Test #2 Flashcards
3rd M/C primary osseous malignancy. Characterized by the formation of cartilage.
Chondrosarcoma
Chondrosarcoma is the M/C primary malignant bone tumor of what locations?
Hand
Sternum
Scapula
Secondary chondrosarcoma’s are a result of malignant degeneration of what two tumors?
Enchondroma
Osteochondroma
What age group/gender are M/C’ly affected by chondrosarcomas?
40-60yoa, Males
What is the most frequent complaint assoc. w/ chondrosarcoma?
Dull pain w/ an avg duration of several years
M/C sites of chondrosarcoma?
Distal femur (M/C) Pelvis Prox. humerus Ribs, sternum Scapula
Which part of the bone is chondrosarcoma usually found?
Usually metaphyseal but may be diaphyseal
What are the radiographic features of chondrosarcoma?
Well-marginated, expansile, osteolytic lesion
Cortex may be thick or thin
Punctate, flocculent, circular, ring-like matrix
Occasional periosteal response
May have endosteal scalloping
What are radiographic signs of an advanced chondrosarcoma?
Cortical destruction
Soft tissue mass demonstrating calcification
What is high grade vs. low grade differentiation of a chondrosarcoma based on?
Tumor margins
Cortical destruction
Patterns of calcification
Soft tissue involvement
What are complications assoc. w/ chondrosarcoma?
Slow growing w/ late metastasis hematogenously to the lungs
What is the ddx assoc w/ chondrosarcoma?
Prox. enchondroma
Giant-cell tumor if calcification is lacking
M/C benign skeletal growth. Cartilaginous-capped bony growth off the surface of the bone
Osteochondroma AKA Osteocartilaginous exostosis
How long does an osteochondroma grow?
Till maturity
What are the 3 types of presentations for an osteochondroma?
Solitary osteochondroma
Multiple osteochondromas
HME (Hereditary multiple exostosis)
What is the M/C age range for an onsteochondroma?
10-20 years of age
What is the M/C complaint w/ osteochondroma?
hard painless mass near a joint
What can osteochondroma degenerate to?
Chondrosarcoma
What are the M/C locations for osteochondroma?
Distal femur
Prox. tibia
Where is osteochondroma found in the long bones? Spine?
Metaphysis; Secondary centers of ossification
What are the M/C locations for a pedunculated osteochondroma?
Knee
Hip
Ankle
What type of osteochondroma is a osteocartilaginous cap on a long narrow stalk?
Pedunculated
What type of osteochondroma has a broad base w/ localized widening of shaft?
Sessile
What is it called when an osteochondroma points away from the joint?
Coat Hanger exostosis
What is diaphyseal aclasia AKA?
Hereditary Multiple Exostosis (HME)
What is Hereditary Multiple Exostosis?
Multiple osteochondromas mainly in the metaphysis
When is Hereditary Multiple Exostosis M/C’ly discovered?
b/w ages 2-10
What are characteristics of Hereditary Multiple Exostosis?
Hard, painless masses near joint
Bone deformity
Usually bilateral & symmetrical
What deformity is assoc. w/ Hereditary Multiple Exostosis?
Bayonet hand deformity
What are the characteristics of Bayonet Hand deformity?
Shortening of the ulna
Outward bowing of radius
Subluxation of radio-ulnar joint
Where is Hereditary Multiple Exostosis M/C’ly found?
Long bones especially of the lower extremity
This is a benign tumor of cartilage. Originates from a cartilage displaced from the epiphyseal plate
Enchondroma AKA Chondroma
What enchondroma locations have greater potential for malignant degeneration?
Lesions located near the axial skeleton
What are two cartilaginous tumors that tend to b/co malignant?
Enchondroma
Osteochondroma
When is the greatest incidence of enchondromas?
b/w 2nd & 5th decade
How is an enchondroma discovered typically?
After a path fx
What is the M/C site for enchondroma?
Short tubular bones of hands
What are the radiographic features of enchondromas?
Well marginated geographic lesions Thin or thick cortex Endosteal scalloping Often expansile Matrix calcification
What are two characteristics that indicate a cartilaginous tumor?
Matrix calcification
Endosteal scalloping
Multiple enchondromatosis is AKA?
Ollier’s disease
What is multiple enchondromatosis (Ollier’s disease)?
Osseous dysplasia characterized by hypertrophic cartilage that hasn’t been resorbed or ossified normally
What age is multiple enchondromatosis (Ollier’s disease) typically found?
Before 10yrs of age
What are the s/s of multiple enchondromatosis (Ollier’s disease)?
Marked shortening of the extremities
Severe deformity, deforming masses
Facial asymmetry
What syndrome is assoc. w/ multiple enchondromatosis (Ollier’s disease)?
Maffucci syndrome
What are the characteristics of Maffucci syndrome?
Enchondromas
Cavernous hemangiomatosis
Where is multiple enchondromatosis (Ollier’s disease) found?
In Metaphyses & shafts of tubular bones
What are radiographic characteristics of multiple enchondromatosis (Ollier’s disease)?
Rounded or linear radiolucencies
Lesions are expansile w/ or w/o matrix calcification
Bone shortening & deformity d/t eccentric growth
This is an uncommon bone tumor originating from chondroblasts in the epiphyseal cartilage plate
Chondroblastoma AKA Codman’s tumor
What is the peak age range for a chondroblastoma?
10-25 yrs of age
What are the s/s of a chondroblastoma?
Joint pain, tenderness, heat, swelling
Limitation of motion
Weakness, numbness, & muscle atrophy
What are the M/C sites for a chondroblastoma?
Distal femur Prox. tibia Upper humerus Femoral head & greater trochanter Distal tibia
What are the radiographic signs of chondroblastoma?
Well demarcated, oval or round radiolucency
Most are eccentric & may expand the cortex
Matrix calcification on occasion
Thin, sharply demarcated sclerotic margin is characteristic
Chondroblastoma can mimic what?
A subchondral cyst
What are complications assoc. w/ a chondroblastoma?
Formation of secondary ABC
Malignant degeneration after radiation tx
This is a primary malignant bone tumor that doesn’t form neoplastic osteoid or cartilage
Fibrosarcoma
What are the two types of fibrosarcoma?
Medullary or central (M/C)
Periosteal
What are the two M/C malignancies seen in Paget’s?
Osteosarcoma (M/C)
Fibrosarcoma
What is the M/C age to see fibrosarcoma?
30-50yrs of age
What is the chief complaint seen w/ fibrosarcoma?
Progressive local pain & swelling
What may be the initial presentation of a fibrosarcoma?
Pathologic fx
Where are the M/C locations to find a fibrosarcoma?
Longs bones in younger pts
Flat bones in older pts
50% occur around the knee
What are radiographic signs of fibrosarcoma?
majority eccentric medullary lesions
metaphysis that may extend into epiphysis
Expanding osteolytic lesion
Cortical thinning w/ endosteal scalloping
What is are two characteristic signs of fibrosarcoma?
Cortical disruption w/ large soft tissue mass
May see bone sequestration
What is a complication of fibrosarcoma?
hematogenous metastasis to lungs & central skeleton
What is the ddx for fibrosarcoma?
Giant cell tumor
This is a common benign tumor arising from fibrous tissue
Non-ossifying fibroma
What is the peak age range for a NOF?
8-20 (M>F); Pt < 10 FCD, Pt >10 NOF
What are the S/S assoc w/ NOF?
Mostly asymptomatic
Large lesions often cause persistent pain
Path. fx may occur
What is the M/C location for a NOF to occur?
Lower extremity (distal tibia/diametaphyseal)
What does a NOF look like radiographicaly?
Eccentric, ovoid radiolucency
Long axis paralleling the long axis of the bone
What is a fibrous cortical defect AKA?
Caffey’s defect
Subperiosteal cortical defect
Fibrous xanthoma
Where does a FCD originate in the bone?
Periosteum of the metaphysis
What is the peak age range for a FCD?
4-8 yrs of age (M>F)
What is the M/C location for a FCD?
pos. med. aspect of the distal femoral metaphysis
What is the radiographic features of a FCD?
Small, ovoid, cortical radiolucency
Avg. size is 1-2cm
Long axis parallels long axis of the bone
Lobulation or slight bulging of the cortex
This is an uncommon, slow growing, midline tumor arising from remnants of the notochord
Chordoma
What is the M/C age for chordoma?
30-70 yrs of age; M>F
What symptoms are assoc w/ a chordoma that has a sacrococcygeal location?
Constipation
Urinary dysfunction
Perineal pain or numbness
What symptoms are assoc w/ a chordoma that has a spheno-occipital location?
Increased intracranial pressure Headache Pontine & bulbar s/s Ocular disturbances hemiparesis Ataxia
What is the M/C locations for a chordoma?
Sacrococcygeal
Clivus
Vertebrae
What is unique about chordomas and joints?
They may cross joints
What is the main ddx for chordoma?
Osteolytic metastasis
This is a quasimalignant tumor that is derived from connective skeletal tissue. AKA osteoclastoma
Giant Cell Tumor
Of the 4 non-malignant painful tumors, Giant cell tumor is the one least likely to involve what area of the body?
The spine
What is the M/C age & gender affected by Giant cell?
20-40 yrs F>M (malignant ones are predominant in males)
What are S/S assoc. w/ a Giant Cell?
Intermediate dull ache
Sometimes a palpable, tender mass
May affect contiguous joint
Path fx may develop
What lab studies should be used to rule out a brown tumor from a Giant Cell?
Serum calcium
Serum phosphorus
Alkaline phosphatase
What is the M/C location for a Giant Cell?
Distal femur
Prox. tibia
Distal radius
Sacrum (M/C spinal site)
What is the M/C benign tumor of the sacrum?
Giant Cell tumor
What is the M/C neoplasm of the patella?
Giant Cell tumor
Where do malignant Giant Cell tumors tend to show up, especially if male?
Distal radius
What is the classic appearance of giant cell?
Roundish, moderate-sized, expansile, radiolucent lesion extending to the subarticular surface
What are the radiographic features of a Giant Cell tumor?
Margin fairly well defined
Cortex is expanded & thin
Typically no periosteal response
Cortex may be destroyed w/ soft tissue invasion
What is the ddx for giant cell tumor?
Metastatic disease (older pt) Plasmacytoma Fibrosarcoma Chrondrosarcoma ABC
This is the M/C benign tumor of the spine. Benign tumor arising from newly formed blood vessels
Hemangioma
What is the M/C type of hemangioma?
Cavernous
What are the S/S assoc. w/ hemangioma?
Majority are asymptomatic
May complain of vague intermittent pain
Compression fx
What are the M/C locations for a hemangioma?
Spine
Skull
What are the M/C locations in the spine for hemangioma?
Lower thoracic
Upper lumbar
What is the M/C bone in the skull for a hemangioma?
Frontal bone
What is the radiographic appearance of a hemangioma?
Corduroy-cloth appearance in spine
Usually solitary
Sunburst or spoke-wheel appearance in the skull
What is the ddx w/ hemangioma?
Pagets disease
Osteoporosis
This is a fluid filled cyst w/ a fibrous wall
Simple Bone Cyst
What is a SBC AKA?
Unicameral bone cyst
Solitary bone cyst
Juvenile bone cyst
What are the 2 types of SBC?
Active: adjacent to growth plate
Latent: displaced away from growth plate
What is the peak age affect w/ a SBC?
3-14 yrs of age (M>F)
What is the M/C symptom of a SBC?
Path fx
What are the M/C locations of a SBC?
Metaphysis of prox. humerus, prox. femur
Centrally located
What is the classic appearance of a SBC?
Moderate to large expansile lesion broader at the metaphysis than at the diaphysis (truncated cone appearance)
What sign is assoc. w/ a SBC?
Fallen fragment sign
