Tumors and Tumor-like conditions Flashcards
What is the age of occurrence for Ewings Sarcoma?
10-25 (peak is 15 years)
What is the age of occurrence for Osteosarcoma?
10-25 and over 60
What is the age of occurrence for Giant Cell Tumor?
20-40
What is the age of occurrence for Chondrosarcoma?
over 50
What is the age of occurrence for Myeloma?
50-70
What is the most common primary malignancy for ages 0-14?
leukemia
What is the tumor incidence for metastatic disease?
75% of all malignancies
What is the tumor incidence of multiple myeloma?
most common primary malignant tumor of adults
What is the tumor incidence of osteosarcoma?
is the the most common primary malignant tumor in kids
What is the tumor incidence of osteochondroma?
most common benign OSSEOUS tumor
What is the tumor incidence of Hemangioma?
it is the most common benign SPINAL tumor
What are the points of a lesion in a longitudinal plane?
Diaphyseal, metaphyseal, and epiphyseal
What are the positions of a lesion in a horizontal plane?
Central/Medullary, Eccentric, Cortical, Parosteal, Soft tissue
What are the patterns of bone destruction?
Geographic, Moth-eaten, Permeative
What is the least aggressive pattern of bone destruction?
Least aggressive pattern (usually a solitary lesion >1cm
Which type of bone destruction contains numerous small holes in size?
Moth-eaten bone destruction
Which is the most aggressive growing bone destructive lesion?
Permeative bone destruction
What are the patterns of periosteal reactions?
buttressing, single layer, multiple layers/laminated (onion skin), Spiculated (hair on end), Codman’s triangle
What is buttressing/solid periosteal reaction?
it is when additional layers of bone are added to the outside (usually associated with slow growing lesions)
What is the laminated/layered/onion skin reaction?
multiple layers of new layers of bone; it alternates layers of lucency and opacity
What is the onion skin reaction usually associated with?
Ewing’s
What is a spiculated periosteal reaction?
linear radiating spicules of new bone
When the spiculated periosteal reaction is perpendicular to bone, what is it called?
Hair on End
When the spiculated periosteal reaction radiating from a central focus, what is it called?
Suburst
What are spiculated periosteal reactions usually associated with?
highly aggressive lesions such as osteosarcoma
What is codman’s triangle?
it is a triangular elevation of periosteum seen at the peripheral lesion-cortex junction
T/F: codman’s triangle is one of the most aggressive forms of periosteal reaction
True
What are the tumors with cartilage matrix?
Enchondroma, Osteochondroma, Chondroblastoma, Chrondomyxoid fibroma, Chondrosarcoma
(Chondro=cartilage=LIGHT BULB)
What are the appearance of cartilage tumors?
Ring or Arc like, Flocculent, Small Crystals
What are the tumors with an osseous matrix?
Osteoma, Osteoblastoma, Osteochondroma, Osteoid Osteoma, and Osteosarcoma
(Osteo=bone=LIGHT BULB #2)
What are the tumors with a fibrous matrix?
Fibrous Dysplasia, Desmoplastic Fibroma, Non-Ossifying Fibroma, Fibrous Cortical Defect, Ossifying Fibroma, and Fibrosarcoma
What is the number 1 imaging modality to use for tumor evaluation?
PLAIN FILM
What are the most common primary sites of origin for metastasis in women?
breast (70%) is the most common with 80% being lytic, 10% blastic, then followed by thyroid, kidney and uterus
What are the most common primary sites of origin for metastasis in men?
prostate (60%) is the most common with 80% being blastic while lung carcinoma (25%) is mostly lytic
What is the most common pathway of metastasis?
hematogenous dissemination (blood) is the most common at times via Batson’s venous plexus
What are clinical features of Metastatic disease?
Most patients are over the 4th decade (over 40, but the fourth decade is 30-40); may have weight loss, anemic, fever; INITIAL SIGN IS PAIN (like in low back) AND PATHOLOGIC FRACTURE
What are common sites for metastasis?
those areas richest in RED MARROW are most commonly affected?
What is the most common site for metastasis?
SPINE (40%), 2nd is ribs and toes (28%)
what is more common, lytic or blastic?
Lytic (75%); Blastic is only 15%
What are the top three types of pathological collapse?
Metastatic Carcinoma, Multiple Myeloma, and Traumatic Fracture
What is the most common pathological collapse diagnosis seen in kids?
Eosinophilic Granuloma
Is Multiple or Solitary Ivory vertebra more common?
Solitary Ivory Vertebra
What are the top three most common types of Solitary Ivory Vertebrae?
Paget’s Disease, Hodkin’s Lymphoma, Osteoblastic Metastasis
What is the common age for Paget’s?
over 60
What is the common age for Hodgkin’s Lymphoma?
ages 20-40
What is the common age for Osteoblastic Metastasis?
over 40
What is Ostepoikilosis?
multiple bone islands (form when kids and go dormant in adult life)
How common are blow out metastases or expansile bone metastases?
only seen in a small number of primary malignancies (ex. red cell carcinoma, thyroid cancer, hepatocellular carcinoma)
What does ACRO mean?
out in hands and feet
What are the MRI Characteristics of Mets?
T1 is most sensitive because it has a low signal
T2 is the most variable because it is a slightly high signal
What is the most common primary malignancies?
multiple myeloma #1, osteosarcoma #2, chondrosarcoma #3, ewing’s sarcoma #4
What is multiple myeloma?
a malignant proliferation of plasma cells, which infiltrate bone marrow
75% of patients with multiple myeloma are between which ages?
50-70
What is the male:female ration for multiple myeloma?
male to female ration 2:1
What is the initial cardinal symptom of multiple myeloma?
pain is the cardinal symptom
What are some significant laboratory findings for multiple myeloma?
elevated plasma proteins in 50-60%, protein electrophoresis with “m-spike” confirmatory in 80-90%, bence jones proteinuria in 40%, bone marrow biopsy >10%
Where is multiple myeloma seen skeletally?
vertebrae, thoracic and lumbars (extra..pelvis, skull, ribs, clavicle, scapula, femur, and humerus)
What is solitary plasmacytoma?
a localized form of plasma cell proliferation
Where is solitary plasmacytoma seen in the body?
vertebra > pelvis > skull > sternum > ribs
How is solitary plasmacytoma presented?
presents typically as a soap bubbly, highly expansile lesion (sparing posterior elements)
How much of solitary plasmacytoma will develop into diffuse form?
70%
What is the osteolytic defect seen with multiple myeloma?
RAIN DROP SKULL
What is the 2nd most common primary malignant bone tumor overall?
Osteosarcoma
What is osteosarcoma?
a primary malignant tumor or undifferentiated connective tissue which forms neoplastic osteoid
What is the most common primary malignant bone tumor in children and young adults?
Osteosarcoma
What is the male:female ratio for osteosarcoma?
male to female ratio is 3:2
What is the most common location for osteosarcoma?
distal femur (40%); proximal tibia (16%) is #2, proximal humerus (15%) is #3
What specific area of the bone is the osteosarcoma most commonly seen?
75% occur in the metaphysis next to the growth plate
Osteosarcoma commonly mets to the _______
Lungs
What are the lab findings and pathological features?
Sclerotic 50%
Lytic 25%
Mixed 25%
What are some radiologic features for osteosarcoma?
there is an ill defined dense ivory or sclerotic lesion (>5cm) filling medullary space sunburst periosteal rection/codman’s
For osteosarcoma, what type of advanced imaging clearly defines marrow involvement and soft tissue component?
MRI (clearly defined marrow is on T1, soft tissue component on T2)
What is a chondrosarcoma?
a primary malignant tumor of chondrogenic origin (3rd most common primary malignant bone tumor)
What % of primary tumors does the chondrosarcoma account for?
10%
What are the different forms of chondrosarcoma?
primary, secondary, central or peripheral
What is the common age chondrosarcomas occur?
over 50
Are chondrosarcomas more prevalent in males or females?
males (m:f ratio is 2:1)
What are the most common locations for chondrosarcomas?
PELVIS (#1), Proximal humerus (#2), Neck of the femur (#3), Ribs and Sternum (#4)
