radiology > MSK neoplasms > Flashcards

MSK neoplasms Flashcards

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1
Q

MC 1˚ osseous malignancies

A

MM/plasmacytoma (27%), OS (20%), CS (20%)

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2
Q

how much trabecular bone is destroyed before you can see it?

A

70%

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3
Q

what demonstrates permeative & moth eaten app?

A

myelin, lymphoma, ewings, OM, hyperPTH

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4
Q

4 main subtypes OS to know

A

1) conventional intramedullary (85%, higher grade than surface types)
2) parosteal (4%)
3) periosteal (1%)
4) telangiectatic (rare)

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5
Q

Difference btw trabecular vs cortical bone loss

A

Trabecular more rapidly but noticed later bc cortical bones more smooth & orgz

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6
Q

conventional intramedullary-1˚ vs 2˚, where, bf’s, classic met

A
  • 1˚ 10-20 yr old
  • femur (40%), prox tibia (15%)
  • skip lesions, lung (occult PTX)
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7
Q

class OS PW

A

xray –> bone scan + Chest CT –> MRI (entire bone for skip lesions, bx planning) –> bx –> neoadjuvant chemo –> restage, re biopsy –> surgery –> adjuvant chemo –> f/u (2 yrs)

  • re-biopsy: predicts outcome (90% tumor death = good)
  • 2 yr f/u: 80% relapse –> lung. 20%–> bone
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8
Q

Parosteal OS

A

low grade, bulky/big

  • pst distal femur (mimic cortical dermoid tug lesion early on )
  • meatphyseal 90%
  • string sign-radiolucent line sep bulky tumor from cortex.
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9
Q

sunburst pattern

A

aggressive periosteal run looks like sunburst

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10
Q

“reverse zoning phenomenon”

A

denser mature matrix in center, less peripherally (opposite of myositis ossificans)

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11
Q

BWs aggressive periosteal reactions

A
  • Sunburst
  • Reverse zoning phenomenon
  • Lamellated
  • Codman triangle
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12
Q

“lamellated”/onion skin rxn

A

multi layers of parallel peritoneum

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13
Q

Codman triangle

A

edge of raised periosteum ossifies creating appearance of triangle

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14
Q

parosteal vs periosteal osteosarcomas- who, where, marrow ext, grade/outcome

A
  • Parosteal: early adult/middle age, metaphyseal, pst distal femur, marrow ext 50%, low grade, extends OUTWARD
  • Periosteal: 15-25 yo, diaphysial, medial distal femur, no marrow extension, intermediate grade (worse outcome)
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15
Q

Telangiectatic OS-classic app

A
  • 15% narrow zone
  • Rgx: cystic
  • MR: F/F levels, T1+ (methemoglobin)
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16
Q

Order of OS grade/outcome

A 
Parosteal
Periosteal
Telangectatic
Classic
2˚
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17
Q

Ewing’s

A
  • 2nd MC 1˚bone malignancy in peds. ~15 yo. Rare in AA
  • metadiaphysis –> diaph –> metaph
  • permeative, moth eaten. +lamellated, ST 80% (Ca-)
  • met –> bone (spine) (MC), lung
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18
Q

MC sarcoma to met to bone

A

Ewings

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19
Q

chondrosarcoma-what, RFs, where, met, matrix

A
  • low grade tumor in older adults (40-70), M > F
  • RFs: Paget’s, anything cartilaginous (OC, Maffucci), etc)
  • proximal tubular bones (more abundant cartilage) & limb girdles (triradiate cartilage in pelvis)
  • central (intramedullary) or peripheral (at end of osteochondroma)
  • met –> lung
  • “changing matrix”-vs enchondroma
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20
Q

chordoma

A
  • adults 30-60 yr old
  • sacrum (slightly older), clivus (slightly younger), VB (C2)
  • midline, T2+++
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21
Q

MC 1˚ malignancy of spine

A

chordoma

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22
Q

MC 1˚ malignancy of sacrum

A

chordoma

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23
Q

where in spine does chordoma occ

A

VB C2

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24
Q

Enchondroma vs low grade chondrosarcoma-what favors chondrosarcoma?: pain, cortex, size, matrix

A
  • Pain
  • Cortical destruction (scalloping >2/3),
  • > 5cm
  • changing matrix
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25
Lucent Lesions: FOGMACHINES
- Fibrous dysplasia - OB - GCT - Mets - ABC - CB - hyper PTH - inf - NOF - Enchondroma/eusinphilic granuloma - Simple (unicameral) bone cyst
26
Lucent lesions based on age
- <30 yo: EG, ABC, NOF, CB, UBC - any age: inf - >40 yo: mets/myeloma (unless NB met)
27
Epiphyseal equivalents
- carpals - patella - greater trochanter - calcaneus
28
Epiphyseal lesions: AIGC
- abc (after GP closes it ext from metaph) - Inf - GCT - CB & clear cell CS
29
malignant epiphyseal lesion
-clear cell chondrosarcoma
30
what part of bone do mets go
metaph (greatest bs) --> diaphysis
31
fibrous dysplasia-what, phases, app, where
-skeletal developmental anomaly of OB-failure of normal maturation & differentiation--> repl N medullary space - phases: lytic, mixed, blastic - polyostotic & monoostotic (rib mc) - long lesion, gg matrix. PR-, pain - polyostotic: skull, face (lion-like faces); <10 yr old. mangled face, syndromic - long bones, ribs, pelvis --> IL femur (shepherd crook deformity) T1: heterogeneous signal, usually intermediate T2: heterogeneous signal, usually low, but may have regions of higher signal T1 C+ (Gd): heterogeneous contrast enhancement 4 Tc MDP+
32
shepherd crook
- coxa varus angulation | - FD (classic), Paget, OI
33
monostotic vs polyostotic FD
- monastic (20-30 yos) | - multiple lesion=<10 yr old, syndromes (McCune Albright_
34
McCune albright
- polyostotic FD - Cafe Aurait spots - precocious puberty * girl
35
Mazabraud
- polyostocic FD - ST myxoma - (+) risk osseous malignant transformation - middle aged F
36
adamantinoma-what, where, app
- v rare, low grade malignant tibial lesion - soap bubble - resembles FD (mixed lytic & sclerotic) - mal pot
37
non ossifying fibroma (NOF), fibrous cortical defect- what, who, where, app (before regression), mx
- non-neoplastic fibrous org - children (Rare before walking) - knee - app: eccentric, thin sclerotic border - spon't regress (more sclerotic bf disappearing)
38
Bone forming (osteo-) lesions
- Enostosis - osteoma - melorheostosis - osteoid osteoma - OB - OS
39
Cartilage forming (Chondo-) lesions
- synovial chondromatosis/osteochondromatosis - endochondroma - osteochondroma - CB - chondromyxoid fibroma - CS
40
Fibrous origin lesions
- fibroxanthomas: NOF, FCD - Malignant fibrous histiocytoma - FD
41
lesions of unknown cell org
- SBC/UBC - ABC - adamantinoma
42
lesions of vascular org
- hemangioma | - angiosarcoma of bone
43
lesions of hematopoietic orgn
- GCT/osteoclastoma) - eusinophilic granuloma (Langerhands) - Ewing sarcoma
44
fibroxanthomas
waste basket term for NOF (>2-3cm) & FCD (<2cm)
45
Jaffe-campanacci syndrome
multiple NOFs, cafe-au-lait spots, MR, hypogonadism, cardiac malformations
46
enchondroma
- tumor of medullary cavity composed of hyaline cartilage - MC w/ age (peak: 10-30 yo) -metaphysis long bones. Skull/spine spared - app - fingers/toes: lytic - humerus, femur: arcs & rings - chondroid comp = T1-, T2+ lobular lesions - multiple? (esp hands)-syndromes: Ollier dx & maffucci syndrome
47
mc cystic lesions in hands/feet
enchondroma
48
Ollier disease
-multiple enchondromas (3+)
49
Maffucci syndrome
- multiple enchondromas - hemangiomas - greater risk CS than older * Marfucci has More (CA & vascular malform)
50
syndromes ass w/ multiple enchondromas
- Ollier disease | - Maffucci syndrome
51
Eusinophilic granuloma/LCH
benign prol of histiocytes - <30 yo (peak 5-10 yo) - var appearance - solitary (mc), mult - lytic, blastic - +/- sclerotic border - +/- periosteal resp - +/- osseous sequestrum - bone --> skin --> CNS, HB/spleen, lungs, LN/ST, BM, SG, GI
52
3 classic appearances eusinophilic granuloma
1) vertebra plana 2) beveled edge 3) floating tooth w/ lytic lesion in alveolar ridge
53
Ddx vertebra plana (MELT)
- Mets/Myeloma - EG - Lymphoma - Trauma/Tb
54
Ddx osseous sequestrum
OM Lymphoma Fibrosaroma EG
55
Giant cell tumor (GCT)
- 20-30 yo; physis MUST be closed - knee - non sclerotic border (vs NOF), abuts articular surface - locally invasive, pulm met (5%) - ass w/ ABC (
56
osteoid osteoma-who, app, loc
- adolescent (10-25%) - Lucent nidus surr by dense sclerotic cortical bone - Loc - meta/diaphysis long bone (femora neck=MC) - pst spine (L > C > T)
57
associations of osteoid osteoma
- painful scoliosis, convexity pointed away from lesion - growth deformity-increased length & girth of long bones - synovitis- if intra-articular, JE - arthritis- from 1˚ synovitis or altered joint mechanics
58
"large amount of edema for size of lesion"
- osteoid osteoma | - edema can involve ST
59
osteoid osteoma nuclear med sign
"double density sign"-cnetral activity surr by less intense reactive bone
60
OO vs stress fx on nuc medicine
stress fx= linear
61
Rx OO-CI/relative CI
percutaneous radio frequency ablation - can't be w/I 2 cm of nerve or other vital structure - typically avoided in hands, spine, pregnant pts
62
osteoblastoma-what, who, where
OO > 2cm - <30 yo - pst elements MC - long bones 35% (diaphysis 75%)
63
Ddx Lucent lesion in pst element spine
OB ABC Met
64
abc-who, where, app
- 1˚ or 2˚ (classically GCT, other benign lesions) - anuerysmal lesion of bone w/ thin wall, blood filled space - <30 yr old - Tib > Vert> femur> humerus - img: T2+, septal enh, F/F
65
solitary (unicameral) bone cyst
- CENTRAL in tubular bone - fallen fragment sign - <30 yo
66
brown tumor (hyperPTH)-what, who, where
- accumulation giant cells and fibrous tissue - lytic or sclerotic - subperiosteal bone resorption - side of finger, edge of clavicle, rib - difference stages healing/sclerosisL resorb --> sclerotic when healed
67
chondroblastoma-who, where, app, mx
- epiphyseal lesion 5-25 yo - femur (greater trochanter) > humerus > tibia - thin sclerotic rim, ext across physical plate (25-50%), periostitis (30%) - bmarrow & ST edema-misleading for bad thing - ONE OF ONLY TUMORS THAT"S NOT T2+ - mx-resection (reocc 30%)
68
chondromyoid fibroma
- rare bening cartilagenous tumor - <30 yo - tibia metaphysis - osteolytic, elongated, eccentric, cortical expansion _ bite like configuration - looks like NOF
69
what is special about chondroblastoma
one of only tumors that's not T2+
70
least common benign lesion of cartilage
Chondromyoxid fibroma
71
avulsion fracture lesser trochanter
pathologic fx
72
pathology of intertrochanteric region
lipoma SBC FD (monostotic)
73
POEMS
rare medical syndrome w/ plasma cell proliferation (typically myeloma), neuropathy, organomegaly - Polyneuropathy - Organomegaly - endocrinopathy - M-protein - Skin lesions
74
liposclerosing myxofibroma-most classic location, app, malignant degeneration
-benign fibro-osseous lesion made of a mixture of histo elements (lipoma, myxoma, myxofibroma, fibroxanthoma, FD-like features, cyst formation, ischemic ossifications, cartilage) - intertrochanteric region - geographic lytic lesion, sclerotic margin -10% malignant degeneration-follow
75
osteochondroma/exostosis what, malignant potential (based on what?)
- cartilagenous forming developmental anomaly/tumor pointing away from joint - MC benign tumor. - bmarrow flows into it - mal pot very small-cap >1.5 cm
76
exostosis and enostosis
- exostosis=cartilagenous forming bony protrusion | - bone island
77
only benign tumor associated with radiation
exostosis
78
multiple hereditary exostosis
AD condition w/ multiple osteochondromas - sessile or pedunculated - (+) risk malignant transformation
79
Trevor Disease/Dysplasia epiphyseal hemimelica (DEH)-what, who, where, app, mx
osteochondromas at epiphysis --> joint deformity - ankle, knee (bad soccer players) - young children - cartilagenous irregular mass, point INTO joint - mx-surgical excision
80
supracondylar spur (Avian spur)
- Aunt minnie, normal variant - osseous process at medial supracondylar humerus - point into joint - compress median n if ligament of strutters smashes it
81
peripsteal chondroma (juxxta-cortical chondroma)
- rare cartilagenous lesion in finger of child | - saucerization of adj cortex w/ sclerotic periosteal rxn
82
osteofibrous dysplasia
- developmental tumor-like, fibroosseous condition - benign lesion in tib/fib of child <10 yo - spon't regression -almost exclusively in ANT TIB DIAPH - ant tibial bowing - char sclerotic band - can occ with adamantinoma, looks like NOF -indis from NOF, FD, adamantinoma
83
NOF in anterior tibia w/ anterior bowing
osteofibrous dysplasia
84
distal femoral metaphyseal irregularity/cortical desmoid-what, where, mx, Mao, bw
- lucency at pst lat distal femoral metaph (BL). - incidental- Do not touch. No further img - BW: "scoop like defect" - likely MOA: chronic tug lesion from adductor magnus
85
"scoop like defect"
distal femoral metaphyseal irregularity/cortical desmoid
86
most pathologic calcification in the body
calcium hydroxyapatite
87
most abundant form of calcium in bone
calcium hydroxyapatite
88
calcific tendinitis
-Ca hydroxyapatite deposition disease. 1˚ or 2˚
89
MC locs calcific tendinitis
- MC=supraspinatus tenon at insertion near greater tuberosity - longus colli m (ant to atlas--> T3)
90
2˚ causes calcific tendinitis
- chronic renal dx - collagen vascular dx - tumoral calcinosis - hypervitaminosis D
91
osteopoikilosis
- mult bone islands in epiphyses - inherited (AD) or sporadic - joint centered (vs mets) - keloid formers
92
osteopathic striata
- linear, parallel and long lines in metaph of long bones | - +/- pain
93
engelmann's disease/progressive diaphysial dysplasia (PDD)
- fusiform bony enlargement + sclerosis long bones - childhood - BL, symmetric - bone scan hot - loc - tibia-MC - skull --> optic n compression
94
thalassemia vs sickle cell
Thalassemia will obliterate sinuses, SCD will not
95
thalassemia buzzwords
- hair on end - rodent faces - jail bars
96
Causes AVN hip
Perthes - SCD - Gaucher's - steroids - trauma (femoral neck fx-degree of risk related to degree of displacement & disruption reticular less')
97
where does avn hip usually start
superoant articular surface
98
double line sign AVN hip
inner T2+ (granulation tissue) + outer dark (sclerotic border)
99
rim sign AVN hip
T2+ sandwiched btw two T2(-)=fluid btw sclerotic borders of osteochondral fragmentation ==> instab
100
crescent sign AVN hip
Xray subchondral lucency in anterolat aspect of proximal femoral head. indicates imminent collapse
101
plain film stages osteonecrosis
``` 0=N 1= Xray N. MRI edema 2= mixed lytic & sclerotic 3= crescent sign, articular collapse, joint space preserved 4= 2˚ OA ```
102
Paget's dx/osteitis deformans-incidence, epidemiology
- 4% at 40, 8% at 80 | - M > F
103
paget's 3 phases
1) lytic 2) mixed (reparative) 3) sclerotic (latent inactive)
104
"wide bones with thick trabecular"
paget's
105
sgx's and syx's ass w/ paget phases
1) lytic-usually asyx 2) mixed (reparative)- ALP+ 20x, fx 3) sclerotic-hydroxyproline+, fx+, sarcomas
106
blade of grass sign
Paget's. Lucent leading edge in a long bone
107
osteoporosis circumscripta
Paget's. Lucent leading edge in frontal/occipital skull
108
picture frame vertebra
Paget's. Cortex expanded on all sides
109
Cotton wool bone
Paget's. Thick disorganized trabeculae
110
Banana fracture
Paget's. Insufficiency fx of bowed soft bone (femur or tibia)
111
tam o'shanter sgx
Paget's. Thick skull w/ front aspect "falling over the facial bones"
112
Saber shin
Paget's. Bowing of tibia.
113
Ivory vertebra
Paget's & mets. Pagets=expansile
114
Paget's complications
Deafness-mc - spinal stenosis-characteristic - cortical stress fx - CN paresis - CHF (high output) - 2˚ hyperPTH (10%) - 2˚ OS (1%), GCT
115
paget's on bone scan
hyper vascular, 5˚ hotter than other bone
116
what part of skull does Paget's involve
inner and outer tables (vs FD)
117
MC bone involved in Pagets. Compl's
Pelvis - always involves iliopectineal line on pelvic brim - 2˚ OA, acetabular protrusion - classic look on scan
118
rugger jersey spine
top and bottom VB | -renal osteodystrophy, oteopetrosis
119
osteopetrosis
genetic dx w/ impaired osteoclastic resorption - thick cortical bone w/ diminished marrow - rugger jersey or sandwich vertebra - dark T1 (loss of normal marrow)
120
"widening of disc space" aka
"h-shaped vertebrae"
121
Paget's different phases MRI appearance
1) lytic/eary mixed-T2 hetero. T1 iso w/ speckled app 2) late mixed-T1/2+ (fatty) 3) sclerotic-T1/2-
122
Paget active dx vs malignant transformation
- loss of T1 signal w/ cancer | - both T2+, enh
123
paget's nuclear medicine
-hot on all 3 phase bone scan
124
Why are soft tissue masses not accurately diagnosed on MRI?
20-30% bc almost all are T2+, enh
125
soft tissue masses to know
- Malignant fibrous histiocytoma (MFH) - synovial sarcoma - lipoma, atypical lipoma, liposarcoma - hemangioma - myxoma
126
malignant fibrous histiocytoma/pleomorphic undifferentiated sarcoma-who, where, app, ass, RFs
Undifferentiated pleomorphic sarcoma (UPS), previously known as malignant fibrous histiocytoma (MFH), is considered the most common type of soft tissue sarcoma. It has an aggressive biological behavior and a poor prognosis. - older - central loc (proximal arm & leg) - T2- (50%) ("fibrous" - spon't hem (outgrow bs) - 2˚=bone infarcts, radiation
127
"sarcomatous transformation of infarct"
malignant fibrous histiocytoma (MFH)/Pleomorphic undifferentiated sarcoma ("pus")
128
synovial sarcoma-who, where, img, translocation
- 20-40 yos (mc malignancy in teens/young adults of foot/ankle/LE) - translocation of X18 (90%) - peripheral LEs, close to joint; foot, ankle, LE (knee) - 2˚ invasion into joint (10%)-just remember they never involve joint - img: small (slow growing), ST mass, Ca+, bone erosion - triple sign-T2 high, medium, low signal in same mass (probably at knee) - bowl of grapes-fluid levels in mass (probably in knee) - xray ST mass + Ca
129
synovial sarcoma vs baker's cyst
sarcoma. .. - complex - blood flow
130
Synovial sarcoma vs other sarcomas
attacks bone, causes pain
131
"ball like tumor" in extremity of young adult
synovial sarcoma
132
ST tumor in food of young adult
synovial sarcoma
133
MFH (PUS) vs synovia sarcoma
- MFH-old, central, T2 variable | - SS-young, per, T2 triple sign
134
MC liposarcoma <20 yo
myxoid liposarcoma
135
spectrum fat containing ST masses
lipoma --> atypical lipoma --> liposarcoma
136
lipoma vs atypical lipoma/low grade liposarcoma vs high grade liposarcoma
- lipoma-Super. Completely fat sat, no sept - AL/LGL- may incomp fat sat, thick chunky sept - HGL- Deep. Incompl/no fat sat/, thick nodular complex enhancing content. +/- fat. Deep
137
T/F: hemangiomas respect fascial boundaries
false
138
mazabraud syndrome
- polyostotic fibrous dysplasia | - mult ST myxomas
139
myoma
T2+, T1- | -ass w/ mazabraud syndrome
140
mx GCT
arthroplasty (bc ext to articular surf)
141
pigmented villonodular synovitis (PVNS)-what, who, where, app, rx, recurrence rate
- small nodules lining synovium, synovial proliferation + hemosiderin dep (via tendency to bleed) - adults (polyarticular in kids) - focal or diffuse - intraarticular, knee 65-80% - osseous erosion w/ preservation of joint space and normal mineralization - tendency to bleed --> hemosiderin --> blooming, low sign - T1/T2(-), blooming - (+) large hemorrhagic joint effusion - Ca (late) - rx=synovectomy - recurr 20-50%
142
GCT of the tendon sheath/PVNS of the tendon
hand (palmar) 2nd MC ST mass of hand/wrist (after ganglion) - T1/T2(-) - diffusely/avid enh -vs glomus tumor: T1(-), *T2+, enh
143
1˚ synovial chondromatosis
- 1˚ or 2˚ (from OA). Non-inflamm metaplastic/true Neo - mult cartilaginous nodules in synovium of joints, tendon sheaths, bursae--> loose bodies. +/- Ca - knee (70%) - 40s-50s - rx-removal LBs +/0 synovectomy
144
PVNS vs synovial chondromatosis
- PVNS-hemarthosis, never Ca | - SC-no hemarthosis, +/- Ca
145
1˚ vs 2˚ synovial chodnromatosis
2˚ loose bodies fewer, larger; extensive degen
146
diabetic myonecrosis-who, where, app, bx?
- muscle infarction in poorly controlled DM 1 - thigh (80%), calf (20%) - edema, enh, irregular m necross - no bx-delays recovery, compl++
147
lipoma arborescents
frond-like depo fatty tissue in synovial lining of joints, bursa - suprapatellar bursa knee. Normal knee or ass w/ OA, chronic RA, trauma. UL - 50-70s - img=fat
148
tumoral calcinosis
- Hereditary phosphate metabolism (Ca normal, P isn't.) - big lobular/cystic Ca near joint. - Layering fluid/Ca levels. No erosion/destruction joint. - Hip (greater trochanteric bursa), elbow, shoulder (knee rare)
149
tumoral calcinais vs metastatic Ca
look sim but labs different
150
what to avoid when biopsying pelvis
-gluteal m's (may need for reconstruction)
151
what to avoid when biopsying knee
- crossing joint space via supra patellar or other communicating bursae - quadriceps tendon (unless involved)
152
what to avoid when biopsying shoulder
pst 2/3 (axillary n courses pst --> ant== may denervate ant 1/3 of nerve)
153
don't touch lesions
- myositis ossificans - avulsion injury - cortical desmoid - synovial herniation pit ("Pitt's pit)
154
synovial herniation pit ("Pitt's pit)
lytic appearing lesion ass w/ femoral acetabular impingement syndrome
155
metastatic Ca
- MOA=hypercalcemia | - fine and diffuse ST Ca + renal/lung Ca
156
non ossifying fibroma aka
fibrous cortical defect | fibroxanthoma
157
mx NOF
curettage and bone graft-if indicated (ex: patho fx)
158
chondroid matrix
Calcifications in chondroid tumors have many descriptions: rings-and-arcs, popcorn, focal stippled or flocculent.
159
osteoid matrix
trabecular ossification pattern in benign bone-forming lesions and as a cloud-like or ill-defined amorphous pattern in osteosarcomas.
160
plasmacytoma
proliferation of plasma cells | -lytic lesions + ST mass
161
myxoma
- intramuscular tumor, mc in thigh, butt, shoulder girdle - char T2+, T1 (-)/~ - + hypointense sept, nods - + hetero enh
162
Gorham disease/ Gorham massive osteolysis/ gorham-stout syndrome/ disappearing bone disease
- rare vascular disorder of lymphatic etiology - bone resorption + ST change at skel site + splenic cysts Bone: - spon't, progressive resorption of bone - MC=skull, shoulder, pelvis - usually single bone --> regional (no regard for boundaries) - hx trauma - +patho fx -splenic lesions/cyst ST change at site of skeletal involvement
163
plantar fibromatosis
- fibroblastic and myofibroblastic tumor - plantar fascia of foot, BL 20-50% - M>F MR: - T1 (-)/~ - T2 hetero - enh+ hetero -US: hetero hypoecho
164
paraosteal osteochondromatous proliferation/ "Nora lesion"
- rare, exophytic growths from osseous cortical surfs, - bone, cartilage & fibrous tissue - post reparative vs benign neoplastic
165
parosteal osteosarcoma vs myositis ossificans
- PS: centrally most dense | - MO: peripherally most dense
166
telangiectatic OS vs ABC
OS: 1) thick nodular separations, surrounding ST comp (best demonstrated on contrast+ CT or MRI 2) matrix mineralization in the lesion 3) aggr fx's, ex: cortical destruction
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glomus tumor
benign sublingual tumor (hamartoma) developing from neuromyoarterial gloms bodies) - T2+, T1-, richly vascular (MRI/MA) - mx- surgical excision (complete resolution of syx's after!)
168
patellar lesions
* end of bone * benign (usually) -CB --> GCT
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sclerotic MM ass
rare | -ass w/ POEMS
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periosteal chondroma/ juxtacortical chondroma
- benign cartilage tumor arising on surface of bone deep to periosteum - metaph of long bones - saucerization of cortex, sclerotic margination, dense periosteal rxn - +matrix -T1, T2- (chondroid composition)
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hemangiopericytoma/ solitary fibrous tumor
- heterog group of benign and malignant spindle cell neoplasms - staghorn branching pattern - hypoglc and osteomalacia
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bx shoulder lesion
ant
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bx prox tvb metaph
ant med
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Pannus Rheumatoid Arthritis
synovial inflammatory mass posterior to C2 and surrounding the dens in association with odontoid erosion.
175
Typical patient age range for tumors
<20 yo 20-40 40
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typical skel loc descriptors for tumors
- flat vs tubular - epiphyseal vs metaphyseal vs diaphyseal - medullary vs cortical
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True of false: the margin of lesion and type of periosteal reaction indicate benign vs malignant
False. It indications lesion aggression
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Bone lesions with age predilection <20: benign & mal
Benign: - fibrous cortical defect, NOF, SBC, ABC - LCH - OB, OO - osteofibrous dysplasia - chondromyxoid fibroma - fibrous dysplasia - enchondroma Malignant: - leukemia, ES, HL - OS (conventional, periosteal, telangiectatic.) - mets (rare) - NB, RB - rhabdomyosarcoma
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Bone lesions with age predilection 20-40: benign & mal
Benign: - enchondroma - GCT - OB, OO - chondromyxoid fibroma - FD Mal: - OS (periosteal) - adamantinoma
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Bone lesions with age predilection >40: benign & mal
Benign: - FD - Paget disease - NHL - chondrosarcoma - malignant fibrous histiocytoma - osteosarcoma (secondary to Paget disease and radiation) Mal: - mets (MC) - MM
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The specific radiographic features that should be evaluated
tumor location, margins and zone of | transition, periosteal reaction, mineralization, size and number of lesions, and presence of a soft-tissue component.
182
the most important piece of clinical information | when assessing a bone tumor
age
183
why does OS have predilection for metaph and why does ES have predilection for red marrow?
``` some tumors (eg, osteosarcoma) have a predilection for sites of rapid bone growth, usually the metaphyseal region, while other tumors (eg, Ewing sarcoma) tend to follow the distribution of red marrow ```
184
Apophysis
(a growth center that does not contribute to the length of a bone) is the equivalent of an epiphysis
185
Describing margins
Focal & discrete= Type 1= "geographic" -1a-well defined border with sclerotic rim -1b-focal lytic lesion with ill-defined border Infiltrative= - Type 2: "moth-eathen" - Type 3: "permeative" -from least to most aggressive appearing
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benign but aggressive appearing lesions
OMS | LCH
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well defined margin but mal
GCT
188
Why are they called " small round blue cell group"
histologic appearance on hematoxylin and eosin stained specimens *OM and LCH also look "blue"
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classic "permeative" lesions
small round blue cell grp (ES, lymphoma)-small enough to fit through the haversian canals
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patterns of periosteal rxn
1) solid, unilamellated- nonaggressive. - Slow growing allowing bone to wall it off 2) multilamellated (onionskin)-intermediately aggressive - Wax & wane such that bone continually trying to wall off but cannot. 3) Interruption (regional disruption)-aggressive - Has broken through the periosteum 4) spiculated, hair-on-end (T to cortex), sunburst-most aggressive
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codman triangle-what, what lesions
- elevation of periosteum away from cortex with angle formed where elevated periosteum and bone come togehter - conventional OS - inf, subperiosteal hematoma
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How does sequestrum form
diestructive process caues fragment of bon e(sequestrum) to become stuck in lytic region
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trabecular patterns of: - ABC, desmoplastic fibroma - PD - hemangioma
- ABC, DF: honeycomb - PD: coarse - hemangioma: Sunburst/spoke-and-wheel in long bone. "Corderoy" (vertically oriented, coarsened) in VB
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matrix
type of tissue of tumor: - osteoid - chondral - fibrous - adipose
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mineralization
calcification of matrix
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mineralized chondral tissue/cartilate
punctate, flocculent, comma-shaped, arclike/ringlike
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mineralization of bone
fluffy amorphous cloudlike
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mets vs osteopoikolosis
OPK=same size, centered around joints
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mult lytic lesions >40 yo
- mets - mm - NHL - brown tumors
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pathophys of lytic expansile/"soap bubble" appearanc
slow growing medullary process grows outward but bone has time to lay down new periosteum
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endosteal scalloping vs saucerization
- Endo scall: in to out | - sauce: out to in
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tumors with ST components
- OS - ES - lymphoma
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"end of bone" sites
- epiphyses - aphophyses - patella - sm bones of wrist - mid/hindfoot - subarticular portions of flat bones (SI joints, acetabuli, glenoid)
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Specific sites for tumors: - adamantinoma, OFD - epidermal inclusion cyst, glomus tumor - periosteal desmoid, parosteal OS - chordoma - hemangioma - SBC, intraosseous lipoma - OB, ABC
- adamantinoma, OFD: tib ant cortex - epidermal inclusion cyst, glomus tumor - periosteal desmoid, parosteal OS-pst cortex of distal femur - chordoma-clivus, VB, sacrum - hemangioma-VB - SBC, intraosseous lipoma-calcaneus - OB, ABC-pst elements of spine
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Specific sites for tumors: - adamantinoma, OFD - epidermal inclusion cyst, glomus tumor - periosteal desmoid, parosteal OS - chordoma - hemangioma - SBC, intraosseous lipoma - OB, ABC
- adamantinoma, OFD: tib ant cortex - epidermal inclusion cyst, glomus tumor - periosteal desmoid, parosteal OS-pst cortex of distal femur - chordoma-clivus, VB, sacrum - hemangioma-VB - SBC, intraosseous lipoma-calcaneus - OB, ABC-pst elements of spine
radiology
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