MSK Bone Tumors Flashcards
(155 cards)
1
Q
Lodwick classification of bone destruction?
A
Type:
- 1: geographic
- 2: moth-eaten
- 3: permeative
2
Q
Lodwick classification of bone destruction –> Type 1: geographic –> 3 subtypes?
A
- 1A: thin sclerotic margin –> almost always non-agg
- 1B: well-defined margin –> usu non-agg
- 1C: partially indistinct
3
Q
Lodwick classification of bone destruction –> type 3: permeative –> can be seen with what conditions? (3)
A
- lymphoma
- leukemia
- Ewing sarcoma
4
Q
bone lesion –> fluffy, cloud-like matrix –> what matrix type?
A
Osteoid
5
Q
bone lesion –> ring&arc, popcorn-like matrix –> what matrix type?
A
Chondroid
6
Q
bone lesion –> groundglass matrix –> what matrix type?
A
fibrous
7
Q
what is fallen fragmt sign?
A
simple bone cyst –> path fx –> fx fragmt inside bone cyst
8
Q
bone island (enostosis) –> bone scan?
A
normal
9
Q
osteopoikilosis –> synd? (2)
A
AD:
- mult bone island
- keloid
10
Q
what is osteopathia striata?
A
benign asympt dysplasia: long bone, flat pelvic bone –> linear bands of sclerosis
11
Q
osteopathia striata –> bone scan?
A
normal
12
Q
osteoma –> location?
A
cortex:
- skull
- frontal, ethmoid sinus
13
Q
Gardner synd –> synd? (3)
A
AD:
- mult osteoma
- intestine polyps
- soft tissue –> desmoid tumor
14
Q
melorheostosis –> imaging appearance?
A
cortex –> thick & irreg –> “candle-wax” appear
15
Q
melorheostosis –> assoc soft tissue finding?
A
overlying scleroderma-like skin lesion
16
Q
melorheostosis –> location?
A
unilat LE –> single sclerotome distribution
17
Q
melorheostosis –> bone scan?
A
intense uptake
18
Q
osteoid osteoma –> classic clinical presentation?
A
teen/YA –> night pain –> relieve by ASA
19
Q
osteoid osteoma –> XR/CT appearance?
A
- lucent nidus –> surrounding sclerosis
- central calc
20
Q
osteoid osteoma –> bone scan?
A
“double density” sign:
- nidus –> intense uptake
- sclerosis –> adj reactive uptake
21
Q
osteoid osteoma –> tx?
A
- IR radiofreq ablation
- surgical curettage
- resect
22
Q
what is osteoblastoma?
A
osteoid osteoma –> >2cm
23
Q
differentiate: osteoid osteoma vs osteoblastoma –> clinical presentation?
A
osteoid osteoma:
- teen/YA
- pain
- relieve w ASA
osteoblastoma:
- teen/YA
- pain
- NOT relieve w ASA
24
Q
osteoblastoma –> MC location?
A
spine –> post elements
25
YA --> spine post element --> lytic lesion --> ddx? (2)
- osteoblastoma
| - aneurysmal bone cyst
26
osteoblastoma --> MC imaging appearance?
lucent lesion --> mineralized
27
2ary osteosarcoma --> etiology? (2)
- Paget dz
| - radiation
28
osteosarcoma --> general imaging hallmarks? (4)
- bony destruct
- osteoid matrix
- agg periosteal rxn
- assoc ST mass
29
osteosarcoma --> 4 MC subtypes?
- #1 conventional (intramedullary)
- telangiectatic
- parosteal
- periosteal
30
osteosarcoma --> conventional (intramedullary) subtype --> MC location?
knee --> metaphysis:
- femur
- tibia
31
osteosarcoma --> telangiectatic subtype --> can look like what bone lesion?
benign ABC
32
differentiate: telangiectatic osteosarcoma vs other osteosarcomes
telang: no matrix
other ostesarcomas: osteoid matrix
33
osteosarcoma --> parosteal subtype --> arise from what part of bone?
outer periosteum
34
osteosarcoma --> parosteal subtype --> MC location?
distal femoral metaphysis --> post aspect
35
osteosarcoma --> parosteal subtype --> imaging appearance?
cauliflower-like exophytic --> lucent line separate from cortex
36
osteosarcoma --> parosteal subtype --> epidemiology?
30s-40s
37
osteosarcoma --> least malig subtype
parosteal
38
osteosarcoma --> periosteal subtype --> arise from what part of bone?
inner periosteum
39
osteosarcoma --> periosteal subtype --> MC location?
femur/tibia --> diaphysis
40
osteosarcoma --> periosteal subtype --> epidemiology?
<20yo
41
osteosarcoma --> MC mets location? appearance?
lungs --> calcify
42
what is synovial osteo/chondromatosis?
non-neoplastic --> synovial metaplasia --> intra-articular cartilag nodules
43
synovial osteo/chondromatosis --> MC location?
knee
44
mult round intra-articular bodies --> ddx? (2)
- synovial chondromatosis
| - OA --> intra-articular bodies
45
MRI --> mult intra-articular foci --> low signal --> ddx? (2)
- synovial chondromatosis --> ossified
| - pigmented villonodular synovitis (PVNS)
46
what is enchondroma?
benign --> lesion of mature hyaline cartilage rests
47
enchondroma --> matrix?
long bone --> chondroid
hand --> no visible matrix --> lytic lesion
48
enchondroma --> ddx? (2)
- medullary bone infarct
| - chondrosarcoma
49
enchondroma --> tx?
curettage
50
what is osteochondroma?
benign --> bone growth projecting outward --> cartilage-cap
51
osteochondroma --> location?
metaphysis --> grow away from epiphysis
52
osteochondroma --> key imaging finding?
cortex & medulla continuous w host bone
53
osteochondroma --> potenial comp?
malig transform --> chondrosarcoma
54
mult osteochondromas --> what condition?
familial osteochondromatosis (mult hereditary exostoses)
55
chondroblastoma --> age?
skeletally immature --> 5-25yo
56
chondroblastoma --> location?
- long vs flat bone?
- dia/meta/epi-physis?
- MC bone?
- centric vs eccentric?
- long bone --> epiphysis --> eccentric
| - knee/prox humerus
57
chondroblastoma --> T2 signal?
T2 --> low-interm
| most chondroid lesions --> T2 hyper
58
chondroblastoma --> tx?
- curettage
- cryosurg
- radiofreq ablation
59
chondroblastoma --> benign or malig?
benign
60
what is chondromyxoid fibroma?
very rare --> benign cartilage tumor
61
chondromyxoid fibroma --> location?
knee --> femur/tibia metaphysis --> ecc
62
chondromyxoid fibroma --> imaging appearance:
- XR
- MR
XR --> sclerotic margins
MR --> T2 hyper
63
2ary chondrosarcoma --> etiology? (3)
- enchondroma
- Paget dz
- osteochondroma
64
osteochondroma --> what finding is highly sugg of chondrosarcoma?
cartilage cap >2cm
65
chondrosarcoma --> MC subtype?
conventional (intramedullary)
66
chondrosarcoma --> MC imaging appearance?
- medulla --> expansile lesion --> chondroid matrix
- cortex --> thick --> endosteal scallop
- assoc ST mass
67
chondrosarcoma --> dedifferentiated subtype --> aggressive --> can contain elements of what other bone lesions?
- fibrosarcoma
| - osteosarcoma
68
nonossifying fibroma (fibroxanthoma) --> epidemiology?
child & adol
69
differentiate: nonossifying fibroma vs fibrous cortical defect
NOF = FCD:
- >2cm
- sympt
70
nonossifying fibroma (fibroxanthoma) --> MC location?
long bone --> leg
71
nonossifying fibroma (fibroxanthoma) --> XR appearance?
- narrow zone of transition --> sclerotic margin
| - no matrix calc
72
nonossifying fibroma (fibroxanthoma) --> natural progression?
adult --> spont sclerotic involution
73
undifferentiated pleomorphic sarcoma not otherwise specified (malig fibrous histiocytoma) --> epidemiology?
middle age - older
74
undifferentiated pleomorphic sarcoma not otherwise specified (malig fibrous histiocytoma) --> locations? (3)
- thigh
- retroperitoneum
- bone
75
undifferentiated pleomorphic sarcoma not otherwise specified (malig fibrous histiocytoma) --> bone --> imaging appearance?
aggressive lytic lesion
76
what is fibrous dysplasia?
congenital --> benign non-neoplastic --> normal cancellous bone --> replace abnormal fibrous tissue
77
fibrous dysplasia --> epidemiology?
- child
| - YA
78
fibrous dysplasia --> MC comp?
femoral neck --> path fx
79
fibrous dysplasia --> long bone --> location?
metadiaphysis --> central
80
fibrous dysplasia --> femur --> deformity?
shepherds crook
81
YA --> pelvis --> supra-acetabulum --> cystic lesion --> ddx? (2)
- fibrous dysplasia
| - unicameral bone cyst
82
McCune-Albright synd --> synd? (3)
- polyostotic fibrous dysplasia
- precocious puberty
- cafe au lait spots
83
Mazabraud synd --> synd? (2)
- fibrous dysplasia
| - intramusc myxoma
84
vertebral hemangioma --> MRI appear?
fat --> T1/T2 bright
85
vertebral hemangioma --> XR/CT --> sign?
reactive thicken trabeculae:
- "corduroy" striation
- "polka dot"
86
angiosarcoma --> mets location?
lung
87
giant cell tumor --> epidemiology?
skeletal mature --> 20-40yo
88
giant cell tumor --> location?
long bone --> metaphysis/epiphysis --> articular surface --> eccentric
89
multifocal giant cell tumor --> can be see in what condition? (2)
- Paget dz
| - hyperPTH
90
giant cell tumor --> tx?
- curettage
| - wide resect
91
Ewing sarcoma --> epidemiology?
child & adol --> male predominance
92
child --> aggressive lytic lesion --> ddx? (4)
- Ewing sarcoma
- osteomyelitis
- LCH
- neuroblastoma mets
93
Ewing sarcoma --> XR appearance?
agg lesion:
- permeative bone destruct
- agg periosteal rxn
- assoc ST mass
94
mult myeloma (plasmacytoma) --> MC appearance?
mult lytic lesions
95
what is sclerosing myelomatosis?
uncommon variant of mult myeloma (plasmacytoma)
96
sclerosing myelomatosis --> assoc synd?
POEMS synd
97
POEMS synd --> synd? (5)
- polyneuropathy
- organomeg --> liver/spleen
- endocrine disturb --> amenorrhea/gynecomastia
- monoclonal gammopathy
- skin change --> hirsutism, hyperpig
98
adult --> mult lytic lesion --> ddx? (2)
- mult myeloma
| - mets
99
mult myeloma (plasmacytoma) --> originating tissue?
red marrow
100
differentiate: mult myeloma vs mets (2)
mult myeloma:
- not involve areas w minimal red marrow --> pedicles
- bone scan --> can be neg
101
what is plasmacytoma?
mult myeloma --> solitary tumor
102
primary bone lymphoma --> epidemiology?
>40yo
103
vertebral body --> diffusely sclerotic "ivory" --> ddx? (1)
lymphoma
104
lymphoma --> typical imaging appearance?
- agg lytic lesion
| - assoc ST mass
105
intraosseous lipoma --> MC locations? (4)
- calcaneus
- femur --> subtrochanteric
- distal tibia/fibula
- metatarsal
106
intraosseous lipoma --> calc appearance?
central or ring-like calc
107
lipoma --> contain non-adipose tissue --> ddx? (2)
- benign lipoma
| - well-differentiated liposarcoma (atypical lipoma)
108
well-differentiated liposarcoma (atypical lipoma) --> imaging features that suggest liposarcoma? (4)
- >10cm
- thick septat
- globular/nodular soft tissue
- <75% fat
109
what is chordoma?
notochord remnant --> malig lesion
110
chordoma --> location?
axial skeleton --> midline:
- spheno-occipital
- C2 body
- sacro-coccyx
111
chordoma --> appearance?
high destruct lesion --> irreg scallop border
112
chordoma --> calc or no calc?
can have calc (d/t necrosis)
113
simple bone cyst (unicameral bone cyst) --> MOA?
child/adol --> bone growth --> local disturb --> benign
114
simple bone cyst (unicameral bone cyst) --> location?
- MC bone?
- epi/meta/dia-physis?
- central vs ecc?
humerus/femur --> prox diaphysis --> central
115
differentiate: simple bone cyst (unicameral bone cyst) vs aneurysmal bone cyst:
- periosteal rxn
- central vs ecc
SBC:
- no periosteal rxn
- central
ABC:
- periosteal rxn
- central or ecc
116
simple bone cyst (unicameral bone cyst) --> location --> which bones? (5)
- humerus
- femur
- tibia
- calcaneus
- iliac
117
what bone lesions demonstrate fluid-fluid levels? (4)
- simple bone cyst
- aneurysmal bone cyst
- giant cell tumor
- telangiectatic osteosarcoma
118
pediatric --> proximal humerus --> fallen fragmt sign --> dx?
simple bone cyst
119
simple bone cyst --> tx?
intra-lesion inject --> methylprednisolone --> osteogenesis
120
what's inside simple bone cyst?
- fluid
| - nothing
121
what is aneurysmal bone cyst?
blood-filled sinusoids & solif fibrous element --> expansile multicystic lesion
122
aneurysmal bone cyst --> epidemiology?
child & adol
123
agg lesion --> bx --> pathology shows aneurysmal bone cyst --> what does this indicate?
true lesion not bx
124
adamantinoma --> what bone?
tibia
125
adamantinoma --> ddx? (1)
fibrous dysplasia
126
adamantinoma --> imaging feature?
"soap bubble" appearance
127
differentiate: mets vs osteoporosis --> compression fx
mets --> can involve:
- pedicle
- post elements
128
breast cancer --> solitary bone lesion --> high predictive for mets --> what location?
sternum
129
bony mets --> lytic --> what primary cancers? (3)
- lung
- thyroid
- kidney
130
bony mets --> blastic --> what primary cancers? (5)
- prostate
- seminoma
- transitional cell CA
- mucinous tumor
- carcinoid
131
bony mets --> lytic and/or blastic --> what primary cancers? (3)
- breast
- stomach
- colon
132
what is myositis ossificans?
trauma --> skeletal muscle --> heterotopic bone formation
133
myositis ossificans --> MC locations? (2)
- elbow
| - thigh
134
myositis ossificans --> ddx? (1)
parosteal osteosarcoma
135
differentiate: myositis ossificans vs parosteal osteosarcoma --> calc?
myositis ossificans --> peripheral calc
parosteal osteosarcoma --> central calc
136
myositis ossificans --> appearance --> natural progression?
- wk 1-2: soft tissue mass
- wk 3-4: form amorphous osteoid matrix --> adj bone periosteal rxn (can look like early osteosarcoma)
- wk 5-8: peripheral --> mature into compact bone
- <6mo: ossification --> progress to mature
- >6mo: decrease in size
137
myositis ossificans --> bx or no bx? why?
no bx --> path may resemble sarcoma --> unnecess surg
138
what is brown tumor?
hyperPTH --> inc osteoclast activation --> benign lytic lesion
139
brown tumor --> ddx? (1)
giant cell tumor
140
hyperPTH --> imaging features? (4)
- brown tumor
- osteopenia
- subperiosteal bone resorb
- ST calc
141
hyperPTH --> subperiosteal bone resorb --> MC location? (2)
- 2nd/3rd middle phalanx --> radial aspect
| - clavicle --> acromion
142
2ary hyperPTH --> etiology? (1)
renal fail
143
renal fail --> renal osteodystrophy (2ary hyperPTH) --> spine appearance?
"rugger jersey" spine
144
epiphysis --> lucent lesion --> ddx? (5)
GEIChA:
- giant cell tumor
- eosinophilic granuloma
- infx
- chondroblastoma
- aneursymal bone cyst
145
malig tumor at epiphysis --> dx?
clear cell chondrosarcoma
146
ABC --> epidemiology?
<30yo
147
ABC --> MC bone?
tibia
148
classic sclerotic mets? (3)
- prostate
- carcinoid
- medulloblastoma
149
classic lytic mets? (2)
- renal
| - thyroid
150
diffuse ostepenia --> malig ddx? (1)
mult myeloma
151
ant tibia --> lesion that looks like non-ossifying fibroma --> assoc ant tibial bowing --> dx?
osteofibrous dysplasia
152
pleomorphic undifferentiated sarcoma (malig fibrous histiocytoma) --> T2 signal?
dark to interm
153
pleomorphic undifferentiated sarcoma (malig fibrous histiocytoma) --> MC location?
prox extremities
154
spine --> post element --> bone lesion --> ddx? (5)
- osteoblastoma
- ABC
- osteoid osteoma
- myeloma
- mets
155
spine --> vertebral body --> bone lesion --> ddx? (7)
- GCT
- chordoma
- LCH
- Ewing
- lymphoma
- myeloma
- mets
