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Tumors Flashcards

1
Q

MC overall malignancy

A

Metastatic disease

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2
Q

MC primary malignant bone tumor in adult

A

Multiple Myeloma

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3
Q

MC primary malignancy tumor in kids/young adults

A

Osteosarcoma

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4
Q

2nd MC primary malignant tumor in adults

A

Chondrosarcoma

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5
Q

2nd MC primary malignant tumor in kids

A

Ewing sarcoma

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6
Q

Mc benign spinal tumor

A

Hemangioma

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7
Q

Mc benign bone tumor

A

Osteochondroma

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8
Q

Mc benign tumor of the sacrum

A

Giant cell tumor

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9
Q

Mc benign tumor of the hand

A

Enchondroma

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10
Q

Buttressing. And associated with what?

A

Additional layers of new bone added to exterior creating an expanded ossueous contour

Associated with slow growing lesions

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11
Q

Laminated/layered/onion skin. And associated with hat

A

Alternating layers of lucency and opacity with alternating growth. Thick or thin.

Can be seen in slow or aggressive lesions . Classic with Ewing’s

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12
Q

Colman’s triangle and speculated periosteum reaction often associated with what

A

Osteosarcoma

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13
Q

Reasons for missing pedicle

A
  1. Congential
  2. Destructive
    - tumor (primary: ABC/osteoblastoma; secondary: lyric Mets MC!!!!; ST tumor: neurofibroma)
    - infection
  3. Surgical
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14
Q

DDx for ivory vertebra

A

Lymphoma
Blastic mets
Pagets

20-40: mc lymphoma
40+: mc blastic Mets

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15
Q

DDx for pathological collapse

A

OP
Lytic Mets
MM

Child: mc eosinophilia granuloma

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16
Q

Tests for MM

A

PEP
Skeletal survey
MRI
Biopsy

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17
Q

Tests for lytic Mets

A

Bone scan

MRI

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18
Q

What do carcinomas arise from?

A

Epithelial cells

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19
Q

What do sarcomas arise from?

A

Bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue

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20
Q

Description of cartilaginous matrix

A 
Ring or arc like
Flocculent
Small crystals 
Popcorn like
Stippled
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21
Q

Pathway of metastasis

A

Hematogenous dissemination (blood) via Batson’s plexus aka vertebral plexus

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22
Q

Alkaline phosphatase will be increased in what kind of CA?

A

Blastic

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23
Q

Where in the skeleton does Mets usually spread

A

Spine (40)
Ribs/sternum (28)
Pelvis/sacrum (12)

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24
Q

Mets distal to elbow and knee is termed what and due to what?

A

Acral metastasis

Due to lung primary

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25
Q

Blow out mets MC from what

A

Renal or thyroid

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26
Q

MC reason for pedicle destruction

A

Lytic mets

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27
Q

Radiographic features of vertebral mets

A 
Ivory vertebra
Pedicle destruction
Pathological collapse (OP, LM, MM)
Focal OP
Malignant schmorl node formation
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28
Q

T1 and T2 determining old vs new pathological fractures

A

“T1 white is right”

New: T1 dark, T2 bright

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29
Q

DDX for ivory vertebra

A

Paget
Hodgkins Lymphoma
Osteoblastic mets

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30
Q

Area of dense sclerosis on the anterior superior VB without sclerosis

A

Blastic mets

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31
Q

Bone island. Alt Ddx?

A

Blastic density that is longitudinal. Normal alkaline phosphatase levels and bone scan

Ddx: blastic mets

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32
Q

Osteopoikilosis

A

Multiple bone islands

Usually in pelvis

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33
Q

What does patient need to diagnose blastic mets

A

BCP for alkaline and acid phosphatase levels
PSA
Digital rectal exam

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34
Q

Avulsion fracture of lesser trochanter. MC diagnosis in child? Adult?

A

Child: avulsion Fx
Adult: lytic mets

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35
Q

Top 4 primary malignancies in order

A

Multiple myeloma, osteosarcoma, chondrosarcoma, Ewing sarcoma

(MOCE)

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36
Q

Malignant proliferation of plasma cells that infiltrate bone marrow

A

MM

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37
Q

Age of patients with MM

A

50-70

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38
Q

Clinical s/s of MM

A

Pain is cardinal sign
CRAB
(Hypercalcemia, renal/respiratory disease, anemia, bone disease)

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39
Q

Major lab findings with MM

A 
M-spike
A:G ratio (increased G)
Bence Jones 
Rouloux formation
Increased serum ca++ and protein
Bone marrow biopsy >10% plasma cells
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40
Q

Osteosarcoma. Stats/age

A

Mc primary malignant BT in child. (#2 MBT). 10-25

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41
Q

Location of osteosarcoma

A

Metaphysis

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42
Q

Raindrop skull

A

MM

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43
Q

Bones affected by MM

A

T/L vertebra, pelvis, skull

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44
Q

Area MM

A

Diaphysis

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45
Q

Age of osteosarcoma

A

10-25, 60+

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46
Q

Area of osteosarcoma

A

Metaphysis

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47
Q

Bone affected by osteosarcoma

A

Distal femur 40%
Prox tibia 15%
Humerus

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48
Q

Appearance of osteosarcoma

A 
50% sclerotic 
More than 5cm in medullary space 
Sunburst periosteal reaction/Codmans 
Large ST mass 
Painful swelling
Cumulus/cloud-like density
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49
Q

MRI characteristics of mets

A

Dark T1

Light t2

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50
Q

Bones affected by MM

A

Vertebra-T, L

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51
Q

What are the two bone tumors that occur solely in the diaphysis

A

MM

Ewing sarcoma

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52
Q

Solitary plasmactyoma findings

A

Soap bubbly
Highly expansive

Vertebra>pelvic>skull

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53
Q

What tumors have blastic appearances

A

Osteosarcoma

Osteoma

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54
Q

What tumor usually has mets to lungs before being discovered

A

Osteosarcoma

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55
Q

Age for chondrosarcoma

A

50+

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56
Q

Locations for chondrosarcoma

A

Proximal humerus
Neck/femur
Ribs/sternum
Pelvis**

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57
Q

XRAY of chondrosarcoma

A

Round area of de-mineralization
Popcorn matrix calcification
Large soft tissue mass

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58
Q

Ddx for chondrosarcoma

A

Enchondroma
Medullary infarct

Both usually no pain

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59
Q

Age and bone location for Ewing

A

Diaphyisis

10-25

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60
Q

Bones in Ewing sarcoma

A

Long tubular bones (femur, tibia, humerus, fibula)

Flat bones >20yrs

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61
Q

Appearance of Ewing sarcoma

A 
Lytic 
Moth eaten-permeating
Onion skin reaction
ST mass
Cortical saucerization (scooped out of outer cortex)
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62
Q

Cortical saucerization

A

Scooped out appearance of outter cortex

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63
Q

Aka for giant cell

A

Osteoclastoma

64
Q

Age and bone location for giant cell

A

20-40

Met-epiph

65
Q

Location of giant cell

A

85% long bone: d. Femur, prox tibia, d radius (mc malignant)

66
Q

XRAY of giant cell

A 
Geographic
Eccentric
Met-epiph
Subarticular
Expansive/soap bubble
Cortical thinning
67
Q

Giant cell tumor where has highest chance of malignant transformation

A

Distal radius

68
Q

Coat hanger exostosis

A

Solitary osteochondroma

69
Q

Cauliflower cap

A

Solitary osteochondroma

70
Q

Area in bone of osteochondroma

A

Metaphysis

71
Q

Bones of osteochondroma

A

Long bones

Femur, tibia, proximal radius

72
Q

Pain and new growth to an osteochondroma may indicate what

A

Malignant transformation to osteosarcoma

73
Q

HME aka diaphyseal achalasia

A

Multiple osteochondromas

74
Q

Age of osteochondroma and HME aka diaphyseal achalasia

75
Q

Findings associated with HME

A

Madelung deformity/bayonet deformity: shortening of ulna and radius bend over it
Shortening of 4th.5th MC

76
Q

Direction of pedunculated osteochondroma

A

Toward the mid shaft

77
Q

Location in bone for SBC

A

Metaphysis

78
Q

Age of SBC

79
Q

Bones for SBC

A

Proximal humerus
Femur
Fibula
Calcaneous neck

80
Q

Madelung/bayonet deformity

81
Q

Fallen fragment sign

A

SBC (solitary bone cyst)

82
Q

XRAY of solitary bone cyst

A 
Metaphysical
Lucent
2-3cm 
Cone appearance/truncated
Asymptomatic 
Central
83
Q

Area in bone for ABC

A

Metaphysis

84
Q

Age for ABC

85
Q

Bones for ABC

A

Spine-30%
Neural arch

Long bones
Flat bone: P

86
Q

XRAY for ABC

A

Eccentric
Lytic
Expansive/soap bubble
Pain

87
Q

Fluid-fluid levels seen on CT

88
Q

Osteoblastoma area in bone

A

Met-diaphyseal

89
Q

Age of osteoblastoma

90
Q

Bones of osteoblastoma

A

Neural arch
Long bones
Small bones of hands/feet

91
Q

XRAY of osteoblastoma

A

Lucent
Expansive
>2cm
Metaphysical—> diaphyseal

92
Q

Age of osteoid osteoma

93
Q

Bone of osteoid osteoma

A

Long
Proximal femur***
Prox tibia
Neural arch—concave scoliosis

94
Q

Location in bone for osteoid osteoma

A

Metaphysis-diaphysis

95
Q

XRAY of osteoid osteoma

A 
Nidus in cortex
Lucent
Geographic
Cortical thickening
Pain relieved by aspirin!!**
96
Q

What tumor has pain relieved by aspirin

A

Osteoid osteoma

97
Q

Nidus

A

Osteoid osteoma

98
Q

Double density sign

A

Osteoid osteoma

99
Q

Age of osteoma

100
Q

Bones of osteoma

A

Frontal/ethmoid sinus

Calvarium

101
Q

XRAY of osteoma

A

Blastic lesions
~2cm
Geographic

102
Q

What tumor is associated with Gardner’s syndrome

103
Q

Age of enchondroma

104
Q

Bones of enchondroma

A

Hands/wrist phalanges>MC

Long bones

105
Q

Area in bone of enchondroma

A

Metaphysis/diaphysis

106
Q

XRAY of enchondroma

A 
Lytic
Expansive
Geographic
Central
Stippled/punctuate calcification
107
Q

5 tumors that have cartilage matrix

A 
Osteochondroma
Chondroblastoma
Chondromyxoid fibroma
Enchondroma
Chondrosarcoma
108
Q

Multiple enchondroma

A

Olliers/enchondromatosis

109
Q

Olliers associated with multiple ST hemangioma

A

Maffucci syndrome

110
Q

Age of hemangioma

111
Q

Bones inhemangioma

A

Lower T, upper L vertebra

Calvarium

112
Q

XRAY for hemangioma

A

≤Accentuated vertical trabeculation
Accordion/honeycomb/corduroy
Posterior bulge of cortex

Skull: <4cm round lytic lesioNS with sunburst appearance /spoke wheel

113
Q

Spoke wheel appearance

A

Hemangioma

114
Q

Accordion/corduroy/honeycomb appearance

A

Hemangioma

115
Q

Age of chondroblastoma

116
Q

Area in bone of chondroblastoma

A

Apophysis/epiphysis

117
Q

Bones of chondroblastoma

A

2/3 LE

Prox femur, distal femur, proximal tibia

118
Q

XRAY of chondroblastoma

A 
Round lytic lesion
Eccentric
1-6cm
Geographic
Lobulated
Punctuate/ca++
119
Q

Age of FCD

120
Q

Bones of FCD

A

Long bones of LE

Post/med/distal femur

121
Q

Area in bone of FCD

A

Metaphysis

122
Q

XRAY of FCD

A 
Lytic
Geographic
Central
1-2cm
Expansive 
Sclerotic 
Asymptomatic
123
Q

FCD or NOF—which is bigger?

124
Q

age of NOF

125
Q

Bones of NOF

A

Long bones of LE

Distal tibia

126
Q

Area in bone of NOF

A

Metaphyseal

127
Q

XRAY of NOF

A 
Lytic
Eccentric 
2+cm
Sclerotic boarder
Asymptomatic 
Migrates toward diaphysis
128
Q

Age of pagets

129
Q

Bones commonly affected with pagets

A

Pelvis
Lumbars/T
Femur
Calvarium

130
Q

XRAY of pagets

A 
Changed density
Irregular trabeculation
Thickened cortex
Subarticular to diaphysis!!!
Osseous deformity
131
Q

Direction of pagets

A

Subarticular to diaphysis

132
Q

Complications of pagets

A 
Peripheral N compression
Spinal stenosis
Blind
Facial palsy
Pathological fx
High CO
DJD
Malignant transformation —> osteosarcoma
133
Q

What tumors may have malignant transformation to osteosarcoma

A

Paget

Olliers

134
Q

Paget and ollier may have malignant transformation into what?

A

Osteosarcoma

135
Q

Stage 1- pagets

A

Lytic/degenerative stage

Increased hydroxyproline

136
Q

Stage 2 of paget

A

Mixed

Increased alkaline phosphatase

137
Q

Stage 3 pagets

A

Sclerotic/ivory

Normal serum ca/P. Increased bone scan activity

138
Q

Stage 4 paget

A

Malignant degeneration to osteosarcoma

139
Q

Osteoporosis circumscripta

A

Well-defined lytic changes to frontal and occipital bone in pagets

140
Q

Cotton wool appearance

A

Ill-defined density seen in pagets

141
Q

Rim sign

A

Iliopectineal line thickening seen in pagets

142
Q

What is seen in the pelvis wit pagets

A

Rim sign (iliopectineal line thickening)
Expansion
Acetabular protrusion

143
Q

Candle flame/blade of grass sign

A

Advancing edge of lytic phase (toward diaphysis) seen with pagets

144
Q

Looser lines/banana fx

A

Horizontal lucency/fx seen with pagets

145
Q

Shepards crook

A

Bowing of prox femur head seen with paget and fibrous dysplasia

146
Q

Brim sign

A

Iliopectineal line thickening seen with paget

Aka rim

147
Q

Picture frame vertebra

A

Thickened endplates and cortex of VB in pagets

148
Q

Ivory vertebra seen with

A

Paget
Blastic mets
Lymphoma

149
Q

Fibrous dysplasia age

150
Q

Bones in fibrous dysplasia

A

Monostotic

Proximal femur MC (also craniofacial bones)

151
Q

XRAY of fibrous dysplasia

A 
Lucent lesions
Thick rim (Rind sign) 
Ground glass appearance of medullary 
Expansive in skull
Shepards crook/sabreshin deformity 
Geographic
152
Q

Fibrous dysplasia seen with cafe-au-last spots and endocrine dysfunction is what?

A

McCune Albright syndrome

153
Q

McCune Albright syndrome

A

Fibrous dysplasia with cafe-au-lait spots, and endocrine disruption

154
Q

Rind sign

A

Fibrous dysplasia

Medullary cavity lesions with a thick or thin rim of sclerosis

155
Q

Complications of fibrous dysplasia

A 
Leg length discrepancy
Osseous deformities
CN compromise
Acetabular protrusion
Pro ptosis (eyes bulging) 
Malignant transformation (fibrosarcoma)

Di Imaging 2 (5 decks)

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