MIDTERM TUMOR Flashcards
(416 cards)
1
Q
What are common sites of neoplasms?
A
FEMUR, pelvis, humerus
(UNCOMMON in spine)
2
Q
Osteosarcom neoplasm %
A
50-55%
3
Q
Fibrosarcoma neoplasm %
A
20-25%
4
Q
Chondrosarcoma neoplasm %
A
10%
5
Q
What is a neoplasm?
A
Abnormal cellular growth that can be benign or malignant
- Malignant: Ability to metastasize/spread
- Benign: Does not metastasize, but this does not mean insignificant
6
Q
Any cell found in bone can produce ______
A
a tumor
* Subdivided by what type of cell it comes from
7
Q
If a tumor originates in bone it is called a _____
A
primary bone tumor
8
Q
What is a secondary bone tumor basic definition?
A
Starts somewhere else and metastasizes to bone
9
Q
What is a tumor like lesion?
A
Lesions that radiographically appear as tumors but are not histo-pathologically classified as a tumor - usually produce geographic radiolucency
10
Q
Primary bone tumors, benign category:
A
- Osteoma - MOST COMMON, intramembranous bone tumor, dont hurt
- Osteoid Osteoma - not as common, HURT
- Osteoblastoma - RARE, but half occur in spine
12
Q
Describe conventional osteosarcomas:
A
Most of these are central sclerotic (about 75%) originate from inside the bone and loves the distal femoral metaphysis
- 72% (over 2/3 of all osteosarcomas)
13
Q
What is multifocal Osteosarcomatosis?
A
Most often in children in first decade, nearly always fatal
14
Q
Osteosarcoma can be from post therapeutic radiation, t/f
A
true
15
Q
What type of malignant bone tumor is extremely vascular?
A
Telangiectatic
16
Q
What type of tumor can become an ostoesarcoma?
A
Dedifferentiated chondrosarcoma
17
Q
What osteosarcoma originates in the soft tissue attached to the bone?
A
Extraskeletal Osteosarcoma
19
Q
What is a tumor of the cortical bone?
A
Chondroma, and it is a common benign
20
Q
What is a benign bone tumor that is inside the bone?
A
Enchondroma
21
Q
Is osteochondroma benign or malignant?
A
Benign
22
Q
What is a fibromyxoid chondroma?
A
Tumor made of fibrous mucus cartilage
- Dominant content is cartilage
- Loves the TIBIA - rare to be anywhere else
BENIGN
23
Q
What is a chondroblastoma?
A
High concentration found in the epiphysis - where chondroblasts are located - may spread into rest of bone
BENIGN**
24
Q
What are the 3 Malignant cartilage Tumors?
A
- Primary Chondrosarcoma
- Secondary Chondrosarcoma
- Clear cell chondrosarcoma
25
Q
What is primary chondrosarcoma?
A
Didn’t require anything else for it to be there, it originates by itself
26
Q
What is secondary chondrosarcoma?
A
From a preexisting benign tumor that malignantly degenerate - can be multiple
- Central secondary chondrosarcoma - From ENCHONDROMA, central is inside the bone in medullary cavity or cortex
- Peripheral - OSTEOCHONDROMA - located external to the bone, looks like a trunk/stalk of broccoli coming off
27
Malignant bone tumr =
Osteosarcoma
28
Peripheral secondary chondrosarcoma comes from _____ ?
Osteochondroma
29
What is clear cell chondrosarcoma?
Usually near a joint, mistaken for chondroblastoma
30
What is one of the more common bone tumors?
Giant cell tumor of bone/osteoclastoma
31
What are the characteristics of Giant cell tumor?
* Classically expansile soap bubble lesion
* about 1 in 5 are malignant
* "Quasi - malignant" can go either way - **_80% malignant_**
32
Where do giant cell tumors most likey occur?
At the knee (HURT)
35
Ewings Sarcoma is in what category?
Marrow tumor (round cell tumor)
* Classically gives laminated periosteal reaction
* moth eaten appearance
* big tubular bone in young children
36
What is the most common primary bone malignancy in first decade (peak in teenagers)?
**_EWINGS SARCOMA_**
* dont confuse Leukemia, which is the most common _malignancy_ in the first decade
37
What category is Non-Hodgkin Lymphoma under? (NHL)
Marrow tumor (round cell tumor: malignant)
38
What is the most common primary bone malignancy?
_**Multiple Myeloma\*\*\*\* TEST**_
39
Where would you see true punched out lesions?
Multiple Myeloma
40
Explain Myelomatosis:
Form of multiple myeloma:
* Produces osteopenia, looks like osteoporosis - will also have weakness and fatigue due to anemia - radiographically will look the same
41
What will plasmacytoma have?
Geographic soap bubble lesion
42
What is "extra osseous" ?
Branch of multiple myeloma
* Mass in nasal pharynx (difficulty breathing), very uncommon
43
What is under the Benign Vascular and Connective Tissue tumor?
**_Hemangioma_** - produces localized coarsening of the trabecular pattern
44
What is the "Malignant vascular tumor?'
Fibrosarcoma
45
What is the notochord remnant tumor?
Chordoma - most often found in Clivus, C2, sacro-coccygeal, will cross the joint
50
What are the key points of osteolytic mets?
* Destroys by physical bulk and restricting osteoblasts
* 80% of metastasis found in spine, ribs and pelvis with another 10% found in cranium
* Rarely go beyond the elbow and knee
51
What accelerates osteoblasts?
Osteoblastic mets
52
Pic of mixed mets
53
What are 2 of the most common benign bone tumors?
Chondroma and Solitary Osteochondroma - asymptomatic
54
How can tumors be classified?
* They can be classified by location of where they originate - most often from the **metaphysis**
56
What are the top "Malignant Tumors" ?
MOCEF - top 5 primary malignant
1. Multiple Myeloma: **Over 40**
2. Osteosarcoma: **under 30**
3. Chondrosarcoma: **40 - 60**
4. Ewing's: **Under 40**
5. Fibrosarcoma: **30 - 60**
64
Central secondary chondrosarcoma comes from \_\_\_\_\_
Enchondroma
70
Marrow tumors, aka:
round cell tumors
71
What is the common theme with marrow tumors (round cell tumors)?
_**Occur in diaphysis and are all MALGINANT AND DESTRUCTIVE \*\*\*\*\*\***_
83
What are secondary tumors?
Metastatic tumors in bone
84
Vast majority of secondary tumors are \_\_\_\_\_
**Hematogenous**
85
Osteolytic mets is a \_\_\_\_\_
secondary tumor
86
What has 75% occurence %, osteolytic mets or osteoblastic mets?
Osteolytic
90
What is in the "Tumor Like" category?
* Not exhaustive list
* **Fibrous dysplasia** - as common as Paget's
92
If a tumor is most likely benign, what will it's characteristics be?
* Almost always originate before age of 30 (with exception of giant cell tumor 20-40 years old)
KNOW THIS\*\*\*
94
Primary Bone Tumors:
* Bone Forming Tumors
* Cartilage Forming Tumors
* Giant Cell Tumor of Bone/Osteoclastoma
* Marrow Tumors (Round Cell Tumors)
* Vascular and Connective Tissue Tumors
* Notochord Remnant Tumor
95
What are the Bone forming primary bone tumors?
* **_Benign_**
* Osteoma
* Osteoid Osteoma
* Osteoblastoma
* **_Malignant - Osteosarcomas_**
* Conventional Osteosarcoma
* 72% central
* 75% sclerotic
* 25% lytic
* Parosteal Os 4%
* Periosteal Os 1%
* Multifocal Os/osteosarcomatosis 1%
* Osteosarcoma of Jaw - 6%
* Post Radiation Os - 4%
* Os in Paget's disease - 3%
* Os Degeneration from benign condition - 1%
* Telangiectatic Os - 3%
* Dedifferentiated Chondrosarcoma - 3%
* Extraskeletal Os. \< 1%
96
What are the Benign Cartilage Forming Tumors?
* Benign
* Chodnroma/Enchondroma
* Solitary Osteochondroma
* Chondromyxoid Fibroma/Fibromyxoid Chondroma
* Chondroblastoma
97
What are the malignant Cartilage forming tumors?
Malignant
* Primary Chondrosarcoma - arise de novo
* Secondary Chondrosarcoma - from preexisting benign tumor
* Central - From enchondroma
* Peripheral - From Osteochondroma
* Clear cell chondrosarcoma - mistaken form chondroblastoma, low grade
* Extra Skeletal - Rare
98
What are the marrow tumors (round cell tumors?)
* Ewing's Sarcoma
* NHL (non hodgkin lymphoma) of bone/reticulum cell sarcoma
* Multiple Myeloma
99
What are the branches of multiple myeloma?
* Classical MM
* Myelomatosis
* Plasmacytoma
* Extra Osseous MM
100
Vascular and Connective Tissue tumors are in what category, what are their subcategories?
It is in the category of "primary bone tumor"
* Benign - Hemangioma
* Malignant - Fibrosarcoma
101
Metastatic Tumors in bone - most common skeletal malginancy
* Osteolytic Mets
* Osteoblastic Mets
* Mixed Mets
102
Tumor Like Conditions:
PRIMARY BONE TUMORS
* Solitary bone cyst/Unicameral bone cyst
* Aneurysmal bone cyst
* Fibrous Cortical defect and nonossifying fibroma
* Fibrous Dysplasia
* Brown Tumor of hyperparathyroidism
* Pseudotumors of Hemophilia
* Large Arthritic Cysts/Geode
103
If it's a benign tumor they overwhelmingly originate when?
Before the Age of 30
104
If a tumor is asymptomatic and benign, it may not show till \_\_\_\_
age 50
105
When does Giant cell tumor usually occur?
20-40 this is an exception
106
Metastisis happens how?
Through Vascular system
107
Big 6 strongest potential to spread?
1. Breast - females 70%
2. Lung - 25%
3. Prostate - Males 60%
4. Kidney
5. Ewing's
6. Neuroblastoma
\*\*\* Breast, lung, prostate, and kidney account for 80%
108
Where does lytic Mets come from?
Physical bulk - pressure from the tumor taking up space which impedes the osteoblasts
* More common (75% of metastasis destroys)
109
Approximately 80% of all osseous metastases will be found \_\_\_\_\_
In the axial skeleton
* 28% ribs
* 39% vertebra
* 13% bony pelvis
10 % of skeletal metastasis will be found in the cranium
10% extremities
110
Is Enostosis primary or secondary bone tumor?
Primary
AKA BONE ISLAND
111
What is enostosis classified as?
Tumorlike, usually an incidental finding, and is asymptomatic
112
What are the characteristics of Enostosis?
* Rare in children
* Osteosclerotic bone lesion
* Can be considered a hamartoma (benign tumor that is multicellular and has all the cells of the host tissue)
113
Where is the location of Enostosis?
Intramedullary Location - usually up against inner surface of cortex
* Composed of normal appearing compact lamellar bone with haversian canals
* Blends with surround trabecular bone creating irregular margin
114
What is the radiological appearance of Enostosis
* Round to oval (.2 - 2 cm) osteoblastic area
* Epiphyseal or metaphyseal
* Bone scan NORMAL
95 % no need for further radiologic evaluation
115
WHat is the differential diagnosis for Enostosis?
Osteoblastic Mets, osteoma, osteoid osteoma, low grade osteosarcoma
116
Osteoblastic mets \_\_\_\_
HURTS
117
low grade osteosarcoma is \_\_\_\_
PAINFUL
118
When would you take a biopsy of Enostosis?
Increase in size of 25% in 6 months
119
Bony pelivs is a common site to see \_\_\_\_
enostosis
120
Giant bone island is a \_\_\_\_\_
Enostosis that is \> 2-3 cm in size
More likely to have increased activity on bone scan
121
What are the possible diseases related to Enostosis?
* Osteopoikilosis
* Osteopathia Striata
* Melorheostosis
122
Osteopoikilosis =
Periarticular bone islands
123
Osteopathia Striata =
Lesions are more elongated in periarticular pattern, Vooerheve disease, fan-like bands in flat bones
124
What are the 3 common characteristics of Melorheostosis?
* Osteosclerotic bone disorder
* Often symptomatic (pain, decreased ROM, contractures, limb swelling, bowing)
* Scleroderma - like skin lesions over osseous changes
125
What is the radiology of Melorheostosis?
o Osseous excrescences often exuberant and lobulated along bone surface
o Single limb—more common lower extremity
o Also endosteal involvement may extend into marrow space
o Intense activity on bone scan
o Long drippy bone island
126
Benign Bone forming:
OSTEOMA
OSTEOID OSTEOMA
OSTEOBLASTOMA
127
Osteoma aka:
Ivory Exostosis
128
What is a benign, slow growing hamartomatous lesion composed of well differentiated mature bone?
Osteoma
129
What is the defect in Osteoma?
One resorption or formation during skeletal maturation
130
What does osteoma arises beneath?
Endosteum from inner surface of cortex
131
What causes surrounding reactive bone formation in Osteomas?
Elevation of periosteum from underlying bone
132
Osteoma is a bone of \_\_\_\_\_
Intramembranous origin
133
Extracranial Osteoms -
.03% of bone biopsied primary bone lesions
134
Paranasal sinus osteomas -
.4%
Most have a osteosclerotic lesion in a frontal or ethmoid lesion
135
What are the associated abnormailities with Osteoma?
* Gardner's Syndrome
* Mutation of Adenmatous Polyposis Coli Gene (5q21)
* Multiple osteomas, intestinal polypsos, soft tissue desmoid tumors
* Bone lesions may precede intestinal polyposis
136
Describe Gardner's Syndrome in Osteoma:
* Autosomal Dominant
* Syndrome of hamartomatous tumors in different locations
* One of the key findings - osteomas
* Will develop color cancer (precursor to colon cancer)
137
In osteoma, most just have \_\_\_\_
single solitary osteoma
138
What are the clinical issues associated with Osteoma?
* Small lesions usually asymptomatic
* Project away from cortical surface
* Palpable enlarging osseous mass
139
What is the nasal issue with Osteoma?
* Large oseomain paranasal sinus may obstruct nasal ducts
* Can erode wall of cranial fossa and dura
* Can cause mucocele, sinusitis, headache, pain
140
What can osteoma tumors near orbit cause?
Cause exopthalmosis, double vision, vision loss
141
What about the Hx of Osteoma:
* Found before 30 but can be seen anytime
* EQUAL GENDER
* No malginant potential
142
What looks identical to bone island but has different location?
Osteoma
143
What does Osteoma look like radiographically?
(first 3)
* Well defined round dense sclerotic lesion attach to underlying bone
* Vast majority in frontal and ethmoid sinus
* DENSE ivory like sclerotic mass
144
What does Osteoma look like radiographically?
(last 3)
* No satellite lesions
* Low signal on MRI
* Plain film is good to see them
145
OSTEOID OSTEOMA: main characteristics
* Painful!
* Produce dense periosteal reaction
* Can regress spontaneously - infarction
* Local swelling and point tenderness
146
What is Osteoid Osteoma characterized by?
Nidus less than 1 cm of osteoid/woven bone is vascular tissue surrounded by zone of reactive sclerosis
147
What is elevated in Osteoid Osteoma?
Prostaglandin E2 elevated 100-1000 times within Nidus (pain and vasodilation)
148
Describe the nidus in Osteoid osteoma:
Radiolucent and is the actual tumor
149
Pain is worse at night with what tumor?
Osteoid Osteoma
150
Whats the origin of Osteoid Osteoma?
Unknown, inflammatory, traumatic, vascular, viral
151
What is a distinguishing characteristic of Osteoid Osteoma?
These can produce a painful scoliosis, and they happen in the spine (lean into a legion)
152
Osteoid Osteoma is more common in \_\_\_\_\_\_
males 2-3:1
153
What are the first 4 radiological features of Osteoid Osteoma?
* Long bones are common
* Metaphysis/Diaphysis
* Phalanges of hands and feet
* Spine (10%)
* Posterior Elements 90% - posterior arch lamina
* Vertebral body 10%
154
What are the last 5-6 radiological features of osteoid osteoma?
* Cortical: 70-80%
* Radiolucent Nidus \< 1.5 cm with surrounding dense sclerosis
* Periosteal reaction may be present
* Medullary: 25%
* CT - well defined, round oval nidus surrounded by sclerosis
* MRI - T1 WI nidus isointense to muscle
155
What does osteoid osteoma look like on bone scan?
lights up
(will have a solid dense periosteal reaction)
156
OSTEOBLASTOMA aka:
Giant osteoid osteoma, osteogenic fibroma
157
What is Osteoblastoma characterized by?
* Production of osteoid and woven bone
* Lesion \> 1.5 cm
* Histology similar to osteoid osteoma
158
What are the %'s associated with Osteoblastoma?
\< 1% of primary bone tumors
3% benign bone tumor
159
Describe Osteoblastoma:
* Circumscribed mass, often surrounded by shell of cortical bone or periosteum
* Sharp interphase between lesion and cancellous bone
160
What does the nidus look like in Osteoblastoma?
* 2-10 cm, friable, deep red (highly vascular)
* Very vascular connective tissue stroma with interconnecting trabecular bone
161
What are the symptoms of osteoblastoma?
* Dull, localized pain of insidious onset
* Pain rarely interferes with sleep
* Localized swelling, tenderness, and decreased ROM
* Doesnt respond well to aspirin
162
Osteoblastoma originates \_\_\_\_
under 30
163
Osteoblastoma gender pref.
2-3:1 in males
164
WHat can Ostoeblastoma have?
Foci of aggressive stage 3 lesion (prone to aneurysmal bone cysts formation)
RECURRENCE AFTER resection = 10-25%
165
In aggressive osteoblastoma, the recurrence is ____ %
50
166
First 4 things of Osteoblastoma (radiology):
* 30-50% SPINAL
* Posterior elements --\> 60% spinous, transverse process, pedicle
* Posterior elements with extension into vertebral body 25%
* Vertebral body 15%
* Long bones, 30% originate in metaphysis
167
What are the 5-8 radiographic features of Osteoblastoma?
* Hands and feet 15%
* Skull and Jaw 15%
* Pelvis 5%
* Expansile, lytic circumscribed lesion
* Reactive sclerosis 60%
168
Last radiologic features of Osteoblastoma:
* CAN rapidly increase in size
* Secondary aneurysmal bone cyst (ABC): 16% can look exactly the same
* NECT: Expansile, lytic lesion with or without matrix mineralization
* Can be purely radiolucent inside, speckled (inside matrix), or sclerotic looking
***_KEY IS EXPANSION_***
169
MALIGNANT PRIMARY BONE TUMORS:
Osteosarcoma, aka Osteogenic Osteosarcoma
170
What is the main definition of Osteosarcoma?
Malignant tumor with ability to produce osteoid directly from neoplastic cells
171
Talk about the growth rate of Osteosarcoma:
Frequency of tumor occurence corresponds to greatest growth rate during adolescence
172
What is chemically happening in osteosarcoma?
Overexpression of P-glycogen in OGS cells with propensity for metastasis and rx failure
alteration in Rb genes in OGS
173
Think of osteosarcoma as \_\_\_\_
osteoblastic malignant tumor
174
Periosteal reaction of osteosarcoma =
Spiculated
175
2nd primary bone tumor is \_\_\_\_
Osteosarcoma (MOCEF)
176
When does osteosarcoma peak?
teens
177
Where is the most common location for osteosarcoma?
Distal femoral metaphysis
178
Osteosarcomatosis survival:
Change low
179
Where will osteosarcoma metastasize to?
LUNG
180
Osteosarcoma has a majority of unknown origin, primary, but secondary to predisposing factors are:
* Paget's Disease (4th stage)
* Bone infarction
* Radiation
181
What is the most common malignant primary bone tumor in young adults and children?
Osteosarcoma
182
What are common sites of neoplasms?
FEMUR, pelvis, humerus
(UNCOMMON in spine)
183
Osteosarcom neoplasm %
50-55%
184
Fibrosarcoma neoplasm %
20-25%
185
Chondrosarcoma neoplasm %
10%
186
What is a neoplasm?
Abnormal cellular growth that can be benign or malignant
* **Malignant**: Ability to metastasize/spread
* ***Benign***: Does not metastasize, but this does not mean insignificant
187
Any cell found in bone can produce \_\_\_\_\_\_
a tumor
\* Subdivided by what type of cell it comes from
188
If a tumor originates in bone it is called a \_\_\_\_\_
primary bone tumor
189
What is a secondary bone tumor basic definition?
Starts somewhere else and metastasizes to bone
190
What is a tumor like lesion?
Lesions that radiographically appear as tumors but are not histo-pathologically classified as a tumor - usually produce geographic radiolucency
191
Primary bone tumors, benign category:
1. Osteoma - **_MOST COMMON_**, intramembranous bone tumor, dont hurt
2. Osteoid Osteoma - not as common, ***HURT***
3. Osteoblastoma - _RARE_, but half occur in spine
193
Describe conventional osteosarcomas:
Most of these are central sclerotic (about 75%) originate from inside the bone and loves the distal femoral metaphysis
* **72% (over 2/3 of all osteosarcomas)**
194
What is multifocal Osteosarcomatosis?
Most often in children in first decade, nearly always fatal
195
Osteosarcoma can be from post therapeutic radiation, t/f
true
196
What type of malignant bone tumor is extremely vascular?
Telangiectatic
197
What type of tumor can become an ostoesarcoma?
Dedifferentiated chondrosarcoma
198
What osteosarcoma originates in the soft tissue attached to the bone?
Extraskeletal Osteosarcoma
200
What is a tumor of the cortical bone?
Chondroma, and it is a common benign
201
What is a benign bone tumor that is inside the bone?
Enchondroma
202
Is osteochondroma benign or malignant?
Benign
203
What is a fibromyxoid chondroma?
Tumor made of fibrous mucus cartilage
* Dominant content is cartilage
* Loves the **_TIBIA_** - rare to be anywhere else
**_BENIGN_**
204
What is a chondroblastoma?
High concentration found in the epiphysis - where chondroblasts are located - may spread into rest of bone
BENIGN\*\*
205
What are the 3 Malignant cartilage Tumors?
* Primary Chondrosarcoma
* Secondary Chondrosarcoma
* Clear cell chondrosarcoma
206
What is primary chondrosarcoma?
Didn't require anything else for it to be there, it originates by itself
207
What is secondary chondrosarcoma?
From a preexisting benign tumor that malignantly degenerate - can be multiple
* **Central** secondary chondrosarcoma - From ENCHONDROMA, central is inside the bone in medullary cavity or cortex
* **Peripheral** - OSTEOCHONDROMA - located external to the bone, looks like a trunk/stalk of broccoli coming off
208
Malignant bone tumr =
Osteosarcoma
209
Peripheral secondary chondrosarcoma comes from _____ ?
Osteochondroma
210
What is clear cell chondrosarcoma?
Usually near a joint, mistaken for chondroblastoma
211
What is one of the more common bone tumors?
Giant cell tumor of bone/osteoclastoma
212
What are the characteristics of Giant cell tumor?
* Classically expansile soap bubble lesion
* about 1 in 5 are malignant
* "Quasi - malignant" can go either way - **_80% malignant_**
213
Where do giant cell tumors most likey occur?
At the knee (HURT)
216
Ewings Sarcoma is in what category?
Marrow tumor (round cell tumor)
* Classically gives laminated periosteal reaction
* moth eaten appearance
* big tubular bone in young children
217
What is the most common primary bone malignancy in first decade (peak in teenagers)?
**_EWINGS SARCOMA_**
* dont confuse Leukemia, which is the most common _malignancy_ in the first decade
218
What category is Non-Hodgkin Lymphoma under? (NHL)
Marrow tumor (round cell tumor: malignant)
219
What is the most common primary bone malignancy?
_**Multiple Myeloma\*\*\*\* TEST**_
220
Where would you see true punched out lesions?
Multiple Myeloma
221
Explain Myelomatosis:
Form of multiple myeloma:
* Produces osteopenia, looks like osteoporosis - will also have weakness and fatigue due to anemia - radiographically will look the same
222
What will plasmacytoma have?
Geographic soap bubble lesion
223
What is "extra osseous" ?
Branch of multiple myeloma
* Mass in nasal pharynx (difficulty breathing), very uncommon
224
What is under the Benign Vascular and Connective Tissue tumor?
**_Hemangioma_** - produces localized coarsening of the trabecular pattern
225
What is the "Malignant vascular tumor?'
Fibrosarcoma
226
What is the notochord remnant tumor?
Chordoma - most often found in Clivus, C2, sacro-coccygeal, will cross the joint
231
What are the key points of osteolytic mets?
* Destroys by physical bulk and restricting osteoblasts
* 80% of metastasis found in spine, ribs and pelvis with another 10% found in cranium
* Rarely go beyond the elbow and knee
232
What accelerates osteoblasts?
Osteoblastic mets
233
Pic of mixed mets
234
What are 2 of the most common benign bone tumors?
Chondroma and Solitary Osteochondroma - asymptomatic
235
How can tumors be classified?
* They can be classified by location of where they originate - most often from the **metaphysis**
237
What are the top "Malignant Tumors" ?
MOCEF - top 5 primary malignant
1. Multiple Myeloma: **Over 40**
2. Osteosarcoma: **under 30**
3. Chondrosarcoma: **40 - 60**
4. Ewing's: **Under 40**
5. Fibrosarcoma: **30 - 60**
245
Central secondary chondrosarcoma comes from \_\_\_\_\_
Enchondroma
251
Marrow tumors, aka:
round cell tumors
252
What is the common theme with marrow tumors (round cell tumors)?
_**Occur in diaphysis and are all MALGINANT AND DESTRUCTIVE \*\*\*\*\*\***_
264
What are secondary tumors?
Metastatic tumors in bone
265
Vast majority of secondary tumors are \_\_\_\_\_
**Hematogenous**
266
Osteolytic mets is a \_\_\_\_\_
secondary tumor
267
What has 75% occurence %, osteolytic mets or osteoblastic mets?
Osteolytic
271
What is in the "Tumor Like" category?
* Not exhaustive list
* **Fibrous dysplasia** - as common as Paget's
273
If a tumor is most likely benign, what will it's characteristics be?
* Almost always originate before age of 30 (with exception of giant cell tumor 20-40 years old)
KNOW THIS\*\*\*
275
Primary Bone Tumors:
* Bone Forming Tumors
* Cartilage Forming Tumors
* Giant Cell Tumor of Bone/Osteoclastoma
* Marrow Tumors (Round Cell Tumors)
* Vascular and Connective Tissue Tumors
* Notochord Remnant Tumor
276
What are the Bone forming primary bone tumors?
* **_Benign_**
* Osteoma
* Osteoid Osteoma
* Osteoblastoma
* **_Malignant - Osteosarcomas_**
* Conventional Osteosarcoma
* 72% central
* 75% sclerotic
* 25% lytic
* Parosteal Os 4%
* Periosteal Os 1%
* Multifocal Os/osteosarcomatosis 1%
* Osteosarcoma of Jaw - 6%
* Post Radiation Os - 4%
* Os in Paget's disease - 3%
* Os Degeneration from benign condition - 1%
* Telangiectatic Os - 3%
* Dedifferentiated Chondrosarcoma - 3%
* Extraskeletal Os. \< 1%
277
What are the Benign Cartilage Forming Tumors?
* Benign
* Chodnroma/Enchondroma
* Solitary Osteochondroma
* Chondromyxoid Fibroma/Fibromyxoid Chondroma
* Chondroblastoma
278
What are the malignant Cartilage forming tumors?
Malignant
* Primary Chondrosarcoma - arise de novo
* Secondary Chondrosarcoma - from preexisting benign tumor
* Central - From enchondroma
* Peripheral - From Osteochondroma
* Clear cell chondrosarcoma - mistaken form chondroblastoma, low grade
* Extra Skeletal - Rare
279
What are the marrow tumors (round cell tumors?)
* Ewing's Sarcoma
* NHL (non hodgkin lymphoma) of bone/reticulum cell sarcoma
* Multiple Myeloma
280
What are the branches of multiple myeloma?
* Classical MM
* Myelomatosis
* Plasmacytoma
* Extra Osseous MM
281
Vascular and Connective Tissue tumors are in what category, what are their subcategories?
It is in the category of "primary bone tumor"
* Benign - Hemangioma
* Malignant - Fibrosarcoma
282
Metastatic Tumors in bone - most common skeletal malginancy
* Osteolytic Mets
* Osteoblastic Mets
* Mixed Mets
283
Tumor Like Conditions:
PRIMARY BONE TUMORS
* Solitary bone cyst/Unicameral bone cyst
* Aneurysmal bone cyst
* Fibrous Cortical defect and nonossifying fibroma
* Fibrous Dysplasia
* Brown Tumor of hyperparathyroidism
* Pseudotumors of Hemophilia
* Large Arthritic Cysts/Geode
284
If it's a benign tumor they overwhelmingly originate when?
Before the Age of 30
285
If a tumor is asymptomatic and benign, it may not show till \_\_\_\_
age 50
286
When does Giant cell tumor usually occur?
20-40 this is an exception
287
Metastisis happens how?
Through Vascular system
288
Big 6 strongest potential to spread?
1. Breast - females 70%
2. Lung - 25%
3. Prostate - Males 60%
4. Kidney
5. Ewing's
6. Neuroblastoma
\*\*\* Breast, lung, prostate, and kidney account for 80%
289
Where does lytic Mets come from?
Physical bulk - pressure from the tumor taking up space which impedes the osteoblasts
* More common (75% of metastasis destroys)
290
Approximately 80% of all osseous metastases will be found \_\_\_\_\_
In the axial skeleton
* 28% ribs
* 39% vertebra
* 13% bony pelvis
10 % of skeletal metastasis will be found in the cranium
10% extremities
291
Is Enostosis primary or secondary bone tumor?
Primary
AKA BONE ISLAND
292
What is enostosis classified as?
Tumorlike, usually an incidental finding, and is asymptomatic
293
What are the characteristics of Enostosis?
* Rare in children
* Osteosclerotic bone lesion
* Can be considered a hamartoma (benign tumor that is multicellular and has all the cells of the host tissue)
294
Where is the location of Enostosis?
Intramedullary Location - usually up against inner surface of cortex
* Composed of normal appearing compact lamellar bone with haversian canals
* Blends with surround trabecular bone creating irregular margin
295
What is the radiological appearance of Enostosis
* Round to oval (.2 - 2 cm) osteoblastic area
* Epiphyseal or metaphyseal
* Bone scan NORMAL
95 % no need for further radiologic evaluation
296
WHat is the differential diagnosis for Enostosis?
Osteoblastic Mets, osteoma, osteoid osteoma, low grade osteosarcoma
297
Osteoblastic mets \_\_\_\_
HURTS
298
low grade osteosarcoma is \_\_\_\_
PAINFUL
299
When would you take a biopsy of Enostosis?
Increase in size of 25% in 6 months
300
Bony pelivs is a common site to see \_\_\_\_
enostosis
301
Giant bone island is a \_\_\_\_\_
Enostosis that is \> 2-3 cm in size
More likely to have increased activity on bone scan
302
What are the possible diseases related to Enostosis?
* Osteopoikilosis
* Osteopathia Striata
* Melorheostosis
303
Osteopoikilosis =
Periarticular bone islands
304
Osteopathia Striata =
Lesions are more elongated in periarticular pattern, Vooerheve disease, fan-like bands in flat bones
305
What are the 3 common characteristics of Melorheostosis?
* Osteosclerotic bone disorder
* Often symptomatic (pain, decreased ROM, contractures, limb swelling, bowing)
* Scleroderma - like skin lesions over osseous changes
306
What is the radiology of Melorheostosis?
o Osseous excrescences often exuberant and lobulated along bone surface
o Single limb—more common lower extremity
o Also endosteal involvement may extend into marrow space
o Intense activity on bone scan
o Long drippy bone island
307
Benign Bone forming:
OSTEOMA
OSTEOID OSTEOMA
OSTEOBLASTOMA
308
Osteoma aka:
Ivory Exostosis
309
What is a benign, slow growing hamartomatous lesion composed of well differentiated mature bone?
Osteoma
310
What is the defect in Osteoma?
One resorption or formation during skeletal maturation
311
What does osteoma arises beneath?
Endosteum from inner surface of cortex
312
What causes surrounding reactive bone formation in Osteomas?
Elevation of periosteum from underlying bone
313
Osteoma is a bone of \_\_\_\_\_
Intramembranous origin
314
Extracranial Osteoms -
.03% of bone biopsied primary bone lesions
315
Paranasal sinus osteomas -
.4%
Most have a osteosclerotic lesion in a frontal or ethmoid lesion
316
What are the associated abnormailities with Osteoma?
* Gardner's Syndrome
* Mutation of Adenmatous Polyposis Coli Gene (5q21)
* Multiple osteomas, intestinal polypsos, soft tissue desmoid tumors
* Bone lesions may precede intestinal polyposis
317
Describe Gardner's Syndrome in Osteoma:
* Autosomal Dominant
* Syndrome of hamartomatous tumors in different locations
* One of the key findings - osteomas
* Will develop color cancer (precursor to colon cancer)
318
In osteoma, most just have \_\_\_\_
single solitary osteoma
319
What are the clinical issues associated with Osteoma?
* Small lesions usually asymptomatic
* Project away from cortical surface
* Palpable enlarging osseous mass
320
What is the nasal issue with Osteoma?
* Large oseomain paranasal sinus may obstruct nasal ducts
* Can erode wall of cranial fossa and dura
* Can cause mucocele, sinusitis, headache, pain
321
What can osteoma tumors near orbit cause?
Cause exopthalmosis, double vision, vision loss
322
What about the Hx of Osteoma:
* Found before 30 but can be seen anytime
* EQUAL GENDER
* No malginant potential
323
What looks identical to bone island but has different location?
Osteoma
324
What does Osteoma look like radiographically?
(first 3)
* Well defined round dense sclerotic lesion attach to underlying bone
* Vast majority in frontal and ethmoid sinus
* DENSE ivory like sclerotic mass
325
What does Osteoma look like radiographically?
(last 3)
* No satellite lesions
* Low signal on MRI
* Plain film is good to see them
326
OSTEOID OSTEOMA: main characteristics
* Painful!
* Produce dense periosteal reaction
* Can regress spontaneously - infarction
* Local swelling and point tenderness
327
What is Osteoid Osteoma characterized by?
Nidus less than 1 cm of osteoid/woven bone is vascular tissue surrounded by zone of reactive sclerosis
328
What is elevated in Osteoid Osteoma?
Prostaglandin E2 elevated 100-1000 times within Nidus (pain and vasodilation)
329
Describe the nidus in Osteoid osteoma:
Radiolucent and is the actual tumor
330
Pain is worse at night with what tumor?
Osteoid Osteoma
331
Whats the origin of Osteoid Osteoma?
Unknown, inflammatory, traumatic, vascular, viral
332
What is a distinguishing characteristic of Osteoid Osteoma?
These can produce a painful scoliosis, and they happen in the spine (lean into a legion)
333
Osteoid Osteoma is more common in \_\_\_\_\_\_
males 2-3:1
334
What are the first 4 radiological features of Osteoid Osteoma?
* Long bones are common
* Metaphysis/Diaphysis
* Phalanges of hands and feet
* Spine (10%)
* Posterior Elements 90% - posterior arch lamina
* Vertebral body 10%
335
What are the last 5-6 radiological features of osteoid osteoma?
* Cortical: 70-80%
* Radiolucent Nidus \< 1.5 cm with surrounding dense sclerosis
* Periosteal reaction may be present
* Medullary: 25%
* CT - well defined, round oval nidus surrounded by sclerosis
* MRI - T1 WI nidus isointense to muscle
336
What does osteoid osteoma look like on bone scan?
lights up
(will have a solid dense periosteal reaction)
337
OSTEOBLASTOMA aka:
Giant osteoid osteoma, osteogenic fibroma
338
What is Osteoblastoma characterized by?
* Production of osteoid and woven bone
* Lesion \> 1.5 cm
* Histology similar to osteoid osteoma
339
What are the %'s associated with Osteoblastoma?
\< 1% of primary bone tumors
3% benign bone tumor
340
Describe Osteoblastoma:
* Circumscribed mass, often surrounded by shell of cortical bone or periosteum
* Sharp interphase between lesion and cancellous bone
341
What does the nidus look like in Osteoblastoma?
* 2-10 cm, friable, deep red (highly vascular)
* Very vascular connective tissue stroma with interconnecting trabecular bone
342
What are the symptoms of osteoblastoma?
* Dull, localized pain of insidious onset
* Pain rarely interferes with sleep
* Localized swelling, tenderness, and decreased ROM
* Doesnt respond well to aspirin
343
Osteoblastoma originates \_\_\_\_
under 30
344
Osteoblastoma gender pref.
2-3:1 in males
345
WHat can Ostoeblastoma have?
Foci of aggressive stage 3 lesion (prone to aneurysmal bone cysts formation)
RECURRENCE AFTER resection = 10-25%
346
In aggressive osteoblastoma, the recurrence is ____ %
50
347
First 4 things of Osteoblastoma (radiology):
* 30-50% SPINAL
* Posterior elements --\> 60% spinous, transverse process, pedicle
* Posterior elements with extension into vertebral body 25%
* Vertebral body 15%
* Long bones, 30% originate in metaphysis
348
What are the 5-8 radiographic features of Osteoblastoma?
* Hands and feet 15%
* Skull and Jaw 15%
* Pelvis 5%
* Expansile, lytic circumscribed lesion
* Reactive sclerosis 60%
349
Last radiologic features of Osteoblastoma:
* CAN rapidly increase in size
* Secondary aneurysmal bone cyst (ABC): 16% can look exactly the same
* NECT: Expansile, lytic lesion with or without matrix mineralization
* Can be purely radiolucent inside, speckled (inside matrix), or sclerotic looking
***_KEY IS EXPANSION_***
350
MALIGNANT PRIMARY BONE TUMORS:
Osteosarcoma, aka Osteogenic Osteosarcoma
351
What is the main definition of Osteosarcoma?
Malignant tumor with ability to produce osteoid directly from neoplastic cells
352
Talk about the growth rate of Osteosarcoma:
Frequency of tumor occurence corresponds to greatest growth rate during adolescence
353
What is chemically happening in osteosarcoma?
Overexpression of P-glycogen in OGS cells with propensity for metastasis and rx failure
alteration in Rb genes in OGS
354
Think of osteosarcoma as \_\_\_\_
osteoblastic malignant tumor
355
Periosteal reaction of osteosarcoma =
Spiculated
356
2nd primary bone tumor is \_\_\_\_
Osteosarcoma (MOCEF)
357
When does osteosarcoma peak?
teens
358
Where is the most common location for osteosarcoma?
Distal femoral metaphysis
359
Osteosarcomatosis survival:
Change low
360
Where will osteosarcoma metastasize to?
LUNG
361
Osteosarcoma has a majority of unknown origin, primary, but secondary to predisposing factors are:
* Paget's Disease (4th stage)
* Bone infarction
* Radiation
362
What is the most common malignant primary bone tumor in young adults and children?
Osteosarcoma
363
20% of primary bone malignancies describes what?
Osteosarcoma
364
What is a heterogenous mass with ossified and non ossified components?
Osteosarcoma
365
What are the common symptoms of Osteosarcoma?
Progressive pain, soft tissue mass, swelling, pathological fracture
366
What happens with the cortex during Osteosarcoma?
Penetration of the cortex with often large extraosseous tumor mass
367
What is common with Osteosarcoma in regards to spreading?
Pulmonary mets is common
(like the lungs!) = Pneumothorax
368
What are you going to have an increase with in Osteosarcoma?
Serum Alkaline Phosphatase
369
Describe the age in Osteosarcoma:
* Age = Bimodal
* First peak: 2-3 decade
* Second peak: \> 6th decade
370
What is the gender in Osteosarcoma?
Gender = **_M_**:F
**_1.3-1.6_** : 1
371
What is the 5 year survival for Osteosarcoma?
41%
372
What is the 5 yr with respectable tumor and "No mets"?
60-70%
373
Where are you most likely going to see Osteosarcoma? (location)
* Knee = 55%
* **_Metaphyses of long tubular bones = 80%_**
* Extension into epiphysis: 75%
* Flat Bones, VB: 20%
* In older pt (\> 50 yrs) axial skeleton and flat bones: 40%
374
What is the size of Osteosarcoma?
5-10cm
375
What are some main characteristics of Conventional Osteosarcoma?
* Poorly defined, intramedullary mass, extends through cortex
* Moth eaten bone destruction
* Aggressive P rxn.: Codman's triangle, sunburst pattern
* Indistinct border with wide ZOT
* Soft tissue mass +/- tumor calcification
376
What is described as "Telangiectatic Osteosarcoma?"
* Purely lytic lesion
* Cystic cavities filled with blood, necrosis
* Fluid Levels
377
Describe Multicentric Osteosarcoma:
* Synchronous Osteoblastic Osteosarcoma at multiple sites
* **_ONLY IN CHILDREN_**
* HORRIBLE PROGNOSIS
378
Describe Parosteal Osteosarcoma:
* Low grade osteosarcoma in older age group (20-50)
* Posterior Distal Femur
* Attached to underlying cortex at origin
379
Describe Periosteal Osteosarcoma:
* Intermediate grade Osteosarcoma
* Most common diaphyseal
* No medullary involvement
* **_CORTICAL THICKENING_**
380
Describe Gnathic Osteosarcoma:
* Involvement of mandible, maxilla
* Sclerotic, lytic, mixed
* Peri rxn
* Soft tissue extension (pictured below)
381
Describe Secondary Osteosarcoma:
Arises in pre-existing lesion of bone such as Paget disease, prior radiation, bone infarction, fibrous dysplasia, prosthesis, OI, chronic osteomyelitis, retinoblastoma
* About half of osteosarcoma over age 50 are secondary, 67% over age 60
382
What is helpful in imaging surface of OGS (Chondroblastic Osteosarcoma)?
NECT
383
CECT (Contrast Enhanced C T) helps further identify what disease?
Osteosarcoma
384
What would you see with Osteosarcoma on NucMed?
Increased uptake (staging, skip lesions, metastasis)
385
Osteochondroma is \_\_\_\_\_\_
asymptomatic, common, and is also called "exostosis"
386
What is osteochondroma?
Developmental osseous anomaly resulting in exophytic outgrowth on surface of bone (individuals are born with these)
387
What is osteochondroma the result of?
Ectopic epiphyseal tissue (tissue in wrong place)
388
What is the SINGLE MOST COMMON BENIGN BONE TUMOR?
Osteochondroma
389
Describe the bony part of osteochondroma:
Bony part is an integral part of host bone - cortex of host is continuous with cortex of lesion and medullary cavity of host is continuous with medullary part of lesion
390
What is Sessile Osteochondroma associated with?
Undertubulation of long bones (erlenmeyer flask deformity)
391
Describe the exostosis in osteochondroma:
Bony part is stalk/base, cartilage cap is over the top in the soft tissue (only visible to the extent it is calcified)
392
Benign cartilage tumors (enchondroma and osteochondroma) have a strong tendency to \_\_\_\_
Calcify in the cartilage
393
Why don't Osteochondromas hurt?
Because they are space occupying, they can cause symptoms by pressure (compression) = SECONDARY symptoms
394
When do osteochondromas stop growing?
When the individual matures and stops growing,
* Surgical resection = do sometimes reoccur, and only resect them if they are casuing physical mass symptomatology (pushing against adjacent soft tissue)
395
What are the 3 subforms of osteochondroma?
Solidary Osteochondroma
Multiple Osteochondroma
Hereditary (genetic) Multiple Exostosis (HME)
396
Describe Solidary Osteochondroma:
SINGLE, MOST COMMON, big tubular bones (metaphyses)
* tibia
* humerus
* femur
397
Describe Hereditary (genetic) multiple exostosis (HME):
* Many, dozens!
* GENETIC
* Can lead to bone deformity
* KNEES!!!
* Sessile more common
398
What can Hereditary (genetic) multiple exostosis result in (HME)?
Pseudo-Madelung deformity (ulnar shortening, bowing of radius)
399
What do you have to worry about with HME?
Increased risk of malignant transformation
400
What is MAIN COMPLICATION associated with osteochondroma?
**Malignant degeneration of the cartilage cap**
401
Chondrosarcoma can become:
Central or Peripheral
402
Peripheral chondrosarcoma means:
External to medullary cavity in soft tissue
403
If osteochondroma hurts, what should happen?
If it hurts where it didn't hurt before this would be a red flag for malignant degeneration
404
Enchondroma is symptomatic or Asymp.?
Asymptomatic
405
What is the 2nd most common benign bone tumor?
Enchondroma
406
Describe Enchondroma:
* Well defined lytic lesion with chondroid matrix
* Juxtacortical (next to cortex)
* Most commonly in MEDULLARY CAVITY
407
Where are you going to find enchondroma?
Short tubular bones of hand and feet (60%)
* **MOST COMMON TUMOR OF PHALANGES OF THE HAND\*\***
408
Snowflake calcification would be seen with what tumor?
Enchondroma
409
What are enchondromas subject to?
Pathological fracture (thins cortex), and pain unexplained by fracture should make you think malignant degeneration
410
If enchondroma becomes malignant, what does it become?
CENTRAL CHONDROSARCOMA
411
What can enchondroma look similar to?
medullary infarct
412
What is Ollier disease?
Enchondromatosis
413
Explain Olliers disease:
* Multiple enchondromas
* expansile
* predilection of appendicular skeleton
* mostly unilateral monemelic distribution
414
What can Ollier disease become?
Sarcomatous Transformation (25-30%)
415
Maffuci Syndrome is associated with what benign bone tumor?
Enchondroma
416
What exactly is Maffuci Syndrome?
* Multiple enchondromas (ollier) and soft tissue hemangiomas
* Commonly have phelbolits (small, rounded calcifications)
417
Describe what you'd see with Maffuci Syndrome:
Very large enchondromas, projecting into soft tissues
* **_MALIGNANT TRANSFORMATION into CHONDROSARCOMA (central) = 15-25%_**
418
Chondroblastoma aka
Codman's Tumor
419
What is the best diagnostic clue for Chondroblastoma?
Well defined lytic lesion centered in epiphysis of skeletal immature patients
420
Where are you most likely to find Chondroblastoma?
LONG BONES 80%
421
What does chondroblastoma really like?
TIBIA
422
Chondroblastoma causes pain, T/F?
TRUE, that's why it is LESS LIKELY to become Malignant
423
Chondromyxoid fibroma aka
Fibromyxoid Chondroma
424
Where are you going to see chondromyxoid fibroma?
LOWER EXTREMITY (Loves the knee)
* knee 55%
* foot 20-25%
425
What age group would you see chondromyxoid fibroma?
young adults (60%), \< 30 y.o.
426
What will you see radiographically with chondromyxoid fibroma?
Geographic 1A-1C lesion
* Eccentric metaphyseal location, often cortical
427
Chondromyxoid fibroma will usually turn malignant?
t/f
FALSE, they are PAINFUL!!
More likely to tell someone (Dr.) about it when they're painful
428
What are the 3 key features of Chondromyxoid Fibroma?
1. Myxoid, fibrous and chondroid tissue in various proportions
2. Expansile remodeling simulating cortical permeation
3. Rare matrix mineralization
429
Chondrosarcoma is the \_\_\_\_
3rd most common primary bone tumor
MO**_C_**EF
430
Chondrosarcoma is the most common:
Malignant tumor of the hand, sternum
431
What are the most common locations for chondrosarcoma?
Pelvis, Femur, humerus
432
What symptoms are associated with Chondrosarcoma?
Slow growing tumor = Deep pain, constipation, bladder issues (affects sacrum)
433
What will you see radiographically with Chondrosarcoma?
Expansile geographic lesion, calcification (ring like), Margination has variable growth rate.
*_**ENDOSTEAL SCALLOPING\*\*\***_*
434
Chondrosarcoma can be ____ or \_\_\_\_\_\_
central or peripheral
* central = inside bone
* eccentric = outsie bone
435
Will you have lab findings with Chondrosarcoma?
NO!
436
Chondrosarcoma comes in 2 forms, what are they?
* **_Primary_**: Denovo
* **_Secondary_**: More common to come from something pre-existing like benign cartilage tumor
437
What are the primary types of Chondrosarcoma?
* Intramedullary
* periosteal/juxtacortical
* clear cell
* mesenchymal
* myxoid
* extraskeletal
* dedifferentiated
438
What are the secondary types of chondrosarcoma?
* enchondroma
* osteochondroma
* paget disease
* radiation induced
439
Describe Intramedullary Chondrosarcoma:
* symptoms: pain (95-99%) and mass (82%)
* Average age 40-45
* Metaphysis
440
Describe Intramedullary Chondrosarcoma:
* Geographic 1A-1C to permeative (often predominantly sclerotic)
* Deep Endosteal scalloping
* Expansile remodeling
* Soft tissue mass (20-76%)
* Chondroid Matrix (78% by x-ray, 94% by CT)
441
Describe Juxtacortical Chondrosarcoma:
* 2nd - 4th decade (MALE predilection)
* Metaphyseal particularly femur and humerus
* Similar to juxtacortical chondroma
* Periosteal lesion - cortical erosion
* chondroid features with matrix calcification
* Larger than juxtacortical chondroma ( \> 3-4 cm)
442
2nd part of Juxta cortical chondrosarcoma:
* Similar appearance to periosteal OGS (but no hair onend p rxn)
* Intramedullary canal usually spread
* Most lesions are low grade
* Good prognosis 83% 5 year survival rate
443
Clear cell chondrosarcoma:
* 2 % of chondrosarcoma
* slightly younger age
* 75-80% lesion prox femur or humerus
* propensity for epiphysis
* better prognosis
444
Clear cell chondrosarcoma 2:
* Geographic 1A-1C lytic
* Totally lytic 50%; calcified chondroid matrix 33%
* Rind of sclerosis simulate nonaggressive lesion 20%
* Soft tissue mass less common (10%)
445
Dedifferentiated Chondrosarcoma:
* Older pt. ave 60 yrs
* 10-20% of chondrosarcomas
* Often associated with secondary chondrosarcoma
* Location
* femur 20%
* humerus 15%
* pelvis 30%
* Ribs and scap 12%
* Low grade Chondrosarcoma
* Spindle cell component
446
Dedifferentiated Chondrosarcoma 2:
* Radiology emulates pathology: dual characteristics
* one region chondrosarcoma, second area aggressive
* bone destruction
* Cortical permeation and soft tissue mass 70%
447
Giant Cell Tumor:
* Quasi - malignant (Yochum)
* Can have an aggressive behavior and even metasysis to lungs (rare)
* Multinucleated giant cells in the tumor
* Peak age: 20-40
* Location: knee and femur, sacrum
448
What are the radiographic findings of Giant cell tumor?
* Lytic, subarticular and eccentric
* Often lack a sclerotic rim
* No host reaction
449
Hemangioma is a \_\_\_\_
congenital anomaly
450
Where do hemangioma occur?
Bone skin and viscera
451
Where in the body do Hemangiomas occur?
* 50% osseous hemangiomas in spine
* 20% in skull
* remaining in ribs, patella, long bones, and short tubular bones of the hand and feet
USUALLY SOLITARY LESIONS
452
What are the 2 broad categories of Hemangioma?
1. Capillary
1. Hap hazardly arranged capillary sized vessels
2. Cavernous
1. Dilated vessels, lined with attenuated endothelial cells
453
Hemangiomas (gender)
Femal to male
3:2
454
Where are hemangiomas seen?
Vertebral body lower thoracic spine and upper lumbar spine
455
What are the appearances of hemangioma?
* Exaggerated vertebral radiopaque striations, called "acordion," or "corduroy cloth" or "jail bar pattern"
* Cervical spine pattern often exhibit a "honeycomb" appearance
* CT = "Polka dot"
456
Glomus Tumor:
* Pt 4-5th decade
* Tumor of neuromyoarterial glomus
* Almost all in terminal phalanx soft tissue
* Bone erosion/invasion (15-65%)
457
What is angiomatosis?
Multifocal or diffuse infiltration of bone by hemangiomatous or lymphangiomatous lesions with or without soft tissue involvment
458
What are the characteristics of angiomatosis?
* Young pt. (first 3 decades)
* M\>F = 2:1
* No malignant potential
459
Describe the involvment associated with angiomatosis:
* Osseous Involvment: Benign Course
* Visceral Involvment: Poor prognosis
460
What are Angiomatous Syndromes?
* Maffucci syndrome
* Osler-Weber-Rendu
* Klippel-Trenaunay-Weber
* Massive Osteolysis of Gorham
461
Massive osteolysis of Gorham aka:
Vanishing bone disease
462
What are the key features of Massive Osteolysis of Gorham?
* Pt \>40
* 50% with history of trauma
* Upper ext. favored, may extend across joint
463
2 characteristics of Massive Osteolysis of Gorham:
Progressive bone absorption and fragmentation (simulate neuropathy)
Proliferating vascular channels
464
What is Histiocytosis X?
* Langerhans cell histiocytosis
* Eosinophilic granuloma (less severe) localized one lesion
* Hand Schueller-Christian disease
* **_Letterer-Siwe (most severe) die before 2_**
465
Describe the bone lesions of Eosinophilic granuloma:
Rare beyond the age of 20
* **MC** **presentation**: Solitary, painful bone lesions although they may be disseminated and polyostotic (HSC, LS)
* **Location**: Skull (MC) & Vertebra
GREAT PROGNOSIS
466
What do you see radiographically with bone lesions of Eosinophilic granuloma?
* Lytic lesion, well defined, sharp demarcated
* Beveled edges in the skull (crater like)
* Associated sequestrum
* (+) scintigraphy
* Lab findings vary
467
What is eosinophilic granuloma Ddx?
* Leukemia
* Lymphoma
* Osteomyelitis (sequestrum)
* Ewings
468
What is the only tumor that crosses joints?
CHORDOMA
Behaves like an INFECTION
469
What are the characteristics of chordoma?
* age \> 40
* Originates in remnants of notochord
* Location: Sacro-coccygeal, spheno-occipital region (clivus), cervical spine (C2)
470
Destructive lesion in sacrum =
CHORDOMA
471
What will the patient present with (w/ Chordoma)?
Bowel/bladder deficiency, increased intracranial pressure, cord encroachment
* Very EXPANSILE LESION
* GEOGRAPHIC, slow growing but aggressive
472
What is "tumor of the nerves?"
Schwanoma / Neurofibroma
473
Where is Schwanoma/neurofibroma found?
In cranial nerves, nerve roots, or in the periphery
474
What will you see with Schwanoma / Neurofibroma?
Radiographically, none for the tumor, but the tumor can erode or reshpae bone
**Example: ENLARGEMENT of IVF,** erodes pedicles and VB
475
What are the "Tumor Like Lesions?"
* Fibrous Xanthoma
* Fibrous Dysplasia
* Aneurysmal Bone Cyst (ABC)
* Simple Bone Cyst (SBC)
* Fibrous Dysplasia
476
What is fibrous xanthomas?
* Fibrous cortical defect (4-8)
* Non-ossifying fibroma (8-20)
NON PAINFUL INCIDENTAL FINDING
Location: around knee
477
Radiographic Presentation of Fibrous Xanthoma:
* Geographic, elongated lesion with a sclerotic border
* Bubbly appearance, endosteal scalloping
* Expansile, thin cortex
* Pathological fracture if very large
478
Simple Bone Cyst aka:
Unicameral or solitary bone cyst
Not a tumor: Fluid Filled Cyst
479
What are the features of Simple Bone Cyst?
* Age: Pediatrics
* Locations:
* MC: Proximal Humerus
* Proximal Femur
* Asymptomatic Presentation unless fractured
480
Radiographically what will you see with simple bone cyst?
* Large, expansile, geographic lesion
* Centric, medullary of long bones
* Well-defined, endosteal scalloping
* Metaphyseal, slides down the diaphysis with growth
* **_Truncated-cone appearance_**
* **_Fallen fragment sign (bone cyst)_**
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What is aneurysmal bone cyst named for?
Its shape: Expansile, dilated-blood vessels are not involved
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Main features of aneurysmal bone cyst:
* **Age: 5-25**
* Location: Femur, tibia, posterior elements of the spine
* Only benign tumor that can cross physis
* Fairly aggressive
* Has nothing to do with vasculature (Pseudotumor)
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Radiographic appearance of Aneurysmal bone cyst:
* Large expansile, geographic lesion
* Metaphyseal, diaphyseal
* Cortical thinning
* May cause neuro defect due to size
* **_CAN CROSS JOINT SPACE_**
**_LOOKS LIKE OSTEOBLASTOMA_**
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Aneurysmal bone cyst does what to spine?
Common to affect posterior elements, pedicle destruction doesnt = malignancy, looks exactly like osteoblastoma. (COMMON IN PEDES)
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Fibrous Dysplasia features:
* Bone disorder of unknown origin
* May be associated with skin and endocrine processes (McCune - Albright) pigment problems and puberty problems
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2 forms of Fibrous Dysplasia:
Monostotic (70%) and Polyostotic
Endocrine harming vs non endocrine harming
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Polyostotic vs Monostotic
* Monostotic: Can usually be an incidental finding
* Polyostotic: Forms can manifest along with a precocious puberty around age 8
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Fibrous Dysplasia appearance:
* **Leonine appearance**: Forehead/face, looks like a lion
* Cherubism: Fibrous Dys. of the jaw
* Can cause BONE DEFORMITY
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Ground glass appearnace thinking =
fibrous dysplasia
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Common sightings in Fibrous Dysplasia:
Pseudofractures, path fractures, geographic, elongated lucent lesion with ground glass matrix, thick sclerotic rim, cortical thinning and scalloping
