Tumors and Tumor-like conditions Flashcards
What is the rate of metastasis in all malignancies?
75% of cancers will lead to metastatic disease
Name the most common primary malignant tumor in adults.
multiple myeloma
What is the most common primary malignant tumor in kids?
osteosarcoma
What is the most common benign osseous tumor?
osteochondroma
Name the most common benign spinal tumor.
hemangioma
What properties of geographic bone destruction show a least aggressive pattern?
usually a solitary lesion <1cm short zone of transition well defined margin-smooth or lobulated
What are the properties of moth-eaten bone destruction (moderate degree of aggressiveness)?
Numerous small holes (2-5mm) longer zone of transition margins are not well defined loves mid-shaft
What are the characteristics for permeative bone destruction (the most aggressive growing lesion)?
numerous small holes (1mm in size) wide zone of transition poorly demarcated or imperceptible borders
Name the cortical change and age range of this person
Buttressing/thickening
Child-open growth plates
This is actually a stress fracture of a young boy
Name the coritcal change
Endosteal scalloping
Name the patholgy.
Hint: typically malignant, a round cell lesion
Ewing’s Sarcoma
Name the pathology.
Hint: hair on end spiculations (often associated with this highly agressive lesion)
osteosarcoma
Name the pathology
Hint: one of the most aggressive forms of periosteal reactions
Codman’s triangle
Name the pathology.
Hint-“c” shaped
calcified cartilage
Primary site for metastisis in females?
Males?
Breast 70%
Prostate 60%
Most common pathway of mets?
hematogenous dissemination (blood) via Batson’s venous plexus
What is the most common site for mets?
The spine at 40%
second are the ribs and sternum at 28%
What percentage of mets are lytic?
75%
What are the differences between lytic and blastic mets?
lytic-more holes
blastic-more dense (more white)
Blow out bone metastases or expansile bone metastases are typically only encountered in a relatively small number of primary malignancies including what cancers?
renal cell carcinoma
thyroid cancer
hepatocellular carcinoma
75% of all patients who get multiple myeloma are in what age range?
50-70 years
What is the male to female ration with the occurance of multiple myeloma?
male to female
2:1
What are the clinical features (signs and symptoms) of multiple myeloma?
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
What are the common labratory findings associated with multiple myeloma?
protein electrophoresis with “M-spike”
Bence Jones proteinuria
Where are the most common locations of multiple myeloma?
Vertebrae-thoracic and lumbars
Name the primary cancer that caused the osteolytic defects pictured
Multiple myeloma
pictured: raindrop skull
Name the pathology
multiple myeloma
What are the MRI findings with multiple myeloma?
diffuse low T1 with high signal endplates
Iso to high T2 change, use STIR
multiple wedge compression fractures
little soft tissue mass
Name the 2nd most common primary malignant bone tumor overall, which is the most common primary malignant tumor in children and young adults.
osteosarcoma
What is the age distribution for osteosarcoma?
10-25 years old primarily and secondarily >60 years old
What are the clinical features of osteosarcoma?
painful swellings (1-2 months duration)
minor joint restriction
fever
Where does osteosarcoma grow rapidly in children?
knee
40% in distal femur
T/F osteosarcoma commonly matastasis to the lungs.
true
the lungs fill with bone
Name the tumor
osteosarcoma
*usually in the distal femur, bone is more white with sunbursting
Name the tumor
osteosarcoma
*distal femur, subursting=typical for osteosarcoma*
Name the third most common primary malignant bone tumor.
chondrosarcoma
What is the age and male to female ratio most likely to get chondrosarcoma?
50 years old
male to female ratio is 2:1
What tumor has a popcorn matrix calcification in 2/3 with 1/3 being purely lytic?
chondrosarcoma
Name the tumor
chondrosarcoma
*“C” shaped, popcorn matrix, proximal humerus
Name the fourth most common primary malignant bone tumor, but second most common in children.
Ewing’s Sarcoma
What is the typical age and sex for Ewing’s sarcoma?
10-25:peak at 15 years old
male to female ration- 1.2:3
What are the clinical features of Ewing’s sarcoma?
severe localized pain (remember that is not common with other malignancies)
palpable soft tissue mass
fever, secondary anemia, leukocytosis, and increased ESR simulating infection
Where does Ewing’s sarcoma love to be in those under 20 years old?
long tubular bones 60% (femur, tibia, humerus, fibula)
diaphyseal 33%
metadiaphyseal 44%
Name the tumor
Ewing’s sarcoma
What is the name for a neoplasm that originates from nonbone forming supportive connective tissue of the marrow?
giant cell tumor
What percentage of giant cell tumors are malignant?
20%
which means 80% are benign (duh)
85% of the time, giant cell tumors show up where?
in the long bones-distal femur and proximal tibia
What are the clinical features of giant cell tumors?
localized pain of an aching nature, restricted joint motion
Name the tumor.
giant cell tumor
- *usually have soap bubbly appearance*
- *subarticular*
What is the name for a bony exostosis on the external surface of a bone and usually lined by a hyaline cartilage cap?
solitary osteochondroma
Name the most common benign osseous tumor.
solitary osteochondroma
What type of solitary osteochondroma has a broad base and no stalk and is common in the humerus and scapula?
sessile
What type of solitary osteochondroma has a long stalk with a cartilage cap and is common in the knee, hip and ankle?
pedunculated
descriptive terms: coat hanger exostosis and cauliflower cap
What are the two important radiographic appearances to remember for solitary osteochondromas?
- cortex and spongiosa blend imperceptibly with the host bone
- growth is at an angle to the long axis and towards the midshaft
Name the tumor.
solitary osteochondroma
*growth is at an angle to the long axis towards the midshaft
What are the radiographic features of hereditary multiple exostosis?
- shortening of the 4th and 5th metacarpals
- supernumerary fingers and toes
- madelung or bayonet deformity
- disproportionate shortening of extremity
Name the tumor
hereditary multiple exostosis
name the tumor
hereditary multiple exostosis
Which tumor has a truncated cone appearance?
solitary bone cyst
name the tumor
solitary bone cyst
*radiolucency-black area in bone
name the tumor
solitary/simple bone cyst
What is the name for a non-neoplastic expansile lesion containing thin-walled blood-filled cystic cavities?
aneurysmal bone cyst
What is the age range for aneurysmal bone cysts?
10-30 years old
75% occur below the age of 20
Are aneurysmal bone cysts more common in males or females?
65% occur in females
What are the clinical features of aneurysmal bone cysts?
- acute onset of pain with rapid increase in severity over 6-12 weeks
- history of trauma
- neurologic signs with spinal involvement (radiculopathy or quadriplegia)
Where do aneurysmal bone cysts love to be?
posterior elements of vertebra -30%
-spares the body
T/F aneurysmal bone cysts have an almost invisible thin cortex on a CT?
true
name the tumor
aneurysmal bone cyst
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?
aneurysmal bone cyst
An ovoid lytic, painful lesion in the greater trochanter of the femur in a 20 year old female would most likely be?
chondroblastoma
A 55 year old female complains of pain in her hands. Exam reveals lytic mets disease. The likely primary source would be?
primary lung cancer
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?
non ossifying fibroma
The rim sign is an early radiographic feature of cortical thickening about what region?
the pubic bones and iliopectineal line
Paget’s
A ring of sclerosis is a radiographic feature characteristic of this lesion of bone?
fibrous dysplasia
Bowing of the long bone such as saber shin or Sheppard’s crook deformity are features that may be associated with?
Fibrous dysplasia
Paget’s Disease
osteomalacia
The closer this neoplasia is to the axial skeleton, the higher chance of degeneration?
enchondroma
The clinical presentation of a patient with osteoma is?
no pain
The presence of accentuated verticle trabeculae may be associated with what?
osteoporosis
hemangiomas
Paget’s disease
This pain producing neoplasm will often times create a radiographic appearance of a fusiform type of cortical thickening with 1cm central lucency?
osteoid osteoma
The double density sign on a bone scan is a finding often seen with this neoplastic condition.
osteoid osteoma
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?
enchondroma
Which radiographic feature is NOT consistent with a neoplasm of primary origin?
- presence of periosteal reaction
- presence of associated soft tissue mass
- large size of lesion >5cm
- multiple sites of osseous involvement
- this would be mets and that is secondary
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.
hemangioma
The classic feature of multiple myeloma of the skull are due to?
20-100 defects of similar size and shape
Cortical thickening, course trabeculations, osseous demineralization and increase in bone size are all possible radiographic features for this bone disease.
paget’s disease
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?
osteoid osteoma
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?
SBC with a fallen fracture
Those areas of rapidly growing bone that may serve as common sites of tumor development in children include?
proximal tibia and distal femur metaphysis
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?
chondroblastoma
Cortical splitting or cortical tunneling are radiographic features that might be associate with what disease process?
Ewing’s sarcoma
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?
multiple myeloma
Metastasis which arise from breast primaries in females most commonly are of this osseous presentation, and less commonly of this presentation?
lytic and blastic
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?
an aggressive secondary tumor from primary lung tumor
Evaluation of the extent of soft tissue or marrow involvement in neoplastic conditions is best accomplished using which imaging modality?
MRI
Differential considerations for one-eyed pedicle sign would be?
lytic mets or congentical absence
How do bone metastasis from thyroid carcinoma and renal cell carcinoma present?
expansile soap bubbly lesions
The age of occurance for osteosarcoma is usually?
10-25 years old
The term white is right on T1 weighted MRI refers to the presence of what structure?
medullary bone
Of the listed lesions, which is/are most commonly found in a central location in a tubular bone?
SBC
enchondroma
T/F Chondrosarcoma common sites of involvement include pelvis and femur?
true
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?
Ewing’s sarcoma
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.
giant cell tumor
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?
hereditary multiple exostosis
The most common pattern of metastatic disease is?
lytic changes-75%
Reverse A-G ration, anemia, bense jones protenuria, and the M-spike of protein electophoresis are often findings associated with what?
multiple myeloma
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.
osteochondroma
simple bone cyst
Blastic mets from prostate cancer
Osteosarcoma
fibrous cortical defect
Multiple myeloma
chondroblastoma
lytic mets from breast cancer
hemangioma
Ewing’s Sarcoma
Paget’s Disease
hereditary multiple exostosis
