Bone Tumors

Question 1

What is the best radiographic method to diagnose a bone tumor?

Answer 1

x-ray

Question 2

What is your first step when diagnosing a bone tumor?

Answer 2

is the lesion latent, active or aggressive?

Question 3

describe the margin, periosteal reaction and soft tissue mass in a latent bone lesion.

Answer 3

narrow margins
no periosteal reaction
soft tissue mass is absent

Question 4

describe the margin, periosteal reaction and soft tissue mass in an active bone lesion.

Answer 4

• wide margins
• none or mild periosteal reaction
• soft tissue mass is absent

Question 5

describe the margin, periosteal reaction and soft tissue mass in an aggressive bone lesion.

Answer 5

• wide or poorly defined margins
• mild or major perisoteal reaction
• soft tissue mass is present

Question 6

perisoteal reactions occur with what type of lesions?

Answer 6

more active/aggressive lesions

Question 7

what is considered a narrow margin?

Answer 7

0. 1-1.0mm

* tumor and surrounding normal bone are touching

Question 8

what is considered a wide margin?

Answer 8

2-10mm

*can see where the tumor is and the undamaged bone

Question 9

what is considered a poorly defined margin?

Answer 9

several cm

*can tell there is a tumor in teh bone or areas that are distinctly abnormal

Question 10

what is a geographic lesion?

Answer 10

well-defined lesion with a narrow margin

Question 11

What is a moth-eaten appearance?

Answer 11

ill-defined areas of lucency (rathere than a single discrete lesion)

Question 12

what is a permeative lesion?

Answer 12

ill-defined pattern of lucency with many small, irregular holes in the bone
*usually associated with aggressive infection or malignancy

Question 13

what are the 3 descriptions of appearance of lesions?

Answer 13

1. geographic
2. moth-eaten
3. permeative

Question 14

regarding periosteal reactions, if you see a full layer of solid, uninterrupted perisoteal new bone along the margin of teh affected bone, what does this tell you about the lesion?

Answer 14

it is slow-growing

Question 15

regarding perisoteal reaction, if you see a lamellated or onion-skin appearance of new bone, what does this tell you about the lesion?

Answer 15

the lesion grows in fits and starts (on/off growing)

Question 16

if growth of lesion is very rapid, what 2 patterns may develop?

Answer 16

1. sun-burst or hair-on-end appearance

2. Codman’s triangle

Question 17

what is sun-burst apeparance?

Answer 17

periosteum has no time to lay down bone and Sharpey’s fibers become calcified at different lengths

Question 18

what is hair-on-end appearance?

Answer 18

occurs with rapidly growing lesions because Sharpey’s fibers become calcified at all the same lengths

Question 19

what is Codman’s triangle?

Answer 19

signifies an aggressive lesion because only the edges of the raised periosteum will ossify

Question 20

what is step 2 of diagnosing bone tumors?

Answer 20

ask yourself what does the matrix look like?

Question 21

a speckled matrix is indicative of what cell origin?

Answer 21

chondroid matrix (cartilage cells)

Question 22

a matrix derived from bone will have what matrix appearance?

Answer 22

cloudy matrix

Question 23

a matrix derived from fluid-filled cysts or hyaline is indicative of what type of lesion?

Answer 23

ground glass appearance

Question 24

Name the cartilage-forming tumors.

Answer 24

1. osteochondroma
2. solitary enchondroma
3. chondroblastoma
4. chondrosarcoma

Question 25

Name the bone-forming tumors.

Answer 25

1. osteoid osteoma and osteoblastoma | 2. osteogenic sarcoma

Question 26

Which are the benign tumors?

Answer 26

1. enchondroma 2. osteochodnroma 3. osteoid osteoma 4. osteoblastoma 5. giant cell tumor (also malignant) 6. chondroblastoma

Question 27

Which are the malignant tumors?

Answer 27

1. osteogenic sarcoma 2. chondrosarcoma 3. fibrosarcoma 4. Ewing's sarcoma 5. metastatic carcinoma

Question 28

what is step 3 of diagnosing bone tumors?

Answer 28

is the lesion lytic or sclerotic, solitary or multiple?

Question 29

What is the mnemonic for solitary lytic lesions of bone?

Answer 29

``` "FOG MACHINES" F-fibrous dysplasia O-osteoid osteoma/osteoblastoma G-giant cell tumor M-metastasis, myeloma A-aneurysmal bone cyst C-chondroblastoma, chondromyxoid fibroma H-hyperparathyroidism, hemangioma I-infection N-non ossifiying fibroma E-eosinophilic granuloma, enchondroma S-solitary bone cysts, sarcoidosis ```

Question 30

What bone tumor is seen with Albright's syndrome?

Answer 30

fibrous dysplasia

Question 31

Which bone tumor appears as a "long lytic lesion in a long bone"?

Answer 31

fibrous dysplasia

Question 32

Name this bone tumor: night pain that is relieved by aspirin or NSAIDs "hurts like a b and is tough to see"

Answer 32

osteoid osteoma

Question 33

Name this bone tumor that attacks the ends of long bones (metaphysis) of teenagers. There is no surrounding reactive bone sclerosis.

Answer 33

osteoblastoma

Question 34

Name this bone tumor that is massive in the metaphysis and may metastasize to lungs or transform to fibrosarcoma or osteogenic sarcoma?

Answer 34

giant cell tumor (of bone)

Question 35

What is the most common primary malignant tumor of bone in the body?

Answer 35

multiple myeloma

Question 36

what does multiple myeloma appear as?

Answer 36

moth-eaten appearance | multiple punched-out lesions

Question 37

what bone tumor appears as "mosaic glass on MRI"?

Answer 37

aneurysmal bone cyst

Question 38

Which bone tumor has a "fluffy, cotton wool appearance"?

Answer 38

chondroblasto`ma

Question 39

Name this bone tumor that has a "chicken-wire matrix".

Answer 39

chondromyxoid fibroma

Question 40

what condition produces "brown tumors"

Answer 40

hyperparathyroidism

Question 41

Name this bone tumor that has "long striations with long lucencies"

Answer 41

hemangiomas

Question 42

which bone tumor appears very similarly to fibrous dysplasia?

Answer 42

non-ossifying fibroma

Question 43

which bone tumor appears as "soap bubble appearance"?

Answer 43

non-ossifying fibroma

Question 44

Which bone tumor loves the ends of long bones and has "speckled tone"?

Answer 44

enchondroma

Question 45

which bone tumor has "endosteal scallopping"?

Answer 45

eosinophilic granuloma

Question 46

which bone tumor is almost exclusively in the calcaneus, under the mdidle facet especialy.

Answer 46

solitary bone cysts (unicameral bone cysts)

Question 47

which malignant lesion affects those <1 y/o?

Answer 47

neuroblastoma

Question 48

which malignant lesion affects ages 1-10?

Answer 48

Ewing's sarcoma

Question 49

Which malignant lesions affects age 10-30?

Answer 49

osteosarcoma | Ewing's sarcoma

Question 50

which malignant lesions affect age 30-40?

Answer 50

fibrosarcoma, lymphoma

Question 51

which malignant lesions affect age 40+?

Answer 51

metastasis, myeloma, chondrosarcoma

Question 52

which malignant lesion most commonly exhibits onion-skin appearance to the periosteum?

Answer 52

Ewing's sarcoma

Question 53

Ewing's sarcoma affects which part o fthe foot?

Answer 53

1/3 in hindfoot- 30% survival | 2/3 in forefoot - 70% survival

Question 54

where does osteosarcoma like to affect?

Answer 54

rapidly growing bones, esp knees

Question 55

what is the most common malignant bone tumor of foot and ankle?

Answer 55

chondrosarcoma

Question 56

what is the mnemonic for solitary or multifocal sclerotic lesions of bone?

Answer 56

COP BOBS HIP

Question 57

COP

Answer 57

chronic osteomyelitis osteochondroma Paget's disease

Question 58

BOBS

Answer 58

breast metastasis osteogenic sarcoma bone island stress fracture

Question 59

HIP

Answer 59

hemangioma infarct prostate metastasis

Question 60

Name this tumor: aberrant proliferation of epiphyseal cartilage cells and ceases growth at time of skeletal maturation

Answer 60

osteochondroma

Question 61

osteochondroma is similar to subungual exostosis. how do you differentiate this?

Answer 61

subungual exostosis is more common in females and does not arise from epiphysis like osteochondroma does *subungual exostosis arises from distal phalanx

Question 62

what is a bone island?

Answer 62

area of sclerotic bone due to increased osteoblastic activity; is benign

Question 63

what is the "flame-shaped" sclerotic lesions of bone?

Answer 63

Paget's disease

Question 64

what looks like "candle wax disease"?

Answer 64

melorrheostosis

Question 65

what looks like linear striations?

Answer 65

osteopathia striata

Question 66

what looks like spotted bones?

Answer 66

osteopoikilosis