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CORE: MSK > Bone Tumors > Flashcards

Bone Tumors Flashcards

1
Q

Types of periosteal reaction?

A

benign: solid periosteal reaction
aggressive: lamellated, sunburst, codman triangle

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2
Q

Patterns of bone destruction?

A

zone of transition

geographic pattern: thin zone of transition, sclerotic or well defined

moth-eaten: difficult to define a border, aggressive

permeative: multiple tiny holes that infiltrate bone (lymphoma, leukemia, Ewing)

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3
Q

Matrix types of tumor

A

osteoid: fluffy, cloud like (malignant osteosarcoma)
chondroid: ring/arc or popcorn (enchondroma, chondrosarcoma)
ground glass: fibrous dysplasia, blurring of trabeculae

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4
Q

fallen fragment sign

A

simple bone cyst; pathologic fracture

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5
Q

aneurysmal expansile feature

A

ABC

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6
Q

resorption of distal clavicles/tumoral calcinosis

A

hyperparathyroidism (brown tumors)

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7
Q

<20 yo, bone tumor?

>40yo, bone tumor?

A

aggressive <20; eosinophilic granuloma/LCH, infection, Ewing

aggressive > 40; myeloma, mets

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8
Q

Eccentric bone lesions

A

giant cell tumor, chondroblastoma, ABC, NOF, chondromyxoid fibroid (rare)

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9
Q

Central bone lesions

A

simple bone cyst, enchondroma, fibrous dysplasia

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10
Q

small spiculated osteoblastic focus

A

enostosis/bone island; arises from medullary canal

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11
Q

Osteopoikilosis

A

AD syndrome of multiple bone islands and keloid formation

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12
Q

Osteoma?

Associated syndrome?

A

cortex of skull or frontal/ethmoid sinuses ; rises from cortex

Gardner syndrome: AD of multiple osteomas, intestinal polyposis, soft tissue desmoid tumors

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13
Q

Melorheostosis

A

pain, decreased ROM, leg bowing, leg-length discrepancy

single lower limb in single sclerotome

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14
Q

Hallmark of melorheostosis

A

thickened, irregular cortex with “candlewax” appearance

increased uptake bone scan

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15
Q

Presentation osteoid osteoma

A

night pain relieved by aspirin in teen/young adult; long bones common

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16
Q

osteoid osteoma

A

nidus of osteoid tissue surrounded by reactive bone sclerosis; osteoblastic

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17
Q

Double density sign

A

uptake centrally in nidus and adjacent reactive uptake/sclerosis

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18
Q

Hallmark of osteoid osteoma

A

lucent nidus with sclerosis

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19
Q

Treatment osteoid osteoma

A

radiofrequency ablation, surgical curettage, resection

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20
Q

Osteoblastoma vs osteoid osteoma

A

osteoblastoma >2cm

much less common than osteoid osteoma (4x less) and pain is not relieved by aspirin

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21
Q

common location for osteoblastoma?

A

posterior elements of the spine

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22
Q

Ddx posterior element lytic lesion

A

osteoblastoma vs aneurysmal bone cyst;

favor osteoblastoma is there is mineralization

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23
Q

osteosarcoma, primary and secondary

A

primary osteosarcoma: neoplastic cells from osteoid lineage

secondary: Paget disease (extremely aggressive)/after radiation

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24
Q

Major subtypes of osteosarcoma

A

conventional (most common), telangiectatic, juxtacortical types (parosteal and periosteal)

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25
Q

Conventional/intramedullary osteosarcoma

A

most common type; adolescents/young adults, around knee or metaphysis femur/tibia

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26
Q

Telangiectatic osteosarcoma

A

osteolytic destructive sarcoma, may mimic ABC

vascular with large cystic spaces filled with blood

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27
Q

Parosteal osteosarcoma

A

arises from outer periosteum; posterior aspect of femoral metaphysis with cauliflower like exophytic morphology

patients in their 20-30s; least malignant type

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28
Q

Periosteal osteosarcoma

A

inner periosteum; cortical thickening, aggressive periosteal reaciton, soft tissue mass

younger patient 20s; commonly diaphysis of femur/tibia

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29
Q

osteosarcoma mets?

A

commonly to lung; where they calcify

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30
Q

synovial chondromatosis , osteochondromatosis

A

monoarticular; intra-articular lobulated cartilaginous nodules –> calcification (osteochondromatosis)

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31
Q

common location for synovial chondromatosis

A

knee; shoulders/hip/elbows may also be affected

rarely may degenerate into chondrosarcoma

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32
Q

Hallmark of synovial chondromatosis

A

XR: round intra-articular bodies of similar size/variable minerzalization (ddx intraarticular bodies from OA)
MR: globular/rounded foci of low signal (ddx PVNS)

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33
Q

Enchondroma

A

benign lesion of mature hyaline cartilage rests; popcorn or ring/arc calcifications ; hyperintense lobulated appearance on T2

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34
Q

ddx for enchondroma

A

medullary bone infarct (serpentine sclerosis) and chondrosarcoma

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35
Q

enchondroma in the hand

A

geographic lytic lesion

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36
Q

Ollier vs Maffucci syndrome

A

Ollier: multiple enchondromas
Maffucci: multiple enchondromas and phleboliths

increased risk of malignant degeneration into chondrosarcoma (Maffuci more)

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37
Q

most common benign bone lesion

A

osteochondroma; benign cartilage cap projecting outward from bone

38
Q

signs of malignant transformation of osteochondroma to chondrosarcoma

A
  • pain in the absence of pathologic fracture
  • associated soft tissue mass
  • cartilage cap >2 cm
39
Q

syndromes with osteochondroma

A

familial osteochondromatosis/multiple hereditary exostoses (autosomal dominant)

commonly affects knees

40
Q

chondroblastoma

A

benign; long bone epiphysis of pediatric patients (knees, proximal humerus)

41
Q

chondroblastoma treatment

A

curettage, cryosurgery, radiofrequency ablation

42
Q

chondroblastoma MR findings

A

low/intermediate T2 weighted images

43
Q

chondromyxoid fibroma

A

eccentric in tibial/femoral metaphysis about knee; sclerotic margins and high T2 signal

44
Q

malignant tumor of cartilage?

A

chondrosarcoma

45
Q

Primary and secondary chondrosarcoma

A

Primary: conventional/intramedullary chondrosarcoma ; dedifferentiated, rare mesenchymal, clear cell variants

Secondary: enchondroma degeneration, Paget, osteochondroma

46
Q

NOF or fibroxanthoma

A

radiolucent long bone lesion (leg) in children/adolescents

believed to arise from periosteum?

47
Q

alt name for malignant fibrous histiocytoma (MFH)

A

undifferentiated pleomorphic sarcoma not otherwise specified

48
Q

most common adult soft tissue sarcoma

A

MFH; middle aged adults in thigh/retroperitoneum

49
Q

Fibrous dysplasia patients

A

non neoplastic condition of children/young adults ; congenital!

may result in pathologic fracture (femoral neck); shepherd’s crook

50
Q

Fibrous dysplasia patterns

  • femur
  • ribs/long bones
  • pelvic bones
  • skull base
A
  • varus deformity, shepherd’s crook
  • indistinct/ground glass
  • cystic
  • expansile
51
Q

Ddx for expansile skull base lesions

A

pediatrics: fibrous dysplasia
adults: Pagets

52
Q

fibrous dysplasia congenital lesions

A

McCune Albright: polyostotic fibrous dysplasia, precocious puberty, cutaneous cafe au lait spots

Mazabraud syndrome: fibrous dysplasi and intramuscular myxomas

53
Q

Radiographic signs associated with hemangiomas

A

corduroy appearance/striations

polka-dot sign of thickened trabeculae in cross- section

MR: high T1/T2 signal

54
Q

bone hemangioma

A

occurs in vertebral body; vascular channels lined by endothelial cells ; may have soft tissue mass

55
Q

angiosarcoma bone

A

clustering of multifocal lesions in single anatomic region

lung mets

56
Q

Age for osteoclastoma/giant cell tumor

A

20-40s

57
Q

Location of giant cell tumor

A

eccentrically at articular ends; arises from metaphysis and involves epiphysis

58
Q

LCH demographic

A

5-10yo kids

59
Q

Hallmarks of LCH

A

beveled edge skull
floating tooth in madible/maxilla
vertebra plana

60
Q

Ewing sarcoma age?

A

children/adolescents; male predominance

second most common after osteosarcoma

61
Q

Ewing sarcoma appearance

A

aggressive lesion with permeative bone destructive, aggressive periosteal reaction, soft tissue mass

62
Q

Ddx for ewing sarcoma

A

osteomyelitis, eosinophilic granuloma (LCH), metastatic neuroblastoma

63
Q

Multiple myeloma age

A

> 40; most common primary malignant bone tumor

64
Q

Presentation multiple myeloma

A

multiple lytic lesions; diffuse myelomatosis with endosteal scalloping

65
Q

POEMS syndrome? association?

A

polyneuropathy, organomegaly, endocrine disturbances, monoclonal gammopathy, skin changes

association: sclerosing myelomatosis

66
Q

Ddx for multiple lytic lesions

A

metastatic disease, multiple myeloma (doesn’t involve posterior elements)

67
Q

Solitary multiple myeloma met

A

plasmocytoma –> MM in 5 years

68
Q

primary bone lymphoma age?

A

> 40; consider with ivory/sclerotic vertebral body

69
Q

Bone lipoma sites

A

calcaneus, sutrochanteric region of femur, distal tibia/fibula, metatarsals

70
Q

Imaging considerations with bone lipoma

A

may contain some nonadipose tissue

71
Q

Liposarcoma imaging findings

A

> 10 cm, thick septations, globular/nodular soft tissue; <75% fat

72
Q

Chordoma

A

malignant lesion from notocord remnant from axial skeleton; sphenooccipital region, body of C2, or sacrococygeal location

73
Q

Chordoma imaging features

A

destructive lesion with irregular scalloped borders; calcifications due to necrosis

74
Q

Bone cyst imaging locations

A

hollow/fluid filled lesion in proximal humerus/femur; calcaneus, iliac bone/tibia

75
Q

age for simple bone cyst

A

children/adolescents

76
Q

Imaging findings for simple bone cyst

A

no periosteal reaction; fallen fragment sign (if pathologic fracture), located centrally in bone, fluid levels on MRI

77
Q

ddx fluid levels in bone cyst

A

ABC, bone cyst, giant cell tumor, telangiectatic osteosarcoma

78
Q

Treatment for bone cyst

A

inject methylprednisolone

79
Q

ABC histology

A

blood filled sinusoids and solid fibrous elements; may be secondary to pre-existing tumor

80
Q

ABC age and location

A

expansile lesion anywhere in bone and posterior elements of spine; children/adolescents

81
Q

Adamantinoma?

A

soap bubble lesion in the tibia; similar to fibrous dysplasia; very rare

82
Q

solitary sternal lesion?

A

breast cancer mets

83
Q

fracture of lesser trochanter?

A

think pathologic fracture from mets

84
Q

pedicle/posterior vertebral body fracture

A

metastases

85
Q

Lytic lesions/mets

A

lung, breast, thyroid, kidney, stomach/colon

86
Q

Sclerotic lesions/mets

A

breast, prostate/seminoma, TCC, mucinous tumors, carcinoid

87
Q

Myositis ossificans?

A

heterotopic bone formation in muscle usually secondary to trauma; commonly elbow/thigh

88
Q

How to differentiate from myositis ossificans and parosteal osteosarcoma?

A

osteosarcoma more heavily calcified centrally

myositis ossificans calcified more peripherally

89
Q

Do you biopsy myositis ossificans?

A

no; unnecessary surgry as it may resemble sarcoma

90
Q

Evolution of myositis ossificans

A

Week 1-2: soft tissue mass
Week 3-4: amorphous osteoid matrix; periosteal reaction of bnoe may mimic early osteosarcoma
Week 5-8: periphery of lesion matures into compact bone
6 mo: ossification matures

91
Q

What is brown tumor?

A

lytic lesion seen in hyperparathyroidism (increased osteoclast activation); osteopenia, subperiosteal bone resorption, soft tissue calcifications

92
Q

rugger jersey spine

A

osteodystrophy

CORE: MSK (13 decks)

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