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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
Conventional/intramedullary osteosarcoma
most common type; adolescents/young adults, around knee or metaphysis femur/tibia
26
Telangiectatic osteosarcoma
osteolytic destructive sarcoma, may mimic ABC vascular with large cystic spaces filled with blood
27
Parosteal osteosarcoma
arises from outer periosteum; posterior aspect of femoral metaphysis with cauliflower like exophytic morphology patients in their 20-30s; least malignant type
28
Periosteal osteosarcoma
inner periosteum; cortical thickening, aggressive periosteal reaciton, soft tissue mass younger patient 20s; commonly diaphysis of femur/tibia
29
osteosarcoma mets?
commonly to lung; where they calcify
30
synovial chondromatosis , osteochondromatosis
monoarticular; intra-articular lobulated cartilaginous nodules --> calcification (osteochondromatosis)
31
common location for synovial chondromatosis
knee; shoulders/hip/elbows may also be affected rarely may degenerate into chondrosarcoma
32
Hallmark of synovial chondromatosis
XR: round intra-articular bodies of similar size/variable minerzalization (ddx intraarticular bodies from OA) MR: globular/rounded foci of low signal (ddx PVNS)
33
Enchondroma
benign lesion of mature hyaline cartilage rests; popcorn or ring/arc calcifications ; hyperintense lobulated appearance on T2
34
ddx for enchondroma
medullary bone infarct (serpentine sclerosis) and chondrosarcoma
35
enchondroma in the hand
geographic lytic lesion
36
Ollier vs Maffucci syndrome
Ollier: multiple enchondromas Maffucci: multiple enchondromas and phleboliths increased risk of malignant degeneration into chondrosarcoma (Maffuci more)
37
most common benign bone lesion
osteochondroma; benign cartilage cap projecting outward from bone
38
signs of malignant transformation of osteochondroma to chondrosarcoma
- pain in the absence of pathologic fracture - associated soft tissue mass - cartilage cap >2 cm
39
syndromes with osteochondroma
familial osteochondromatosis/multiple hereditary exostoses (autosomal dominant) commonly affects knees
40
chondroblastoma
benign; long bone epiphysis of pediatric patients (knees, proximal humerus)
41
chondroblastoma treatment
curettage, cryosurgery, radiofrequency ablation
42
chondroblastoma MR findings
low/intermediate T2 weighted images
43
chondromyxoid fibroma
eccentric in tibial/femoral metaphysis about knee; sclerotic margins and high T2 signal
44
malignant tumor of cartilage?
chondrosarcoma
45
Primary and secondary chondrosarcoma
Primary: conventional/intramedullary chondrosarcoma ; dedifferentiated, rare mesenchymal, clear cell variants Secondary: enchondroma degeneration, Paget, osteochondroma
46
NOF or fibroxanthoma
radiolucent long bone lesion (leg) in children/adolescents believed to arise from periosteum?
47
alt name for malignant fibrous histiocytoma (MFH)
undifferentiated pleomorphic sarcoma not otherwise specified
48
most common adult soft tissue sarcoma
MFH; middle aged adults in thigh/retroperitoneum
49
Fibrous dysplasia patients
non neoplastic condition of children/young adults ; congenital! may result in pathologic fracture (femoral neck); shepherd's crook
50
Fibrous dysplasia patterns - femur - ribs/long bones - pelvic bones - skull base
- varus deformity, shepherd's crook - indistinct/ground glass - cystic - expansile
51
Ddx for expansile skull base lesions
pediatrics: fibrous dysplasia adults: Pagets
52
fibrous dysplasia congenital lesions
McCune Albright: polyostotic fibrous dysplasia, precocious puberty, cutaneous cafe au lait spots Mazabraud syndrome: fibrous dysplasi and intramuscular myxomas
53
Radiographic signs associated with hemangiomas
corduroy appearance/striations polka-dot sign of thickened trabeculae in cross- section MR: high T1/T2 signal
54
bone hemangioma
occurs in vertebral body; vascular channels lined by endothelial cells ; may have soft tissue mass
55
angiosarcoma bone
clustering of multifocal lesions in single anatomic region lung mets
56
Age for osteoclastoma/giant cell tumor
20-40s
57
Location of giant cell tumor
eccentrically at articular ends; arises from metaphysis and involves epiphysis
58
LCH demographic
5-10yo kids
59
Hallmarks of LCH
beveled edge skull floating tooth in madible/maxilla vertebra plana
60
Ewing sarcoma age?
children/adolescents; male predominance second most common after osteosarcoma
61
Ewing sarcoma appearance
aggressive lesion with permeative bone destructive, aggressive periosteal reaction, soft tissue mass
62
Ddx for ewing sarcoma
osteomyelitis, eosinophilic granuloma (LCH), metastatic neuroblastoma
63
Multiple myeloma age
>40; most common primary malignant bone tumor
64
Presentation multiple myeloma
multiple lytic lesions; diffuse myelomatosis with endosteal scalloping
65
POEMS syndrome? association?
polyneuropathy, organomegaly, endocrine disturbances, monoclonal gammopathy, skin changes association: sclerosing myelomatosis
66
Ddx for multiple lytic lesions
metastatic disease, multiple myeloma (doesn't involve posterior elements)
67
Solitary multiple myeloma met
plasmocytoma --> MM in 5 years
68
primary bone lymphoma age?
>40; consider with ivory/sclerotic vertebral body
69
Bone lipoma sites
calcaneus, sutrochanteric region of femur, distal tibia/fibula, metatarsals
70
Imaging considerations with bone lipoma
may contain some nonadipose tissue
71
Liposarcoma imaging findings
>10 cm, thick septations, globular/nodular soft tissue; <75% fat
72
Chordoma
malignant lesion from notocord remnant from axial skeleton; sphenooccipital region, body of C2, or sacrococygeal location
73
Chordoma imaging features
destructive lesion with irregular scalloped borders; calcifications due to necrosis
74
Bone cyst imaging locations
hollow/fluid filled lesion in proximal humerus/femur; calcaneus, iliac bone/tibia
75
age for simple bone cyst
children/adolescents
76
Imaging findings for simple bone cyst
no periosteal reaction; fallen fragment sign (if pathologic fracture), located centrally in bone, fluid levels on MRI
77
ddx fluid levels in bone cyst
ABC, bone cyst, giant cell tumor, telangiectatic osteosarcoma
78
Treatment for bone cyst
inject methylprednisolone
79
ABC histology
blood filled sinusoids and solid fibrous elements; may be secondary to pre-existing tumor
80
ABC age and location
expansile lesion anywhere in bone and posterior elements of spine; children/adolescents
81
Adamantinoma?
soap bubble lesion in the tibia; similar to fibrous dysplasia; very rare
82
solitary sternal lesion?
breast cancer mets
83
fracture of lesser trochanter?
think pathologic fracture from mets
84
pedicle/posterior vertebral body fracture
metastases
85
Lytic lesions/mets
lung, breast, thyroid, kidney, stomach/colon
86
Sclerotic lesions/mets
breast, prostate/seminoma, TCC, mucinous tumors, carcinoid
87
Myositis ossificans?
heterotopic bone formation in muscle usually secondary to trauma; commonly elbow/thigh
88
How to differentiate from myositis ossificans and parosteal osteosarcoma?
osteosarcoma more heavily calcified centrally myositis ossificans calcified more peripherally
89
Do you biopsy myositis ossificans?
no; unnecessary surgry as it may resemble sarcoma
90
Evolution of myositis ossificans
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
What is brown tumor?
lytic lesion seen in hyperparathyroidism (increased osteoclast activation); osteopenia, subperiosteal bone resorption, soft tissue calcifications
92
rugger jersey spine
osteodystrophy

CORE: MSK (13 decks)

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