Test #1 Flashcards
1
Q
Osteomas have a predilection for what site in the body?
A
Skull
2
Q
Enchondromas have a predilection for what part of the body?
A
Hand
3
Q
Hemangiomas have a predilection for what site in the body?
A
Vertebra
4
Q
Where is the M/C location for a Ewing’s Sarcoma?
A
Shaft of the femur in younger people
Can show up in pelvis if pt is older
5
Q
Examples of tumors that predominate in areas of red or hematopoietic marrow
A
Ewings
Lymphoma
Myeloma
6
Q
Majority of bone tumors & infections arise in which part of the bone?
A
Metaphysis
7
Q
Bone tumors typically arise in locations where the homologous normal cells are _________
A
Most active
8
Q
This is caused by a puncture wound that forces epithelial cells into the bone where it grows & develops into a cyst
A
Epidermoid cyst
9
Q
If a lesion involves the vertebral body is it more likely to be malignant or benign?
A
Malignant
10
Q
If a lesion is more likely to involve the pos. vertebra is it more likely to be malignant or benign?
A
Benign
11
Q
A “cleavage line” usually indicates what type of lesion location?
A
Parosteal location
12
Q
Malignant or aggressive lesions tend to be small or large at time of discovery?
A
Large except for:
Fibrous dysplasia
Simple Bone Cyst
ABC
13
Q
If a lesion is longitudinal in shape then it tends to be malignant or benign?
A
Benign
14
Q
If a lesion is pleomorphic (round-shape) then it tends to be malignant or benign?
A
Malignant
15
Q
An imperceptible zone of transition of a lesion indicates what?
A
It’s malignant
16
Q
If the zone of transition of a lesion is sharp, it indicates what?
A
It’s benign
17
Q
What are the 3 types of lesion margins?
A
A margin w/ sharp demarcation by sclerosis
A margin w/ sharp demarcation & no sclerosis
A margin w/ an ill-defined region
18
Q
What are 2 types of lesions that typically have a sharp margination?
A
Fibrous dysplasia
SBC
19
Q
What are 2 examples of lesions w/ an imperceptible margination?
A
Metastasis
Infections
20
Q
What % of cancellous bone must be destroyed before evidence is noted on conventional films?
A
30%-50%
21
Q
What are the 3 patterns of bone destruction?
A
Geographic pattern
Moth-eaten pattern
Permeative pattern
22
Q
Which 2 patterns of bone destruction indicate malignancy or infection?
A
Moth-eaten pattern
Permeative pattern
23
Q
What are the characteristics of the Geographic pattern of bone destruction?
A
Least aggressive pattern Circumscribed & uniformly lytic Tend to be sharply marginated May be trabeculated M/C indicative of a slow-growing lesion
24
Q
What are characteristics of the Moth-eaten pattern of bone destruction?
A
Multiple small or moderate sized lucenies (2-5mm)
Margins are frequently ill-defined
Longer zone of transition
Indicative of aggressive lesions
25
What are characteristics of the Permeative pattern of bone destruction?
Multiple holes <1mm in size
Poorly demarcated, not easily separated from normal bone
Areas of destruction may coalesce
Indicative of a very aggressive lesion
26
What is the dominate internal extracellular substance of a lesion called?
Matrix
27
Most tumors have what type of matrix?
Radiolucent matrix
28
This type of calcification occurs in devitalized (dead) tissue
Dystrophic calcification
29
This type of calcification results from abnormal calcium metabolism
Metastatic calcification
30
This type of matrix has a diffuse to hazy, fluffy, cotton, or cloud-like appearance
Osseous matrix
31
This type of matrix has a stippled, flocculent, arc or ring-like, popcorn-like, comma shaped appearance
Cartilage matrix
32
This type of matrix has a smoky, hazy, or ground glass appearance
Fibrous matrix
33
This type of matrix is hard to identify on plain film if it is intraosseous
Fat matrix
34
What are the two types of osseous matrix?
Tumor new bone (confined to bone)
| Reactive new bone (seen in soft tissue)
35
What are the characteristics of Tumor New Bone?
New bone produced by osteogenic tumors
Fluffy, cloud-like in appearance
May appear homogenous or inhomogenous
36
What lesion is an example of Tumor New Bone?
Osteosarcoma
37
This type of osseous matrix lays down new bone in response to a stimulus
Reactive New Bone
38
What two lesions are examples of reactive new bone type of osseous matrix?
Degenerative sclerosis
| Metastasis
39
What are the characteristics of cartilage matrix?
Many cartilage tumors produce matrix calcification
Extent & frequency of pathologically evident calcification is usually greater than seen on xray
Stipple, flocculent, pop-corn, ring-like appearance
40
What are examples of lesions assoc. w/ cartilage matrix?
Chrondrosarcoma
Enchondromas
Chondroblastomas
41
What are characteristics of a fibrous matrix?
Uniform increase in radiodensity
Smokey or hazy, ground glass appearance
Often difficult to identify
42
What is an example of a lesion assoc. w/ fibrous matrix?
Fibrous dysplasia
43
What is the trabeculation pattern assoc. w/ a giant cell tumor?
Delicate or thin
44
What is the trabeculation pattern assoc. w/ an ABC?
Delicate, horizontal possibly extending into the soft tissue
45
What is the trabeculation pattern assoc. w/ a hemangioma?
Honeycombed, striated, radiating
46
What is the trabeculation pattern assoc. w/ a NOF?
Lobulated
47
This is a key factor is assessing the growth rate of a lesion
Cortical integrity
48
What are the 3 types of appearances assoc. w/ cortical integrity?
Cortical erosion
Cortical Penetration
Cortical Expansion
49
Which of the 3 types of cortical integrity appearances implies malignancy or infection?
Cortical Penetration
50
This type of cortical integrity appearance is caused by slow growing medullary tumors that erode the inner cortex producing a lobulated or scalloped appearance
Cortical Erosion
51
This is a frequent feature of cartilaginous & fibrous tumors
Endosteal scalloping
52
This type of cortical integrity appearance is the result of progressive endosteal erosion together w/ periosteal bone formation. It is generally a sign of a benign, medullary tumor, however may be the result of a slow-growing malignancy
Cortical expansion
53
This is a fundamental response of bone to disease in which the Haversian system allows spread of the bone forming irritant causing the periosteum to lift
Periosteal response
54
What layer is the new bone formed by in a periosteal response?
Cambium layer
55
What is the latent period seen in a periosteal response?
10-21 day latent period
56
What age group if a periosteal response more often seen?
Children b/c the periosteum is more easily lifted in children
57
What are examples of bone forming irritants that can cause a periosteal response?
```
Blood
Pus
Neoplasm
Edema
Granulation Tissue
```
58
This is a type of periosteal response that is solid or simple & most often benign
Uniterrupted responses
59
This type of periosteal response is AKA a laminated or layered (onion-skin) periosteal response, Spiculated periosteal response, or Codman's triangle & also indicates malignancy or infection
Interrupted Response
60
This periosteal response causes a continuous layer of new bone that attaches to the outer cortical surface. It may be undulating, smooth, elliptical & is related to a slow form of irritation
Solid Periosteal Response
61
What lesions are assoc. w/ a solid periosteal response?
Osteoid osteoma
Stress Fx
Venous stasis
HPO (hypertrophic pulmonary osteoarthropathy)
62
What is the M/C cause of hypertrophic pulmonary osteoarthropathy (HPO)?
Bronchogenic carcinoma
63
This type of periosteal response has alternating layers of opaque & lucent densities & can be seen w/ slow growing & aggressive tumors & infections
Laminated Periosteal Response AKA layered, onion-skin, lamellated
64
What lesion is assoc w/ a laminated periosteal response?
Ewings Sarcoma
65
This type of periosteal response has fine lines of new bone oriented perpendicular to the cortex or radiating from a point source. Usually indicative of very aggressive bone tumors
Spiculated periosteal response AKA Perpendicular, brushed whiskers, hair-on-end, sunburst
66
What lesions is assoc. w/ Spiculated Periosteal Responses?
Osteosarcoma
67
This results from the subperiosteal extension of the lesion & may accompany malignant, benign tumors or infections
Codman's triangle AKA Codman's angle, periosteal cuff
68
When you see an aggressive bone lesion in a child, you should think of what 3 things?
Osteosarcoma
Ewings Sarcoma
Infection
69
Benign tumors & tumor-like conditions typically do not exhibit soft tissue extensions except for?
Giant-cell
ABC
Osteoblastomas
70
What non-neoplastic conditions may exhibit a soft tissue component?
Osteomyelitis
71
What do soft tissue changes include?
Displaced overlying skin lines
Altered myofascial planes
Density changes (opacity vs lucency)
72
What do tumors do to myofascial plane lines?
Displace them
73
What do infections do to myofascial plane lines?
Obliterates them
74
How do infections & tumors differ when it comes to joint spaces?
Infections may cross joint spaces & the open physis, whereas tumors generally do not. Exceptions: ABCs will cross growth plates, chordromas
75
Osseous dissemination of cells originating from a primary malignant neoplasm
Metastatic bone tumor
76
What is the M/C osseous malignancy?
Metastasis
77
What are the M/C primary sites of metastatic bone tumors?
```
Breast
Prostate
Lung
Kidney
Thyroid
Bowel
```
78
What are the least common sites of metastatic bone tumors?
CNS tumors
| basal cell carcinoma of the skin
79
Primary malignant tumors arise in what type of bone?
Normal bone
80
Secondary malignant tumors arise in what type of bone?
diseased bone
81
Bone tumors usually metastasize through the _______ whereas other tumors usually go through the ______
Blood;Lymph
82
What are the M/C primary tumors that lead to metastasis in females?
Breast
Thyroid
Kidney
Cervix
83
What are the M/C primary tumors that lead to metastasis in males?
Prostate
Lung
Bladder
84
What are the M/C primary tumors that lead to metastasis in children?
<5 yoa - neuroblastoma
| 10-20 yoa - Ewings & osteosarcoma
85
What is the leading primary tumor that causes osteolytic metastasis in females?
Breast
86
What is the leading primary tumor that causes osteolytic metastasis in males?
Lung
87
What is the leading primary tumor that causes osteolytic metastasis in children?
Neuroblastoma
88
What is the leading primary tumor that causes osteoblastic metastasis in females?
Breast
89
What is the leading primary tumor that causes osteoblastic metastasis in males?
Prostate
90
What is the leading primary tumor that causes osteoblastic metastasis in children?
Hodgkins
91
What age group is metastasis M/C in?
after the 4th decade
92
What is the M/C presentation of metastasis?
Bone pain at the site, insidious in onset & progressive
93
What is the M/C complication of metastasis?
Pathologic fx
94
What are some clinical manifestations of metastasis?
may be asymptomatic; bouts of excerbation/remission
May see a soft tissue mass
Weight loss, cachetic (state of ill health), anemia, fever
95
Where do a majority of metastatic lesions occur?
In the spine
96
What are some lab values that would show an altered value?
```
ESR
Calcium
Alkaline Phosphatase
Acid Phosphatase & PSA
Proteins
```
97
What lab value could help distinguish b/w metastatic & myeloma?
Proteins
98
What is the M/C pathway for metastatic dissemination?
Hematologic frequently via Batson's plexus
99
What is the imaging procedure of choice for metastasis screening?
Bone scintigraphy
100
What are the M/C (H-to-L) skeletal locations for metastasis?
```
Vertebrae
Ribs & Sternum
Pelvis
Skull
Prox. long bones
```
101
Are metastatic tumors more often osteolytic or osteoblastic?
Osteolytic
102
What are radiographic features of osteolytic metastasis?
Cortical & trabecular destruction
Moth-eaten or permeative pattern
Wide zone of transition
May be expansile
103
What are radiographic features of osteoblastic metastasis?
```
Localized or diffuse increased radiopacity
Scattered pattern (Snow-ball)
Poorly defined margins
```
104
What are some radiographic features that differentiate metastasis from a primary tumor?
Usually multiple sites
Usually no periosteal response
Rarely a soft tissue mass
Rarely expands bone
105
What are the M/C primaries assoc. w/ a blow-out metastasis?
Thyroid & kidney
106
What are some characteristics of a blow-out metastasis?
Often highly expansile & bubbly
May be solitary
Often mimics a primary malignancy
107
FOGMACHINES is the mnemonic for expansive lesions of bone. What do the letters stand for?
```
Fibrous dysplasia
Osteoblastoma
Giant Cell
Metastatic disease/myeloma
ABC - Aneurysmal bone cyst
Cartilaginous tumors
Hyperparathyroid cyst (Brown tumor)/Hemangioma
Infection
NOF - Non ossifying fibroma
Enchondroma/Eocinophilic granuloma
Simple bone cyst
```
108
What areas of the spine are the M/C sites for metastasis?
Lumbar & thoracic (Body & pedicle)
109
Metastasis is the M/C cause of destruction of what part of the vertebra?
Pedicle
110
What sign is assoc. w/ pedicle destruction caused by metastasis?
Winking Owl Sign or One-eyed pedicle
111
What are the 3 M/C causes of ivory vertebrae?
Osteoblastic metastasis (Normal size)
Pagets (Enlarged)
Hodgkins (Scalloping)
112
What sign does osteolytic metastasis cause in the ribs?
Extrapleural sign (M/C cause)
113
Where is the M/C location for metastasis in the distal extremities?
The foot
114
What is the M/C primary to metastasize into the distal extremities?
Lung
115
What type of metastasis is M/C'ly seen in the skull?
Osteolytic
116
This is AKA Kahler's disease. M/C primary osseous malignancy
Multiple myeloma
117
Multiple myeloma is a malignant proliferation of what type of cells?
Plasma cells
118
What is the M/C cause of death from multiple myeloma?
Pneumonia/respiratory failure
119
What is the 2nd M/C cause of death from multiple myeloma?
Renal disease
120
What age group is most affected by multiple myeloma?
50-70 years of age
121
Who is affected by multiple myeloma more, males or females?
Males 2:1
122
What are some typical symptoms of multiple myeloma?
fever & fatigue related to anemia
| Progressive pain, M/C low back, aggravated by exercise & weight bearing
123
What are hematology lab features of multiple myeloma?
Normochromic normocytic anemia
Thrombocytopenia
Marked rouleax formation
Increased ESR
124
What are the biochemical lab features of multiple myeloma?
```
Increased serum Ca
Increased serum uric acid
Hyperglobulinemia w/ reverse A/G ratio
M spike on serum protein electrophoresis
Bence Jones proteinuria
```
125
What are the M/C skeletal locations for multiple myeloma?
Lower T-spine & L-spine
Skull
Pelvis
Ribs
126
What is the best imaging method for identifying multiple myeloma?
X-rays
127
What is the earliest manifestation of multiple myeloma on an xray?
Loss of bone density
128
What is a pathological collapse of a vertebra assoc. w/ multiple myeloma called?
Wrinkled vertebra
129
What is a pedicle sign?
multiple myeloma spares the pedicles early in the disease
130
What is the radiographic hallmark of multiple myeloma?
sharply circumscribed, purely osteolytic, punch-out lesions
131
multiple myeloma in the skull is known as?
Rain drop skull
132
Severe & diffuse bone destruction assoc. w/ multiple myeloma M/C'ly occurs where?
Pelvis
| Sacrum
133
Where is expansion of bone assoc w/ multiple myeloma M/C?
Ribs
Long bones
Pelvis
134
This is a highly expansile, geographic lesion typically a soap bubble appearance. Localized form of multiple myeloma.
Solitary plasmacytoma
135
What are the M/C sites of a solitary plasmacytoma?
Mandible
Pelvis
Vertebrae
Ribs
136
What is the ddx for multiple myeloma?
Osteolytic metastasis
Osteoporosis
Possibly NHL
137
What is the ddx for solitary plasmacytoma?
Blow-out metastasis
Brown tumor
Fibrous dysplasia
Giant-cell
138
What % of solitary lesions develop into multiple myeloma?
70%
139
4th M/C primary osseous malignancy. Distinctive small, round cell primary sarcoma, probably arising from the connective tissue of bone marrow
Ewings Sarcoma
140
Types of round cell tumors?
Ewings Sarcoma
non-Hodkins lymphoma
Multiple Myeloma
141
What are the 2 M/C osseous malignancies under 25yrs of age?
Osteosarcoma
| Ewings Sarcoma
142
What age group/gender is most affected by ewings sarcoma?
5-25yoa, male 2:1
143
What are symptoms assoc. w/ ewings sarcoma?
Increasing local pain (several months duration)
Soft tissue mass, tender but not warm
Malaise & moderate fever
144
What's the difference b/w osteomyelitis & ewings sarcoma?
Timing - osteomyelitis takes days/weeks, ewings sarcoma progresses over months
145
What are lab findings assoc. w/ ewings sarcoma?
Leukocytosis
Anemia
Elevated ESR
146
What is the classic appearance of a ewings sarcoma on a xray?
Permeative pattern of destruction involving diaphysis
Laminated periosteal response
Saucerization
147
Does ewings sarcoma have a narrow or wide zone of transition?
Wide
148
Extrinsic pressure from the soft tissue mass assoc. w/ ewings sarcoma causes what?
Saucerization
149
What imaging method is best for demonstrating soft-tissue & bone marrow involvement of ewings sarcoma?
MRI
150
What is the M/C complication of ewings sarcoma?
Metastasis to bone & lung (M/C primary osseous malignancy to metastasis to bone)
151
What is the ddx for ewings sarcoma?
Osteomyelitis
Metastatic neuroblastoma
NHL
Osteosarcoma
152
2nd M/C primary malignancy. Neoplastic osteoid & bone matrix formed by malignant cells of connective tissue
Osteosarcoma
153
Secondary osteosarcoma's are assoc. w/ what diseases?
Paget's disease
| Fibrous dysplasia
154
What age group & gender is most affected by osteosarcomas?
10-25 yoa; Males 2:1
155
What lab value may be elevated w/ an osteosarcoma?
Alkaline phosphatase
156
Where is the M/C location for an osteosarcoma?
Distal femur (50-75% involve the knee)
157
Where is osteosarcoma most often seen in older pts?
Flat bones
158
Where do osteosarcomas typically originate?
Metaphysis
159
What are the periosteal responses seen w/ osteosarcoma?
Sunburst (classic)
Hair-on-end
Codman's triangle
Occasionally laminated response
160
What are typical xray findings assoc. w/ osteosarcoma?
Soft tissue mass is common
Tumor new bone w/i the destructive lesion or at its periphery
Cumulus cloud appearance
161
What are complications assoc. w/ osteosarcoma?
Metastasis: Pulmonary (pneumothorax) & osseous
"Cannon-ball metastasis"
Pathologic fx
162
What is the 5 year survival rate for osteosarcoma?
Exceeds 50% (averages 20%)
163
Type of osteosarcoma seen in pts 25-40?
Parosteal Osteosarcoma
164
What are the M/C locations for a parosteal osteosarcoma?
Femoral metaphysis (M/C)
Prox. tibia
Prox. humerus
165
What are the radiographic features of a parosteal osteosarcoma?
Dense oval or spherical shaped mass
Attached to the cortical surface
May see a radiolucent cleft separating a portion of the mass form the bone
Most likely seen on pos. aspect of femur
166
What is NHL AKA?
Primary bone lymphoma
Reticulum cell sarcoma
Lymphosarcoma
Histiocytic lymphoma
167
What type of tumor is a NHL?
Round cell tumor (rare)
168
What is the criteria for primary NHL?
Initial involvement of a single bone w/ at least 6 months before distal metastasis w/o generalized NHL
169
What age group, gender are most affected by NHL?
25-40; 2:1 Males
170
What are typical symptoms assoc. w/ NHL?
Dull, aching pain & swelling of long duration at site
Minor symptoms possible present a year or more
General well-being of pt usually good
Fever & weight loss may be present
171
NHL is the M/C primary malignancy to give rise to what?
Pathologic fx
172
M/C sites for NHL?
Femur
Tibia
Humerus
173
What are the M/C locations of NHL in the bone?
Diaphyseal
| Metaphyseal adjacent to the diaphysis
174
What are radiographic findings assoc w/ NHL?
permeative pattern of bone destruction
Minimal to no periosteal response
Cortex often distrupted (expansions or thickening)
Sclerotic lesions possible in vertebrae & flat bones
175
What type of pts are less likely to have a periosteal response?
Older pt's
176
What is the ddx assoc. w/ NHL?
Systemic lymphoma
Ewing's sarcoma
Paget's disease
Myeloma
