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CORE MSK > Bone Tumors > Flashcards

Bone Tumors Flashcards

1
Q

Lucent Epiphyseal Lesions

A

AIG“the evil” Company

  • ABC
  • Infection
  • Giant cell
  • Chondroblastoma
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2
Q

What bones are epiphyseal equivalents?

A
  • Carpals
  • Patella
  • Greater Trochanter
  • Calcaneus
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3
Q

Differential diagnosis for lucent bone tumors in patients that are:

  1. Less than 30
  2. Any age
  3. Over 40
A

Less than 30 = EG, ABC, NOF, Chondroblastoma, and Solitary Bone Cyst

Any age = Infection

Greater than 40 = mets and myeloma

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4
Q

Classic appearnce of Fibrous Dysplasia

A

Long lesion in a long bone with a ground glass matrix

No periosteal reaction or pain

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5
Q

What is the difference between McCune Albright and Mazabraud Syndrome?

A

Both are polyostotic fibrous dysplasia syndromes

McCune Albright

  • Girl
  • Cafe au lait spots
  • Precocious puberty

Mazabraud

  • Woman (middle aged)
  • Soft tissue myxomas
  • Increased risk for osseous malignant transformation
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6
Q

What is Jaffe-Campanacci Syndrome?

A

***Low yield

  • NOFs
  • Cafe au lait spots
  • Mental retardation
  • Hypogonadism
  • Cardiac malformations
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7
Q

How do you differentiate an enchondroma from a low grade chondrosarcoma?

A

Pain: Low grade chondrosarcomas can be painful

Size: Enchondroma (1-2 cm) vs low grade chondrosarcoma (>4-5cm)

Changes: Archs and ring pattern may move around with low grade chondrosarcoma but will not change with an enchondroma

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8
Q

Name two multiple enchondroma syndromes

A

Ollier and Maffuci

Maffuci has More - Cancer risk and vascular malformations

If you see phleboliths or hemangiomas (lucent centered calcifications) think Maffuci

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9
Q

3 classic Eosinophilic Granuloma (EG) appearances

A
  1. Vertebral plana in a kid
  2. Skull with lucent beveled edge (also in a kid)
  3. “Floating Tooth” with lytic lesion in alveolar ridge – differential case
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10
Q

Classic DDx for Osseous Sequestrum

A
  • Osteomylitis
  • Lymphoma
  • Fibrosarcoma
  • EG

*Osteoid Osteoma can mimic a sequestrum

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11
Q

Classic DDx for vertebra plana

A

MELT

  • Mets / Myeloma
  • EG
  • Lymphoma
  • Trauma / TB
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12
Q

Facts about Giant Cell Tumor (GTC)

A
  • Physis must be closed
  • Non sclerotic border
  • Abuts the articular suface

Things to know

  • Most common in the knee - abuting articular surface
  • Most common at age 20-30
  • Association with ABCs (can turn into them)
  • They are “quasi-malignant” - 5% can mets to the lung
  • Fluid levels on MRI
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13
Q

What is typical apperance of an osteoid osteoma?

A

Oval lytic lesion (“lucent nidus”) surrounded by dense sclerotic bone

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14
Q

Classic DDx for lucent lesion in the posterior elements

A
  • Osteoblastoma
  • ABC
  • TB
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15
Q

Typical age and location for a solitatry bone cyst

A

Less than 30 years old

Proximal humerus > femur > calcaneus

Fallen fragment sign = bone fragment in the dependent portion of a lucent bone lesion

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16
Q

Lytic or sclerotic lesion with history of hyperparathyroidsm think…

A

Brown tumor

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17
Q
A
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18
Q

Classic blastic mets are

A

Prostate, carcinoid, and medulloblastoma

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19
Q

Classic lytic mets are

A

Renal and Thyroid

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20
Q

Test to differentiate a bone island from a prostate met

A

Bone scan

Bone Island should be mild or not active

Prostate met should be HOT

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21
Q

Multiple myeloma typically spares

A

Posterior elements

22
Q

Multiple myeloma can manifest as

A

Diffuse osteopenia

23
Q

Classics: Long lesion in a long bone

A

Fibrous dysplasia

24
Q

Classics: Ground glass

A

Fibrous dysplasia

25
Classics: Lytic lesion with a hazy matrix
Fibrous dysplasia
26
Classics: Chondroid matrix in the proximal humerus or distal femur
Enchondroma
27
Classics: Lucent lesion in the finger or toes
Enchondroma
28
Classics: Epiphyseal tibial lesion in a teenager
Chondroblastoma
29
Classics: Epiphyseal equivalent lesion
Chondroblastoma or GCT \*Technically GCT grows into the epiphysis
30
Classics: Lucent lesion with a fracture (fallen fragment) in the humerus
Solitary (Unicameral) bone cyst
31
Classics: Lucent lesion in the greater trochanter
Chondroblastoma
32
Classics: Calcaneal lesion with a central calcification
Intraosseus lipoma
33
Classics: Lucent lesion in the skull
EG
34
Classics: Vertebra planna in a kid
EG
35
Classics: Vertebra plana in an adult
Mets (or myeloma)
36
Classics: Sequestrum / nidus in the tibia or femur
Osteoid osteoma
37
Classics: "Painful Scoliosis"
Osteoid osteoma
38
Classics: Calcified lesion in the posterior elements of the C-Spine
Osteoblastoma
39
Malignant Fibrous Histocyoma (aka Pleomorphic Undifferentiated Sarcoma)
* Old people and central location (proximal arms and legs) * Dark to intermediate on T2 * Assocated with spontanous hemmorhage * Bone infarcts can turn into MFH * Radiation is a risk factor
40
Synovial sarcoma
* Young * Peripheral (knee, foot) * T2 triple sign (bowl of grapes) Random trivia * Most sarcomas don't attack bones; synovial sarcoma can * Most sarcomas present as a painless mass; synovial sarcomas can hurt * Soft tissue calcifications and bone erosions are highly suggestive * Slow growing and small in size can trick people into thinking it is B9
41
Myxiod Liposarcoma
* Most common liposarcoma in patients younger than 20 * Can look like a cyst (T2 bright and T1 dark) - confusing * Need gad to differentiate
42
Soft tissue myxoma signal characteristics
* T2 bright * T1 iso to dark Multple soft tissue myxomas + polyostotic fibrous dysplasia = Mazabraud Syndrome
43
Treatment Trivia Osteosarcoma
Chemo first (to kill micro mets) followed by wide excision
44
Treatment Trivia Ewings
Both chemo and radiation followed by wide excision
45
Treatment Trivia Chondrosarcoma
Usually wide excision (low grade and major concern is local recurrence)
46
Treatment Trivia Giant Cell Tumor
Because it extends to the articular surface it will require arthroplasty
47
PVNS versus Synovial Chondromatosis
* PVNS is associated with hemarthrosis (blooming on GRE) * PVNS never calcifies * Synovial chondromatosis may calcify (see on plainfilm below)
48
Lipoma arborescens appearance
* "Frond like" * Behaves like fat (T1 bright, T2 bright, response to fat saturation) * Associated with OA, chronic RA, or prior trauma Tricks: * Shown on gradient and need to appreciate fat-fluid interface * Shown on US with "frond-like hyperechoic mass"
49
Cortical Desmoid
* DO NOT TOUCH LESION * Location = posteriomedial epicondyle of the distal femur * Tug lesion * Can be hot on bone scan
50
Synovial Herniation Pit / Pitt’s Pit
* Characteristic location in the **anterosuperior femoral neck** * **Lytic** appearing lesions * Associated with femoral acetabular syndrome? DO NOT TOUCH LESION

CORE MSK (1 decks)

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