Tumors Flashcards
(170 cards)
1
Q
What is the most common intraosseous location for a neurofibroma?
A
Maxilla/Mandible
2
Q
Most common location of a chondromyxoid fibroma?
A
Tibia
3
Q
Most common location of a adamantinoma?
A
Tibia
4
Q
What % of malignant tumors are metastatic?
A
70%
5
Q
What % of metastatic lesions are osteolytic?
A
75%
6
Q
What is the M/C abdominal neoplasm in childhood? What is the 2nd M/C?
A
1st = Wilms' tumor 2nd = neuroblastoma
7
Q
a. What % of Ollier’s disease malignantly degenerates?
b. What % of Maffucci’s disease malignantly degenerates?
A
a. up to 50% (5-30% Resnick)
b. over 50% (20% Resnick)
8
Q
What % of HME malignantly degenerates?
A
20%
9
Q
What type of bone does osteomas arise from?
A
membranous bones
10
Q
What is the M/C for an osteoma?
A
frontal sinuses (also ethmoid sinus)
11
Q
Which segment in the spine is osteoid osteoma likely to be found?
A
Lumbar > cervical > thoracic
12
Q
Identify the following statements to be true or false.
- Osteopoikilosis has cutaneous findings.
- Osteoid osteomas have no gender predilection.
- Osteoid osteomas develop significant reactive sclerosis when intraarticular.
- Osteoblastomas are more vascular than osteoid osteomas.
- Radiofrequency ablation is choice of treatment for osteoid osteoma.
- Osteoblastomas can cause scoliosis.
- Osteoid osteomas like to occur M/C in spine while osteoblastomas like to occur M/C in long bones.
A
- True - 25% –> keloid formations, scleroderma-like lesions
- False - 3M:1F
- False - there is not much periosteum there to react
- True - more osteoblasts too
- False - will cause compression fx
- True - on concave side
- False - other way around
13
Q
What is the appearance of osteoid osteoma on scintigraphy?
A
Double Density Sign = intense activity centrally in region of nidus and less intense peripherally
14
Q
How big is the nidus in conventional osteoblastoma?
A
> 1cm
15
Q
What is the histological hallmark of an aggressive osteoblastoma?
A
epithelioid osteoblast –> hard to differentiate from osteosarcoma
16
Q
What is the characteristic location of an osteofibrous dysplasia?
A
anterior aspect, middle 1/3rd tibial diaphysis
17
Q
What is the age range for conventional osteosarcoma according to Yochum?
A
10-25yrs
18
Q
What is the gold standard for imaging of osteosarcoma?
A
plain film
19
Q
What is the most likely location for conventional osteosarcoma mets?
A
pulmonary > osseous & nodal
20
Q
Which is the most common location for gnatic osteosarcoma?
A
Mandible > maxilla
21
Q
What is the classic radiographic appearance of telangectatic osteosarcoma?
A
expansile, soap-bubbly lesion
22
Q
Which subtype of osteosarcoma is histologically similar to Ewing’s?
A
small cell osteosarcoma
23
Q
What are the radiographic features of intracortical osteosarcoma?
A
- within cortex (no medullary involvement)
- purely lytic with sclerotic rim
- no periosteal reaction
- diaphyseal based in tibia/femur
24
Q
Where on the femur is the most likely location for a periosteal osteosarcoma to occur?
A
distal femur – ANTERIOR (medial or lateral)
25
What is the most likely location for a parosteal osteosarcoma?
distal femur -- POSTERIOR
26
What is implied by the "zoning pattern" in reference to periosteal osteosarcoma?
more mature bone centrally (near cortical surface) and less peripherally??
27
At what age does parosteal osteosarcoma occur?
late teens to 40s --> later than both conventional and periosteal osteosarcoma
28
What are the features of Rothmund-Thompson?
short stature, dystrophic nails, cutaneous abnormalities, radial ray anomalies, multiple osteosarcomas (other tumors also possible)
29
What's the most and least common finger involved in enchondromas?
M/C = 5th finger
| Least common = thumb
30
What % of enchondromas calcify in the hand/foot?
50%
31
what is an exophytic enchondroma in the ribs called?
enchondroma protuberans
32
What is more sensitive to distinguish between enchondroma and low grade chondrosarcoma - histology or image findings?
image findings; enchondroma & low-grade chondrosarcoma can look the exact same on histology
33
Which of the 3 is more common to occur: periosteal osteosarcoma, periosteal chondrosarcoma and periosteal chondroma?
periosteal chondroma >>> periosteal chondrosarcoma > periosteal osteosarcoma
34
What are the radiographic features of periosteal chondroma?
- metaphyseal
- frequently at entheses
- saucerization/scalloping
- 50-75% calcification
35
What is the age group for periosteal chondroma?
<30yoa
36
What is an aka for chondroblastoma?
Codman's tumor
37
What % of chondroblastomas calcify?
30-50% (but may need CT to see)
38
What are the clinical features of chondromyxoid fibromas?
slowly progressive pain, point tenderness & restricted motion
39
Which is the most common location for a chondromyxoid fibroma?
Tibia
40
What are the radiographic features of chondromyxoid fibroma?
- eccentric
- metaphysis
- expansile
- calcification RARE!
41
True or False: cartilaginous caps on osteochondromas are thinner in children vs. adults.
False -- they are thicker (3cm vs <1cm)
42
What is the best diagnostic modality for imaging an osteochondroma?
Radiographs
43
What are 6 complications of osteochondromas?
1. Fracture
2. Osseous deformities
3. Vascular injury
4. Neurologic compromise
5. Bursa formation
6. Malignant transformation
44
Typically, what % of solitary osteochondromas malignantly degenerate?
~1%
45
What systemic disorder can be associated with osseous excrescences?
pseudohypoparathyroidism & pseudo-pseudohypoparathyroidism
46
What % of individuals with HME have a positive family history?
90%
47
What % of HME malignantly degenerate?
up to 25% (but more likely 5%)
48
What are exostosis beneath/adjacent to the nail bed called?
subungual exostosis
49
What is the M/C location for a subungual exostosis?
Great toe
50
Except for hematologic tumors, chondrosarcoma is the M/C malignant tumor of which bones?
- scapula
- ribs
- sternum
- small bones of hand
51
What % of conventional chondrosarcomas have calcification?
up to 60-70%
52
Which chondrosarcoma almost always involves the epiphysis when in a long bone?
clear cell chondrosarcoma
53
Which cartilage based bone tumor can also arise in the soft tissues?
mesenchymal chondrosarcoma
54
What is the average age range for a mesenchymal chondrosarcoma?
25yrs (younger than the other subtypes)
55
Excluding the appendicular skeleton, what's another common location for mesenchymal chondrosarcoma?
craniofacial (20%)
56
List who radiographic features that help in distinguishing between conventional vs mesenchymal chondrosarcoma.
Mesenchymal chondrosarcoma:
1. occur in a younger pop'n
2. has a tendency for the diaphysis
57
What is the most aggressive form of chondrosarcoma?
Dedifferentiated chondrosarcoma
58
What type of radiographic pattern/components constitutes dedifferentiated chondrosarcoma?
Bimorphic:
1. Well-differentiated cartilaginous portion -- looks low grade (eg. low-grade chondrosarcoma)
2. High-grade noncartilaginous sarcomatous portion -- aggressive appearing (eg. osteosarcoma, MFH)
59
What is the typical size and symptom of an FCD and NOF?
FCD 3 cm (symptomatic)
60
Why do NOF/FCD cause osteomalacia/rickets?
B/c the tumor releases a humoral substance that decreases the threshold of renal reaborption of phosphorus --> causes hypophosphatemia
61
What are some of the features of Jaffe-Campanacci Syndrome?
- young (5-15yrs)
- multiple NOF's (>3)
- cafe-au-lait spots
- mental retardation
- hypogonadism
- cryptorchidism (undescended testes)
- cardiovascular abnormalities
- ocular abnormalities
62
What is the almost exclusive location for a juxtacortical desmoid?
postero-medial aspect femur
63
What is the classic radiographic appearance of a periosteal desmoid?
- saucerization
| - periostitis
64
What is the age range for a juxtacortical desmoid?
15-20yrs
65
What is the age range for a desmoplastic fibroma?
<30yrs
66
What locations do desmoplastic fibromas occur in?
- mandible
- femur
- innominate
67
What is the classic radiographic appearance of a desmoplastic fibroma?
soap-bubbly lytic lesion (that can look aggressive)
68
What is a prominent MRI differentiating feature of desmoplastic fibroma?
Low T1 and Low T2 signal!
69
Liechtenstein's Rule describes which tumor?
fibrosarcoma in the knee
70
What are classic radiographic features of fibrosarcoma?
- little periostitis
- absence of calcification
- extensive soft tissue mass
- sequestrum
71
What's another name for fibroxanthoma?
fibrous histiocytoma
72
What is the gender predilection for benign and malignant GCT?
benign --> mildly female
| aggressive --> 3M:1F
73
GCTs in the skull & facial bones are often associated with which condition?
Paget's
74
What sign is produced on scintigraphy with GCT?
donut sign -- intense accumulation around periphery of neoplasm
75
What's another name for Goltz-Gorlin syndrome?
Focal dermal hypoplasia
| ocular defects & skeletal anomalies --> claw hands/clinodactyly, polydactyly, syndactyly
76
Which body region is most commonly involved in multicentric GCTs?
hands
77
What's the 2nd M/C soft tissue mass of the hand? What's the first?
```
1st = ganglion cyst
2nd = GCT tendon sheath
```
78
Name two condition that have giant cells and like to affect the mandible and maxilla?
Giant cell reparative granuloma & ossifying fibroma
79
What's another name for extragnathic reparative granuloma?
Solid ABC
80
Causes of MFH?
- de novo
- within a medullary bone infarct
- paget's disease
- following radiation treatment
81
MFH likes to occur most often where within the body?
soft tissues
82
Another name for cementifying SBC?
cementoma
83
Where is the most common location for a cementifiying SBC?
proximal femur
84
What are the features of Mazabraud?
polyostotic FD + fibrous & myxomatous soft tissue tumors
85
What % of FD is monostotic?
70-80%
86
What is the M/C location of polyostotic FD?
ribs > femur > tibia > mandible
87
Where is the M/C location for polyostotic FD?
skull & facial bones
88
What is the M/C benign lesion of the ribs?
FD
89
What is the classic triad with McCune-Albright Disease?
1. polyostotic fibrous dysplasia
2. cutaneous pigmentation
3. precocious sexual development
90
Endocrine conditions associated with FD:
- Cushing's disease
- acromegaly
- hyperthyroidism
- HPT
- extrainsular-hypothalamic diabetes mellitus
91
What is the rarest primary benign bone tumor (according to Yochum)?
Intraosseous lipoma
92
True or False: intraosseous lipomas are assymptomatic
False - 2/3rds have local pain
93
Which bone is the M/C location for an intraosseous lipoma?
fibula (20%)
94
What is the M/C soft tissue tumor?
Lipoma
95
M/C soft tissue location for a lipoma?
subcutaneous fat (particularly trunk > shoulder > upper arm)
96
2nd M/C soft tissue location for a lipoma?
intramuscular
97
Which benign fatty tumor is very vascular?
hibernoma
98
What's another name for Dercum's disease?
juxta-articular adiposis dolorosa
99
What is Dercum's disease and what are the clinical sx?
diffuse or nodular accumulations of subcutaneous fat
Clinical: painful fatty deposits, postmenopausal women, generalized obesity, weakness, emotional instability
100
What are common locations for macrodytrophia lipomatosa?
- 2nd-3rd digits of hand/foot
- median nerve
- plantar nerve
101
What is the differential for localized gigantism?
- maffucci syndrome
- NF 1
- Klippel-Trenaunay-Weber syndrome
- Proteus syndrome
- amyloidosis
- melorheostosis
102
What are the 2 requirements to diagnose primary intraosseous lipoma?
1. under microscope, must look like a liposarcoma
| 2. soft tissue mass & metastasis must be ruled out first
103
What is the most common benign tumor of the esophagus?
leimyoma
104
What is the 1st, 2nd and 3rd M/C soft tissue sarcoma in adults?
1. MFH
2. liposarcoma
3. leiomyosarcoma
105
What the M/C location for a leiomyosarcoma?
thigh
106
What is the M/C soft tissue malignancy in childhood?
rabdomyosarcoma
107
What's the M/C location for rhabdomyosarcoma in kids?
head & neck
108
Which type of hemangioma is found in flat bones (eg. skull, ilium) and which type is found in the vertebral body?
Flat bones: cavernous hemangioma
| VB: capillary hemangioma
109
What is the M/C skeletal location for hemangioma?
T/S vertebral body
110
What abnormalities are associated with soft tissue hemangiomas?
- Klippel-Trenaunay-Weber
- Maffucci Syndrome
- Kasabach-Merritt Syndrome
- Blue Rubber Nevus Syndrome
- Turner Syndrome
- Osler-Weber-Rendu Syndrome
111
What's cystic hygroma and where is it most commonly located?
soft tissue lymphangioma
75% found in head, neck and axilla
112
What's the best diagnostic clue for a glomus tumor?
soft tissue mass in subungual region that erodes underlying bone
113
What triggers severe paroxysmal attacks of pain in a glomus tumor?
exposure to cold OR minimal trauma
114
Hemangiopericytoma arise from which type of cells?
cells of Zimmerman (pericytes surrounding the capillary walls)
115
Hemangiopericytomas like to occur where in the body?
soft tissues (thigh > retroperitoneum > head/neck)
116
Which vascular tumor is known to affect areas of preexisting conditions (eg. osteomyelitis, avn, other neoplasms)?
angiosarcoma
117
Angiosarcomas arise from which type of cells?
endothelial cells of blood vessels
118
What characterizes the Kasabach-Merritt Syndrome?
capillary hemangiomas with extensive purpura before the age of 1
119
Which virus is associated with Karposi's sarcoma?
human herpes virus 8 (HHV-8)
120
What is Gorham's disease?
uncontrolled, destructive proliferation of vascular or lymphatic capillaries
2nd stage is replacement of absorbed bone by fibrosis
121
M/C of Gorham's disease?
upper arm, shoulder
122
What is the most common intraosseous location for a neurofibroma and schwannoma?
mandible
123
What's the M/C aggressive presacral neoplasm?
chordoma
124
What % of sacral tumors are chordomas?
40%
125
Chordomas in younger patients tend to occur where?
spheno-occipital region
126
What % of chordomas in the sacro-coccygeal region calcify?
50%
127
What % of chordomas in the spheno-occipital region calcify?
20-70%
128
33% of chordomas in the clivus are of what type?
chondroid
129
Mets is more common than primary osseous malignancy by how many times?
25-35x
130
Acral mets comes mostly from which tumors?
lung (broncogenic carcinoma), colon and renal primaries
131
What's the M/C skeletal location to have mets to to periarticular bone with intraarticular extension?
knee
132
What's the M/C location for secondary HOA?
tibia
133
Differentials that can cause a "cold" bone scan are:
- infection
- multiple myeloma
- ischemic necrosis
- radiation changes
- complete destruction of bone
134
What does a "superscan" mean?
increased accumulation of radiopharmaceutical agent diffusely throughout skeleton without kidney activity
135
What is the "flare" phenomenon in relation to tumor therapy on scintigraphy?
increase accumulation of radipharmaceutical agent during the early stages of therapy....relates to either increase regional blood flow or accentuation of bone turnover at site of metastasis
136
Which primary tumor is known to cross the disc space in the spine?
Ewing's
137
What is the lab result often seen with Ewing's sarcoma?
PAS +ive glycogen (70-100%)
138
Lymphoma that affects multiple bones and does not have lymph node or visceral involvement is called:
primary multifocal osseous lymphoma (PMOL)
139
What has a higher predilection for bone involvement, primary or secondary lymphoma?
secondary
140
Primary non-hodgkin's lymphoma is likely to affect which age population?
children (>50% have PMOL)
141
Primary Hodgkin's primarily affects which age group and what type of histological cells do they have?
Adults
Reed-Sternberg
142
Which of the two have sclerotic lesions? Non-Hodgkin's or Hodgkin's lymphoma?
Hodgkin's (occurs in 45% of disease affecting bone)
143
What's a common location for Burkitt's lymphoma in African children?
facial bones (maxilla > mandible)
144
Lymphoma that involves the skin is called:
mycosis fungoides
145
Multiple myeloma has an increase in which immunoglobulin?
IgG (55-60%)
146
Waldenstrom's macroglobulinemia has in increase in which immunoglobulin?
IgM
147
The 1st radiographic finding of MM is:
generalized osteopenia
148
Collapse of a VB in MM is called:
wrinkle vertebra
149
Where's the M/C location for plasmacytoma in the spine?
T/S
150
Dissemination of plasmacytoma to MM occurs within how many years?
5 years
151
What are the radiographic findings associated with leukemia?
- generalized osteopenia
- alternating radiolucent and dense metaphyseal bands
- osteolytic lesions
- periostitis
- osteosclerosis (less common)
152
What is the green colored tumor associated with leukemia?
chloroma
153
Name 4 types of small cell tumors of bone.
- Ewing's sarcoma
- Non-Hodgkin's lymphoma
- metastaic neuroblastoma
- embryonal rhabdomyosarcoma
154
Which benign bone tumor can calcify to resemble a dental tumor?
SCB --> cementoma
155
What is the M/C skeletal location for an epidermoid cyst?
skull
156
What's the M/C location overall in the body for an epidermoid cyst?
soft tissues
157
When seen in the distal phalanx, an epidermoid cyst is usually seen on the: a) volar aspect OR b) dorsal aspect?
volar aspect
158
What is the M/C mechanism of an epidermoid cyst?
post-traumatic
159
What is the M/C long bone and spine location for an ABC?
Long bone: tibia
| Spine: T/S
160
What is the proposed etiology of an adamantinoma?
misplaced germ cells of teeth
161
What is the M/C location for an adamantinoma?
Anterior tibia
162
What is the M/C location for an ameloblastoma?
mandilbe
163
What % of synovial sarcoma is located within the joint cavity?
<10%
164
As per an angiogram, what is true about a hemophilic pseudotumor?
They are avascular
165
What is the difference between carcinoma and sarcoma?
Carcinoma = arise from epithelial cells (eg. colon, breast, lung, prostate). These comprise >90% of cancers.
Sarcoma = arise from mesenchymal cells (eg. bone, cartilage, fat, muscle). Most sarcomas are named from the cell they arise from (eg. osteosarcoma, chondrosarcoma, liposarcoma etc.)
166
Pseudofractures in Paget's occurs on which side of the curve (convex or concave)?
Convex
167
Giant cell tumor of the facial bones is seen in which condition?
Paget's
168
What is the M/C spinal site for GCT?
Sacrum
169
What is the M/C benign tumor of the sacrum?
GCT
170
Where is the M/C location for a malignant GCT?
distal radius
