Neoplasms Flashcards
(22 cards)
Define a primary tumour
Originate in bone or from bone-derived cells and tissues
Define a secondary tumour
Originate in other sites and spread (metastasize) to the skeleton.
What are some common sources of secondary metastasise?
prostate, breasts, lungs, thyroid & kidneys are primary carcinomas that most commonly metastasise to bone
What are the two types of primary tumours?
benign tumours and cancers (malignancy)
What are the different sources of primary benign tumours?
neoplastic, developmental,
traumatic, infectious, or inflammatory
How does the periosteal response differ in primary neoplasms and malignant/metastatic?
Parimay Periosteal Response: Common solid (eg Osteoid Osteoma)
Malignant/metastatic Periosteal Response: Common laminated or spicualted
How does the marginal transition differ in primary neoplasms and malignant/metastatic?
Primary Neoplams:
Often Sharp Zone of Transition (or margination)
Malignant and Metastatic:
Often Imperceptible or wide zone of transition (or margination)
What does a wide zone of transition indicate?
Poor, hazy or ill defined margins is indicative of aggressive bone destruction as seen in infections and malignant tumours.
What are the three types of medullary response
Osteolytic, Osteoblastic and mixed
How would you describe an osteolytic lesion?
These are typified by their loss of localized bone structure and density. It is the subtle loss of bone density that is most difficult to perceive of all patterns of bone disease. Three patterns of radiolucent destruction are identified – geographic, moth eaten and permeative.
How would you describe an osteolytic GEOGRAPHIC lesion?
Other terms are well circumscribed and uniformly lytic lesions. Usually solitary, > 1 cm and a sharper margin. In general are slower growing lesions, i.e. Least aggressive with narrow zone of transition.
How would you describe an Moth-Eaten lesion?
Multiple poorly marginated small or moderately sized lucencies are characteristic of this pattern. Frequently the margins of each lesion are ragged and irregular. This type of destruction reflects an aggressive abnormality with intermediate zone of transition (eg. OM).
How would you describe a Permiative lesion?
Numerous tiny, pin hole sized lucencies (less than 1mm) constitute a permeative pattern. A wide zone of transition is evident. These lesions frequently overlooked because of their size, and with progression may enlarge enough to become moth eaten in character. Usually
seen in the most rapidly aggressive malignant
bone tumours.
How would you describe an osteoblastic lesion?
These show increased density due to overproduction of bone or calcium laden tissue. These may be diffuse ivory-like or localized.
How would you describe a mixed lesion?
Both lytic and blastic patterns are evident. Most common in mixed metastasis.
What are the different types of periosteal responces?
Three basic periosteal patterns
1: Solid,
2: Laminated
3: Spiculated. (Sunburst)
What type of conditions would you see a solid/continuous periosteal response?
Typically related to a very slow form of irritation. Example: stress #, osteoid osteoma, venous stasis and hypertrophic osteoarthropathy.
How would you described a laminted periosteal response?
Onion skinned. Alternating layers of lucent and opaque densities on the external bone surface.
How would you described a spiculated periosteal response?
Additional Terms include brushed whiskers and hair on end. The term SUNBUSRT has been used to describe radiating spicules of bone from a point source. Each spicule is separated from the other by an interposed radiolucent region. This pattern is indicative of a very aggressive bone tumour, often Osteosarcoma.
What is the hall mark finding of an osteochondroma?
Pedunculated exostosis from cortical surface
with a hyaline cartilage cap
What age does a osteochondroma usually present?
75% discovered before age 20
Where are osteochondroma’s usually found?
Long bones femur (34%) humerus (18%) tibia (15%) also pelvis, scapulas and ribs
