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b&j neoplasias
B&J Imaging & Malignancies of Bone
| Question | Answer |
|---|---|
| What are the qualities of a geographic lesion? | 1. narrow zone of transition 2. may have sclerotic border 3. sharp margins 4. usually benign 5. may be multiloculated of septated 6. bulbby, "soap bubble" |
| What are three different behaviors of osteolytic lesions? | geographic motheaten permeative |
| What are three behaviors of osteoblastic lesions | diffuse ivory-like localized |
| What are 6 features of motheaten lesions? | wide zone of transition ill-defined borders multi tiny holes usually aggressive malignancy infection |
| What are 7 characteristics of permeative lesions? | wide zone of trans ill-defined border pinhole-sized lesions often can't see holes usually aggressive malignancy infection |
| What can tumor matrix be made of? | fat cartilage osseous fibrous nothing |
| What are three different types of cartilage calcifications? | stippled calcifications flocculent calcifications arc and rings calcifications |
| Fibrous matrix has a _____ appearance? | ground glass appearance |
| What is the latent period for periosteal bone rxn>? | 10-21 day latent period |
| What is a periosteal response? | reactive new bone formation |
| What stimulates a periosteal response? | blood pus tumor hyperemia inflammation |
| What type of periosteal rxn is usually benign? | solid (single layer) |
| What are the 3 types of usually aggressive periosteal rxns? | laminated (onion skin) spiculated (hair on end, sunburst) codmans triangle |
| Periostitis is a synonym for what? | for perisoteal response/rxn |
| What is the MOST aggressive type of periosteal rxn? | spiculated |
| If see a soft tissue mass, what is the usual condition? | primary malignancy |
| What is the problem with tissue biopsy? | problem with needle track seeding |
| What is the most common bone tumor? | METS (70%), primary malig is 30% |
| What is the MC primary site of METS in men and women? | men: prostate (60%) females: breast (70%) |
| What is the second MC primary site of METS in men and women? | lungs, men 25% |
| What is the 3rd MC site of primary mets in men and women? | thyroid |
| what is the 4th mc primary site of mets in men and women? | kidney |
| what is the 5th mc primary site of mets in men and women? | women: uterus men: bowel |
| What is the MC primary site of METS in children? | neuroblastoma |
| What is the 2nd MC primary site of METS in children? | ewings |
| what is the 3rd MC primary site of METS in children? | lymphoma |
| What percentage of pts with malignancy will get skel mets? | 20-35% |
| Solitary mets lesion on __% of the time | 10% |
| skel mets tends to be ___ sites and the cause of ___ | multiple sites cause of death |
| What type of primary site mets is the MC to have an associated path fx? | breast cancer |
| What is the usually age group for skeletal mets to occur> | 50-75 |
| What are the clinical findings associated with skeletal mets? | Nocturnal bone pain path Fx hx of cancer unexplained wt loss anemia fever soft tissue mass deformity . |
| How long after primary malignancy can skeletal mets occur? and associated clinical findings here? | 15 years later! CFs pain is persistent sxs may be minimal |
| Skeletal mets clinical exams? | digital rectal exam breast exam/mammogram skin exam |
| what happens to ESR in skeletal mets? | increases |
| What type of skel mets causes an increase in serum ca2+ | in lytic skeletal mets |
| What type of skeletal mets causes an increase in alk phos? | blastic processes |
| What type of skeletal mets causes an increase in acid phosphatase? and what else will be raised with it? | prostateeeee cancer psa will also be raised... |
| What are the pathways of extension for skeletal mets? | direct lymphatic hematogenous (via veins) |
| What is the MC type of skeletal mets lesions? | osteolytic (75%) |
| What is the % of osteoblastic mets? | 15% |
| what is the % of mixed mets/ | 10% |
| What primary site of mets are usually osteoblastic (5, starting with MCs) | 1. breast 2. prostate 3. colon 4. stomach 5. testessss <3 |
| What primary site of mets are usually osteolytic (7, starting with MCs) | 1. lung 2. breast 3. prostate 4. renal 5. thyroid 6. colon 7. skin |
| what is the BEST tool for evaulating METS? | PET scan (shows areas of glucose uptake) |
| Bone scans are ___, not ____ | Bone scans are sensitive, but not specific |
| What is a superscan? | On a bone scan when you don't see kidney or bladder hot spots, indicating DIFFUSE METS! VERY BAD |
| Radiographs for mets are ____ and ____ | are non-sensitive, non-specific |
| CT scans are ____ and ____ for mets bone lesions | sensitive and specific |
| What is best for viewing bone marrow and soft tissues? | mri |
| Where is the MC place for mets to travel? | axial skeleton (80%) |
| Where else besides the axial skel does mets like to travel? | skull and prox limbs |
| What % of skull lesions are blastic? | 10% |
| What is winking owl sign? | osteolytic pedicle destructuion |
| What is blind vertebra? | ostelytic lesion of both pedicles |
| If there is an ivory vertebra what is the dif dx? | iHOP. ivory - Hodgkins lymphoma, osteoblastic mets, pagets dz |
| Ivory vert with anterior scalloping | Hodgkins lymphoma |
| Ivory vert with enlargement | Pagets |
| Ivory vert without anything else to the vert | Osteoblastic mets |
| Which primary carcinomas lead to expansile osteolytic lesions (blow out mets) | RATS renal cell carcinoma adrenal (pheocromocytoma) thyroid carcinoma skin (melanoma) |
| What is a pancoast tumor and what problems are associated with it? | It's a lung tumor which grows into bone by direct extension Problems: HORNERS (miosis, anhyrdosis, ptosis), TOS, and ct pain |
| What is Acral mets? | Acral mets is mets distal to the knee and elbow, which is quite rare. |
| What are the three most common primary cancers associated with Acral mets (in order) | 1. LUNG 2. breast 3. kidney |
| What is the MC primary malignant tumor of bone? | Multiple myeloma |
| What are the 4 MC primary malignant tumors of bone in order? | MOCE 1. mult myeloma 2. osteosarcoma 3. chondrosarcoma 4. ewings sarcoma |
| Multi myeloma: __% of biopsied bone tumors ___% of hematologic malignancies | 27% biopsied 10% hematologic maligs |
| what is the age range 75% of the time for mult myeloma? | 50-70 |
| What is the male to female ratio of mult myeloma, and what race is it common in? | 2:1 M:F, and common in Af. americans |
| What are common clinical features of multiple myeloma? | path Fx bact infection (esp lung) secondary amyloidosis bone pain weakness & fatigue bleeding fever and wt loss neurological signs |
| What is the cardinal inital sx of mult myeloma? | bone pain which is aggravated by wt bearing |
| What are the diagnostic criteria found with mult myeloma? | 10% abnormal atypical or immature plasma cells in bone marrow AND 1 of these: serum M-protein Spike Urine M-protein spike or Bence Jones proteinuria osteolytic bone lesions osteoporosis biopsy proven plasmacytoma |
| What is usually the 1st radiographic sign of mult myeloma? | osteopenia... therefore need a hx could see a fx |
| What is the MC bone that mult myeloma likes to attack? | vertebra (69%) ;) |
| where does mult myeloma go... in order of MC? | vertebra 69^ ribs 59% skull 40% pelvis 40% femur 24% humerus 20% clavicle 15% scapula 13% |
| Late radiographs of mult myeloma show whattt? | punched-out lesions vert collapse DIAPHYSEAL osteolytic lesions pedicles may spread rare sclerotic vertebra |
| how is a bone scan in mult myeloma? | often normal |
| where is raindrop skull seen? | mult myeloma |
| If see an L5 fx what should you think of? | path fx, l5 is uncommon to fx |
| what is tx for mult myeloma? | radiotherapy chemotherapy bone marrow transplant Thalidomide |
| How is the prognosis for mult myeloma? | poor 90% die within 3 years :( |
| What is plasmacytoma? | a solitary myeloma that is geographic, soap bubble appearance, highly expansile |
| What can plasmacytoma develop into, and the % of the rate of that | 70% of time develops into multiple myeloma |
| what is the 2nd MC primary malig tumor of bone? | Central osteosarcoma (20% of all malig bone tumors) |
| what area does central osteosarc love to live in? | metaphysis |
| what is the age range for central osteosarc, and male to female ratio? | 10-25 (75%) M:F = 2:1 |
| what clinical feature may be present with central osteosarc? | painful swelling of the involved limb |
| what will be elevated with central osteosarc? | alk phos |
| what % of central osteosarc occurs in the spine? | 3.5-7% |
| what is the MC bone of central osteosarcoma? | Femur 46% |
| list the bones usually involved with central osteosarc, in order | Femur 46% Tibia 21% Humerus 11% Pelvis 7% Spine <7% |
| what are cannon ball lesions seen with... and what are they? | seen with central osteosarc METS. It is Mets to the Lungs |
| what is the 2nd MC bone tumor to METS to other bone? | central osteosarc |
| what is the MC bone tumor to mets to other bone? | ewings sarc |
| central osteosarc can be sclerotic, lytic, or mixed... which is MC, and what are the %s of the three dif ways | SCLEROTIC MC @ 50% lytic and mixed are at 25% |
| Name common imaging findings with central osteosarc | Ivory osteoblastic lesion cumulus cloud appearance (lobulated mass) permeative osteolytic metaphyseal - tubular bones periosteal rxn (sunburst, codmans, laminated) cortical destruction soft tis mass |
| What is the TX of central osteosarc? | chemo amputation limb salvage surgery |
| What is the prognosis of central osteosarc | 80% survival rate |
| What are all the named types of osteosarcs? | central/conventional multicentric secondary parosteal telangiectatic extraosseous |
| What is secondary osteosarcoma? And cause? | Malignant degeneration of benign process such as Pagets fibrous dysplasia oseteochonroma Also caused by radiation therapy |
| What does primary and secondary chondrosarcoma arise from? | primary: de novo secondary: from malignant degeneration (enchondroma and osteochonrdoma |
| What are the two types of chondrosarcoma, named by location? | Central (intramedullary) peripheral (surface of bone) |
| What is the 3rd MC malignant bone tumor? | chondrosarcoma |
| What is the age range and sex ratio of chondroscarcoma? | Age 40-60 M:F = 2:1 |
| What are three clinical features of chondrosarcoma? | Pain late in dz large soft tis mass severe pain after path fx |
| What are the top four skeletal locations of chondrosarcoma? | Pelvis 24% Femur 24% Humerus 10% Ribs 8% |
| where does chondrosarc typically mets to? | lungs |
| where are chondrosarcs usually located in bone? | within the metaphysis or diaphysis |
| What is the presentation of chondrosarcoma 66% of the time? | Popcorn (flocculent) or arc and rings calcification |
| What is the presentation of chondrosarcoma 33% of the time? | osteolytic |
| What are the shapes of the radiolucencies in chondrosarcoma? | round or oval |
| is there periosteal rxn with chondrosarcoma? | yes - either spiculated or laminated |
| What is the tx for chondrosarcoma? | local excision amputation segmental resection |
| What is the prognosis of chondrosarcoma? | 90% 5 year survival after surgery |
| What else is on the df/dx list with low-grade chondrosarcoma? | enchondroma and bone infarction |
| what is the 4th most common primary bone tumor? | Ewings sarcoma (7%) |
| there is lower incidence of ewings sarcoma in what race? | af americans |
| what is the age range and sex ratio of ewings sarcoma? | 10-25 M:f 2:1 |
| what is the MC primary malignant bone tumor to mets to bone? | ewings sarcoma |
| what might ewings sarcoma mimic? | infection d/t fever, anemia, and ESR |
| what is a clinical feature of ewings sarcoma? | localized pain and swelling |
| What are the top five places ewings sarcoma likes to be? | Femur 22% Pelvis 18% Tibia 11% Humerus 10% Fibula 9% |
| what does ewings sarcoma like to live in bone? | diaphyseal permeative lesion! |
| what is characteristic of ewings sarcoma? | saucerization of the cortex |
| what is the periosteal rxn involved with ewings? | spiculated or laminated |
| ewings sarcoma can lead to? | path fx (5%) |
| What is the TX of ewings sarcoma? | amputation for lesions aboutknee radiotherapy and cehmotherapy in early lesions |
| What is the prognosis of ewings sarcoma? | 35% 5 year survival rate |
| What is the MC type of fibrosarcoma? | Medullary (central) |
| What may secondary fibrosarcoma arise from? | degenerated fibrous dysplasia, pagets, and bone infarct |
| What are the 2 types of fibrosarcomas? | medullary and periosteal |
| what % of bone tumors are fibrosarcoma? | 2% |
| What is the age range of fibrosarcoma and the sex ratio? | 30-50 M=F |
| Where is fibrosarcoma located 50% of the time? | around the kneee, it loves the knee |
| What are the most common bones to get fibrosarcoma? | 2/3 Femur tibia humerus |
| what sx will a pt with fibrosarcoma have | pain and swelling |
| At time of discovery of fibrosarcoma what is usually the case? | the lesions are usually large |
| What is the lichtenstein rule of thumb in regards to fibrosarcoma? | A fibrosarcoma should be ruled out if a primary malignant lesion is observed around the knee |
| where are fibrosarcomas typically located within the bone? | metaphyseal and eccentric |
| what are some common imaging findings associated with fibrosarcoma? | moth-eaten or permeative cortical destruction large soft tiss mass minimal periosteal bone rxn wide zone of transition |
| what is the MC soft tissue sarcoma of late adult life? | malignant fibrous histiocytoma 30% |
| what is malignant fibrous histiocytoma a variant of? | fibrosarcoma |
| what is malignant fibrous histiocytoma a common complication of? | bone infarcts |
| What is the tx for fibrosarcoma? | amputation |
| what is the survival rate of fibrosarcoma? | 30% 5 year survival rate |
| What is % of fibrosarc that mets? | >70% mets |
| how common is chordoma? | Rare |
| what is cordoma? | vestigial remnants of notochord |
| chordoma is _____ aggressive with a _____ growth rate | chrodoma is locally aggressive with a slow growth rate |
| Where is the Mc location for chordoma? | sacrococcygeal |
| where are the three mc locations of chordoma? | 1. sacrococcygeal 50% clivus 35% vertebral (C2) 15% |
| Chordoma sx depend on what? | depend on location, they could be clinically silent |
| Sacrococcygeal chordoma may cause what? | pressure on intestine and urinary tract which may cause obstruction and compression of nerve roots (tho less likely) |
| What may a chordoma @ the clivus cause? | pressure on pontine, occular, cerebellar strucs |
| What causes central vertebral body destruction, lytic destruction, and amorphous calcifcations? | Chordoma |
| what are image findings of chordoma? | central vert body destruction lytic destruction amorphous calcifcation (50%) soft tissue mass (enlarged presarcral space) rare solitary ivory vert |
| What is the problem with chordoma? | often dx is late |
| What is the tx for sacrococcygeal chordoma? and the survival rate? | resection 5 year survival rate is 8.7% |
| what is the tx for clivus chordoma and survival rate? | radiation most pts die within 3 years |
| Non-Hodgkins lymphoma aka? | reitculum cell sarcoma |
| what is the initial presentation of non-hodgkins lymphoma? | solitary bone lesion |
| what % of primary bone tumors in nonhodgkins lymphoma? | 3-4% |
| non hodgkins lymphoma is rare...? | rare extranodal lymphoma |
| secondary skeletal involvement in what % of pts with nhl? | 30% |
| what are the mc locations of non hodgkins lymphoma? | femur tibia humerus pelvis spine |
| what is the age range and sex ratio of non hodgkins lymphoma? | 20-40 M:F 2:1 |
| what is the mc primary malignant tumor to have a path fx? | non hodgkins lymphoma |
| what are some clinical features of non hodgkins lymphoma? | intermittent local pain pt looks very healthy 50% of pts report sx over 1 yr round cell tumor |
| what are image findings assoicated with non hodgkins lymphoma? | permeative medullary destruction diaphysis minimal laminated periostitis soft tissue mass |
| what must non hodgkins lymphoma be d/dx with? | ewings sarcoma |
| Hodgkins lymphoma is rarely seen as? | as a primary osseous lesion |
| what % of pts will develop osseous mets from hodgkins lymphoma? | 10-20% |
| what is the mc location for hodgkins lymphoma? | vertebral body |
| what is the % of lytic vs blastic vs mixed of hodgkins lymphoma? | 75% lytic 15% blastic 10 % mixed |
| what does ivory vert of hodgkins lymphoma also present with? | scalloping of anterior and lateral vert body |
| What is the prognosis and tx of hodgkins lymphoma? | good prognosis with radiation therapy |
Created by:
margaretrhager
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