Mets And Primary

Question 1

MC spine (tx/lx); axial skeleton, skull, prox extremeties

Answer 1

Mets general

Question 2

MC 1’ sites of general mets

Answer 2

Breast
Lung
Prostate
Kidney
Thyroid
Bowel

Question 3

MC age for general mets

Answer 3

> 40

Question 4

Motheaten - permeative lytic (MC) or blastic depending on primary CA (ivory vertebra = 3 Main causes)

Answer 4

Mets, general

Question 5

2-4 cm, polystotic (only 10% are solitary), cortical destruction, no periosteal response, indistinct margins, occasional soft tissue mass

Answer 5

Mets - general

Question 6

Weight loss, cachexia, anemia, fever

Answer 6

General mets

Question 7

MC cause of missig pedicle

Answer 7

Osteolytic mets

Question 8

Motheaten or permeative lytic

Answer 8

Primary tumors

Question 9

> 6cm, monostotic, cortical destruction, aggressive periosteal response, indistinct margins, soft tissue masses

Answer 9

Primary tumors

Question 10

Plasma cell (round cell neoplasm) matrix; same location as mets plus humerus and femur diaphysis

Answer 10

MM

Question 11

Age range for MM and sex

Answer 11

50-70 (rare <40)

Males

Question 12

Lytic - multiple. Punched out defects - high incidence of pathologic fx (20%)

Answer 12

MM

Question 13

Normocytic/normochromic anemia and thrombocytopenia, renal disease, abnormal serum and urinary protein/reversed A/G ratio, elevated ESR/CA/uric acid/Rouleaux formation

Answer 13

MM

Question 14

M spike
Bence jones protein in urine
Bone marrow aspirate

Answer 14

MM

Question 15

MC cause of death: bacterial PNA and renal dz (myeloma kidney)

Answer 15

MM

Question 16

Localized plasma cell neoplasm. Mandible, ilium, vertebrae, ribs, prox. Femur, scapula

Answer 16

Solitary plasmacytoma

Question 17

Age/sex for solitary plasmacytoma

Answer 17

<50 in 50%

Question 18

Geographic lytic (“soap bubbly”) and highly expansile

Answer 18

Solitary plasmacytoma

Question 19

70% develop MM within 5 years

Answer 19

Solitary plasmacytoma

Question 20

connective tissue; center of bone = MC, 75% in metaphysis of long bone; NOT common in vertebrae

Answer 20

Osteosarcoma

Question 21

Age/sex of osteosarcoma

Answer 21

10-25 (75%)

Males

Question 22

Possible fever, increased ALP

Answer 22

Osteosarcoma

Question 23

Osteosarcoma painful?

Answer 23

Yes. And swelling. Onset of sx = dx is >6 months

Question 24

Cumulus could appearance
Cortical disruption
Spiculated periosteal response
Soft tissue mass

Answer 24

Osteosarcoma

Question 25

Mets to lungs common

Answer 25

Osteosarcoma | Do a chest CT

Question 26

Cannonball mets

Answer 26

Osteosarcoma | Mets to lungs.

Question 27

Cartilaginous matrix and bones preformed in cartilage in metaphyseal or diaphyseal (mc pelvis and prox femur; many other places too)

Answer 27

Chondrosarcoma

Question 28

MC primary Ca of hand, sternum and scapula

Answer 28

Chondrosarcoma

Question 29

Age/sex for chondrosarcoma

Answer 29

40-60 | Males

Question 30

Painful mets/primary tumors

Answer 30

``` MM Solitary plasmacytoma Osteosarcoma Chondrosarcoma Ewings Fibrosarcoma Chordoma Hodgkin's lymphoma ```

Question 31

Large and poorly defined with endosteal scalloping

Answer 31

Chondrosarcoma

Question 32

Popcorn or stippled

Answer 32

Chondrosarcoma

Question 33

Grows slowly, symptoms from 2-5 years

Answer 33

Chondrosarcoma

Question 34

Ddx for chondrosarcoma

Answer 34

Enchondroma | Osteochondroma

Question 35

Marrow of long bones (round cell) in diaphysis FLAT BONES Rare in spine

Answer 35

Ewing's sarcoma

Question 36

Age/sex of ewing's

Answer 36

10-25/30 Males UNCOMMON IN BLACKS

Question 37

Fever, anemia, leukocytosis, increased ESR

Answer 37

Ewing's

Question 38

Aggressive periosteal response (lamintaed) with wide zone of transition

Answer 38

Ewing's

Question 39

Mimics infections, common mets to lungs

Answer 39

Ewing's

Question 40

``` Long bones (MC knee) Mets late to liver, lung, lymph, brain ```

Answer 40

Fibrosarcoma

Question 41

age/sex of fibrosarcoma

Answer 41

30-50

Question 42

Highly destructive, expanding, ST mass but no periosteal reaction!!!

Answer 42

Fibrosarcoma!

Question 43

Notochordal remnant cells left behind b/w skull base and coccyx. Mc in sacrococcygeal

Answer 43

Chordoma

Question 44

Age/sex of chordoma

Answer 44

40-70 | Males

Question 45

Cortical expansion; may increase AP diameter of sacrum; calcification in 50%; ST mass

Answer 45

Chordoma

Question 46

Only primary malignancy to cross IVD space!!

Answer 46

Chordoma

Question 47

DDX for chordoma

Answer 47

``` Lytic mets Chondrosarcoma GCT ABC Plasmacytoma ```

Question 48

Extranodal lymphoma in femur, tibia, humerus

Answer 48

Non-hodgkin's lymphoma

Question 49

Age/sex of non-hodgkin's lymphoma

Answer 49

20-50 | Males

Question 50

Local, intermittent pain: dull, aching, not relieved by rest

Answer 50

Non-hodgkin's lymphoma

Question 51

Minimal periosteal response, soft tissue mass

Answer 51

Non-hodgkin's lymphoma

Question 52

Patient is generally healthy, often palpable mass or swelling

Answer 52

Non-hodgkin's lymphoma

Question 53

MC in vertebral body, IVORY VERTEBRAh

Answer 53

Hodgkin's lymphoma

Question 54

MC symptom of hodgkin's lymphoma

Answer 54

PAIN

Question 55

Anterior scalloping

Answer 55

Hodgkin's lymphoma

Question 56

Polyostotic, exuberent periosteal response,

Answer 56

Hodgkin's lymphoma

Question 57

Ddx for hodgkin's lymphoma

Answer 57

Blast mets, paget's