Diagnostic Imaging 2- Exam 3- Tumor 1 Malignant Notes- part 1

Cancer that begins in bone, cartilage fat muscle blood vessels or other connective or supportive tissue

Sarcoma

Malignancies derived from hematopoietic cell

Lymphoma and leukemia

Tumor which resembles an immature or embryonic tissue

Blastoma

New tumors that appear far from the original tumor

Metastasis

Differential diagnosis by predictive factors

Age

Incidence

Skeletal location

Interosseous location

Tumor appearance

Clinical presentation

What is most common form of malignancies

Metastatic disease

Most common primary malignant tumor in adults

Multiple myeloma

Must common primary malignant tumor in kids

Osteosarcoma

Most common benign osseous tumor

Osteochondroma

Most common benign spinal tumor

Hemangioma

Most common tumors are based on

Location

-hand, proximal humerus, etc.

Positions that a tumor can be in the bone or around the bone

Central/medullary

Eccentric

Cortical

Parosteal

Soft tissues

Example of a metaphyseal central tumor

Example of a metaphyseal eccentric tumor

Example of a cortical tumor location

Example of a soft tissue tumor location

How much bone destruction do you need from a tumor in order to see it on X ray

30-50%

Wha are the 3 types of bone destruction from tumors

Geographic

Moth eaten

Permeative

What is the most benign pattern of bone destruction

Geographic

What is the most progressive pattern of bone destruction

Permeative

What is the least aggressive pattern of bone destruction and has a short zone of transition

Geographic bone destruction

Geographic bone destruction is indicative of

Slow growing lesion

Example of a geographic well defined bone destruction

Example of geographic ill defined bone destruction

Example of geographic not well defined bone tumor

Example of geographic well defined bone tumor

What bone destruction is numerous small holes with a longer zone of transition than geographic, with margins that are not well defined

Moth eaten bone destruction

Example of moth eaten destructive changes

Example of moth eaten destructive changes with cortical destruction

One more example of moth eaten destructive changes in the ilium this time

Confirm

Difference between Permeative and moth eaten destructive changes example

What is the most aggressive type of bone destruction with a wide zone of transition, it is a bunch of small holes, poorly demarcated or imperceptible borders

Permeative bone destruction

Example of Permeative destructive changes

Difference between all the types of destructive changes example

Difference between all the types of destructive changes, drawing this time

One more example of moth eaten destructive changes that are in the ilium

Confirm

Shorter zone of transition, means what for tumors

Less aggressive

Longer zones of transition means what for tumors

More malignant

Order the patterns of bone destruction in order form less malignant to the most malignant

Geographic (least)

Moth eaten

Permeative (most)

Example of cortical thickening (or buttressing)

Expansile and thin cortex example

Endosteal scalloping

Different types of cortical changes

Buttressing/thickening

Endosteal scalloping

Splitting or tunneling

Thinning with or without expansion

Penetration with or without periosteal reaction

What are the things that can cause a periosteum reaction

Subperiosteal extension of blood, pus or tumor or hyperemia, inflammation and edema

Patterson of periosteal reactions

Buttressing

Single layer

Multiple layers/laminated

Speculated

Codman`s triangle (worst one to have)

What is a membrane that lines the outer surface of all bones, except area covered by articular cartilage

Periosteum

Laminated periosteal reaction

Spiculated (hair on end) periosteal reaction

Solid periosteal reaction

Codman`s triangle periosteal reaction

What is the formation of new bone in response to injury or other stimuli of the periosteum surrounding the bone

Periosteal reaction

What is it when additional layers of new bone are added to the exterior creating an expanded osseous contour

Buttressing/solid periosteal reaction

Buttressing periosteal reaction

Solid (aka buttressing) periosteal reaction

Buttressing/solid periosteal reactions are usually associated with

Slow glowing lesions and usually benign

Multiple lathers of new new layers of bone

Laminated/layered/onion skin periosteal reaction

Alternating lawyers of lucency and opacity with alternating growth

Laminated/layered/onion skin periosteal racing

Laminated/layered/onion skin periosteal reaction

What type of periosteal reaction is classically associated with Ewings sarcoma

Laminated/layered/onion skin

Linear radiating spicules of new bone

Spiculated periosteal reaction

When spiculated periosteal reaction is perpendicular to the bone it is known as

Hair on end

When spiculated periosteal reaction is radiating from a central focus it is known as

Sunburst

Spiculated periosteal reaction

Example of a sunburst spiculated periosteal reaction

Example of a spicualted reaction with a codmans triangle in there too

What type of periosteal reaction is often associated with highly aggressive lesions, such as osteosarcoma

Spiculated

What is a triangular elevation of periosteum seen at the peripheral lesion-cortex junction for a periosteal reaction

Codmans triangle

Example of codmans triangle

Periosteal reactions ordered from least malignant to most malignant

Solid

Sunburst (Spiculated)

Onion peel

Codmans triangle

What is one of the most aggressive forms of periosteal reaction

Codmans triangle

Different appearances of cartilaginous matrix

Ring or arc like

Flocculent

Small crystals

Popcorn like

Stippled

Benign tumors with cartilage matrix

Enchondroma

Osteochondroma

Chondroblastoma

Chrondomyxoid fibroma

Flocculant cartilage matrix

Crystal like cartilage matrix

Stippled cartilage matrix

Malignant tumors with cartilage matrix

Chondromsarcoma

What are radiodense areas that are variable in size, may occupy parts of or entire lesion and can be homogenous or inhomengous increased density changes/sclerosis

Osseous matrix

Benign tumors with osseous matrix

Osteoma

Osteoblastoma

Osteochondroma

Osteoid osteoma

Small hole with a lot of sclerosis means

Osseous matrix

Tumors with a fibrous matrix look like

Hazy, lucent, ground glass appearance

Malignant tumors with osseous matrix

Osteosarcoma

Benign tumors with fribrous matrix

Fibrous dysplasia

Desmoplastic fibroma

Non-ossifying fibroma

Fibrous cortical defect

Ossifying fibroma

Ostoeid matrix mineralization

Chondroid (rings and arcs) matrix mineralization

Fibrous matrix mineralization

Malignant tumor with fibrous matrix

Fibrosarcoma

Bone expansion typically occurs from what type of tumor

Primary

Periosteal reactions are more common in what type of tumors

Primary

Presence of soft tissue mass is more common from what type of tumors

Primary

When the size of the lesion is less than 6cm than it is typically from what type of tumor

Primary

What type of imaging looks for metabolism hot spots

Bone scan

What type of imaging looks for increased density areas

DEXA scan