2. Benign Tumors Flashcards
(161 cards)
1
Q
A round/oval, well circumscribed uniformly opaque calcific radiopacity that arises in membranous bones
A
Osteoma
usually less than 2 cm
2
Q
MC benign tumor of nose and paranasal sinuses
A
Osteoma
3
Q
found in paranasal sinuses, inner and outer skull tables
A
Osteoma
4
Q
Fills the entire sinus
and may cause ocular disturbances, headaches, and sinusitis
A
Giant Osteomas
5
Q
Mandibular Osteoma will cause
A
Mechanical and cosmetic problems
6
Q
Osteomas may be associated with what syndrome?
A
Gardner’s Syndrome
7
Q
Colonic polyposis, soft tissue fibromas, and multiple osteomas that are protuberant, oval, dense.
A
Gardener’s Syndrome:
8
Q
Discrete area of sclerosis in located anywhere (except skull)
A
Bone Island (Enostoma)
9
Q
Bone islands are symptomatic or Asymptomatic?
A
Asymptomatic and clinically insignificant
10
Q
what distinguishes a Bone Island from blastic metastasis?
A
Brush border
11
Q
bone islands affect what part of the bone?
A
Epiphysis and metaphysis but NOT the diaphysis
12
Q
A giant bone island is larger than
A
1.0cm
13
Q
DDx for Bone Island: (Enostoma)
A
- Blastic metastasis
- Osteoid osteoma
- Osteoma
- Osteopoikilosis
14
Q
Bone Island are possibly caused by cortical bone that has failed to undergo __________ during the process of endochondral
ossification
A
medullary
resorption
15
Q
Bone islands typically appear
as
A
round-to-ovoid sclerotic
intramedullary foci
16
Q
The long axis of the bone
island is aligned ______ to
the long axis of the bone
A
parallel
17
Q
Bone islands are composed of
cortical bone and appear as what signal intensity?
A
low signal intensity on MRI on all pulse sequences
18
Q
Do bone islands typically appear “hot”
on bone scans?
A
NO
19
Q
Radiolucent nidus with surrounding reactive
sclerosis in 10-25 yo.
A
Osteoid Osteoma
20
Q
Pain from an osteoid osteoma is relieved by
A
aspirin
21
Q
Gradual severe deep aching pain than can be referred to a nearby joint, worse at night, with Limited ROM, painful limp, stiffness, and weakness
A
Osteoid Osteoma
22
Q
Painful rigid scoliosis from an Osteoid Osteoma is usually on the ______ side
of curve
A
concave
23
Q
What bones does an osteoid osteoma affect?
A
50% in tibia and femur and 10% in spine
24
Q
Osteoid Osteomas are
usually less than
A
1.0 cm
25
Highly vascularized fibrous connective tissue in osteoid osteomas
nidus (may not be seen)
26
may need what to Dx osteoid osteoma?
CT
27
Intramedullary OO do not produce much sclerosis
| except the sclerosis
outside of the capsular bone region
28
Helps show bone edema around the nidus
MRI
29
Very high levels of have _________ been found in the
| osteoid osteoma lesion
prostaglandins
30
– Aspirin also relieves pain (worse at night)
– Nidus >1.0 cm in size
– No angiographic vascular blush
Brodie’s Abscess
31
success in 92 % of Osteoid Osteoma cases
Thermocoagulation
32
Osteoid Osteoma spinal lesions in the posterior arch need
surgery
33
Central sclerotic focus in a radiolucent nidus, characteristic
of of
osteoid osteoma
34
a safe and effective method for treatment of osteoid osteoma
| at any location
Percutaneous thermocoagulation
35
2-10 cm expansile lesion with a eggshell-thin cortical margin found in 10-20 yo
Osteoblastoma
36
Osteoblastomas are usually located in the?
posterior neural arch of the spine
37
Pain that is usually NOT at night and NOT relieved by aspirin
Osteoblastoma
38
Osteoblastoma my be
sclerotic
39
Osteoblastoma treatment for small and large lesions
Excision/curettage for small lesions and Radiation therapy for inoperable spinal lesions
40
Small percentage of osteoblastomas become
malignant
41
cortical expansion and mass with
| ossific matrix
Osteoblastoma
42
Osteoblastoma will show ____ signal intensity in the surrounding soft
tissues consistent with _____
high, edema
43
Arises from residual islands of cartilage left in metaphysis as physis grows away in the hands (50%) and feet in 10-30 yo
Solitary Enchondroma
44
m/c benign tumor of hand
Solitary Enchondroma
45
Usually a painless tumor in the hands (50%) and feet
| May see pathologic Fx
Solitary Enchondroma
46
Sudden onset of pain without trauma signals
| malignant transformation of a Solitary Enchondroma to a
chondrosarcoma
47
Geographic radiolucent expansile
| lesion centrally placed in the metaphysis with ENDOSTEAL SCALLOPING
Solitary Enchondroma
48
50% of Solitary Enchondroma's have __________ due to
| cartilagenous matrix
punctate calcification
49
Neuroarterial lesion in hand causing pressure erosion of tuft
Glomus (vascular) tumor
50
Post trauma introduction of epidermoid tissue into bone
Inclusion cyst
51
skin puncture causes fibrous outer lining and filled with a soft,cheese-like material (keratin)
Epidermal Inclusion Cyst
52
functions to regulate skin circulation
normal glomus unit (neuromyoarterial apparatus)
53
m/c site of glomus tumors is ______ and
| 75% of the lesions occur in the ____
subungual, hand
54
Solitary Enchondroma malignantly transforms to a Chondrosarcoma when located close to or within
axial skeleton
55
If pathologic Fx of Solitary Enchondroma, treat with...
casting, curettage, or replace with bone chips, or cement packing (calciumphosphate)
56
should benign lesions should be irradiated?
no
57
Expansile, lytic lesion in the proximal phalanx of the fifth digit with a distinct zone of transition, thinning of the cortex, and a
pathologic fracture
Solitary Enchondroma
58
Fluffy calcific matrix within the medullary canal
Solitary Enchondroma
59
Malignant degeneration of Enchondromas are more likely with large lesions and
with endosteal scalloping involving over
50% of the cortex
60
other reported
| features of malignant transformation of an enchondroma include
Enlarging radiolucent area, pathologic Fx, or
| disappearance of preexisting calcification areas
61
Multiple Enchondromatosis, aka
Ollier’s disease
62
Unpainful, Unossified remnants of cartilage in diaphyses and metaphyses that likes small bones of hands and feet
Multiple Enchondromatosis (Ollier’s dz)
63
MRI is helpful to detect malignant degeneration/transformation of Multiple Enchondromatosis (Ollier’s dz), which occurs at what percent?
10-50%
64
In Multiple Enchondromatosis (Ollier’s dz), when patients have pain or Rapid growth
malignant transformation should be suspected
65
Enchondromas are metabolically active or inactive?
ACTIVE
66
Loss of calcification in a focal region suggests what?
malignant degeneration with destruction of the
| underlying enchondroma by sarcomatous tissue
67
Multiple radiolucent
| metaphyseal lesions
Multiple Enchondromatosis (Ollier’s dz)
68
Enchondromatosis of bone and soft
| tissue cavernous hemangiomas m/c affects hands
Maffucci’s Syndrome
69
Maffucci’s Syndrome has a ___ greater incidence of malignant
| transformation than Ollier’s Disease
25%
70
In Maffucci’s Syndrome, areas of radiolucency
| represent _________, and opaque spots represent ________.
enchondromas, phleboliths
71
hemangiomas from Maffucci’s may occur in
| other organs, including the
GI tract
72
A painful primary benign bone tumor of cartilage origin in 10-25 yo
Chondroblastoma (Codman’s tumor)
73
Arises from cells of the physis
Chondroblastoma (Codman’s tumor)
74
Chondroblastoma (Codman’s tumor) are eccentric in location in the medullary canal of the
Femur, proximal tibia and proximal humerus
75
Eccentric, medullary oval/round lytic lesion in epiphysis with a marginal sclerotic rim and short zone of transition
Chondroblastoma (Codman’s tumor)
76
Matrix Calcification and possibly solid periosteal reaction
Chondroblastoma (Codman’s tumor)
77
DDx of Chondroblastoma (Codman’s tumor)
Brodie’s abscess, AVN, and Giant Cell Tumor
78
treatment for Chondroblastoma (Codman’s tumor)
surgical curettage and bone chip packing
79
A cartilagenous tumor in 10-30 yo and 50-70 yo composed of chondroid, fibrous, and myxoid tissues
Chondromyxoid Fibroma
80
Chondromyxoid Fibroma are usually found on the Proximal Third of the
Tibia
81
Eccentric oval/round geographic lesion with endosteal scalloping and sclerosis along medullary side
(Trabeculated/soap bubble)
Chondromyxoid Fibroma
82
large, lucent, slightly expansile, eccentric,
| metaphyseal lesion with thin sclerotic borders
Chondromyxoid Fibroma
83
Fibrous Cortical Defects could be associated with
avulsion Fx at a muscle attachment
84
Posterior-medial surface of distal femur
Fibrous Cortical Defect
85
a large lesion (>8 cm) due to faulty ossification in 8-20 yo
Non-Ossifying Fibroma
86
a thin, lytic, eccentric, and ovoid diametaphyseal lesion (2-7 cm) due to faulty ossification in 8-20 yo
Non-Ossifying Fibroma
87
NOF is m/c at the
distal tibia
88
Non-Ossifying Fibroma is also called a
Fibrous Xanthoma of Bone
89
Dense sclerotic border along medullary side
| and periosteal reaction with pathologic fx
NOF
90
NOF has high or low uptake on bone scan?
high
91
Peripheral sclerotic border with a central lucency
NOF
92
Fluid filled cyst lined with thin layer of fibrous tissue in 3-14 yo
Simple Bone Cyst
93
Simple bone cyst, Aka
unicameral (one house) bone cyst
94
2/3 of Simple Bone cysts undergo
pathologic Fx
95
Simple Bone Cyst usually hit the proximal
humerus and femur
96
A Simple Bone Cyst that originates in the metaphysis is considered ____
and one in the diaphysis is ____.
active, latent
97
Geographic or cystic radiolucency that is broad at the metaphyseal end, and narrower at diaphyseal end with Endosteal scalloping and Light/incomplete septation
Simple Bone Cyst
98
Simple Bone Cyst have a truncated __________ appearance
cone shaped
99
There is no matrix calcification with a
Simple Bone Cyst
100
2 SIGNS of simple bone cyst
Fallen Fragment Sign and Hinged Fragment Sign
101
A small, detached, floating bone
fragment that changes position in cyst with
movement
Fallen Fragment Sign
102
fragment is attached at one end but opposite end moves with
| movement
Hinged Fragment Sign
103
Oval, geographic radiolucent lesion in subtalar region of
| anterior calcaneus
Calcaneal (Simple Bone) Cyst
104
Calcaneal (Simple Bone) Cysts usually occurs at the
base of the calcaneal
| neck
105
The major DDx for calcaneal cysts are a
lipoma and trabecular thinning
| pseudotumor
106
Cystic cavity filled with blood in 5-20 yo that is not a true cyst and not an aneurysm but likely post-traumatic
Aneurysmal Bone Cyst (ABC)
107
Acute pain with rapid increasing severity in 5-20 with spinal stenosis and epidural mass effect
ABC
108
what explains the neuro changes and spinal stenosis in ABC's?
ABCs like the posterior neural arch of the spine
109
Aneurysmal Bone Cysts like what areas?
tubular bones and neural arch of T and L spine
110
M/C benign bone tumor of clavicle
ABC
111
Expanding cyst
| with eggshell and soap bubble appearance around 8-10 cm in size
Aneurysmal Bone Cyst
112
Fine septations with thin calcific rim and small flecks of calcification
ABC
113
Rarest primary benign bone tumor
Intraosseous Lipoma
114
Lytic lesion with well defined/sclerotic border with a calcific radiopacity of central necrosis in wide age range
Intraosseous Lipoma
115
Intraosseous Lipomas may be expansile with
endosteal scalloping
116
Usually asymptomatic and usually found incidentally
Intraosseous Lipoma
117
Intraosseous Lipoma are m/c in
metaphyses of long bones (tibia/fibula), calcaneus, and metatarsals
118
Dystrophic calcification in Intraosseous Lipomas is known as
Cockade Sign
119
Composed of newly formed capillary, cavernous,
| or venous blood vessels usually seen over 40 yo
Hemangioma
120
MC benign bone tumor of spine
Hemangioma
121
Many hemangioms are not seen on plain film, but seen on
MRI
122
neuro symptoms from spinal hemangioma are usually from
cord compression
123
Because the spinal canal vs. cord size is smallest, most symptomatic spinal lesions are in the
mid thoracic spine
124
may result in death during tooth extraction
| due to exsanguination of blood
Hemangioma in Maxilla and Mandible
125
75% of Hemangiomas are located in the
spine and skull
126
types of hemangiomas
Capillary and Cavernous
127
most common type of Hemangiomas
Cavernous
128
Large, thin walled blood vessels and sinuses surrounded by resorbed bony trabeculae usually in skull and vertebral body
Cavernous Hemangioma
129
Usually solitary with coarse vertical striations in vertebral body separated by
radiolucent zones called Corduroy Cloth Appearance
Spinal Hemangioma
130
Corduroy Cloth Appearance
Spinal Hemangioma
131
Angiomatous vessels replace resorbed bone rendering the vertebral body osteopenic
Spinal Hemangioma
132
Skull Hemangiomas are
| m/c located in the
frontal bone
133
Sunburst or Spoke-Wheel Appearance
Skull Hemangiomas
134
Skull Hemangiomas usually destroy the
outer table of skull
135
Palpable soft tissue mass with phleboliths, usually in forearm/lower leg/paravertebral area,
Soft Tissue Hemangioma
136
Corduroy Cloth Appearance results in vertebral body being stronger or weaker than neighboring vertebral
bodies
STRONGER
137
do we restrict activities due to vertebral hemangioma?
NO
138
Polka Dot Appearance on CT
Hemangioma
139
Jailhouse Appearance and Corduroy Cloth Appearance on MRI:
Hemangioma
140
nonvascular matrix tissues of hemangioma
- Fat
- smooth muscle
- bone trabeculae
fibrous tissue
- clotted blood products
141
A greater proportion of fat (T1) in vertebral hemangiomas
| is associated with a
reduced likelihood of symptoms
142
Neural compression in hemangiomas is more likely with a greater
proportion of
hypervascular or hemangiomatous
| tissue (T2)
143
Low T1 signal and high T2 signal for a vertebral hemangioma indicates
more aggressive behavior and common with vertebral collapse
144
MC benign skeletal growth or tumor
Solitary Osteochondroma
145
Bony exostosis projecting from external surface and usually has hyaline lined cartilagenous cap
Solitary Osteochondroma
146
50% of all neoplasms
| and 75% occur before age 20
Solitary Osteochondroma
147
Solitary Osteochondromas are asymptomatic unless
blood vessels, nerves, or joints are disturbed
148
Solitary Osteochondroma occurs in
any bones preformed in cartilage
149
Cortex and medullary cavity blend imperceptibly with host bone
Solitary Osteochondroma
150
what indicates malignant degeneration/transformation of a solitary osteochondroma?
- a cartilage cap >2cm in adults and >3cm in children
| - Break in cortex or growing soft tissue mass
151
Solitary Osteochondroma point away from the joint due to
muscle pull
152
what is m/c affected by a Solitary Osteochondroma?
Knee metaphysis
153
Cauliflower and coat hanger Exostoses
Solitary Osteochondroma
154
Measures cartilagenous cap thickness
MRI
155
Multiple osteochondromas in 2-10 yo
Hereditary Multiple Exostoses (HME)
156
Painless lumpy joints that are usually bilateral and symmetric
Hereditary Multiple Exostoses (HME)
157
* Shortening of ulna
* Outward bowing of radius
* Subluxation of radioulnar joint
Bayonet Hand Deformity
158
Bayonet Hand Deformity
Hereditary Multiple Exostoses (HME)
159
– Cauliflower pelvic lesions
Hereditary Multiple Exostoses (HME)
160
malignant transformation of HME
5-25%, m/c to pelvis and shoulder
161
HME treatment is usually
surgical resection for cosmetics rather than for symptoms
