Tumor and tumor-like processes Flashcards
What is the most common source of osteoblastic metastatic carcinoma in adult females?
Breast Cancer
List the three common causes of solitary sclerotic vertebral body/ivory vertebra.
- Hodgkin’s lymphoma (anterior scalloping)
- Osteoblastic mets
- Paget’s disease – cortical thickening and expansion
Is it common to find a tumor involving a joint?
No
Is multiple myeloma more common in the vertebral body or neural arch?
Vertebral body
What malignancy demonstrates as a cold bone scan?
Multiple Myeloma
Which is the most dense (white on x-ray) primary malignant bone tumor?
Osteosarcoma (2nd most common primary malignant bone neoplasm)
What is the common age range of primary osteosarcoma?
10-25 years old (in older pts, likely dt malignant degeneration of benign process)
What is the difference between sunburst and onion skin appearance?
Sunburst – seen in hemangioma, lytic skull lesions with striations in a “sunburst” or “spoked wheel” pattern
characteristic of osteosarcoma
Onion skin – layered or laminated periosteal rxn created by several parallel concentric layers or lamellae of periosteal new bone
implies a more aggressive process, but can be dt both benign and malignant conditions
most characteristic of Ewing’s sarcoma but could be found in osteosarcoma, osteomyelitis, stress fxs, eosinophilic granulomas in very young pts
Which part of the long bone is commonly involved in osteosarcoma?
Metaphysis – especially in distal femur, proximal tibia and proximal humerus
What is codman’s triangle?
When the periosteum lifts off of the cortex, creating triangular layers that form at the margin of the lesion, often in osteosarcomas (also seen in osteomyelitis)
*triangle itself is usually tumor free
Why is Ewing’s sarcoma commonly found in the diaphysis of long bone?
Because it arises from the red bone marrow, which is mainly in the diaphysis and is closely related to reticulum cell sarcoma
What is a geographic lytic appearance and does it suggest more benign or aggressive neoplasms? What are the other two lytic appearances of tumors?
Geographic lytic appearance = confined to a relatively specific area that is more or less easily defined, more likely to be benign
Other two types:
Moth eaten
Permeative
Which condition presents as a solitary exostosis that points away from the nearest joint?
Osteochondroma
Compare the incidence of malignant transformation in osteochondroma and hereditary multiple exostosis.
Osteochondroma: malignant degeneration in 1% (solitary)
Hereditary Multiple Exostosis: 20% malignant degeneration
What is a “corduroy vertebra”?
Corduroy cloth appearance of vertebrae, seen in hemangioma due to lytic lesions with coarse vertical striations
Is spinal hemangioma commonly solitary or polyostotic?
Solitary
Which is the most common benign bone tumor of the spine?
Hemangioma
Hemangioma
age 40 and up
usually asx – can have pain or muscle spasm occasionally
neurological compromise due to ballooning of vertebral body, extension of tumor into central canal, pathologic fx, hemorrhage
75% found in spine and skull
usually in vertebral body, 10-15% into arch
usually solitary
body expansion is rare
Is a bone island symptomatic?
Bone Island = Enostoma
- Usually asymptomatic
- Occurs in pelvis, sacrum, proximal femur, and any bone except skull
- compact lamellar bone in spongiosa
- can look like blastic mets on an xray
Which benign tumor classically demonstrates as pain worst at night and easily relieved by aspirin?
Osteoid Osteoma pain refers to nearby joint usually in kids can cause painful, rigid scoliosis can occur in any bone (50% in femur and tibia, 20% phalanges, 10% spine) tends to be in cortex of bone
Which part of the bone is usually involved with osteoid osteoma?
Cortex:
see increased opacity on xray, actual lesion is lucent (but usually
What is the appearance of the tumor matrix in enchondroma?
Cartilaginous lesion inside the cartilage thinned cortex endosteal scalloping stippled calcification Asx, but can cause pathologic fx Age 10-30 Can happen in any bone with cartilage Most common tumor of phalanges Can potentially transform to chondrosarcoma (think pain – if no pain, likely benign)
What is multiple enchondromatosis called?
Two types:
1.Ollier’s Disease
usually unilateral, monomelic (may cause growth change, shortened limb)
malignant transformation rate 25-50%
2.Maffucci’s syndrome (Below, can see phleboliths)
soft tissue hemangiomas
phleboliths
greater risk of malignant transformation than Ollier’s
What is the most common location of fibrous cortical defect?
In cortex of bone in lower extremity: tibia or fibula, also humerus, ribs, ilium
2-8 years old
What is a fallen fragment sign associated with?
Simple Bone Cyst
Fallen fragment = piece of cortex falls off into cyst and sinks to bottom
Which benign bone tumor is named according to its appearance rather than its histological composition?
Aneurysmal Bone Cyst – cystic, blood filled cavity, “aneurysmal” dt appearance
Describe the radiographic difference between an enchondroma, simple bone cyst, aneurysmal bone cyst and osteochondroma.
1. Enchondroma (see photo previous page top right) Geographic lytic Expansile Thinned cortex, endosteal scalloping Metaphyseal-diaphyseal Most central Calcification in 50% No periosteal rxn, no soft tissue mass
- Simple Bone Cyst (see photo on previous page)
Ages 3-4
Asx
2/3 undergo pathologic fx
fluid-filled cyst
75% in proximal humerus or femur
“fallen fragment” sign with fracture – piece of cortex falls into cyst and sinks to bottom of it - Aneurysmal Bone Cyst (see photo above right)
expansile
lytic, septated
eccentric
markedly thinned cortex
metaphyseal, may extend to epiphysis (only benign tumor to cross growth plate)
periosteal response more common
4. Osteochondroma (see photo page 12) bony exostosis: cortex continuous with host bone; normal trabeculae cartilaginous cap may calcify project away from joint sessile produces asymmetric widening
Is giant cell tumor painful? Is it malignant?
Yes, Painful!
“Quasimalignant” – 20% malignant, 80% benign
Is Paget’s disease monostotic or polyostotic?
Polyostotic
Right side more common than left
List the radiographic features of Paget’s disease in a long bone such as the femur or tibia.
In Long bones – thickened cortex, bowing deformities (saber shin = shin that looks like a curved sword), shepherd’s crook deformity = thickening of cortex plus bowing, blade of grass (candle flame or V-shape) – looks like cut piece of grass or tip of flame (lytic appearance)
Skull: osteoporosis circumscripta (circumscribed, outlined lytic area ), cotton wool appearance (spots all over skull)
Jaw – increased size
Spine – ivory vertebrae, picture frame vertebra (thickened cortex)
Pubic Bone – unilateral, “brim sign” – thicker on one side than the other (below)
In General:
increased or decreased bone density
coarsened less distinct, trabeculae
thickened cortex (less distinct)
bone expansion
subarticular extension
pseudofractures (similar to insufficiency stress fx)
deformities (like bowing)
pathologic fx (mild trauma causes bone to break)
Paget’s disease general info:
rare before age 40, usually over 55
mostly asx, found incidentally on xray of low back
most common sx: dull, boring pain
temperature of involved area may increase
see enlargement of bone – causes mass effect on surrounding structures
can have heart problems bc vascular lesions – cause heart to work harder
