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b&j neoplasias

B&J Imaging & Malignancies of Bone

QuestionAnswer
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