8. Skeletal Metastasis

Question 1

almost all tumors have reported incidences of metastases to bone except tumors of

Answer 1

central nervous

system and basal cell carcinoma of the skin

Question 2

Leptomeningeal Metastasis from primary Medulloblastoma of brain

Answer 2

Drop Metastasis

Question 3

“sugar coating” enhancement

Answer 3

Drop Metastasis

Question 4

4-year-old with medulloblastoma

presents with

Answer 4

morning vomiting and ataxia

Question 5

responsible for ~70% of all bony metastases

Answer 5

Female breast cancer

Question 6

results in ~60% of skeletal metastases

Answer 6

Prostate carcinoma

Question 7

Metastatic osseous lesions in children <5 yo are usually due to

Answer 7

neuroblastoma

Question 8

Metastatic Bone Tumors between 10-20 yo

Answer 8

Ewing’s and Osteosarcoma

Question 9

Metastatic Bone Tumors Between 20 and 35 yo

Answer 9

Hodgkin’s lymphoma

Question 10

May have increased serum calcium in

Answer 10

extensive lytic

metastasis

Question 11

Blastic metastasis will increase

Answer 11

alkaline phosphatase

Question 12

PSA and/or acid phosphatase will elevate if what is disrupted?

Answer 12

prostate

capsule

Question 13

drop metastasis in CSF is an example of what type of mets?

Answer 13

Implantation or Seeding Metastasis

Question 14

Valveless epidural vertebral veins that function as a venous lake or pool

Answer 14

Batson’s Venous Plexus

Question 15

provides the
pathophysiological basis for early metastasis of
prostate cancer to pelvis, lumbar spine, and
remainder of axial skeleton

Answer 15

Prostatic venous plexus may drain directly into

vertebral venous plexus

Question 16

Approximately 90% of patients present with Spinal metastasis present with

Answer 16

bone and/or back pain followed by radicular pain

Question 17

most ominous symptom in patients with metastatic disease to the spine

Answer 17

Bone pain at night

Question 18

Destruction due to osteoclast stimulating cytokines secreted by tumor cells.

Answer 18

Lytic Metastasis

Question 19

Contrast is inserted into the thecal sac (subarachnoid space) via fluoroscopic
control

Answer 19

MYELOGRAPHY

Question 20

Osteoid reacts to tumor cells by laying down nonneoplastic bone as a futile attempt at bone repair

Answer 20

Blastic Metastasis

Question 21

Bone Scan will detect what percent of metabolic activity alteration?

Answer 21

3-5%

Question 22

Radiation emitting substance, with low radiation dose a convenient half life for clinical use, is taken up and concentrated in
regions of high metabolic activity in bone

Answer 22

99mTc-MDP

Question 23

bone scan with be positive how long before you see disease on plain film?

Answer 23

18 months

Question 24

Useful for cortical bone involvement and presence of soft

tissue mass formation

Answer 24

Computed Tomography (CT, CAT):

Question 25

Better than CT for detecting bone lesions and assessment of | soft tissue mass formation

Answer 25

MRI

Question 26

Replacement of fatty bone marrow by tumor cells results in

Answer 26

loss of normal bright signal intensity on T1 weighted images

Question 27

75% of metastatic bone tumors are

Answer 27

lytic

Question 28

Motheaten or permeative pattern is classic in metastatic bone tumors and occurs mc with

Answer 28

breast and lung carcinoma metastasis

Question 29

Primary tumors of thyroid and kidney may | produce

Answer 29

blow-out metastatic patterns

Question 30

favors primary tumors

Answer 30

- Periosteal reactions - Soft tissue mass - Long lesions >6cm - Most tumors that expand bone - usually solitary, whereas metastatic lesions are usually multiple

Question 31

Earliest and most subtle sign of metastasis to vertebral body is

Answer 31

focal osteoporosis compared to adjacent bodies

Question 32

due to disc herniation into vertebral body from destruction and weakening of vertebral body

Answer 32

Malignant Schmorl’s Nodes

Question 33

Regarding neural arch, the _____ is mc involved by metastasis

Answer 33

pedicle | winking owl sign

Question 34

Bilateral pedicle destruction, known as

Answer 34

Blind Vertebra

Question 35

When a single vertebral body is involved with a diffuse homogeneous radiopacity

Answer 35

Ivory Vertebra

Question 36

3 mc causes of ivory vertebra

Answer 36

Blastic Metastasis, Paget’s Disease, and Hodgkin’s Lymphoma

Question 37

mc cause of extrapleural sign is

Answer 37

rib metastasis

Question 38

Blow out rib lesions are from

Answer 38

thyroid and renal metastasis

Question 39

description of the extrapleural Sign

Answer 39

1. Smooth contour 2. Convex towards lung 3. Edges taper

Question 40

Predilection for distal phalanx of finger to be affected by metastasis from

Answer 40

primary bronchogenic carcinoma

Question 41

Periosteal Reactions are very rare in metastatic lesions, with the exception of

Answer 41

neuroblastoma

Question 42

Complications of bone metastasis

Answer 42

- pathologic fracture - Damage to physis - Extradural compression of spinal cord - AVN

Question 43

mc complication of bone metastasis is

Answer 43

pathologic fracture

Question 44

Greater chance for pathologic fracture when > 50% of the

Answer 44

cortex is destroyed

Question 45

Soft tissue masses typically accompany metastatic disease to small bones such as ribs, and is usually due to

Answer 45

hemorrhage

Question 46

ribs are commonly affected by

Answer 46

expansion

Question 47

Presence of sclerosis in a lytic lesion may be a sign of

Answer 47

healing

Question 48

what seem to be most reliable to measure | response to therapy?

Answer 48

Bone scans

Question 49

Second mc abdominal neoplasm in childhood | Wilm’s is mc

Answer 49

neuroblastoma | (75% arise in adrenal gland)

Question 50

Adrenal neuroblastomas are highly fatal and mc prior to age

Answer 50

5

Question 51

neuroblastomas have a ________ of calcification in 2/3 of cases

Answer 51

Granular pattern

Question 52

- Typically osteolytic and fairly symmetric - Vertebral compression fractures with widening of paravertebral stripe

Answer 52

Neuroblastoma

Question 53

- Lytic lesions - Widening of sutures - Sunburst periosteal reaction - Metastatic lesions to brain produce plaques on brain that may widen sutures

Answer 53

pathognomonic Skull changes from a neuroblastoma

Question 54

most common pediatric malignancy in infancy

Answer 54

Neuroblastoma

Question 55

Hypertrophic Osteoarthropathy (HOA) may occur secondary to

Answer 55

pulmonary lesions

Question 56

in children cyanotic congenital heart disease is a potential | cause of

Answer 56

Hypertrophic Osteoarthropathy (HOA)

Question 57

- Clubbing of Fingers - Periostitis in the distal tibial diaphyses - “Double stripe or railroad track” appearance

Answer 57

Pulmonary Hypertrophic Osteoarthropathy

Question 58

periosteal proliferation and right upper lobe perihilar mass

Answer 58

Pulmonary Hypertrophic Osteoarthropathy