive appearance w/ expansile pattern, bone destruction, paravertebral extension – indistinguishable from ABC
Age and gender of epidural lipomatosis?
Mean age = 43yrs
M>F
M/C location of epidural lipomatosis within the spine?
T/S (60%) > L/S (40%)
Etiology of epidural lipomatosis?
Long-term exogenous steroid adminstration OR excessive endogenous steroid production
What is the measurement in the AP dimension of the epidural fat to consider this condition?
7mm in T/S
What is the clinical presentation of epidural lipomatosis?
Weakness (85%) & back pain (60%)
Age and gender for ABC?
60% < 20yrs
F mildly > M
What’s the recurrence rate for ABC?
20-30%
What are the 3 theories of ABC pathophysiology?
1) consequence of trauma and local circulatory disturbances
2) underlying tumor-inducing vascular process
3) de novo genesis as a primary neoplasm with cytogenic abnormalities
What % of ABC occurs in the spine?
10-30%
75-90% extend into VB from neural arch
What scintigraphy sign is present for ABC?
“Donut sign” = rim of activity around a photopenic region, representing hypervascularity in the periphery
What is the most common spinal tumor?
Hemangioma
Age and gender for hemangiomas?
30-50s
M>F
(aggressive lesions more common in F)
What is the M/C type of hemangioma?
Cavernous hemangioma (other types are capillary and venous)
Aggressive hemangiomas are likely to occur in what part of the spine?
Thoracic
What % of GCT are in the spine?
~3%
What is the recurrence rate of GCT?
12-50%
What is the most frequent benign tumor to affect the spine?
GCT
What is the most common location for chordoma?
sacrococcygeal (50%) > spheno-occipital (35%) > vertebral bodies (15%)
Calcifications in sacral chordomas occur in what %?
70%
What is the most common benign bone tumor?
Osteochondroma
Age and gender for osteochondromas?
10-30yrs
M:F (3:1)
The M/C location for osteochondroma in the spine?
Spinous processes
What incidence of osteosarcomas occur in the spine?
up to 3%
What % of chondrosarcomas are in the spine?
up to 12%
Age and gender of Ewing’s sarcoma
90% < 20yrs
M:F (2:1)
What % of Ewing’s sarcoma have already metastasized at initial diagnosis?
30%
What part of the vertebra does Ewing’s affect?
vertebral body
What is the M/C form of lymphoma?
B-cell lymphoma (80-90%) - Non-hodgkin’s lymphoma
What is the M/C malignancy of the epidural space?
lymphoma
What is the cause of lymphoma?
Etiology unknown;
Risk factors: chemical exposure to pesticides, fertilizers or solvents, Epstein-Barr virus, family hx of Hodgkin’s.
What is the etiology of multiple myeloma?
Unknown;
But neoplastic plasma cells accelerate ostoclastic bone resportion and inhibits osteoblastic bone formation
What % of prostate cancer metastasis involves the spine?
90%
What primary cancers cause purely blastic metastasis?
Prostate, carcinoid, bladder, nasopharynx and medulloblastoma
What primary cancers cause mixed metastasis?
Lung, breast, cervix and ovarian
What primary cancers cause lytic metastasis?
Breast, lung, kidney and thyroid and melanoma
What is the M/C spinal location for a hemangioblastomas? (Give level and intra/extradural specifics.)
T/S > C/S
60% intramedullary
20% intradural-extramedullary
Inhomogeneous, tiny foci of signal changes (low T1, high T2) is which type of multiple myeloma?
Type 2
What are the 3 patterns of multiple myeloma?
Type 1: focal lesions (low T1, high T2)
Type 2: homogeneous, multiple foci (low T1, high T2)
Type 3: total marrow involvement (high T1/T2)
Where is the M/C location for skeletal mets?
Spine
What region of the spine is M/C involved in osteoid osteoma?
Lumbar > cervical > thoracic
What region of the spine is M/C involved in osteochondroma?
Cervical (50% C2 predilection), posterior elements
What are the 3 M/C locations for chordoma (from M/C to least)?
Sacrococcygeal (50%) > spheno-occipital»_space; cervical
Which region of the spine is the M/C location for Ewing’s sarcoma?
Sacrum
Where is the M/C location within the body for a neuroblastic tumor?
Adrenal gland (40%)
Where is the M/C location within the body for a plasmacytoma?
Vertebral body
