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DI 2 > Tumors and Tumor-like conditions > Flashcards

Tumors and Tumor-like conditions Flashcards

1
Q

What is the rate of metastasis in all malignancies?

A

75% of cancers will lead to metastatic disease

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2
Q

Name the most common primary malignant tumor in adults.

A

multiple myeloma

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3
Q

What is the most common primary malignant tumor in kids?

A

osteosarcoma

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4
Q

What is the most common benign osseous tumor?

A

osteochondroma

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5
Q

Name the most common benign spinal tumor.

A

hemangioma

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6
Q

What properties of geographic bone destruction show a least aggressive pattern?

A

usually a solitary lesion <1cm short zone of transition well defined margin-smooth or lobulated

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7
Q

What are the properties of moth-eaten bone destruction (moderate degree of aggressiveness)?

A

Numerous small holes (2-5mm) longer zone of transition margins are not well defined loves mid-shaft

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8
Q

What are the characteristics for permeative bone destruction (the most aggressive growing lesion)?

A

numerous small holes (1mm in size) wide zone of transition poorly demarcated or imperceptible borders

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9
Q

Name the cortical change and age range of this person

A

Buttressing/thickening

Child-open growth plates

This is actually a stress fracture of a young boy

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10
Q

Name the coritcal change

A

Endosteal scalloping

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11
Q

Name the patholgy.

Hint: typically malignant, a round cell lesion

A

Ewing’s Sarcoma

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12
Q

Name the pathology.

Hint: hair on end spiculations (often associated with this highly agressive lesion)

A

osteosarcoma

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13
Q

Name the pathology

Hint: one of the most aggressive forms of periosteal reactions

A

Codman’s triangle

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14
Q

Name the pathology.

Hint-“c” shaped

A

calcified cartilage

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15
Q

Primary site for metastisis in females?

Males?

A

Breast 70%

Prostate 60%

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16
Q

Most common pathway of mets?

A

hematogenous dissemination (blood) via Batson’s venous plexus

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17
Q

What is the most common site for mets?

A

The spine at 40%

second are the ribs and sternum at 28%

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18
Q

What percentage of mets are lytic?

A

75%

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19
Q

What are the differences between lytic and blastic mets?

A

lytic-more holes

blastic-more dense (more white)

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20
Q

Blow out bone metastases or expansile bone metastases are typically only encountered in a relatively small number of primary malignancies including what cancers?

A

renal cell carcinoma

thyroid cancer

hepatocellular carcinoma

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21
Q

75% of all patients who get multiple myeloma are in what age range?

A

50-70 years

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22
Q

What is the male to female ration with the occurance of multiple myeloma?

A

male to female

2:1

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23
Q

What are the clinical features (signs and symptoms) of multiple myeloma?

A

pain is the initial cardinal symptom

unexplained weight loss

cachexia

bacterial infections (respiratory)

anemia

renal disease

respiratory disease

deossification of bone

producton of abnormal serum and urinary proteins

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24
Q

What are the common labratory findings associated with multiple myeloma?

A

protein electrophoresis with “M-spike”

Bence Jones proteinuria

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25
Q

Where are the most common locations of multiple myeloma?

A

Vertebrae-thoracic and lumbars

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26
Q

Name the primary cancer that caused the osteolytic defects pictured

A

Multiple myeloma

pictured: raindrop skull

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27
Q

Name the pathology

A

multiple myeloma

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28
Q

What are the MRI findings with multiple myeloma?

A

diffuse low T1 with high signal endplates

Iso to high T2 change, use STIR

multiple wedge compression fractures

little soft tissue mass

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29
Q

Name the 2nd most common primary malignant bone tumor overall, which is the most common primary malignant tumor in children and young adults.

A

osteosarcoma

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30
Q

What is the age distribution for osteosarcoma?

A

10-25 years old primarily and secondarily >60 years old

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31
Q

What are the clinical features of osteosarcoma?

A

painful swellings (1-2 months duration)

minor joint restriction

fever

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32
Q

Where does osteosarcoma grow rapidly in children?

A

knee

40% in distal femur

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33
Q

T/F osteosarcoma commonly matastasis to the lungs.

A

true

the lungs fill with bone

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34
Q

Name the tumor

A

osteosarcoma

*usually in the distal femur, bone is more white with sunbursting

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35
Q

Name the tumor

A

osteosarcoma

*distal femur, subursting=typical for osteosarcoma*

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36
Q

Name the third most common primary malignant bone tumor.

A

chondrosarcoma

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37
Q

What is the age and male to female ratio most likely to get chondrosarcoma?

A

50 years old

male to female ratio is 2:1

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38
Q

What tumor has a popcorn matrix calcification in 2/3 with 1/3 being purely lytic?

A

chondrosarcoma

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39
Q

Name the tumor

A

chondrosarcoma

*“C” shaped, popcorn matrix, proximal humerus

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40
Q

Name the fourth most common primary malignant bone tumor, but second most common in children.

A

Ewing’s Sarcoma

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41
Q

What is the typical age and sex for Ewing’s sarcoma?

A

10-25:peak at 15 years old

male to female ration- 1.2:3

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42
Q

What are the clinical features of Ewing’s sarcoma?

A

severe localized pain (remember that is not common with other malignancies)

palpable soft tissue mass

fever, secondary anemia, leukocytosis, and increased ESR simulating infection

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43
Q

Where does Ewing’s sarcoma love to be in those under 20 years old?

A

long tubular bones 60% (femur, tibia, humerus, fibula)

diaphyseal 33%

metadiaphyseal 44%

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44
Q

Name the tumor

A

Ewing’s sarcoma

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45
Q

What is the name for a neoplasm that originates from nonbone forming supportive connective tissue of the marrow?

A

giant cell tumor

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46
Q

What percentage of giant cell tumors are malignant?

A

20%

which means 80% are benign (duh)

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47
Q

85% of the time, giant cell tumors show up where?

A

in the long bones-distal femur and proximal tibia

48
Q

What are the clinical features of giant cell tumors?

A

localized pain of an aching nature, restricted joint motion

49
Q

Name the tumor.

A

giant cell tumor

  • *usually have soap bubbly appearance*
  • *subarticular*
50
Q

What is the name for a bony exostosis on the external surface of a bone and usually lined by a hyaline cartilage cap?

A

solitary osteochondroma

51
Q

Name the most common benign osseous tumor.

A

solitary osteochondroma

52
Q

What type of solitary osteochondroma has a broad base and no stalk and is common in the humerus and scapula?

A

sessile

53
Q

What type of solitary osteochondroma has a long stalk with a cartilage cap and is common in the knee, hip and ankle?

A

pedunculated

descriptive terms: coat hanger exostosis and cauliflower cap

54
Q

What are the two important radiographic appearances to remember for solitary osteochondromas?

A
  1. cortex and spongiosa blend imperceptibly with the host bone
  2. growth is at an angle to the long axis and towards the midshaft
55
Q

Name the tumor.

A

solitary osteochondroma

*growth is at an angle to the long axis towards the midshaft

56
Q

What are the radiographic features of hereditary multiple exostosis?

A
  1. shortening of the 4th and 5th metacarpals
  2. supernumerary fingers and toes
  3. madelung or bayonet deformity
  4. disproportionate shortening of extremity
57
Q

Name the tumor

A

hereditary multiple exostosis

58
Q

name the tumor

A

hereditary multiple exostosis

59
Q

Which tumor has a truncated cone appearance?

A

solitary bone cyst

60
Q

name the tumor

A

solitary bone cyst

*radiolucency-black area in bone

61
Q

name the tumor

A

solitary/simple bone cyst

62
Q

What is the name for a non-neoplastic expansile lesion containing thin-walled blood-filled cystic cavities?

A

aneurysmal bone cyst

63
Q

What is the age range for aneurysmal bone cysts?

A

10-30 years old

75% occur below the age of 20

64
Q

Are aneurysmal bone cysts more common in males or females?

A

65% occur in females

65
Q

What are the clinical features of aneurysmal bone cysts?

A
  1. acute onset of pain with rapid increase in severity over 6-12 weeks
  2. history of trauma
  3. neurologic signs with spinal involvement (radiculopathy or quadriplegia)
66
Q

Where do aneurysmal bone cysts love to be?

A

posterior elements of vertebra -30%

-spares the body

67
Q

T/F aneurysmal bone cysts have an almost invisible thin cortex on a CT?

A

true

68
Q

name the tumor

A

aneurysmal bone cyst

69
Q

A 16 year old female comes to your office with an insidious onset of lumbar spine pain of a few weeks duration. After physical examination, you decide to xray the lumbar spine and find lytic expansile lesion with intact cortex of approximately 5cm appearing to originate from the pedicle of L4. Your diagnostic consideration at this time should include?

A

aneurysmal bone cyst

70
Q

An ovoid lytic, painful lesion in the greater trochanter of the femur in a 20 year old female would most likely be?

A

chondroblastoma

71
Q

A 55 year old female complains of pain in her hands. Exam reveals lytic mets disease. The likely primary source would be?

A

primary lung cancer

72
Q

A 14 year old male injured his ankle playing soccer. After orthopedic evaluation you decide to xray the area. The findings include a lytic, hazy lesion with sclerotic margination in an eccentric position within the metaphysis of the distal tibia. No prior complaints in the area. This is most likely?

A

non ossifying fibroma

73
Q

The rim sign is an early radiographic feature of cortical thickening about what region?

A

the pubic bones and iliopectineal line

Paget’s

74
Q

A ring of sclerosis is a radiographic feature characteristic of this lesion of bone?

A

fibrous dysplasia

75
Q

Bowing of the long bone such as saber shin or Sheppard’s crook deformity are features that may be associated with?

A

Fibrous dysplasia

Paget’s Disease

osteomalacia

76
Q

The closer this neoplasia is to the axial skeleton, the higher chance of degeneration?

A

enchondroma

77
Q

The clinical presentation of a patient with osteoma is?

A

no pain

78
Q

The presence of accentuated verticle trabeculae may be associated with what?

A

osteoporosis

hemangiomas

Paget’s disease

79
Q

This pain producing neoplasm will often times create a radiographic appearance of a fusiform type of cortical thickening with 1cm central lucency?

A

osteoid osteoma

80
Q

The double density sign on a bone scan is a finding often seen with this neoplastic condition.

A

osteoid osteoma

81
Q

A 29 year old male injures his thumb while playing football with his son. An xray of his hand reveals no fractures. However, a well-defined 2cm ovoid lytic lesion is seen at the base of the fourth proximal phalynx. This is most likely what?

A

enchondroma

82
Q

Which radiographic feature is NOT consistent with a neoplasm of primary origin?

  1. presence of periosteal reaction
  2. presence of associated soft tissue mass
  3. large size of lesion >5cm
  4. multiple sites of osseous involvement
A
  1. this would be mets and that is secondary
83
Q

This benign lesion often occurs in the fifth decade of life. Its often found incidentally in the spine as there are no symptoms and usually requires no treatment.

A

hemangioma

84
Q

The classic feature of multiple myeloma of the skull are due to?

A

20-100 defects of similar size and shape

85
Q

Cortical thickening, course trabeculations, osseous demineralization and increase in bone size are all possible radiographic features for this bone disease.

A

paget’s disease

86
Q

A 12 year old presents to your office with a complaint of severe nightly low back pain and obvious scoliosis of the lumbar spine. Your diagnostic consideration at this time might include?

A

osteoid osteoma

87
Q

A 14 year old male presents to your office with shoulder pain after falling off his skate board. Your xray exam of the shoulder reveals an ovoid well-defined lytic defect extending from the growth plate to the metaphysis with small flank of bone at the bottom of the lytic defect?

A

SBC with a fallen fracture

88
Q

Those areas of rapidly growing bone that may serve as common sites of tumor development in children include?

A

proximal tibia and distal femur metaphysis

89
Q

A 68 year old patient presents with pain and swelling in her shoulder of approximately 9 months duration. She says that her doctor told her she had a benign cartilage tumor in that area when she was 25 years old. Your best consideration at this time is?

A

chondroblastoma

90
Q

Cortical splitting or cortical tunneling are radiographic features that might be associate with what disease process?

A

Ewing’s sarcoma

91
Q

Numerous lytic lesions are found in the diaphyseal region of a femur in a 60 year old female. She complains of leg pain. A bone scan was accomplished and it turned out to be negative. Diagnosis?

A

multiple myeloma

92
Q

Metastasis which arise from breast primaries in females most commonly are of this osseous presentation, and less commonly of this presentation?

A

lytic and blastic

93
Q

A 60 year old male has presented with increasing left hip pain of 2 months for no apparent reason. Your radiographic exam reveals multiple 1-2mm lytic lesions in the femoral neck and greater trochanter. Your most likely diagnosis would be?

A

an aggressive secondary tumor from primary lung tumor

94
Q

Evaluation of the extent of soft tissue or marrow involvement in neoplastic conditions is best accomplished using which imaging modality?

A

MRI

95
Q

Differential considerations for one-eyed pedicle sign would be?

A

lytic mets or congentical absence

96
Q

How do bone metastasis from thyroid carcinoma and renal cell carcinoma present?

A

expansile soap bubbly lesions

97
Q

The age of occurance for osteosarcoma is usually?

A

10-25 years old

98
Q

The term white is right on T1 weighted MRI refers to the presence of what structure?

A

medullary bone

99
Q

Of the listed lesions, which is/are most commonly found in a central location in a tubular bone?

A

SBC

enchondroma

100
Q

T/F Chondrosarcoma common sites of involvement include pelvis and femur?

A

true

101
Q

This lesion is often diaphyseal, has a permeative pattern of bone destruction, often has a laminated periosteal reaction, and usually occurs in individuals 10-25 years of age?

A

Ewing’s sarcoma

102
Q

A 30 year old male enters your office with left knee pain of insidious onset. After orthopedic evaluation, you xray his knee and find an eccentric lytic soap bubbly slightly expansile lesion extending from the metaphysis to the subarticular surface of the distal femur.

A

giant cell tumor

103
Q

A mother brings her 5 year old son to your office asking you to evaluate some palpable lumps about his knees, shoulder, and wrist. There are no complaints of pain in these areas. Your radiographic exam of the extremities reveals numerous secile base and pedunculated bony overgrowths, which are contiguous with bone, cortex and medullary bone. There are also associated bayonet deformities of the forearms bilaterally. Consideration should be given to?

A

hereditary multiple exostosis

104
Q

The most common pattern of metastatic disease is?

A

lytic changes-75%

105
Q

Reverse A-G ration, anemia, bense jones protenuria, and the M-spike of protein electophoresis are often findings associated with what?

A

multiple myeloma

106
Q

Mr. Outa Shape, a 30 year old male, presents to your office with knee pain relating to a history of hurting his knee during a rugby game over the weekend. After a thorough exam, you xray the knee and find bony outgrowth of the distal femoral metaphysis covered with a cartilage cap.

A

osteochondroma

107
Q
A

simple bone cyst

108
Q
A

Blastic mets from prostate cancer

109
Q
A

Osteosarcoma

110
Q
A

fibrous cortical defect

111
Q
A

Multiple myeloma

112
Q
A

chondroblastoma

113
Q
A

lytic mets from breast cancer

114
Q
A

hemangioma

115
Q
A

Ewing’s Sarcoma

116
Q
A

Paget’s Disease

117
Q
A

hereditary multiple exostosis

DI 2 (6 decks)

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