| Question |
Answer |
| Common causes of solitary vertebral collapse |
mets, plasmacytoma, compression fracture, Paget’s, infection |
| Common causes of solitary ivory vertebra |
osteoblastic mets, Hodgkin’s lymphoma, Paget’s |
| What are the most common malignant tumor of the skeleton? |
metastatic bone tumors |
| What types of malignant tumors generally do not spread to bone? |
basal cell carcinoma, CNS tumors |
| What is the most life-threatening complication of any malignancy? |
metastasis |
| What percentage of all malignant tumors are metastatic? |
70% |
| What percentage of Pts with malignancies have osseous metastasis? |
20-35% |
| What 4 primary cancers account for 80% of all osseous mets? |
breast, prostate, lung, kidney. |
| Is alkaline phosphatase eleveated in osteoblastic or osteolytic mets? |
osteoblastic |
| By what 3 routes do cancers metastasize? |
hematogenous, direct extension, lymphatic channels. |
| Plain film xray requires what % of bone loss before mets can be visually detected? |
30% |
| What % of osseous mets are in the axial skeleton? |
80% |
| Blow-out lesions of mets are associated with which 2 types of primary cancers? |
renal, thyroid |
| A neoplastic weakening of the vertebral endplates results in what radiographic feature of mets? |
schmorl’s nodes |
| What is a blind vertebra? |
bilateral pedicle destruction from mets |
| What is the most common cause of the extrapleural sign? |
rib mets |
| A solitary lesion resembling multiple myeloma |
plasmacytoma |
| What is another name for multiple myeloma? |
Kahler’s Dz |
| What is the most common primary malignant bone tumor? |
Multiple myeloma |
| What 5 sites are commonly involved in MM? |
spine, pelvis, skull, ribs, scapula. |
| What percentage of MM Pts’ labs show Bence Jones Proteinuria? |
40% |
| What % of MM Pts have secondary amyloidosis? |
15% |
| what is the most common site for non-medullary plasmacytoma? |
nasopharynx |
| what might be the only early radiographic sign of MM? |
gross osteoporosis |
| what are 3 buzzwords associated with MM’s radiographic features? |
raindrop skull, vertebra plana, punched-out lesions. |
| How does MM usually appear on bone scan? |
Cold |
| What percentage of plasmacytomas develop into MM? |
70% |
| What is the 2nd most common primary malignant bone tumor? |
osteosarcoma |
| What are the most common sites for osteosarcoma? |
knee, shoulder. |
| What is the only consistent lab finding in osteosarcoma? |
raised alkaline phosphatase |
| What is the most common metastatic pattern of osteosarcoma? |
cannonball metastasis to lungs. |
| What is the cumulus cloud appearance? |
roughened and irregular margins of the eccentric, lobulated mass associated with osteosarcoma. |
| What is the 3rd most common primary malignant bone tumor? |
chondrosarcoma |
| What are the 3 most common sites of chondrosarcoma? |
Prox humerus/femur, pelvis |
| Although chondrosarcomas present in a mature population, <2% present here. |
epiphyseal |
| Where do chondrosarcomas metastasize to? |
lungs |
| What is the fourth most common primary malignant bone tumor? |
Ewing’s sarcoma |
| Signs and symptoms of Ewing’s sarcoma may mimic what condition? |
infection |
| What is the only primary bone tumor which mimics the symptoms of infection? |
Ewing’s sarcoma |
| What are the most common locations for Ewing’s? |
long bones of lower extremities, inominates (pelvis) |
| Where does Ewing’s metastasize to? |
bone |
| What percentage of ewing’s present with pathological fractures? |
5% |
| What % of malignant bone tumors are fibrosarcomas? |
2% |
| What fraction of fibrosarcomas initially present with pathological fracture? |
1/3 |
| Where is the classic location for fibrosarcoma? |
metaphyseal, in the knee. |
| What is the only primary malignant bone tumor in which sequestration is found? |
fibrosarcoma |
| What type of primary malignant bone tumor is unique in it’s selective lymphatic spread? |
fibrosarcoma |
| Which primary malignant bone tumor produces the largest soft tissue mass? |
fibrosarcoma |
| What are the most common preexisting beinign conditions to undergo change to secondary fibrosarcoma? |
Paget’s, fibrous dysplasia, osteomyelitis, postradiation, and bone infarct. |
| Is GCT benign or malignant? |
malignant |
| What are the most common sites of GCT? |
knee, wrist, shoulder |
| What is the most common benign bone tumor? |
osteochondroma |
| A bony exostosis with a hyaline cap |
osteochondroma |
| What is the most common clinical presentation of osteochondroma? |
Painless hard mass near a joint. |
| Where are osteochondromas located? |
Any growing physis |
| What is the cortical appearance of osteochondroma? |
blends imperceptibly with the host bone. |
| What type of tumor may cause cauliflower spine? |
osteochondroma |
| What is the most common benign bone tumor of the spine? |
hemangioma |
| What is the classic radiographic feature of hemangioma? |
courdoroy cloth appearance |
| What percentage of hemangiomas present in the spine and skull? |
75% |
| Where in the spine do hemangiomas present? |
vertebral bodies of thoracolumbar junction |
| Rapidly increasing acute local pain is what kind of tumor? |
ABC |
| Osteosarcoma shows a clear predilection for what age and sex? |
males less than 25 years old. |
| Coathanger exostosis describes what type of tumor? |
pedunculated osteochondroma |
| List the most common primary malignant bone tumors in order. |
MM, osteosarcoma, chondrosarcoma, Ewing’s Sarcoma |
| What is the most common malignant bone tumor? |
mets |
| Subarticular radiolucency related to Paget’s Dz is called |
blade of grass appearance |
| Neurofibromatosis is also called |
Von Recklinghausen's Disease |
| Osteoid osteoma is located in the _____, whereas osteoma is located in the ______ |
long bones and spine, skull and sinuses |
| Which 2 conditions are pain worse at night relieved by aspirin? |
osteoid osteoma, brodie’s abscess |
| What is the difference between osteoid osteoma and brodie’s abscess? |
size, brodies abscess will be more than 2 cm in diameter |
| Which 3 conditions have a lucent nidus? |
Osteoblastoma, osteoid osteoma and brodie’s abscess |
| Is ABC neoplastic? |
no |
| Sinus and vision problems, headaches and exopthalmos are all symptoms of what tumor? |
Osteoma |
| What is subungual exostosis? |
osteochondroma at the distal end of the terminal phalanx of a toe or finger causing a Y-shaped distal phalanx |
| Non-hodkins, Ewing’s, and multiple myeloma have what in common? |
they are all round cell tumors. |
| Differentiate between MM and Lytic mets in the skull |
lytic lesions are more apt to be of varying sizes, MM of uniform size |
| Lytic phase of Paget’s Dz may demonstrate what finding in the vertebra? |
vertebra plana |
| What are the 4 stages of pagets? |
1 osteolytic/destructive/monophasic, 2 combined/biphasic, 3 sclerotic or ivory, 4 malignant degeneration |
| Rugger jersey spine occurs in |
hyperparathyroid |
| Osteoma has a predilection for: |
adult females |
| Most common primary malignant bone tumor in the hand is? |
chondrosarcoma |
| Osteoblastic mets should contain the following Ddx: |
Paget’s Dz, osteomyelitis, fibrous dysplasia |
| Brown tumor is a feature of what condition? |
hyperparathyroidism |
| Osteoporosis circumscripta is AKA for |
Paget’s Dz |
| Marie Strumpel’s is AKA for |
Ankylosing Spondylitis |
| Large Coast-of-Maine café-au-lait spots are typical of what process? |
fibrous dysplasia |
| Cancers of the breast, prostate, lung and kidney account for what % of skeletal mets in the spine? |
80% |
Poultry
