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Neuroradiology > Spinal Tumors > Flashcards

Spinal Tumors Flashcards

1
Q

Most common spinal benign neoplasms ?

A

Enostoma, hemangioma, osteoid osteoma, osteoblastoma, ABC, GCT and osteochondroma

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2
Q

Common spinal malignant tumors?

A

Typically uncommon (5% of cases).

Chordoma, chondrosarcoma, lymphoma, Ewing’s sarcoma (or PNET) and osteosarcoma

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3
Q

Osteoid osteoma age range and gender?

A

5-25yrs

M:F (2:1 to 3:1)

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4
Q

What % of O.O. patients get a painful scoliosis?

A

70%

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5
Q

T/F – spine is M/C location of O.O.?

A

F. Only 10% (post elements).

Femur & tibia M/C locations.

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6
Q

What % of O.O are partially calcified?

A

50% (20% are fully)

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7
Q

Age and gender for osteoblastomas?

A

90% < 30yrs;

M:F (2:1)

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8
Q

What are the clinical differences btwn osteobalstomas (OB) vs osteoid osteomas (OO)?

A

OO - nocturnal pain relieved by salicylates;
stability in growth;
predominantly long bone tumors

OB - slow growth;
malignant transformation to osteosarcoma; more aggressive overall
higher rate of recurrence compared to OO;
30-40% in spine;

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9
Q

What are the histological differences between OB and OO?

A

Virutally indistinguishable;

OB > 2cm nidus

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10
Q

What are 3 types of appearances of OB on imaging?

A

1) similar to OO w/ radiolucent center & surrounding sclerosis
2) more expansile w/ prominent sclerotic rim and multiple Ca2++ – M/C appearance
3) aggressive appearance w/ expansile pattern, bone destruction, paravertebral extension – indistinguishable from ABC

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11
Q

Age and gender of epidural lipomatosis?

A

Mean age = 43yrs

M>F

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12
Q

M/C location of epidural lipomatosis within the spine?

A

T/S (60%) > L/S (40%)

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13
Q

Etiology of epidural lipomatosis?

A

Long-term exogenous steroid adminstration OR excessive endogenous steroid production

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14
Q

What is the measurement in the AP dimension of the epidural fat to consider this condition?

A

7mm in T/S

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15
Q

What is the clinical presentation of epidural lipomatosis?

A

Weakness (85%) & back pain (60%)

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16
Q

Age and gender for ABC?

A

60% < 20yrs

F mildly > M

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17
Q

What’s the recurrence rate for ABC?

A

20-30%

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18
Q

What are the 3 theories of ABC pathophysiology?

A

1) consequence of trauma and local circulatory disturbances
2) underlying tumor-inducing vascular process
3) de novo genesis as a primary neoplasm with cytogenic abnormalities

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19
Q

What % of ABC occurs in the spine?

A

10-30%

75-90% extend into VB from neural arch

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20
Q

What scintigraphy sign is present for ABC?

A

“Donut sign” = rim of activity around a photopenic region, representing hypervascularity in the periphery

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21
Q

What is the most common spinal tumor?

A

Hemangioma

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22
Q

Age and gender for hemangiomas?

A

30-50s
M>F
(aggressive lesions more common in F)

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23
Q

What is the M/C type of hemangioma?

A 
Cavernous hemangioma
(other types are capillary and venous)
24
Q

Aggressive hemangiomas are likely to occur in what part of the spine?

A

Thoracic

25
Q

What % of GCT are in the spine?

A

~3%

26
Q

What is the recurrence rate of GCT?

A

12-50%

27
Q

What is the most frequent benign tumor to affect the spine?

A

GCT

28
Q

What is the most common location for chordoma?

A

sacrococcygeal (50%) > spheno-occipital (35%) > vertebral bodies (15%)

29
Q

Calcifications in sacral chordomas occur in what %?

A

70%

30
Q

What is the most common benign bone tumor?

A

Osteochondroma

31
Q

Age and gender for osteochondromas?

A

10-30yrs

M:F (3:1)

32
Q

The M/C location for osteochondroma in the spine?

A

Spinous processes

33
Q

What incidence of osteosarcomas occur in the spine?

A

up to 3%

34
Q

What % of chondrosarcomas are in the spine?

A

up to 12%

35
Q

Age and gender of Ewing’s sarcoma

A

90% < 20yrs

M:F (2:1)

36
Q

What % of Ewing’s sarcoma have already metastasized at initial diagnosis?

A

30%

37
Q

What part of the vertebra does Ewing’s affect?

A

vertebral body

38
Q

What is the M/C form of lymphoma?

A

B-cell lymphoma (80-90%) - Non-hodgkin’s lymphoma

39
Q

What is the M/C malignancy of the epidural space?

A

lymphoma

40
Q

What is the cause of lymphoma?

A

Etiology unknown;

Risk factors: chemical exposure to pesticides, fertilizers or solvents, Epstein-Barr virus, family hx of Hodgkin’s.

41
Q

What is the etiology of multiple myeloma?

A

Unknown;

But neoplastic plasma cells accelerate ostoclastic bone resportion and inhibits osteoblastic bone formation

42
Q

What % of prostate cancer metastasis involves the spine?

A

90%

43
Q

What primary cancers cause purely blastic metastasis?

A

Prostate, carcinoid, bladder, nasopharynx and medulloblastoma

44
Q

What primary cancers cause mixed metastasis?

A

Lung, breast, cervix and ovarian

45
Q

What primary cancers cause lytic metastasis?

A

Breast, lung, kidney and thyroid and melanoma

46
Q

What is the M/C spinal location for a hemangioblastomas? (Give level and intra/extradural specifics.)

A

T/S > C/S
60% intramedullary
20% intradural-extramedullary

47
Q

Inhomogeneous, tiny foci of signal changes (low T1, high T2) is which type of multiple myeloma?

A

Type 2

48
Q

What are the 3 patterns of multiple myeloma?

A

Type 1: focal lesions (low T1, high T2)
Type 2: homogeneous, multiple foci (low T1, high T2)
Type 3: total marrow involvement (high T1/T2)

49
Q

Where is the M/C location for skeletal mets?

A

Spine

50
Q

What region of the spine is M/C involved in osteoid osteoma?

A

Lumbar > cervical > thoracic

51
Q

What region of the spine is M/C involved in osteochondroma?

A

Cervical (50% C2 predilection), posterior elements

52
Q

What are the 3 M/C locations for chordoma (from M/C to least)?

A

Sacrococcygeal (50%) > spheno-occipital&raquo_space; cervical

53
Q

Which region of the spine is the M/C location for Ewing’s sarcoma?

A

Sacrum

54
Q

Where is the M/C location within the body for a neuroblastic tumor?

A

Adrenal gland (40%)

55
Q

Where is the M/C location within the body for a plasmacytoma?

A

Vertebral body

Neuroradiology (7 decks)

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