bone/cartilage tumors Flashcards
(304 cards)
1
Q
location of OB
A
flat bones/vertebra (posterior elements)
2
Q
bone location of OB
A
75% D, then M
3
Q
description of OB
A
bubbly lytic lesion with reactive sclerosis, round/oval, w/ or w/o expansions, cortical thinning, possible ca++ and ST mass
4
Q
bone scan for OB
A
increased uptake
5
Q
bone scan OO
A
double density sign
6
Q
describe OF
A
well circumscribed, lobulated/bubbly expansile, osteolytic/ground glass
ca++ is curvilinear/spheroidal
7
Q
location of OF
A
90% tibia
8
Q
bone location OF
A
mid-D
9
Q
MRI of OF
A
low T1; iso-high T2
10
Q
2nd OS from…
A
Paget’s, extensive bone infarcts, post radiation, OC, and OB
11
Q
Osteoma location
A
skull 9paranasal sinus, vault)
mid clavicle, mandible, maxilla
12
Q
age osteoma
A
40-60 yo
13
Q
MC sinus osteoma
A
frontal 80%
sphenoid very rare
14
Q
rad features osteoma
A
well defined single or multiple dense foci, smooth - no lobulations
15
Q
MR osteoma
A
low T1-T2
16
Q
CT osteoma
A
variable density/ground glass app
17
Q
bone scan osteoma
A
no uptake
18
Q
Gardners syndrome triad
A
colonic polyposis, osteomatosis, and ST tumors
19
Q
enostoma rad features
A
accumulation of dense bone in medullary cavity
single or multiple - uniform sclerotic foci w/ discreet margins
thorny/radiating spicules = brush border app
20
Q
typical size of enostoma
A
<1 cm but can grow slowly
21
Q
MRI enostoma
A
low on all
22
Q
bone scan enostoma
A
usually no uptake, occasionally can be some
23
Q
when to biopsy enostoma
A
if size increase 50% in one year or 25% in size years
24
Q
DDX enostoma
A
blastic mets, osteoma, OO, enchondroma, bone infarct, FD, osteopoikilosis
25
does osteopoikilosis have malignant degeneration
NO
26
osteopathia straita AKA
Voorhoeve's disease
27
osteopathia striata description
```
benign dysplasia of bone
E/M of tubular bones
bilateral
celery stalk metaphysis
DDX: congenital infections (rubella/syphillis/cytomegalovirus)
```
28
OO description
blastic tumor w/ central core of vascular osteoid surrounded by reactive sclerosis
29
age of OO
7-25 yo = adolescents
30
size of OO
<1 cm; no more than 2 cm
31
location of OO
femur then tibia = 50-60% = LE
diaphysis; E rare
posterior elements/pedicle of l/s; concave side of scoliosis
32
pathophysiology of OO
nidus contains prostaglandins
| similar to OB
33
periosteal rxn w/ OO
solid
34
small bones of hand/ft w/ OO
can have prominent ST swelling
35
bone scan OO
double density sign
36
choice of advanced imaging w/ OO
CT
37
average time of resolution w/ OO
33 months; may heal spontaneously
38
DDX OO
OB, Brodie's abscess, stress fx
39
malignant transformation OO
NO
40
age conventional OB
<30 yo
41
MR for OB
```
may simulate malignancy
can have fluid levels
hypointense T1/2 w/ decreased intensity = calcific foci
FLARE phenomenon
enhances w/ contrast
```
42
OB recurrence
10% if incomplete excision
43
aggressive OB hallmark
eosinophilic granuloma = epithelia OB w/ atypical nuclei
44
recurrent tumors w/ aggressive OB
more aggressive
45
DDX of aggressive OB
conventional OB
| OS
46
AKA of OF in tubular bones
osteofibrous dysplasia
47
AKA of OF in facial bones
cement ossifying fibroma or psammamatous OF or juvenile active OF
48
OF location
most in facial bones
| mandible > maxilla
49
OF age
2-4th
| FEMALES
50
OF MC...
painless expansile lesion of tooth bearing region of mandible
51
OF in tubular bones location
tib/fib
middle 1/3 diaphysis
tibia = 90%
52
osteofibrous dysplasia leads too..
painless enlargement and bowing of bone
| ANT/ANT-LAT portion
53
OF dysplasia/OF of long bone assoc....
maybe adamantinoma
54
pathology for OF dysplasia
cytokeratin-positive cells
55
pathology for OF of jaw
psammomatous calcification
56
OF vs FD
FD not as amenable to excision - OF well demarcated and easily removed
57
OF rad appearance
well circumscribed, slow growing uni/multilocular osteolytic lesions
expansile
calcifications - curvilinear, spheroidal
sclerosis/ground glass
58
OF long bone location
mid-diaphysis esp anteriorly
59
OF MRI
low T1, iso high T2; enhancement w/ T1 contrast
60
OF MRI mandible
intermediate to high signal T1/T2 - no ST or cortical destruction
61
prognosis of OF
tends to regress if >10 yo
| surgery if large/aggressive
62
malignancy with OF
none
63
recurrence of OF
high w/ curettage and bone grafting > 60%
| can appear aggressive; may have components of adamantinoma
64
DDX OF
FD - no osteoblastic rimming
adamantinoma - usually larger, older age
well diff intraosseous OS
EG, infection, gnathic OS, denticious cyst
65
primary OS age
10-20 yo; males
66
secondary OS age
elderly - 2nd to malignant degeneration of pagers, bone infarcts, post-radiotherapy, osteochondroma, or OB
67
OS makes up what % of primary bone tumors
20
68
age for OS
10-25
69
OS is MC...
bone tumor in children/adolescents
70
symptoms of OS
pain, swelling, decreased ROM, warmth, pyrexia
71
location of OS
80% in tubular bones
femur - 40%; tibia 16%, humerus 15%
50-75% around knee
72
bone location of OS
metaphyseal; 2-11% diaphyseal
abut open physeal plate in children
if epiphyseal (rare) = femoral condyles
73
path OS
mostly osteoblastic, chondroblastic, and fibroblastic
| hemorrhage - cyst like spaces similar to ABC
74
skip mets occurs in % of OS
25
75
rad appearance OS
```
Mixed MC (resnick); variable appearance
ill defined cumulous cloud; medullary plastic
bone distraction w/ ST mass
```
76
periosteal rxn OS
codman's triangle and sunburst; lamellated less often
77
bone scan OS
helpful to find mets
78
MR OS
low T1, high T2 - enhances w/ gad
79
tx OS
surgery, chemo, radiotherapy
| amputation
80
mets of OS
lung (cannonball mets) - can calcify
| then bone and regional LN
81
GOS location
mandible > maxilla (entire/partial pacification of maxillary sinus is common)
-alveolar ridge and antrum
82
GOS age
30yo (older than conventional); M
83
mets w/ GOS
decreased tendency
84
GOS rad appearance
```
variable; may have matrix ca++
intramedullary extension (diff from osteoma)
ST/cortical involvement
```
85
TOS features
large cystic cavities w/ fresh/clotted blood; uncommon - 11% of OS
86
TOS location
tubular bones - F>T>H
| MC around knee
87
histologically TOS
resembles ABC
88
rate of path fx w/ TOS
25-30% = high
89
TOS rad app
lytic expansile - large multilocular/pseudocystic lacking periosteal rxn
can be well defined
90
bone location TOS
metaphyseal w/ ext to D or E
91
bone scan TOS
DOUGHNUT SIGN - central photopenia w/ peripheral increased uptake
92
lesions w/ doughnut sign
TOS, ABC, GCT, and SBC
93
MRI TOS
fluid fluid levels
hemorrhage shows increased T1 and variable T2
(high signal d/t methemoglobin)
94
CT TOS
low attenuating fluid-fluid levels
95
DDX of TOS
ABC
GCT
angiosarcoma
96
SCOS features
resembles Ewing's
lace-like osteoid pattern
may have periodic acid-Schiff rxn
97
age SCOS
2-4th (may have small children or elderly)
98
location SCOS
F>T>H>ilium
99
SCOS rad app
large mostly lytic lesion - medullary and cortical bone
| 50% have periostitis/ST mass
100
bone location SCOS
E and M
101
prognosis of SCOS
worse than conventional - most die w/in 1 yr
102
intraosseous low grade/well diff OS age
higher age group - ave 33 yrs; FEMALE
103
intraosseous low grade/well diff OS location
distal femur 50%, prox tibia = KNEE
| can occur in cloves = DDX chordoma
104
histologically intraosseous low grade/well diff OS
resembles parosteal OS and FD
105
intraosseous low grade/well diff OS rad appearance
large lesion can be purely sclerotic or mixed
- can lack aggressive features
- altered trabeculations
106
bone location intraosseous low grade/well diff OS
metaphysis
107
DDX intraosseous low grade/well diff OS
FD, NOF, CMF
108
prognosis intraosseous low grade/well diff OS
better than conventional = 90-100% survival
109
recurrence intraosseous low grade/well diff OS
occurs w/ inadequate removal at higher grade
110
intracortical OS features
rarest!!
| can be early manifestation of conventional/periosteal OS
111
age intracortical OS
found adults
112
bone location intracortical OS
diaphysis
113
location intracortical OS
tibia or femur
114
rad appearance intracortical OS
w/in cortex as lytic lesion w/ surrounding sclerosis but without radiating osseous spicules
eccentric
can have multiple calcific foci
115
ST involvement intracortical OS
rare at initial time of diagnosis
**no medullary or ST involvement (possibly later stages)
116
DDX intracortical OS
OO
FD
OB
intracortical abscess
117
surface high grade (conv) OS age
2-3rd; F=M
118
surface high grade (conv) OS location
tubular boes
| MC femur
119
bone location surface high grade (conv) OS
diaphyseal
120
histologically surface high grade (conv) OS
same as conventional - only diff is localization to surface of bone
121
rad appearance surface high grade (conv) OS
may resemble periosteal OS
broad based partially/completely ossified lesion from external surface of bone
cortical bone destruction
122
surface high grade (conv) OS prognosis
equal to conventional high grade
| worse than per/parosteal
123
periosteal OS features
from deep layer of periosteum
| 2ND MC juxtacortical OS
124
age periosteal OS
2-3rd
125
location periosteal OS
long tubular bones
126
bone location periosteal OS
diaphysis
127
femur location periosteal OS
anterior lat/med
128
femur location parosteal OS
posterior
129
rad appearance periosteal OS
thick/irregular cortex, radiating spicules into ST
| non-homogenous spiculated matrix
130
medullary cavity w/ periosteal OS
UNINVOLVED (rare exception)
131
periosteal rx periosteal OS
codman's or sunburst
132
MRI periosteal OS
hypointense T1 and T2
| can see bony spicules radiating from surface
133
DDX on MRI periosteal OS and conventional
conventional typically involves entire circumference of cortex and intramedullary expansion
134
prognosis periosteal OS
better than conventional
| poorer than parosteal
135
features of parosteal OS
arises from outer fibrous layers of periosteum
| MC form originating from surface of a bone
136
recurrence/mets of periosteal OS
occur if inadequate resection
137
age parosteal OS
2-5th
| **higher age group
138
location parosteal OS
long bones - femur 65, humerus 15, tibia 10
| around knee = 70%
139
rad appearance parosteal OS
large radio dense, oval/spheroid mass w/ smooth lobulated/irregular margins
sessile, can have cleavage plane
140
bone location parosteal OS
metaphyseal, less common E
| D is distinctly uncommon
141
String sign
seen in 30% of parosteal OS
| thin radiolucent line separating tumor from cortex
142
ossification of parosteal OS
from base to periphery
| MO is opposite*
143
periostitis w/ parosteal OS
often absent
144
DDX parosteal OS
```
HO
sessile OC
periosteal OS
high grade OS
CS
```
145
prognosis parosteal OS
dedifferentiated parosteal OS can develop from low grade --> high grade mesenchymal component 20-25%
146
multi centric OS features
more than one skeletal site
147
simultaneous multi centric OS
rare, mostly children, poor prognosis
148
metachronous multi centric OS
adolescents/young adults
asymmetric
one or more tumors develop after initial tx of primary OS (could be late mets)
149
unicentric w/ met multi centric OS
skip/transarticular bony mets w or w/ pulmonary mets
| spine and pelvic bones
150
enchondroma def
benign; dev in medullary cavity and composed of lobules of hyaline cartilage
151
age enchondroma
20-40 yo
| M=F
152
enchondroma asymptomatic unless...
path fx or malignant degeneration
153
enchondroma MC...
benign tumor of hands/feet
154
MC phalange for enchondroma
5th finger
155
location enchondroma
proximal phalanges, metacarpal, middle phalanx, terminal phalanx
156
% enchondroma tubular bones
25%, UE
| humerus, femur, tib
157
bone location enchondroma
M of LB; D of hands/ft
158
malignant degeneration of enchondroma
<1%
159
rad appearance enchondroma
well defined lucent lesion (bubbly/lobulated)
endosteal scalloping
50% matrix ca++ (punctate, stippled, rings/arcs, flocculent)
160
enchondroma protuberans
expansile - exophytic growth through cortex
| rare
161
enchondroma MR
low T1; high T2
| calcific foci are low signal
162
DDX enchondroma
ICE
163
difference of enchondroma from low grade chondrosarc
```
endosteal scalloping >2/3 of cortical thickness in >2/3 of the lesion
epiphyseal
>5 cm
older age
painful in absence of fx
```
164
ollier's ds bilateral or unilateral?
often unilateral
165
age ollier's ds
1st decade
166
ollier's ds deformity of wrist
madelung's
167
location ollier's ds
tibia, femur, fib
168
MC location for path fx of ollier's ds in children
femur
169
adult risk of malignant degeneration w/ ollier's ds
5-30%
| mostly to CS (could also be dedeff CS, OS, or chondroid chordoma)
170
lesions do or do not grow after skeletally mature w/ ollier's ds...
NO
171
type of dysplasia of Maffucci's syndrome
mesodermal
172
describe Maffucci's syndrome
enchondromatosis+ ST vascular tumors (hemangioma) - look like phleboliths on film
173
malignant degeneration w/ Maffucci's syndrome
25-50%
| -mostly to CS, usually after 40 yo
174
age Maffucci's syndrome
1st decade
175
type of hemangiomas w/ Maffucci's syndrome
cavernous/capillary
176
location HME
almost all cases have exostoses around the knee
| -more likely to involve scapula too
177
subungual exostosis location
distal phalanx beneath or adjacent to nail bed
great toe in 70-80% - pt usually has hx of trauma/infection
thumb/index finger
178
what portion of phalanx typically involved w/ subungual exostosis
dorsal or dorsomedial aspect of distal portion of phalanx
179
size of subungual exostosis
approx 1 cm
180
features of subungual exostosis
fibrocartilage cap
| lack clear contiguity w/ medullary cavity and cortex (different than OC)
181
Nora's lesion AKA
bizarre parosteal osteochondromatous proliferation = BPOP
182
Turret exostosis AKA
acquired OC
183
location Turret exostosis
dorsal surface of proximal or middle phalanx
- palmer thumb
- not common in metatarsals or phalanges of foot
184
history w/ Turret exostosis
trauma or puncture wound
185
Turret exostosis is likely...
ossifying subperiosteal hematoma
| --> arising from reactive periosteum following trauma
186
clinical findings Turret exostosis
loss of flexion of digit
| pain, ST swelling, cosmetic deformity
187
Trevor's Disease AKA
dysplasia epiphysealis hemimelica
188
age Trevor's Disease
children and young adults
189
clinical features Trevor's Disease
swelling - less likely pain and deformity
one side of body
LE
190
location Trevor's Disease
talus, distal femur, tibia
191
Trevor's Disease distribution
commonly multiple bones in single extremity in 60-70%
192
bone location Trevor's Disease
one side of epiphysis
| Medial 2:1
193
forms of Trevor's Disease
monostotic
classic = multiple bones in single extremity
generalized/severe = entire extremity
194
rad appearance Trevor's Disease
irregular ossifications
adjacent metaphysis may be wide
joint may be widened
195
location Maffucci's Syndrome
50% unilateral
| metacarpals and phalanges of hand
196
complications Maffucci's Syndrome
deformities, malignant transformation
197
malignant transformation Maffucci's Syndrome
20-50 % to CS usually after 40 yo
| -or hemangiosarc, lymphangiosarc, and fibrosarc
198
development of periosteal (juxtacortical) chondroma
develops adjacent to cortical surface; beneath periosteal membrane
199
age periosteal chondroma
<30yo
| most 2nd decade
200
location periosteal chondroma
long tubular bones 70%, hands, feet
| -humerus/femur
201
symptoms periosteal chondroma
initial swelling w/ mild-mod pain
202
periosteal chondroma frequently found at...
insert sites of tendons or ligaments
203
bone location periosteal chondroma
metaphysis
204
rad appearance periosteal chondroma
ST mass w/ erosion or saucerization
medullary sclerosis/periostitis
buttressing or thickened cortex**
ca++ 50%
205
DDX periosteal chondroma
periosteal/juxtacortical CS
206
Chondroblastoma AKA
Codman's tumor
207
age Chondroblastoma
5-25 yo
208
symptoms Chondroblastoma
pain, swelling, tenderness, joint manifestations
209
joint effusions w/ Chondroblastoma
30%
210
bone location Chondroblastoma
epiphysis or apophysis
| can extend into metaphysis 25-50%
211
location Chondroblastoma
femur, humerus, tibia, hands/ft
H/T = proximal
feet = calcanus/talus
212
location in feet of Chondroblastoma
talus and calcaneus
213
pathophysiology of CB
multinucleate giant cells that simulate those in ABC
214
rad app Chondroblastoma
well defined, ovoid, bubbly lytic lesion w/ thin sclerotic rim
ca++ 30-50%
215
size Chondroblastoma
< 5-6 cm
216
ca++ Chondroblastoma
30-50%
217
periostitis Chondroblastoma
30-50%
218
bone scan Chondroblastoma
hypervascularity w/ avid accumulation
219
CT Chondroblastoma
solid periosteal rxn, internal ca++, cortical breach
220
MR Chondroblastoma
low t1; variable (low/intermed) T2
| T2 shows adjacent marrow edema
221
MR sign Chondroblastoma
fluid fluid levels like ABC
222
what commonly occurs w/ Chondroblastoma
secondary ABC
223
management Chondroblastoma
surgical resection (curettage)
224
mets w/ Chondroblastoma
lungs after removal of primary tumor
225
main DDX factor w/ Chondroblastoma
FOGMACHINES
| -most don't have bone marrow edema like CB
226
chondromyxoid fibroma is least common...
benign tumor of cartilage
227
age chondromyxoid fibroma
10-30 yo
228
symptoms chondromyxoid fibroma
slow progressive pain, tenderness, swelling and decreased ROM
229
path fx w/ chondromyxoid fibroma
yes
230
location chondromyxoid fibroma
LTB
| tibia + femur = 55%
231
% of chondromyxoid fibroma in LE
70%
232
bone location chondromyxoid fibroma
metaphysis w/ ext to E; or D
233
rad appearance chondromyxoid fibroma
eccentric geographic bubbly lucent lesion
| cortical expansion, sclerosis, coarse trabeculation
234
ca++ chondromyxoid fibroma
<13%
235
separations chondromyxoid fibroma
pseudotrabeculation = 60%
236
larger lesions w/ chondromyxoid fibroma
cause complete penetration of cortex causing osseous defect = bite (if w/ periostitis)
*highly characteristic w/ chondromyxoid fibroma
237
MR chondromyxoid fibroma
multilobulated - low T1; high T2
238
bone scan chondromyxoid fibroma
doughnut sign
239
management chondromyxoid fibroma
wide block excision/curettage
240
recurrence chondromyxoid fibroma
25%
241
malignant transformation chondromyxoid fibroma
rare
242
some consider osteochondromas MC....
developmental physeal growth defect
243
osteochondroma are MC benign tumor....
of the appendicular skeleton
244
osteochondroma more common in lower or upper extremity?
LE 2:1
245
age osteochondroma
children/adolescents
246
location osteochondroma
femur, humerus, tibia
247
bone location osteochondroma
metaphysis
if in epiphysis = Trevor's disease
248
in adults w/ osteochondroma what size cap is concerning? what size is considered malignant?
>1 cm
3 cm
249
in children w/ osteochondroma the cap may be as thick as...
3 cm
250
osteochondroma point towards or away from joint?
away
251
osteochondroma MR
high T2, low/intermediate T1
252
bone scan osteochondroma
uptake if metabolically active but can't determine benign vs malignant
normal bone scan virtually eliminates malignant degeneration
253
malignant transformation % osteochondroma
1% to chondrosarc
254
HME AKA
diaphyseal aclasis
255
malignant transformation HME
5-25%
256
age HME
1-2nd decades
257
family history HME
yes, autosomal dominant
| chromosomes 8, 11, 19
258
deformities of HME
bilateral coxa valga, Brahman bull appearance of proximal femoral metaphysis
bayonet deformity
madeline's deformity
259
conventional CS age
30-60 yo
260
symptoms conventional CS
pain of 1-2 yrs; warmth w/ ST mass
261
conventional CS location
tubular bones, innominate, ribs, femur
| -proximal F/T/H/Fib
262
conventional CS is MC...
malignant neoplasm of scapula, ribs, sternum, and small bones of hands
263
conventional CS in ribs/sternum arise at what junction
costochondral
264
conventional CS in jaw...
maxilla > mandible
265
bone location conventional CS
metaphysis, can extend into epiphysis
266
high grade conventional CS frequently assoc w/..
non-calcified matrix
267
bone scan conventional CS
increased central accumulation
268
MR conventional CS
high T2; enhances w/ gad
269
mets conventional CS
lung - skeleton- liver- kidney
270
if no ca++ conventional CS may resemble....
plasmacytoma, lymphoma, mets
271
location central CS
tubular bones - femur/humerus
| flat - pelvis
272
rad appearance central CS
elongated slightly expansile, multilobulated lytic lesions, ca++, ST mass
273
peripheral CS features
MC from pre-existing OC or as juxtacortical CS
274
periosteal CS histologically similar to ...
conventional CS
275
age periosteal CS
young/middle aged men
276
MC aspect of femur periosteal CS
posterior metadiaphyseal
277
periostitis periosteal CS
not common, tend to have Codman's triangle
278
clear cell CS age
3-5 decade; rare <15 yo
279
location clear cell CS
LTB, 90% are proximal ends; femur, humerus
| unusual in flat bones
280
bone location clear cell CS
epiphyseal is RULE
281
multiple sites w/ clear cell CS
uncommon
| but could be multifocal tumors or mets
282
rad appearance clear cell CS
lytic and slightly expansile; ca++ in 35%
| 20% have peripheral rind of sclerosis
283
DDX clear cell CS
conventional - pattern of distribution and bone location
CB - older age, metaphyseal extension, lack of periostitis
others: ABC, OB, FD, GCT, mets....
284
prognosis clear cell CS
low grade - much better than conventional
285
recurrence and mets clear cell CS
seen if surgery is conservative
yes, lungs, brains, and bones
286
Mesenchymal CS % in ST
30-75%
287
age Mesenchymal CS
2-4th decade
| ave 25 yo
288
symptoms Mesenchymal CS
pain, swelling, ST mass, stiffness
289
location Mesenchymal CS
femur, ribs, spine
| 20% in craniofacial bones
290
rad appearance Mesenchymal CS
similar to conventional
| lytic, sclerosis, periostitis, usually stippled ca++
291
size Mesenchymal CS
2-18 cm
| smaller than conventional
292
DDX Mesenchymal CS
aggressive lesions
| -ewing's, small cell OS, dediff CS, hemangiopericytoma
293
prognosis Mesenchymal CS
aggressive variant = poor prognosis
294
met w/ Mesenchymal CS
yes, regional and distant LN (unlike conventional)
295
features dedifferentiated CS
variant of conventional that has high grade sarcoma in approx w/ low grade cartilage tumor
296
% of dedifferentiated CS
10% of CS
297
age dedifferentiated CS
5-7th decades
| ave 60 yo (most older than 50)
298
histologically dedifferentiated CS
UNIQUE
| low grade conventional CS w/ pleomorphic or spindle cell sarcoma
299
symptoms dedifferentiated CS
```
pain - ST swelling/mass
path fx (10-40%)
```
300
location dedifferentiated CS
similar to conventional...
LTB and innominate
proximal femur/humerus/tibia
301
rad appearance dedifferentiated CS
similar to conventional - lytic moth-eaten bone destruction
can have some ca++ but has distinct region w/ none
periostitis not prominent**
302
prognosis dedifferentiated CS
extremely poor - ave survival is less than 1 yr
303
dedifferentiated CS has beens een w/...
solitary/multiple OCs
304
pathology of clear cell CS
cysts w/ clear hemorrhagic fluid
olsteoclast type giant cells
ca++ strands = chicken wire pattern (like CB)
stroll cells = lace like osteoid (like OS)
