Tumor Flashcards
Bone lesions with
Localised periosteal reaction
MOON BIS
Metastasis Osteomyelitis Osteoporosis Non-accidental Injury Bleeding disorders Inflammatory arthritides Sickle cell disease
Bone lesions with
Symmetrical periosteal reaction
NJ CARS
Normal infants Juvenile chronic arthritis (JCA) Caffey's disease Acute leukaemia Rickets Scurvy
Eccentric lesion of bone
Expansile
Well-defined
ACNE G
Aneurysmal bone cyst Chondro-myxoid fibroma Non-ossifying fibroma Enchondroma Giant cell tumor
Lucent lesions of bone
No marginal sclerosis
MEME BC
Metastases Encondroma Multiple myeloma Eosinophilic granuloma Brown tumor (hyperparathyroidism) Chondroblastoma
Lucent lesions of bone
Well defined
Marginal Sclerosis
No cortical expansion
BE CSF
Brodie's abscess Enchondroma Chondroblastoma Simple bone cyst Fibrous dysplasia
Differentials for an Osteoid Osteoma (lytic nidus)
BB FOE
Bone island Brodie's abscess Fatigue fracture Osteoblastoma Ewing's sarcoma
Lesions with Fluid levels on MRI
Aneurysmal Bone Cyst
Telangiectatic Osteosarcoma
Goats CSF
GCT OsteoBlastoma ABC Telang OsteoSarc Sarcomas ChondroBlastoma Simple Bone Cyst Fibroxanthoma
Lesions that are cold on bone scan
MCL MRI
Myeloma Chordoma Lytic metastases Melanoma Renal Cell Carcinoma Ischaemic bone
MCL MRI
Or: Smell A Rat
Sarcoma / Myeloma / EG / Lymphoma / Leukemia / AVn / Renal Cell / Abscess / Thyroid
Benign lesions that expand the bone
GAS
Giant cell tumor
Aneurysmal bone cyst
Simple bone cyst
(GAS)
Permeative, moth eaten on XR of tumor implies:
Malignant lesion or infection
Ground glass on XR of tumor implies:
Fibrous matrix
Cloudy appearance on XR of tumor implies:
Osteoid matrix
Stippled calcification (pop corn) implies:
Cartilage matrix
Dyaphysis tumors
LAMEFOE
Lymphoma Adamantinoma Myeloma Ewing's sarcoma Fibrous dysplasia Osteoid Osteoma Eosinophilic granuloma
(LAMEFOE)
Metaphysis tumors
OFFICE CFO
Osteochondroma Fibrous dysplasia Fibrous cortical defect Infection Cysts Enchondroma
Chondrosarcoma
Fibrosarcoma
Osteosarcoma
OFFICE CFO
Epiphysis tumors
C IS AGE
Chondroblastoma Infection Subchondral ganglion Avascular necrosis Giant cell tumor Eosinophilic granuloma
C(hondroblastoma) IS AGE related
Sclerotic bone lesions (name 10) on XR
Osteoma Osteosarcoma Osteopetrosis Osteopoikilosis Metastases Hemangioma Infarct Paget’s Hyperparathyroidism
- Vascular (haemangioma / infarct)
- Infection
- Neoplasm (Osteoma, Osteosarcoma, Metastasis)
- Drugs (Vitamin D)
- Inflammatory
- Congenital (Bone island, Osteopetrosis, Osteopoikilosis)
- Autoimmune
- Trauma
- Endocrine (Paget’s, Hyperparathyroidism)
Lucent bone lesions (there are 14) on XR
FOGMmACHhINEeS
- Fibrous dysplasia
- Osteoblastoma
- Giant cell tumor
- Metastases
- Myeloma
- ABC
- Chondroblastoma
- Hyperparathyroidism
- Haemangioma
- Infection
- Non-ossifying fibroma
- Enchondroma
- EG
- Simple bone cyst
FOGMACHINES
Causes of Vertebra plana
EAT HOME
Eosinophilic Granuloma (most common) Aneurysmal Bone Cyst Tuberculosis Haemangioma Osteoporosis Multiple Myeloma Ewing's Sarcoma
EAT HOME
Biopsy Principles
Longitudinal incision Haemostasis Intramuscular approach Single compartment Frozen section Representative sample Drain in line with incision
Biopsy approaches by joint
Proximal humerus = Anterior deltoid Distal humerus = Brachialis or lateral triceps Wrist = 2nd dorsal compartment Iliac = Abductor muscles Supraacetabular = Smith Peterson Femoral neck = Transtrochanteric Distal Femur = Vastus medialis Tibia = Subcutaneous border
Name 3 variations of Histiocytosis X
Eosinophilic Granuloma
Hand-Schuller-Christian disease (Langerhans cell histiocytosis with visceral involvement)
Letterer-Siwe disease (fatal form in childhood)
Classic triad in Hand-Schuller-Christian disease
Multiple lytic skull lesions
Diabetes insipidus
Exopthalmos
What is a Marjolin’s ulcer
A malignant transformation of the ulcer in cases of chronic osteomyelitis.
Usually SCC, but can also be BCC and melanoma (rarely)
Harrington’s Criteria for impending pathological fracture
> 50% diaphyseal destruction
75% metaphyseal destruction
Subtrochanteric femur destruction
Persistent pain after radiation
Mirel’s criteria for impending pathological fracture
Pain, Site, Size, Type
Pain: Functional = 3, Moderate = 2, Mild = 1
Site: Pertrochanteric = 3, LL = 2, UL = 1
Size: > 66% = 3, >33% = 2, <33% = 1
Type: Lytic = 3, Mixed = 2, Blastic = 1
If it’s 8, intubate (with an IM nail)
What primary bone cancers are treated with Chemotherapy (+/- surgery)
Chondrosarcoma (dediferentiated)
Ewing’s sarcoma
Malignant Fibrous Histiocytoma
Osteosarcoma (intramedullary and periosteal)
Metastatic lesions to bone
Lead kettle (PB KTL)
Prostate Breast Kidney Thyroid Lung
Which sarcomas can metastasize to Lymph nodes?
E-Sarc
Epithelioid sarcoma Synovial sarcoma Angiosarcoma Rhabdomyosarcoma Clear cell sarcoma
“Soap Bubble” appearance on x-ray lesions
Fibrous dysplasia
Aneurysmal bone cyst
Non-ossifying fibroma
Giant cell tumor
Chordoma
Renal Cell Carcinoma
Adamantinoma
Plasmacytoma
Never use Autogenous bone graft to fill what tumor?
Fibrous dysplasia.
The grafted bone will quickly turn into FD again.
What is the pathophysiology of osteolysis in metastatic tumors
Lytic bone mets:
RANKL (produced by osteoblasts)
RANK receptor (on osteoclasts) - stimulates osteoclasts to resorb bone
OPG (produced by osteoblasts) - inhibit osteoclast differentiation
Blastic bone mets:
Endothelin 1 secreted by tumor
RANK:
Receptor Activator of Nuclear Kappa B
Median Survival with Metastatic bone disease (from best to worst)
Thyroid (48 months) Prostate (40 months) Breast (24 months) Kidney (6+ months) Lung (6 months)
Primary cancers that can have Acral Metastases (long reach in the limbs)
Long
Reach
Bone
Lung (44%)
Renal (12%)
Breast (10%)
Also Colon (6%)
Lesions that are DARK on T1 and T2
Desmoid
scAr tissue
fibRous tissue
Kortical bone
Lesions that are LLigHt on T1 and T2
Lipoma
Liposarcoma
Haemangiomoa
Benign bone tumors in an adult
HOPE
Hypothyroid
Osteonecrosis
Paget’s
Enostosis
Vertebral BODY tumors
CHEMMO GI
Chordoma Haemangioma EG Metastases Myeloma Osteosarcoma GCT Infection
Vertebral posterior elements tumors
Osteoid osteoma
Osteoblastoma
ABC
Wormian bones - 6 conditions that cause it
CHOP R Down
Cleidocranial dysostosis Hyperthyroid Hypophosphatasia Osteogenesis Imperfecta Pyknodysostosis Rickett's Downs
Painful tumors
Glomus tumor
Osteoid osteoma
Synovial sarcoma
Haemangioma
Fibrosarcoma
Infection
Neuroma
Liposarcoma (Def Epi Age Sex Site Points Radiol Treatment)
Def: Malignant lipoblasts Epi: 10% of STS (2nd most common) Age: Adult (40-60) Sex: Male Site: Thigh / Retroperitoneum / Popliteal / Inguinal Points: S-100 +ve stain, Does not arise from Lipoma (usually) 1/2 metastasize to lung MRI: heterogenous signal 5 types (W,M,R,P,D) Treat: Wide excision and PostOp RadX
What are the 5 types of Liposarcoma
Well-differentiated (low grade) Myxoid (low grade) Round cell (high grade) Pleomorphic (high grade) Dedifferentiated (high grade)
Malignant Fibrous Histiocytoma (Undifferentiated Pleomorphic Sarcoma) (Def Epi Age Sex Site Points Radiol Treatment)
Def: Primitive mesenchymal cell (Macrophage and Fibroblast)
Epi: The most common soft tissue sarcoma
Age: Adult (50+)
Sex: Male
Site: Thigh / Leg / Arm / Forearm / Retroperitoneal
Points: recently being reclassified as other tumors.
Can be primary or secondary (Paget’s, Bone infarct, RadX, Osteochondromas)
Deep, aggressively enlarging, but mildly painful
50% mets on presentation
50% local recurrence
85% survival if <5cm
MRI: heterogenous, irregular
Treat: Wide resection, RadX for margins, Chemo for Mets
Rhabdomyosarcoma (Def Epi Age Sex Site Points Radiol Treatment)
Def: striated muscle Epi: most common Malignant ST in children (<15 yo) Age: Child (<15 yo) Sex: Site: Groin / Head / Neck Points: small round blue cell tumor Four types: BEPA Radiol: Treat: Neoadjuvant Chemo (in children), Wide resection +/- RadX / Wide resection and RadX in adults
What are the 4 types of Rhabdomyosarcoma
BEPA
Botryoid (bunch of grapes) - hollow viscus - 30% survival
Embryonic - most common / <10 yo / 80% survival
Pleomorphic - rare / adults / skeletal muscle - 25% survival
Alveolar - adolescent / t(2:13) - 60% survival
Synovial Sarcoma (Def Epi Age Sex Site Points Radiol Treatment)
Def: malignant tumor of primitive synovial-like cells that rarely arises within a joint.
Epi: Most common STS of the foot
Age: Adult (15-40)
Sex: Male
Site: most common STS of the foot, but most commonly found around the knee
Points: Mets to lymph nodes, Two types (Bi and Mono)
t(X:18) translocation
Radiol: may have calcification, heterogenous mass on MRI
Good prognosis: calcified, <5cm
Treat: PreOp RadX + Wide excision + PostOp Chemo.
Amputation preferred in hand and foot.
Spine tumors
EG Osteochondroma Osteoid osteoma Osteoblastoma ABC GCT Hemangioma
Ewings
Osteosarc
Chordoma
Mets
Tokuhashi score for Vertebral mets
General condition (out of 2) Bone mets outside the spine (out of 2) Bone mets in the spine (out of 2) Organ mets (out of 1) Primary type (out of 5)
Score 9-11 = 76% 6 month and 30% 12 month survival
Small round blue cell tumors
Lymphoma Ewings Acute lymphoblastic leukaemia Rhabdomyosarcoma Neuroblastoma Retinoblastoma Medulloblastoma Wilms tumor Nephroblastoma Small cell lung cancer
Epithelioid Sarcoma (Def Epi Age Sex Site Points Radiol Treatment)
Def: Epi: Most common soft tissue sarcoma of hand Age: Adolescents (10-35) Sex: Site: Hand / Forearm / Foot and ankle Points: Firm, painless nodule that can ulcerate Radiol: Calcified in 10-20% MRI LowT1, HighT2 (indeterminate) Treat: amputation. Very poor prognosis
