Part 10-test 3 Flashcards by Rachael Beverage

-oma

tumor

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tumor

lesion followed by an abnormal growth of cells

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benign tumor

abnormal tissue masses are are not cancers

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malignant tumor

synonymous with cancer and malignant tumors are usually named using -carcinom, -sarcoma or -blastoma

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cancer

diseases in which abnormal cells divide without control and are able to invade other tissues

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carcinoma

any malignant cancer that arises from epithelial cells

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sarcoma

cancer that begins in bone, cartilage, fat, muscle, blood vessels or other connective or supportive tissue

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lymphoma/leukemia

malignancies derived from hematopoietic cells

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blastoma

tumor (usually malignant) which resembles an immature or embryonic tissue

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metastasis

new tumors that appear far from the original tumor

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predictive factors for differential diagnosis

age
incidence
skeletal location
interosseous location
tumor appearance
clinical presentation

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metastatic disease

74% of all malignancies in bone

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MC malignant tumor in adults

multiple myeloma

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MC malignant tumor in kids

osteosarcoma

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MC benign osseous tumor

osteochondroma

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MC benign spinal tumor

hemangioma

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what pattern of bone destruction is least worrysome? most?

least- geographic

most- permative

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what are the positions of a lesion in the horizontal plane?

central/medullary
eccentric
cortical
parosteal
soft tissues

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describe geographic bone desctruction

least aggressive
usually solitary lesion <1cm
indicative of a slow growing lesion
short zone of transition
margin is well defined, can be smooth or isolated

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describe moth eaten destruction

moderate degree of aggressiveness
numerous small holes (2-5mm) in size
longer zone of transition than geographic
margins are not well defined

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describe permeative bone destruction

most aggressive growing lesion
numerous small holes (1mm) in size
wide zone of transition
poorly demarcated or imperceptible borders

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what are the big differences between benign and malignant holes in bones?

longer zone of transition=more aggressive

shorter zone of transition= less aggressive

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cortical changes that could indicate tumors?

buttressing/thickening
endosteal scalloping
splitting or tunneling
thinning with or without expansion
penetration with or without periosteal reaction

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differential diagnoses of solitary lucent bone lesions

FOG MACHINES
fibrous dysplasia
osteoblastoma
giant cell tumor
metastasis
aneurysmal bone cyst
chondroblastoma
hyperparathyroidism (brown tumor)
infection (osteomyelitis)
non-ossifying fibroma
enchondroma/eosinophilic granuloma
simple (unicameral) bone cyst

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types of periosteal reactions

``` laminated codman's hair on end solid complex ```

describe buttressing/solid periosteal reaction

additional layers of new bone are added to exterior creating an expanded osseous contour

buttressing/solid periosteal reactions are associated with?

slow growing lesions

describe laminated/layered/onion skinned

multiple alternating layers of lucency and opacity with alternating growth can be thin or thick can be seen in slow or aggressive lesions

onion skin/layered/laminated are associated with?

Ewing's sarcoma

describe spiculated

linear radiating spicules of new bone | "hair on end"

describe sunburst

type of spiculated | when bone is radiating from a central focus

spiculated is associated with?

osteosarcoma

describe codman's triangle

triangular elevation periosteum seen at the peripheral lesion-cortex junction may be seen also with benign tumors, infections or other disorders

what is one of the most aggressive forms of periosteal reactions?

codman's triangle

what are the different types of tumor matrices?

``` osseous fibrus vascular muscular cartilaginous ```

cartilaginous matrix appearances

``` ring/arc like flocculent small crystals popcorn like stippled ```

benign tumors with cartilaginous matrix

enchondroma osteochondroma chondroblastoma chondromyxoid fibroma

malignant tumors with cartilaginous matrix

chondrosarcoma

osseous matrix appearances

variable size radiodense areas may occupy parts of entire lesion can be homogenous or inhomogenous increased density changes/sclerosis solid, cloud like, ivory like

benign tumors with osseous matrix

osteoma osteoblastoma osteochondroma osteoid osteoma

malignant tumors with osseous matrix

osteosarcoma

benign tumors with fibrous dysplasia

``` fibrous dysplasia desmoplastic fibroma non-ossifying fibroma fibrous cortical defect ossifying fibroma ```

malignant tumors with fibrous dysplasia

fibrosarcoma

what are the differences between primary and secondary neoplasias?

primary- bone expansion, >6cm in length, periosteal reactions, presence of soft tissue masses secondary- <6cm in length, number of lesions

what is the most common tumor of bone?

metastasis

most common primary sites for mets?

breast, lung, prostate, kidney, thyroid, bowel

describe MC female tumor

70% breast 80% are lytic next MC are thyroid, kidney, uterus

describe MC male tumor

60% prostate 80% are blastic next MC is lung, which is mostly lytic

what are the different pathways of metastasis?

hematogenous dissemination via Batson's venous plexus lymphatic dissemination direct extension

lab values that may be present with metastasis?

``` ESR serum calcium alkaline phosphatase (blastic) acid phosphatase&/or PSA antigen (prostate) serum protein albumin:globulin ratio protein electrophoresis ```

clinical features of metastasis

40 or older recent weight loss, look like death, anemic, fever initial sign may be pathological fx pain is usually persistent and nocturnal

MC sites for metastasis

``` spine ribs and sternum pelvis and sacrum proximal extremities skull ```

acral metastasis

lytic mets to distal elbow and knees most common to hands and feet most commonly linked to lung cancer

radiographic signs of metastasis

osteolytic osteoblastic mixed

radiographic features of vertebral metastasis

``` ivory vertebra pedicle descruction pathologic collapse focal osteoporosis of a body malignant schmorl's node formation ```

most common reason for pathological collapse in adults

lytic mets multiple myeloma traumatic fracture (osteoporosis)

most common reason for a pathological collapse in kids

eosinophilic granuloma

what is the name of a flat or pancake vertebra?

vertebra plana

solitary ivory vertebra are MC seen in?

paget's Hodgkin's lymphoma osteoblastic metastasis

T1 MRI characteristics of metastasis? T2?

T1: most sensitive (shows as a low signal) metastatic lesion oblique, angled or round check for pedicular involvement extradural mass, multiplicity T2: less sensitive (shows as high signal