Di Imaging 2: Exam #3 Tumors (Intro: 1-62, Malignant 63-111, Benign 112-...)

Leukemia

What is the #1 malignancy to occur in people 0-14 years old?

Metastatic Disease (aka Lytic Mets)

What makes up 70% of all malignancies?

Multiple Myeloma

What is the MC malignant tumor in adults?

Osteosarcoma

What is the MC primary malignant tumor in kids?

Solitary Osteochondroma

What is the MC benign osseous tumor?

Hemangioma

What is the MC benign spinal tumor?

Metaphysis

What part of the bone is a preeminent area for malignancies to occur?

Geographic Bone Destruction

What is the least aggressive pattern of bone destruction, that is indicative of a slow growing solitary lesion >1cm with short transitions?

Finding: Rind Sign

Diagnosis: Fibrous Dysplasia

What is the finding & diagnosis?

Moth-eaten Bone Destruction

What type of bone destruction is moderate in aggressiveness and consists of numerous small holes 2-5mm in size with a longer transitions?

Moth-eaten Bone Destruction

What type of bone destruction is being shown?

Permeative Bone Destruction

What is the most aggressive bone destruction type with numerous small holes about 1mm in size?

Permeative Bone Destruction

What type of bone destruction is this?

Permeative & Moth-eating

What bone destruction type/s are usually malignant?

Metastatic

What is the term when a cancer starts in the soft tissue/organs and moves to the bones?

True

T/F: Endosteal scalloping is usually a sign of malignancy?

False, it's usually a sign of benign

T/F: Buttressing is usually a sign of a malignancy

Buttressing

What cortical change is being shown?

Endosteal Scalloping

What cortical change is being shown?

Saucerization (erosion from the outside in)

What cortical change is being shown?

kids

Periosteal reactions usually happen in adults or kids?

Laminated

What pattern of periosteal reaction is being shown?

Spiculated

What pattern of periosteal reaction is being shown?

Buttressing

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

Laminated

What periosteal reaction is classically associated with Ewing's Sarcoma?

Laminated

What periosteal reaction is being shown?

Spiculated

What periosteal reaction is often associated with highly aggressive lesions such as Osteosarcoma? It has "Hair on End" and "Sunburst" appearances.

Codman's Triangle

What is a triangular elevation of periosteum seen at the peripheral lesion-cortex junction, it is Is one of the most aggressive forms of periosteal reaction?

Codman's Triangle

What periosteal reaction is being shown?

Buttressing

Which of the following is usually a benign periosteal reaction?

A. Spicualted

B. Codman's Triangle

C. Laminated

D. Buttressing

Flocculent

What cartilaginous matrix appearance is like a popcorn ball?

See picture, I didn't feel like writing all that stuff out

What are some characteristics of Primary and Secondary Neoplasms?

Metastatic Bone Disease

What arises from a primary extra skeletal site?

70

Metastatic Bone Disease represents ____% of all malignancies

Breast, lung, prostate, kidney, thyroid, bowel

What are the most common originsof metastatic bone disease?

Breast, Lytic

In females the _____ is the most common primary site of origin for metastatic bone disease to happen and it is usually _______ 80% of the time

Breast cancer

(because of the lytic destruction)

A female patient comes in with this x-ray with a previous history of cancer. What do you suspect the cancer was based on the x-ray?

Lung cancer

(because of the lytic destruction, if it was prostate suspect more blastic changes)

A male patient comes in with this x-ray with a previous history of cancer. What do you suspect the cancer was based on the x-ray?

Prostate, blastic

In males the _____ is the most common primary site of origin for metastatic bone disease to happen and it is usually _____ 80% of the time

blastic, lytic

Metastasis of prostate cancer is usually _____ while origin in the lung is mostly _____

Hematogenous dissemination (thru the blood via Batson's venous plexus)

What is the most common pathway of metastasis to move along the body?

Acid phosphatase (aka PSA antigen)

What lab exam is used for determining prostate cancer?

40

Most patients that develop metastatic disease are over the age of ___, and may have had recent unexplained weight loss

Spine

What is the #1 most common area for metastatic disease?

Osteolytic

What is the most common type of metastasis alteration to bone density & texture?

Kidney & Thyroid

A blowout metastasis usually happens from tumors of what organ/s?

Lytic Mets

The one eyed pedicle sign is a characteristic of what disease?

Missing pedicle on the left of L3, and focal osteoporosis on the lateral view, could be lytic mets

What do you see?

Pathologic Collapse of C3 on C4 (a sign of vertebral metastasis)

What is the diagnosis?

Metastatic disease

What would you expect if you see 1-10 holes of variable size in the calvarium?

Multiple Myeloma

What would you expect if you see 1-100 of the same size holes in calvarium?

• Paget's disease

• Hodgkin's lymphoma

• Osteoblastic metastasis

What are the 3 most likely causes of a Solitary Ivory Vertebra?

All of the above

Which of the following may cause pathologic collapse of a vertebrae?

A. Multiple Myeloma

B. Eosinophilic Granuloma

C. Pagets Disease

D. All of the above

Enostosis

What are known as bone islands, are common benign sclerotic bone lesion which usually represent incidental findings? (don't touch lesions)

Enostosis

What is the diagnosis?

Osteopikilosis (aka Multiple Bone Islands)

What is a sclerosing bony dysplasia characterized by multiple benign patches of dense cortical-like bone complete with haversian canals located within the spongiosa?

Osteopikilosis (aka Multiple Bone Islands)

What is the diagnosis?

Osteopikilosis (aka Multiple Bone Islands)

What is the diagnosis?

Blow Out Bone Metastasis

In what condition should you do a kidney or thyroid exam?

Blow Out Bone Metastasis

What is the diagnosis?

T1

What MRI is most sensitive to metastasis?

1. Multiple Myeloma (MC in adults)

2. Ostosarcoma (MC in kids)

3. Chondrosarcoma (2nd in adults)

4. Ewing's Sarcoma (2nd in kids)

List the top 4 primary malignant neoplasms in order from MC to least.

Multiple Myeloma

What is the most common primary malignant tumor, it is a malignant proliferation of plasma cells, which infiltrate the bone marrow?

50-70

75% of patients with Multiple Myeloma are between the ages of ______

Multiple Myeloma

Protein electrophoresis with "M-spike" is confirmatory in 80-90% of what diagnosis?

Multiple Myeloma

Lab findings of Bence Jones proteniuria and a M-Spike would lead you to what potential diagnosis?

Multiple Myeloma

Pain, weight loss, and renal disease are clinical findings of what malignancy?

Solitary Plasmacytoma

What is a localized form of plasma cell proliferation that is most commonly found in the Vertebra yet is spares the posterior elements?

True

T/F: Solitary Plasmacytoma's are most common in the vertebra yet and typically spare the posterior elements of a vertebra

Solitary Plasmacytoma

What is the diagnosis?

Conventional Radiography

What is the best imaging for diagnosing Multiple Myeloma?

Multiple Myeloma

You refer a patient out after finding a "Rain drop skull" appearance on your x-ray for a bone scan and it comes back normal. What is your likely diagnosis?

Multiple Myeloma

A "Rain Drop Skull" is a characteristic of what diagnosis?

Finding: Rain drop skull

Diagnosis: Multiple Myeloma

What is the finding & diagnosis?

50%

What is the 5 year survival rate of multiple myeloma?

Osteosarcoma

What is a primary malignant tumor of undifferentiated connective tissue which forms neoplastic osteoid?

Osteosarcoma

What is the 2nd most common primary malignant bone tumor overall?

Osteosarcoma

What is the most common primary malignant bone tumor in children and young adults?

Osteosarcoma

What malignant neoplasm has a bimodal distribution of age occurrences? (10-25 & >60)

#1 Distal Femur

#2 Proximal Tibia

Where are the top 2 places for a Osteosarcoma to occur?

Metaphysis

Where do 75% of Osteosarcomas affect on the bone?

Osteosarcoma

A patient comes in with painful swelling around the knee (distal femur, proximal tibia) for the last 1-2 months and a fever. On the x-ray you see a sunburst periosteal reaction. What is the likely diagnosis?

Sclerotic

Most osteosarcoma's are:

A. Sclerotic

B. Lytic

C. Mixed

Lung

Metastasis to the _______ is common in Osteosarcoma

Osteosarcoma

What is the diagnosis of the patient with local pain?

Osteosarcoma

What is the diagnosis of the patient with local pain?

Parosteal osteosarcoma

What arises from the outer layer of the periosteum, usually located at the metaphysis most common or distal femur as a painless slowly enlarging mass?

Parosteal osteosarcoma

What is the diagnosis of the patient with no pain?

String sign

What is a sign where a tumor is separate from the rest of the bone?

MRI

What imaging is best for an osteosarcoma because it clearly defines marrow involvement on T1 and soft tissue component on T2

Treatment:

-Amputation (20% 5 yr survival)

-Chemotherapy (75% 4 year survival)

What is the treatment & prognosis for Osteosarcoma?

Chondrosarcoma

What is the 3rd most common primary malignant bone tumor?

Chondrosarcoma

What tumor clinical feature includes:

• Usually over 50 with a 2:1 male to female ratio

• Development of a large soft tissue mass

• Late development of pain

• Duration of symptoms < 2 yrs in 75%

Pelvis

Where is the most common skeletal location to find a chondrosarcoma?

Chondrosarcoma

What is the diagnosis?

Chondrosarcoma (with pain)

Enchondroma (without pain)

What is the likely diagnosis on a patient with pain? What is the likely diagnosis if the patient has no pain?

Ewing's Sarcoma

What is a primitive primary malignant tumor composed of connective tissue framework

of bone marrow?

Ewing's Sarcoma

What is the 4th most common primary malignant bone tumor?

Ewing's Sarcoma

What is the 2nd most common primary malignant bone tumor in children?

10-25, peak at 15yrs

Ewing's Sarcoma is most common between what age?