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Tumors Flashcards

1
Q

What is the most common intraosseous location for a neurofibroma?

A

Maxilla/Mandible

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2
Q

Most common location of a chondromyxoid fibroma?

A

Tibia

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3
Q

Most common location of a adamantinoma?

A

Tibia

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4
Q

What % of malignant tumors are metastatic?

A

70%

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5
Q

What % of metastatic lesions are osteolytic?

A

75%

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6
Q

What is the M/C abdominal neoplasm in childhood? What is the 2nd M/C?

A 
1st = Wilms' tumor
2nd = neuroblastoma
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7
Q

a. What % of Ollier’s disease malignantly degenerates?

b. What % of Maffucci’s disease malignantly degenerates?

A

a. up to 50% (5-30% Resnick)

b. over 50% (20% Resnick)

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8
Q

What % of HME malignantly degenerates?

A

20%

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9
Q

What type of bone does osteomas arise from?

A

membranous bones

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10
Q

What is the M/C for an osteoma?

A

frontal sinuses (also ethmoid sinus)

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11
Q

Which segment in the spine is osteoid osteoma likely to be found?

A

Lumbar > cervical > thoracic

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12
Q

Identify the following statements to be true or false.

  1. Osteopoikilosis has cutaneous findings.
  2. Osteoid osteomas have no gender predilection.
  3. Osteoid osteomas develop significant reactive sclerosis when intraarticular.
  4. Osteoblastomas are more vascular than osteoid osteomas.
  5. Radiofrequency ablation is choice of treatment for osteoid osteoma.
  6. Osteoblastomas can cause scoliosis.
  7. Osteoid osteomas like to occur M/C in spine while osteoblastomas like to occur M/C in long bones.
A
  1. True - 25% –> keloid formations, scleroderma-like lesions
  2. False - 3M:1F
  3. False - there is not much periosteum there to react
  4. True - more osteoblasts too
  5. False - will cause compression fx
  6. True - on concave side
  7. False - other way around
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13
Q

What is the appearance of osteoid osteoma on scintigraphy?

A

Double Density Sign = intense activity centrally in region of nidus and less intense peripherally

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14
Q

How big is the nidus in conventional osteoblastoma?

A

> 1cm

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15
Q

What is the histological hallmark of an aggressive osteoblastoma?

A

epithelioid osteoblast –> hard to differentiate from osteosarcoma

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16
Q

What is the characteristic location of an osteofibrous dysplasia?

A

anterior aspect, middle 1/3rd tibial diaphysis

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17
Q

What is the age range for conventional osteosarcoma according to Yochum?

A

10-25yrs

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18
Q

What is the gold standard for imaging of osteosarcoma?

A

plain film

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19
Q

What is the most likely location for conventional osteosarcoma mets?

A

pulmonary > osseous & nodal

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20
Q

Which is the most common location for gnatic osteosarcoma?

A

Mandible > maxilla

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21
Q

What is the classic radiographic appearance of telangectatic osteosarcoma?

A

expansile, soap-bubbly lesion

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22
Q

Which subtype of osteosarcoma is histologically similar to Ewing’s?

A

small cell osteosarcoma

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23
Q

What are the radiographic features of intracortical osteosarcoma?

A
  • within cortex (no medullary involvement)
  • purely lytic with sclerotic rim
  • no periosteal reaction
  • diaphyseal based in tibia/femur
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24
Q

Where on the femur is the most likely location for a periosteal osteosarcoma to occur?

A

distal femur – ANTERIOR (medial or lateral)

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25
Q

What is the most likely location for a parosteal osteosarcoma?

A

distal femur – POSTERIOR

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26
Q

What is implied by the “zoning pattern” in reference to periosteal osteosarcoma?

A

more mature bone centrally (near cortical surface) and less peripherally??

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27
Q

At what age does parosteal osteosarcoma occur?

A

late teens to 40s –> later than both conventional and periosteal osteosarcoma

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28
Q

What are the features of Rothmund-Thompson?

A

short stature, dystrophic nails, cutaneous abnormalities, radial ray anomalies, multiple osteosarcomas (other tumors also possible)

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29
Q

What’s the most and least common finger involved in enchondromas?

A

M/C = 5th finger

Least common = thumb

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30
Q

What % of enchondromas calcify in the hand/foot?

A

50%

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31
Q

what is an exophytic enchondroma in the ribs called?

A

enchondroma protuberans

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32
Q

What is more sensitive to distinguish between enchondroma and low grade chondrosarcoma - histology or image findings?

A

image findings; enchondroma & low-grade chondrosarcoma can look the exact same on histology

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33
Q

Which of the 3 is more common to occur: periosteal osteosarcoma, periosteal chondrosarcoma and periosteal chondroma?

A

periosteal chondroma&raquo_space;> periosteal chondrosarcoma > periosteal osteosarcoma

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34
Q

What are the radiographic features of periosteal chondroma?

A
  • metaphyseal
  • frequently at entheses
  • saucerization/scalloping
  • 50-75% calcification
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35
Q

What is the age group for periosteal chondroma?

A

<30yoa

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36
Q

What is an aka for chondroblastoma?

A

Codman’s tumor

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37
Q

What % of chondroblastomas calcify?

A

30-50% (but may need CT to see)

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38
Q

What are the clinical features of chondromyxoid fibromas?

A

slowly progressive pain, point tenderness & restricted motion

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39
Q

Which is the most common location for a chondromyxoid fibroma?

A

Tibia

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40
Q

What are the radiographic features of chondromyxoid fibroma?

A
  • eccentric
  • metaphysis
  • expansile
  • calcification RARE!
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41
Q

True or False: cartilaginous caps on osteochondromas are thinner in children vs. adults.

A

False – they are thicker (3cm vs <1cm)

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42
Q

What is the best diagnostic modality for imaging an osteochondroma?

A

Radiographs

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43
Q

What are 6 complications of osteochondromas?

A
  1. Fracture
  2. Osseous deformities
  3. Vascular injury
  4. Neurologic compromise
  5. Bursa formation
  6. Malignant transformation
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44
Q

Typically, what % of solitary osteochondromas malignantly degenerate?

A

~1%

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45
Q

What systemic disorder can be associated with osseous excrescences?

A

pseudohypoparathyroidism & pseudo-pseudohypoparathyroidism

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46
Q

What % of individuals with HME have a positive family history?

A

90%

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47
Q

What % of HME malignantly degenerate?

A

up to 25% (but more likely 5%)

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48
Q

What are exostosis beneath/adjacent to the nail bed called?

A

subungual exostosis

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49
Q

What is the M/C location for a subungual exostosis?

A

Great toe

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50
Q

Except for hematologic tumors, chondrosarcoma is the M/C malignant tumor of which bones?

A
  • scapula
  • ribs
  • sternum
  • small bones of hand
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51
Q

What % of conventional chondrosarcomas have calcification?

A

up to 60-70%

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52
Q

Which chondrosarcoma almost always involves the epiphysis when in a long bone?

A

clear cell chondrosarcoma

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53
Q

Which cartilage based bone tumor can also arise in the soft tissues?

A

mesenchymal chondrosarcoma

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54
Q

What is the average age range for a mesenchymal chondrosarcoma?

A

25yrs (younger than the other subtypes)

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55
Q

Excluding the appendicular skeleton, what’s another common location for mesenchymal chondrosarcoma?

A

craniofacial (20%)

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56
Q

List who radiographic features that help in distinguishing between conventional vs mesenchymal chondrosarcoma.

A

Mesenchymal chondrosarcoma:

  1. occur in a younger pop’n
  2. has a tendency for the diaphysis
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57
Q

What is the most aggressive form of chondrosarcoma?

A

Dedifferentiated chondrosarcoma

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58
Q

What type of radiographic pattern/components constitutes dedifferentiated chondrosarcoma?

A

Bimorphic:

  1. Well-differentiated cartilaginous portion – looks low grade (eg. low-grade chondrosarcoma)
  2. High-grade noncartilaginous sarcomatous portion – aggressive appearing (eg. osteosarcoma, MFH)
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59
Q

What is the typical size and symptom of an FCD and NOF?

A

FCD 3 cm (symptomatic)

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60
Q

Why do NOF/FCD cause osteomalacia/rickets?

A

B/c the tumor releases a humoral substance that decreases the threshold of renal reaborption of phosphorus –> causes hypophosphatemia

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61
Q

What are some of the features of Jaffe-Campanacci Syndrome?

A
  • young (5-15yrs)
  • multiple NOF’s (>3)
  • cafe-au-lait spots
  • mental retardation
  • hypogonadism
  • cryptorchidism (undescended testes)
  • cardiovascular abnormalities
  • ocular abnormalities
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62
Q

What is the almost exclusive location for a juxtacortical desmoid?

A

postero-medial aspect femur

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63
Q

What is the classic radiographic appearance of a periosteal desmoid?

A
  • saucerization

- periostitis

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64
Q

What is the age range for a juxtacortical desmoid?

A

15-20yrs

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65
Q

What is the age range for a desmoplastic fibroma?

A

<30yrs

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66
Q

What locations do desmoplastic fibromas occur in?

A
  • mandible
  • femur
  • innominate
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67
Q

What is the classic radiographic appearance of a desmoplastic fibroma?

A

soap-bubbly lytic lesion (that can look aggressive)

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68
Q

What is a prominent MRI differentiating feature of desmoplastic fibroma?

A

Low T1 and Low T2 signal!

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69
Q

Liechtenstein’s Rule describes which tumor?

A

fibrosarcoma in the knee

70
Q

What are classic radiographic features of fibrosarcoma?

A
  • little periostitis
  • absence of calcification
  • extensive soft tissue mass
  • sequestrum
71
Q

What’s another name for fibroxanthoma?

A

fibrous histiocytoma

72
Q

What is the gender predilection for benign and malignant GCT?

A

benign –> mildly female

aggressive –> 3M:1F

73
Q

GCTs in the skull & facial bones are often associated with which condition?

A

Paget’s

74
Q

What sign is produced on scintigraphy with GCT?

A

donut sign – intense accumulation around periphery of neoplasm

75
Q

What’s another name for Goltz-Gorlin syndrome?

A

Focal dermal hypoplasia

ocular defects & skeletal anomalies –> claw hands/clinodactyly, polydactyly, syndactyly

76
Q

Which body region is most commonly involved in multicentric GCTs?

A

hands

77
Q

What’s the 2nd M/C soft tissue mass of the hand? What’s the first?

A 
1st = ganglion cyst
2nd = GCT tendon sheath
78
Q

Name two condition that have giant cells and like to affect the mandible and maxilla?

A

Giant cell reparative granuloma & ossifying fibroma

79
Q

What’s another name for extragnathic reparative granuloma?

A

Solid ABC

80
Q

Causes of MFH?

A
  • de novo
  • within a medullary bone infarct
  • paget’s disease
  • following radiation treatment
81
Q

MFH likes to occur most often where within the body?

A

soft tissues

82
Q

Another name for cementifying SBC?

A

cementoma

83
Q

Where is the most common location for a cementifiying SBC?

A

proximal femur

84
Q

What are the features of Mazabraud?

A

polyostotic FD + fibrous & myxomatous soft tissue tumors

85
Q

What % of FD is monostotic?

A

70-80%

86
Q

What is the M/C location of polyostotic FD?

A

ribs > femur > tibia > mandible

87
Q

Where is the M/C location for polyostotic FD?

A

skull & facial bones

88
Q

What is the M/C benign lesion of the ribs?

A

FD

89
Q

What is the classic triad with McCune-Albright Disease?

A
  1. polyostotic fibrous dysplasia
  2. cutaneous pigmentation
  3. precocious sexual development
90
Q

Endocrine conditions associated with FD:

A
  • Cushing’s disease
  • acromegaly
  • hyperthyroidism
  • HPT
  • extrainsular-hypothalamic diabetes mellitus
91
Q

What is the rarest primary benign bone tumor (according to Yochum)?

A

Intraosseous lipoma

92
Q

True or False: intraosseous lipomas are assymptomatic

A

False - 2/3rds have local pain

93
Q

Which bone is the M/C location for an intraosseous lipoma?

A

fibula (20%)

94
Q

What is the M/C soft tissue tumor?

A

Lipoma

95
Q

M/C soft tissue location for a lipoma?

A

subcutaneous fat (particularly trunk > shoulder > upper arm)

96
Q

2nd M/C soft tissue location for a lipoma?

A

intramuscular

97
Q

Which benign fatty tumor is very vascular?

A

hibernoma

98
Q

What’s another name for Dercum’s disease?

A

juxta-articular adiposis dolorosa

99
Q

What is Dercum’s disease and what are the clinical sx?

A

diffuse or nodular accumulations of subcutaneous fat

Clinical: painful fatty deposits, postmenopausal women, generalized obesity, weakness, emotional instability

100
Q

What are common locations for macrodytrophia lipomatosa?

A
  • 2nd-3rd digits of hand/foot
  • median nerve
  • plantar nerve
101
Q

What is the differential for localized gigantism?

A
  • maffucci syndrome
  • NF 1
  • Klippel-Trenaunay-Weber syndrome
  • Proteus syndrome
  • amyloidosis
  • melorheostosis
102
Q

What are the 2 requirements to diagnose primary intraosseous lipoma?

A
  1. under microscope, must look like a liposarcoma

2. soft tissue mass & metastasis must be ruled out first

103
Q

What is the most common benign tumor of the esophagus?

A

leimyoma

104
Q

What is the 1st, 2nd and 3rd M/C soft tissue sarcoma in adults?

A
  1. MFH
  2. liposarcoma
  3. leiomyosarcoma
105
Q

What the M/C location for a leiomyosarcoma?

A

thigh

106
Q

What is the M/C soft tissue malignancy in childhood?

A

rabdomyosarcoma

107
Q

What’s the M/C location for rhabdomyosarcoma in kids?

A

head & neck

108
Q

Which type of hemangioma is found in flat bones (eg. skull, ilium) and which type is found in the vertebral body?

A

Flat bones: cavernous hemangioma

VB: capillary hemangioma

109
Q

What is the M/C skeletal location for hemangioma?

A

T/S vertebral body

110
Q

What abnormalities are associated with soft tissue hemangiomas?

A
  • Klippel-Trenaunay-Weber
  • Maffucci Syndrome
  • Kasabach-Merritt Syndrome
  • Blue Rubber Nevus Syndrome
  • Turner Syndrome
  • Osler-Weber-Rendu Syndrome
111
Q

What’s cystic hygroma and where is it most commonly located?

A

soft tissue lymphangioma

75% found in head, neck and axilla

112
Q

What’s the best diagnostic clue for a glomus tumor?

A

soft tissue mass in subungual region that erodes underlying bone

113
Q

What triggers severe paroxysmal attacks of pain in a glomus tumor?

A

exposure to cold OR minimal trauma

114
Q

Hemangiopericytoma arise from which type of cells?

A

cells of Zimmerman (pericytes surrounding the capillary walls)

115
Q

Hemangiopericytomas like to occur where in the body?

A

soft tissues (thigh > retroperitoneum > head/neck)

116
Q

Which vascular tumor is known to affect areas of preexisting conditions (eg. osteomyelitis, avn, other neoplasms)?

A

angiosarcoma

117
Q

Angiosarcomas arise from which type of cells?

A

endothelial cells of blood vessels

118
Q

What characterizes the Kasabach-Merritt Syndrome?

A

capillary hemangiomas with extensive purpura before the age of 1

119
Q

Which virus is associated with Karposi’s sarcoma?

A

human herpes virus 8 (HHV-8)

120
Q

What is Gorham’s disease?

A

uncontrolled, destructive proliferation of vascular or lymphatic capillaries

2nd stage is replacement of absorbed bone by fibrosis

121
Q

M/C of Gorham’s disease?

A

upper arm, shoulder

122
Q

What is the most common intraosseous location for a neurofibroma and schwannoma?

A

mandible

123
Q

What’s the M/C aggressive presacral neoplasm?

A

chordoma

124
Q

What % of sacral tumors are chordomas?

A

40%

125
Q

Chordomas in younger patients tend to occur where?

A

spheno-occipital region

126
Q

What % of chordomas in the sacro-coccygeal region calcify?

A

50%

127
Q

What % of chordomas in the spheno-occipital region calcify?

A

20-70%

128
Q

33% of chordomas in the clivus are of what type?

A

chondroid

129
Q

Mets is more common than primary osseous malignancy by how many times?

A

25-35x

130
Q

Acral mets comes mostly from which tumors?

A

lung (broncogenic carcinoma), colon and renal primaries

131
Q

What’s the M/C skeletal location to have mets to to periarticular bone with intraarticular extension?

A

knee

132
Q

What’s the M/C location for secondary HOA?

A

tibia

133
Q

Differentials that can cause a “cold” bone scan are:

A
  • infection
  • multiple myeloma
  • ischemic necrosis
  • radiation changes
  • complete destruction of bone
134
Q

What does a “superscan” mean?

A

increased accumulation of radiopharmaceutical agent diffusely throughout skeleton without kidney activity

135
Q

What is the “flare” phenomenon in relation to tumor therapy on scintigraphy?

A

increase accumulation of radipharmaceutical agent during the early stages of therapy….relates to either increase regional blood flow or accentuation of bone turnover at site of metastasis

136
Q

Which primary tumor is known to cross the disc space in the spine?

A

Ewing’s

137
Q

What is the lab result often seen with Ewing’s sarcoma?

A

PAS +ive glycogen (70-100%)

138
Q

Lymphoma that affects multiple bones and does not have lymph node or visceral involvement is called:

A

primary multifocal osseous lymphoma (PMOL)

139
Q

What has a higher predilection for bone involvement, primary or secondary lymphoma?

A

secondary

140
Q

Primary non-hodgkin’s lymphoma is likely to affect which age population?

A

children (>50% have PMOL)

141
Q

Primary Hodgkin’s primarily affects which age group and what type of histological cells do they have?

A

Adults

Reed-Sternberg

142
Q

Which of the two have sclerotic lesions? Non-Hodgkin’s or Hodgkin’s lymphoma?

A

Hodgkin’s (occurs in 45% of disease affecting bone)

143
Q

What’s a common location for Burkitt’s lymphoma in African children?

A

facial bones (maxilla > mandible)

144
Q

Lymphoma that involves the skin is called:

A

mycosis fungoides

145
Q

Multiple myeloma has an increase in which immunoglobulin?

A

IgG (55-60%)

146
Q

Waldenstrom’s macroglobulinemia has in increase in which immunoglobulin?

A

IgM

147
Q

The 1st radiographic finding of MM is:

A

generalized osteopenia

148
Q

Collapse of a VB in MM is called:

A

wrinkle vertebra

149
Q

Where’s the M/C location for plasmacytoma in the spine?

A

T/S

150
Q

Dissemination of plasmacytoma to MM occurs within how many years?

A

5 years

151
Q

What are the radiographic findings associated with leukemia?

A
  • generalized osteopenia
  • alternating radiolucent and dense metaphyseal bands
  • osteolytic lesions
  • periostitis
  • osteosclerosis (less common)
152
Q

What is the green colored tumor associated with leukemia?

A

chloroma

153
Q

Name 4 types of small cell tumors of bone.

A
  • Ewing’s sarcoma
  • Non-Hodgkin’s lymphoma
  • metastaic neuroblastoma
  • embryonal rhabdomyosarcoma
154
Q

Which benign bone tumor can calcify to resemble a dental tumor?

A

SCB –> cementoma

155
Q

What is the M/C skeletal location for an epidermoid cyst?

A

skull

156
Q

What’s the M/C location overall in the body for an epidermoid cyst?

A

soft tissues

157
Q

When seen in the distal phalanx, an epidermoid cyst is usually seen on the: a) volar aspect OR b) dorsal aspect?

A

volar aspect

158
Q

What is the M/C mechanism of an epidermoid cyst?

A

post-traumatic

159
Q

What is the M/C long bone and spine location for an ABC?

A

Long bone: tibia

Spine: T/S

160
Q

What is the proposed etiology of an adamantinoma?

A

misplaced germ cells of teeth

161
Q

What is the M/C location for an adamantinoma?

A

Anterior tibia

162
Q

What is the M/C location for an ameloblastoma?

A

mandilbe

163
Q

What % of synovial sarcoma is located within the joint cavity?

A

<10%

164
Q

As per an angiogram, what is true about a hemophilic pseudotumor?

A

They are avascular

165
Q

What is the difference between carcinoma and sarcoma?

A

Carcinoma = arise from epithelial cells (eg. colon, breast, lung, prostate). These comprise >90% of cancers.

Sarcoma = arise from mesenchymal cells (eg. bone, cartilage, fat, muscle). Most sarcomas are named from the cell they arise from (eg. osteosarcoma, chondrosarcoma, liposarcoma etc.)

166
Q

Pseudofractures in Paget’s occurs on which side of the curve (convex or concave)?

A

Convex

167
Q

Giant cell tumor of the facial bones is seen in which condition?

A

Paget’s

168
Q

What is the M/C spinal site for GCT?

A

Sacrum

169
Q

What is the M/C benign tumor of the sacrum?

A

GCT

170
Q

Where is the M/C location for a malignant GCT?

A

distal radius

Tumors (2 decks)

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