Rad 3 week 2

What is the name sign of lytic mets in the skull?

Swiss cheese appearance

What are the causes of pathological compression fracture from most to least likely?*** (DONUT QUESTION)

Osteoporosis

Metastasis

Multiple myeloma

What is the finding of the vertebral endplate in metastasis?

Pathologic schmorl's nodes

What is the Ddx of pathologic schmorl's nodes?

Scheurmann's disease

What are the ddxs for Ivory vertebra?**** (DONUT QUESTION)

Osteoblastic mets

Paget's disease

Hodgkin's lymphoma

T or F: Mets more commonly affects the pedicle than multiple myeloma

True

What are the name signs of lytic mets in the pedicle?

One-eyed owl sign

Winking owl sign

Blind vertebra (bilateral)

What part of the spine is winking owl sign most common in?

Thoracic and lumbar spine

How do you differentiate congenital agonies from cancer of the pedicle?

Congenital agencies has stress hypertrophy of the opposite pedicle

Which benign lesions can destroy a pedicle?

Aneurysmal bone cyst

Osteoblastoma

Where does the pelvis get its blood flow from?

Batson's venous plexus

Which rare form of metastasis is common in the pelvis?

Blowout mets

What is the best imaging modality for ddx of pelvis blastic mets from paget's

CT

What is the primary differentiating factor between blastic mets and paget's

Cortical thickening in paget's

What is indicated by multiple, well defined holes of various sizes without a sclerotic border in the skull?

Lytic metastasis

How is lytic mets of the skull differentiated from multiple myeloma?

multiple myeloma lesions are uniform

What is the name sign of lytic metastasis of the skull?

Swiss cheese appearance

What is the name sign of metastasis in the ribs?

Extrapleural sign / Cat under the rug sign

What is used to determined bone vs. lung tumor?

CT (bone vs. soft tissue window)

How many shades of gray are on x-ray?

250

What is indicated by non-traumatic avulsion of the lesser trochanter?

Metastasis

What is the name sign for cortical mets in the proximal extremity?

Cookie bite erosion

What are the 4 most common primary malignancies of bone?

MOCE

Multiple mteloma

Osteosarcoma

Chondrosarcoma

Ewing's sarcoma

What Age range is multiple myeloma found in?

50-70 yo (75%)

What Age range is osteosarcoma found in?

10-25 yo

What Age range is chondrosarcoma found in?

40-60 yo

What Age range is Ewing's sarcoma found in?

10-25 yo

What is the AKA of multiple myeloma?

Kahler's disease

What is the most common primary bone tumor?

Multiple myeloma (27% of biopsied bone tumors)

What is multiple myeloma?

Malignant proliferation of plasma cells

What type of immunoglobulin is most commonly affected by MM?

IgG

What are the lab findings of MM?

Reversal of the albumin to globulin ratio

M spike on protein electrophoresis (90%)

Bence jones' proteinuria (90%)

Hyperuricemia

Hypercalcemia

What blood conditions are often found with MM?

Normochromic normocytic anemia

thrombocytopenia

Elevated ESR

What is the gold standard for diagnosis of MM?

Sternal biopsy

Why is sternum used for MM diagnosis?

Its size, central location, and hematopoietic potential, ease of access

What demographic is MM most common in?

Black males

What is the most common symptom of MM?

Low back pain

worse during the DAY

What % of MM patients have pathologic fracture?

20%

What are the exam findings of MM?

Weight loss

Cachexia

Anemia

unexplained OSTEOPOROSIS (red flag in anyone!)

What is the most common cause of death in MM patients?

renal disease and renal failure (due to protein accumulation)

What may be the only early sign of MM?

Generalized osteoporosis

What is the primary later finding of MM?

Multiple punched out lesions

What bones are MM most common in?

Femur and humerus

What is the name sign of MM in the skull?

Raindrop skull (more uniform in shape/size than Swiss cheese as in mets)

What is the special name sign of hyper-compression fracture in MM?

Wrinkle vertebra

What is the term for the localized form of MM?

Plasmacytoma

What % ofplasmacytoma patients are less than 50 yo?

50%

Which bones are most commonly affected by plasmacytoma?

Mandible

Ilium

vertebrae

ribs

proximal femur

scapula

T or F: Pathological fracture is common in MM, but not plasmacytoma

False (common in both)

What is the roentgen appearance of plasmactyoma?

Geographic lesion, often expansile with a soap bubble internal architecture

What is the most common cause of bubbly expansile lesions before skeletal maturity (less than 20 yo)?

Aneurysmal bone cyst

What is the most common cause of bubbly expansile lesions between skeletal maturity and 50 yo?

Giant cell tumor

What is the most common cause of bubbly expansile lesions over 50 yo?

Plasmacytoma or blowout mets

What % of plasmacytoma degenerates to multiple myeloma?

70%

What is the second most common primary malignant tumor of bone?

Osteosarcoma

What does the suffix -sarc mean?

A malignancy of undifferentiated flesh or tissue

What is osteosarcoma derived from?

Undifferentiated connective tissue

What is the typical age range of osteosarcoma?

10-25 yo (75%)

What gender is more affected by osteosarcoma?

Males (2x)

What conditions can predispose someone to osteosarcoma?

PAgeet's

FD

Osteochondroma

Radiation therapy

What are the S/S of osteosarcoma?

Painful swelling

history of antecedent trauma

NO weight loss, fever or cachexia

How is osteosarcoma differentiated from Ewing's by symptoms?

Osteosarcoma has no weight loss, fever, or cachexia

What part of the bone does osteosarcoma typically arise from?

Metaphysis (75)

What location is most common for osteosarcoma?

The knee (75%) -- distal femur or proximal tibia and proximal humerus

T or F: osteosarcoma is common in the spine

False

T or F: While osteosarcoma usually begins around the growth plate, it can grow beyond to the epiphysis or diaphysis

True

What is the normal appearance of osteosarcoma?

Sclerotic (50%)

What % of osteosarcoma is lytic?

25%

What % of osteosarcoma is mixed?

25%

What is the name sign of roughened, lobulated margins seen in sclerotic osteosarcoma?

cumulous cloud appearance

What is the classic appearance of osteosarcoma?

Ill-defined metaphysis

moth eaten or permeative and or a dense sclerotic region in the medullary space

What is the most common periosteal response in osteosarcoma?

sunburst/sunray (may see conman's triangle)

T or F: Soft tissue masses are common in osteosarcoma

True

What are the most common sites of metastasis for osteosarcoma?

Lungs 75%

Bones 50%

Kidney 12%

What is the name sign of osteosarcoma metastasis to the lungs?

Cannonball metastases (multiple sarcomatous bone growths within the lungs)

What is the gold standard for differentiating osteosarcoma from Ewing's sarcoma?

Biopsy

What is the best follow-up for osteosarcoma?

Chest CT (due to its predilection to metastasize to the lungs)