Tumors and Tumor-like Processes

Question 1

What is the most common source of osteoblastic metastatic carcinoma in adult females?

Answer 1

Breast CA

Question 2

List the three common causes of solitary sclerotic vertebral body/ivory vertebra

Answer 2

Hodgkins Lymphoma (anterior body scalloping)
Osteoblastic Lymphoma MC
Paget’s Disease (cortical thickening and expansion)

Question 3

Is it common to find a tumor involving a joint?

Answer 3

NO- if the joint is involved think of an arthritic disease before tumor

Question 4

Is multiple myeloma more common in the vertebral body or neural arch?

Answer 4

MC in the vertebral body

Question 5

What malignancy demonstrates as a cold bone scan?

Answer 5

Cold bone scan: looks nml on bone scan, helps differentiate MM from mets. MM has a cold bone scan

Question 6

Which is the most dense primary malignant bone tumor?

Answer 6

multiple myeloma, osteosarcoma (2nd MC), Condrosarcoma (3rd MC, Kids), Ewings (4th MC, kids)

Question 7

What is the common age range of primary osteosarcoma?

Answer 7

75% occur in 10-25 yo, likely dt malignant degeneration of a benign process, second peak

Question 8

What is the difference between sunburst and onion skin appearance?

Answer 8

Sunburst- skull lesions (hemangiomas), characteristic for osteosarcoma
onion skin- implies more aggresive process but can be benign, characteristic of Ewings, mb in osteosarcoma, osteomyelitis, stress fx, eosinophilic granuloma

Question 9

Which part of the long bone is commonly involved in osteosarcoma?

Answer 9

metaphysis of long bone- esp distal femur, proximal tibia, proximal humerus (around the knee is MC)

Question 10

What is codmans triangle?

Answer 10

triangle consisting of several layers of periosteal reaction may form at the margin of the lesion, thought to be pathognomoic for osteosarcoma, but also encountered in osteomyelitis
should be avoided as a biopsy site (no cancer in the triangle)

Question 11

Why is Ewings sarcoma commonly found in the diaphysis of long bone?

Answer 11

bc it arises from red bone marrow and is closely related to reticulum cell sarcoma. mimics “round cell” tumors, leukemia, metastatic neuroblastoma

Question 12

What is a geographic lytic appearance and does it suggest more benign or aggressive neoplasms? What are the other two lytic appearances of tumors?

Answer 12

Geographic: confined to a relatively specific area that is more or less easily defined, more likely a benign process.

Question 13

Which condition present as a solitary exostosis that points away from the nearest joint?

Answer 13

Osteochondroma

Question 14

Compare the incidence of malignant transformation in osteochondroma and hereditary multiple exostosis

Answer 14

Osteochondroma: 1% malignant transformation
HME: 20% malignant transformation

Question 15

What is “corduroy vertebra”?

Answer 15

lytic lesion with coarse vertical striations
usu only at 1-2 vertebral bodies (whereas osteoporosis has similar appearance but at more levels); occurs with hemangiomas, may look like pagets/osteoporosis

Question 16

Is spinal hemangioma usually solitary or polyostotic?

Answer 16

solitary

Question 17

Which is the most common benign bone tumor of the spine?

Answer 17

Hemangioma (for the entire skeleton: osteochondroma)

Question 18

Is a bone island symptomatic?

Answer 18

Endostomas are usu not sympomatic, except in the skull

Question 19

Which benign tumor classically demonstrates as pain worst at night and easily relieved by aspirin?

Answer 19

Osteoid Osteoma

Question 20

Which part of the bone is usually involved with osteoid osteoma?

Answer 20

Cortical is MC, cancellous and subperiosteal are possible but less common

Question 21

What is the appearance of the tumor matrix in enchondroma?

Answer 21

Presents with stippled matrix calcification and endosteal scalloping, geographic lytic, expansile, thinned cortex

Question 22

What is multiple enchondromatosis called?

Answer 22

Ollier’s Disease (and Maffucci’s syndrome, but also has soft tissue hemoangiomas/phleboliths)

Question 23

what is the most common location of fibrous cortical defect?

Answer 23

Lower extremity MC (05 in tibia or fibula); Humerus and Ribs less common

Question 24

What is a fallen fragment sign associated with?

Answer 24

What simple bone cysts undergo pathologic fractures (happens 2/3), piece of bone seen below the fracture
if piece falls into the cyts, = trap-door sign

Question 25

Which benign bone tumor is named according to its appearance rather than its histological composition?

Answer 25

ANEURYSMAL BONE CYST

cystic blood-filled cavity

Question 26

Describe the radiographic difference between enchondroma, simple bone cyst, aneurysmal bone cyst and osteochondroma

Answer 26

Endochondroma: small round oval/cstic defects, stippled matrix calcification, endosteal scalloping, discrete islands of cartilage w/in bone. long bone lesions more likely painful
Simple Bone Cyst: oblong, central, expansile, radiolucent supepiphyseal osteolytic lesion mb fallen fragment sign, usu silent
Aneurysmal bone cyst: osteolytic soap bubble appearance, expansile cortex defect w/ buttressing at the region of expansion from the host bone and very thin cortices at outer edge of lesion. pain and swelling, secondary to trauma
osteochondroma: sessile/pedunculated “coat hanger” exostoses or “cauliflower cap” outgrowth, affect apiphyseal growth

Question 27

Is a giant cell tumor painful? is it malignant?

Answer 27

Painful

Question 28

Is paget’s disease monostotic or polyostotic?

Answer 28

Polyostotic

Question 29

List the radiographic features of Paget’s disease in a long bone such as the femur or tibia

Answer 29

coarse, thickened trabeculae
thickened cortex
bone expansion, subarticular extension
pseudo/stress fractures
deformities,
Skull: osteoporosis circumscripta, cotton wool appearance
Spine: picture frame vertebra and ivory vertebra
Pelvis: brim/rim sign
Femur and Tibia: blade of grass or candle flame appearance, V lesion, sabe shin deformity, shepards crook