Surgery Case - Bone Tumors

Question 1

Most common primary malignant bone tumors?

Answer 1

Osteogenic sarcoma
Ewing’s sarcoma
Fibrosarcoma
Chondrosarcoma

Question 2

Primary bone tumors are rare, accounting for less than __% of all malignant tumors.

Answer 2

1

Question 3

Imaging procedure of choice to evaluate primary bone tumors?

Answer 3

MRI - invaluable in surgical planning (demonstrates intraosseous and soft tissue involvement of the tumor and tumor extension), also helpful in evaluating possible malignant degeneration of osteochondromas by allowing accurate measurements of the cartilage cap

Question 4

Utility of plain radiographs in evaluating primary bone tumors?

Answer 4

Can often predict the probable histology of a potentially malignant bone lesion

Question 5

Utility of CT scan in evaluating primary bone tumors?

Answer 5

Generally less useful than MRI; helpful in defining the integrity of the cortex and distribution of calcification

Question 6

Imaging findings of osteogenic sarcoma?

Answer 6

Bone destruction
Sunburst appearance
Periosteal elevation (MR, bone scan)
Sclerosis

Question 7

Imaging findings of chondrosarcoma?

Answer 7

Mass with calcification
XR - fusiform, lucent defect with scalloping of the inner cortex and periosteal reaction
Extension into the soft tissue may be present as well as punctate or stippled calcification of the cartilage matrix

Question 8

Imaging findings of Ewing’s tumor?

Answer 8

Lytic lesion

“Onion peel” appearance of periosteal reaction

Question 9

What are the common primaries that met to bones?

Answer 9

Prostate (most common from M)
Breast (most common from F)
Lung
Kidney
Bladder
Thyroid
Lymphomas

Question 10

Common bones where mets are common?

Answer 10

Vertebrae>Femur>Pelvis>Ribs>Sternum>Humerus>Skull

Question 11

List the imaging modalities useful to investigate secondary bone tumors.

Answer 11

Plain films
Radioisotope bone scan
CT
MRI
PET

Question 12

Lytic lesions must be >___ cm in diameter to be detected on plain film

Answer 12

1

Question 13

Osteoblastic lesions are best detected on ___.

Answer 13

Bone scan

Question 14

Osteoblastic lesions most commonly arise from ___ cancer.

Answer 14

Prostate (but also breast, lung, and carcinoid)

Question 15

Preferred method for evaluating the entire skeleton for the presence of multiple lesions?

Answer 15

Radionuclide bone scan

Question 16

Preferred method for diagnosing spinal mets in locations difficult to access with bone scan or radiographs?

Answer 16

CT

Question 17

Who else needs a CT scan in the setting of bone mets?

Answer 17

Patients with + bone scans and negative radiographs to clarify pathology

Question 18

Utility of MRI in evaluating bone mets?

Answer 18

More sensitive than CT, especially for lesions involving the spine

Question 19

DDx - lytic bone lesion?

Answer 19

Metastasis
Primary tumor
Osteomyelitis
Plasmacytoma

Question 20

Primary bone tumors occur primarily in patients under ___ years of age.

Answer 20

40

Question 21

___ usually has a sclerotic bone reaction.

Answer 21

Osteomyelitis