4. Osteosarcoma

Question 1

Undifferentiated connective tissue and forms of neoplastic osteoid

Answer 1

Central Osteosarcoma

Question 2

other types of osteosarcomas

Answer 2

• Multicentric
• Parosteal
• Secondary
• Extraosseous

Question 3

Second m/c primary malignant bone tumor

Answer 3

Central Osteosarcoma

Question 4

20% of all primary bone tumors, mostly in 10-25 year olds.

Answer 4

Central Osteosarcoma

Question 5

Painful swelling at site of lesion (85%), with weight loss, fever, and cachexia

Answer 5

Central Osteosarcoma

Question 6

May take ______ or longer to DX the central osteosarcoma tumor

Answer 6

6 months

Question 7

Central osteosarcomas likes ____ bones,

Answer 7

long

primarily knee and shoulder

Question 8

• 58% of Central osteosarcomas tumors occur around the ____.

Answer 8

knee

Typically located in metaphysis

Question 9

m/c affected structure in spine from osteosarcoma

Answer 9

Vertebral body

comp. Fx

Question 10

Secondary Osteosarcoma arise in Paget’s bone at __ %

Answer 10

44

Question 11

If patient has Paget’s disease measure -__________ as a baseline study

Answer 11

alkaline

phosphatase

Question 12

Will Alkaline Phosphatase
levels return to normal with removal of
tumor?

Answer 12

yes

Question 13

__ % of Central osteosarcomas are neoplastic sclerotic bone, __ % are Purely lytic
and __ % are Mixed.

Answer 13

50, 25, 25

Question 14

Pulmonary metastasis in osteosarcoma via hematogenous

route

Answer 14

Cannonball Metastases

ossfified

Question 15

Cannonball metastases represents

Answer 15

sarcomatous pulmonary bone growths

Question 16

Common subpleural nodules that have undergone

excavation –> rupture

Answer 16

Spontaneous Pneumothorax

Question 17

Skeletal Metastasis may occur, called

Answer 17

Skip lesions

Question 18

75% of Central Osteosarcomas are in

Answer 18

metaphyses of long bones

Question 19

Central Osteosarcomas are m/c at the
•
•

Answer 19

distal end of femur

and Proximal tibia and humerus

Question 20

what usually acts as barrier to spread?

Answer 20

Physis

Question 21

• Focal lesion in metaphysis
• Mottled, permeative lesion
• Poorly defined zone of transition
• cortical distruption

Answer 21

Central Osteosarcoma

Question 22

Dense ivory or sclerotic lesion filling medullary

space

Answer 22

Central Osteosarcoma

Question 23

Spiculated or Sunburst periosteal reaction

in soft tissue and occasionally see Codman’s Triangles

Answer 23

Central Osteosarcoma

Question 24

Ill-defined permeative mixed lytic/blastic lesion

can cross the growth plate

Answer 24

Osteosarcoma

Question 25

soft tissue mass and spiculated periosteal reaction indicates

Answer 25

rapid growth

Question 26

seen with large sclerotic | lesions

Answer 26

Cumulous cloud formation

Question 27

Large soft tissue mass formation that may contain

Answer 27

ossification

Question 28

Amputation if accessible and there is no... | Radiotherapy for local pain control

Answer 28

metastasis

Question 29

Average time between recognition of pulmonary | disease and death is

Answer 29

6 months

Question 30

Lytic presentation is rapidly

Answer 30

fatal

Question 31

radiograph of osteosarcoma of distal femoral shaft

Answer 31

- aggressive periosteal changes - Codman triangles - soft tissue mass

Question 32

Sagittal T1-weighted MRI osteosarcoma

Answer 32

``` - abnormal signal intensity is present throughout the visible shaft and metaphysis - growth plate has limited extension of the tumor - Cortical destruction ```

Question 33

Radiograph of femur with osteosarcoma shows | a typical

Answer 33

Codman triangle

Question 34

Mixed sclerotic/lytic primary bone | lesion at the metaphysis with pathological fracture

Answer 34

central Osteosarcoma

Question 35

- Cystic expansile lesion of the distal metadiaphysis that abuts the epiphyseal plate - intermediate signal on T1, and high on T2 images

Answer 35

central Osteosarcoma

Question 36

Rare, Independent lesions occuring simultaneously

Answer 36

Multicentric Osteosarcoma

Question 37

Multicentric Osteosarcoma occur in what age group?

Answer 37

5-10

Question 38

- primary lesions with Rapidly fatal course - blastic lesions which increase alkaline phosphatase - Pulmonary metastasis occurs early

Answer 38

Multicentric Osteosarcoma

Question 39

- Multiple blastic lesions - Bilateral and fairly symmetric - Metaphyseal

Answer 39

Multicentric | Osteosarcoma

Question 40

Slow growing well-differentiated osteosarcoma located on bone surface in juxtacortical location within periosteum in 30-50 yo

Answer 40

Parosteal Osteosarcoma

Question 41

50% of Parosteal Osteosarcomas occur where?

Answer 41

posterior surface of distal femur

Question 42

Average size of Parosteal Osteosarcoma

Answer 42

10 cm

Question 43

- Lobulated, sessile, bony mass with broad based attachment to bone - Cleavage plane = 1-3mm

Answer 43

Parosteal Osteosarcoma

Question 44

helpful imaging for Parosteal Osteosarcoma?

Answer 44

CT

Question 45

DDx for Parosteal Osteosarcoma

Answer 45

Myositis Ossificans Traumatica (MOT)

Question 46

Parosteal Osteosarcoma | vs Myositis Ossificans Traumatica (MOT)

Answer 46

Sarcomas are denser centrally grows over time (exact opposite for MOT)

Question 47

Malignant degeneration of benign disorders to osteosarcoma

Answer 47

Secondary Osteosarcoma

Question 48

who is susceptible to Secondary Osteosarcomas

Answer 48

Watch Dial Painters Ingested radium | (10-15 years later)

Question 49

Secondary Osteosarcoma looks like osteosarcoma with the

Answer 49

Permeative, motheaten, periosteal rxn, soft tissue mass

Question 50

In 1926, _____ was considered a | miracle elixir

Answer 50

radium

Question 51

avg latent period for Post-radiation Sarcoma

Answer 51

15

Question 52

used for Angiography in 1950’s

Answer 52

Thorotrast Injection

Question 53

Large soft tissue mass not adjacent to bone that m/c affects the thigh in 30-50 yo

Answer 53

Extraosseous Osteosarcoma

Question 54

Common pulmonary metastasis in

Answer 54

Extraosseous Osteosarcoma

Question 55

Non-contrast CT of the chest showing multiple, subcentimeter, calcified pulmonary nodules consistent with

Answer 55

metastatic Paget’s sarcoma