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Di Imaging 2 > Tumors > Flashcards

Tumors Flashcards

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1
Q

MC overall malignancy

A

Metastatic disease

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2
Q

MC primary malignant bone tumor in adult

A

Multiple Myeloma

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3
Q

MC primary malignancy tumor in kids/young adults

A

Osteosarcoma

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4
Q

2nd MC primary malignant tumor in adults

A

Chondrosarcoma

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5
Q

2nd MC primary malignant tumor in kids

A

Ewing sarcoma

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6
Q

Mc benign spinal tumor

A

Hemangioma

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7
Q

Mc benign bone tumor

A

Osteochondroma

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8
Q

Mc benign tumor of the sacrum

A

Giant cell tumor

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9
Q

Mc benign tumor of the hand

A

Enchondroma

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10
Q

Buttressing. And associated with what?

A

Additional layers of new bone added to exterior creating an expanded ossueous contour

Associated with slow growing lesions

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11
Q

Laminated/layered/onion skin. And associated with hat

A

Alternating layers of lucency and opacity with alternating growth. Thick or thin.

Can be seen in slow or aggressive lesions . Classic with Ewing’s

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12
Q

Colman’s triangle and speculated periosteum reaction often associated with what

A

Osteosarcoma

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13
Q

Reasons for missing pedicle

A
  1. Congential
  2. Destructive
    - tumor (primary: ABC/osteoblastoma; secondary: lyric Mets MC!!!!; ST tumor: neurofibroma)
    - infection
  3. Surgical
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14
Q

DDx for ivory vertebra

A

Lymphoma
Blastic mets
Pagets

20-40: mc lymphoma
40+: mc blastic Mets

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15
Q

DDx for pathological collapse

A

OP
Lytic Mets
MM

Child: mc eosinophilia granuloma

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16
Q

Tests for MM

A

PEP
Skeletal survey
MRI
Biopsy

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17
Q

Tests for lytic Mets

A

Bone scan

MRI

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18
Q

What do carcinomas arise from?

A

Epithelial cells

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19
Q

What do sarcomas arise from?

A

Bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue

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20
Q

Description of cartilaginous matrix

A 
Ring or arc like
Flocculent
Small crystals 
Popcorn like
Stippled
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21
Q

Pathway of metastasis

A

Hematogenous dissemination (blood) via Batson’s plexus aka vertebral plexus

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22
Q

Alkaline phosphatase will be increased in what kind of CA?

A

Blastic

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23
Q

Where in the skeleton does Mets usually spread

A

Spine (40)
Ribs/sternum (28)
Pelvis/sacrum (12)

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24
Q

Mets distal to elbow and knee is termed what and due to what?

A

Acral metastasis

Due to lung primary

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25
Blow out mets MC from what
Renal or thyroid
26
MC reason for pedicle destruction
Lytic mets
27
Radiographic features of vertebral mets
``` Ivory vertebra Pedicle destruction Pathological collapse (OP, LM, MM) Focal OP Malignant schmorl node formation ```
28
T1 and T2 determining old vs new pathological fractures
“T1 white is right” New: T1 dark, T2 bright
29
DDX for ivory vertebra
Paget Hodgkins Lymphoma Osteoblastic mets
30
Area of dense sclerosis on the anterior superior VB without sclerosis
Blastic mets
31
Bone island. Alt Ddx?
Blastic density that is longitudinal. Normal alkaline phosphatase levels and bone scan Ddx: blastic mets
32
Osteopoikilosis
Multiple bone islands Usually in pelvis
33
What does patient need to diagnose blastic mets
BCP for alkaline and acid phosphatase levels PSA Digital rectal exam
34
Avulsion fracture of lesser trochanter. MC diagnosis in child? Adult?
Child: avulsion Fx Adult: lytic mets
35
Top 4 primary malignancies in order
Multiple myeloma, osteosarcoma, chondrosarcoma, Ewing sarcoma (MOCE)
36
Malignant proliferation of plasma cells that infiltrate bone marrow
MM
37
Age of patients with MM
50-70
38
Clinical s/s of MM
Pain is cardinal sign CRAB (Hypercalcemia, renal/respiratory disease, anemia, bone disease)
39
Major lab findings with MM
``` M-spike A:G ratio (increased G) Bence Jones Rouloux formation Increased serum ca++ and protein Bone marrow biopsy >10% plasma cells ```
40
Osteosarcoma. Stats/age
Mc primary malignant BT in child. (#2 MBT). 10-25
41
Location of osteosarcoma
Metaphysis
42
Raindrop skull
MM
43
Bones affected by MM
T/L vertebra, pelvis, skull
44
Area MM
Diaphysis
45
Age of osteosarcoma
10-25, 60+
46
Area of osteosarcoma
Metaphysis
47
Bone affected by osteosarcoma
Distal femur 40% Prox tibia 15% Humerus
48
Appearance of osteosarcoma
``` 50% sclerotic More than 5cm in medullary space Sunburst periosteal reaction/Codmans Large ST mass Painful swelling Cumulus/cloud-like density ```
49
MRI characteristics of mets
Dark T1 | Light t2
50
Bones affected by MM
Vertebra-T, L
51
What are the two bone tumors that occur solely in the diaphysis
MM | Ewing sarcoma
52
Solitary plasmactyoma findings
Soap bubbly Highly expansive Vertebra>pelvic>skull
53
What tumors have blastic appearances
Osteosarcoma | Osteoma
54
What tumor usually has mets to lungs before being discovered
Osteosarcoma
55
Age for chondrosarcoma
50+
56
Locations for chondrosarcoma
Proximal humerus Neck/femur Ribs/sternum Pelvis****
57
XRAY of chondrosarcoma
Round area of de-mineralization Popcorn matrix calcification Large soft tissue mass
58
Ddx for chondrosarcoma
Enchondroma Medullary infarct Both usually no pain
59
Age and bone location for Ewing
Diaphyisis | 10-25
60
Bones in Ewing sarcoma
Long tubular bones (femur, tibia, humerus, fibula) Flat bones >20yrs
61
Appearance of Ewing sarcoma
``` Lytic Moth eaten-permeating Onion skin reaction ST mass Cortical saucerization (scooped out of outer cortex) ```
62
Cortical saucerization
Scooped out appearance of outter cortex
63
Aka for giant cell
Osteoclastoma
64
Age and bone location for giant cell
20-40 | Met-epiph
65
Location of giant cell
85% long bone: d. Femur, prox tibia, d radius (mc malignant)
66
XRAY of giant cell
``` Geographic Eccentric Met-epiph Subarticular Expansive/soap bubble Cortical thinning ```
67
Giant cell tumor where has highest chance of malignant transformation
Distal radius
68
Coat hanger exostosis
Solitary osteochondroma
69
Cauliflower cap
Solitary osteochondroma
70
Area in bone of osteochondroma
Metaphysis
71
Bones of osteochondroma
Long bones | Femur, tibia, proximal radius
72
Pain and new growth to an osteochondroma may indicate what
Malignant transformation to osteosarcoma
73
HME aka diaphyseal achalasia
Multiple osteochondromas
74
Age of osteochondroma and HME aka diaphyseal achalasia
2-20
75
Findings associated with HME
Madelung deformity/bayonet deformity: shortening of ulna and radius bend over it Shortening of 4th.5th MC
76
Direction of pedunculated osteochondroma
Toward the mid shaft
77
Location in bone for SBC
Metaphysis
78
Age of SBC
3-14
79
Bones for SBC
Proximal humerus Femur Fibula Calcaneous neck
80
Madelung/bayonet deformity
HME
81
Fallen fragment sign
SBC (solitary bone cyst)
82
XRAY of solitary bone cyst
``` Metaphysical Lucent 2-3cm Cone appearance/truncated Asymptomatic Central ```
83
Area in bone for ABC
Metaphysis
84
Age for ABC
10-30
85
Bones for ABC
Spine-30% Neural arch Long bones Flat bone: P
86
XRAY for ABC
Eccentric Lytic Expansive/soap bubble Pain
87
Fluid-fluid levels seen on CT
ABC
88
Osteoblastoma area in bone
Met-diaphyseal
89
Age of osteoblastoma
10-20
90
Bones of osteoblastoma
Neural arch Long bones Small bones of hands/feet
91
XRAY of osteoblastoma
Lucent Expansive >2cm Metaphysical—> diaphyseal
92
Age of osteoid osteoma
10-25
93
Bone of osteoid osteoma
Long Proximal femur*** Prox tibia Neural arch—concave scoliosis
94
Location in bone for osteoid osteoma
Metaphysis-diaphysis
95
XRAY of osteoid osteoma
``` Nidus in cortex Lucent Geographic Cortical thickening Pain relieved by aspirin!!** ```
96
What tumor has pain relieved by aspirin
Osteoid osteoma
97
Nidus
Osteoid osteoma
98
Double density sign
Osteoid osteoma
99
Age of osteoma
Adult
100
Bones of osteoma
Frontal/ethmoid sinus | Calvarium
101
XRAY of osteoma
Blastic lesions ~2cm Geographic
102
What tumor is associated with Gardner’s syndrome
Osteoma
103
Age of enchondroma
10-30
104
Bones of enchondroma
Hands/wrist phalanges>MC | Long bones
105
Area in bone of enchondroma
Metaphysis/diaphysis
106
XRAY of enchondroma
``` Lytic Expansive Geographic Central Stippled/punctuate calcification ```
107
5 tumors that have cartilage matrix
``` Osteochondroma Chondroblastoma Chondromyxoid fibroma Enchondroma Chondrosarcoma ```
108
Multiple enchondroma
Olliers/enchondromatosis
109
Olliers associated with multiple ST hemangioma
Maffucci syndrome
110
Age of hemangioma
30-50
111
Bones inhemangioma
Lower T, upper L vertebra | Calvarium
112
XRAY for hemangioma
≤Accentuated vertical trabeculation Accordion/honeycomb/corduroy Posterior bulge of cortex Skull: <4cm round lytic lesioNS with sunburst appearance /spoke wheel
113
Spoke wheel appearance
Hemangioma
114
Accordion/corduroy/honeycomb appearance
Hemangioma
115
Age of chondroblastoma
5-25
116
Area in bone of chondroblastoma
Apophysis/epiphysis
117
Bones of chondroblastoma
2/3 LE | Prox femur, distal femur, proximal tibia
118
XRAY of chondroblastoma
``` Round lytic lesion Eccentric 1-6cm Geographic Lobulated Punctuate/ca++ ```
119
Age of FCD
2-10
120
Bones of FCD
Long bones of LE | Post/med/distal femur
121
Area in bone of FCD
Metaphysis
122
XRAY of FCD
``` Lytic Geographic Central 1-2cm Expansive Sclerotic Asymptomatic ```
123
FCD or NOF—which is bigger?
NOF
124
age of NOF
8-20
125
Bones of NOF
Long bones of LE | Distal tibia
126
Area in bone of NOF
Metaphyseal
127
XRAY of NOF
``` Lytic Eccentric 2+cm Sclerotic boarder Asymptomatic Migrates toward diaphysis ```
128
Age of pagets
50+
129
Bones commonly affected with pagets
Pelvis Lumbars/T Femur Calvarium
130
XRAY of pagets
``` Changed density Irregular trabeculation Thickened cortex Subarticular to diaphysis!!! Osseous deformity ```
131
Direction of pagets
Subarticular to diaphysis
132
Complications of pagets
``` Peripheral N compression Spinal stenosis Blind Facial palsy Pathological fx High CO DJD Malignant transformation —> osteosarcoma ```
133
What tumors may have malignant transformation to osteosarcoma
Paget | Olliers
134
Paget and ollier may have malignant transformation into what?
Osteosarcoma
135
Stage 1- pagets
Lytic/degenerative stage | Increased hydroxyproline
136
Stage 2 of paget
Mixed | Increased alkaline phosphatase
137
Stage 3 pagets
Sclerotic/ivory | Normal serum ca/P. Increased bone scan activity
138
Stage 4 paget
Malignant degeneration to osteosarcoma
139
Osteoporosis circumscripta
Well-defined lytic changes to frontal and occipital bone in pagets
140
Cotton wool appearance
Ill-defined density seen in pagets
141
Rim sign
Iliopectineal line thickening seen in pagets
142
What is seen in the pelvis wit pagets
Rim sign (iliopectineal line thickening) Expansion Acetabular protrusion
143
Candle flame/blade of grass sign
Advancing edge of lytic phase (toward diaphysis) seen with pagets
144
Looser lines/banana fx
Horizontal lucency/fx seen with pagets
145
Shepards crook
Bowing of prox femur head seen with paget and fibrous dysplasia
146
Brim sign
Iliopectineal line thickening seen with paget Aka rim
147
Picture frame vertebra
Thickened endplates and cortex of VB in pagets
148
Ivory vertebra seen with
Paget Blastic mets Lymphoma
149
Fibrous dysplasia age
0-20
150
Bones in fibrous dysplasia
Monostotic Proximal femur MC (also craniofacial bones)
151
XRAY of fibrous dysplasia
``` Lucent lesions Thick rim (Rind sign) Ground glass appearance of medullary Expansive in skull Shepards crook/sabreshin deformity Geographic ```
152
Fibrous dysplasia seen with cafe-au-last spots and endocrine dysfunction is what?
McCune Albright syndrome
153
McCune Albright syndrome
Fibrous dysplasia with cafe-au-lait spots, and endocrine disruption
154
Rind sign
Fibrous dysplasia | Medullary cavity lesions with a thick or thin rim of sclerosis
155
Complications of fibrous dysplasia
``` Leg length discrepancy Osseous deformities CN compromise Acetabular protrusion Pro ptosis (eyes bulging) Malignant transformation (fibrosarcoma) ```

Di Imaging 2 (5 decks)

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