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

What is the most common places for metastases to occur

Lungs, liver and bone

What is the third most common site for metastatic disease

Bone

What are the types of cancer that most often spread to bone first

Breast and prostate

Metastatic bone disease likes to go where

Places with red marrow (pelvis, spine, humerus, skull, ribs)

Metastic bone disease arises from

A primary extra skeletal site

What represents 70% of all malignancies

Metastatic bone disease

Most common primary sites of metastatic bone disease are from where?

Breast

Lung

Prostate

Kidney

Thyroid

Bowel

Metastic bone disease may be what types

Blastic

Lytic

Mixed

Expansile

What are responsible for 80% of bone metastasis?

Breast, lung and prostate cancer

What percentage of people with breast, lung and prostate cancer will develop bone metastasis

Over half of them

What is the most common bone metastasis for females? Where does it come from and what type is it?

Breast, most of it being lytic

What is the most common bone metastasis for males? Where does it come from and what type is it?

Prostate, most of it being blastic

What type of cancer in males most commonly causes metastasis lytic changes

Lung cancer

What is the most common pathway for metastasis to bone

Hematogenous dissemination (blood) via Batsons Venous plexus (vertebral venous plexus)

What shows up in testing when it is blastic metasis to bones

Alkaline phosphatase

What shoes up in testing when it is prostate cancer

Acid phosphatase and/or PSA antigen

Most patients with metastatic disease are what age

Past 4th decade of life

Clinical features of metastatic disease

Recent weight loss

Cachetic (look dead)

Fever

Initial sign of metastatic disease may be

Pain and pathological fracture

When a patient has pain with metastatic disease, what does it look like

Persistent and nocturnal

Common sites for metastasis are where

Areas rich in red marrow

-spine

-ribs and sternum

-pelvis and sacrum

-proximal extremities

-skull

Where is it rare to get metastasis

Distal to knees and elbow

Lytic Mets distal to elbow and knees most common to hands/feet is called_______ metastasis and is most likely due to

Acral metastasis

From lung primary

Osteolytic signs are most likely from what types of cancer in males and females

Females= breast

Males= lungs

Osteoblastic signs are most likely form what types of cancer in males

Prostate

Blow out radiographic signs of metasis in bone are typically from

Renal and thyroid

Blastic Mets example

Lytic Mets example

Blown out Mets example

Favorite spot of metasis is? Why?

Spine cause of the vertebral venous plexus

Radiographic features of vertebral metastasis

Ivory vertebra

Pedicab destruction

Pathological collapse

Focal osteoporosis of body

Malignant Schmorl`s node formation

Most common reason for a missing pedicle

Lytic metastasis

Missing pedicle etiologies

Congenital

Destructive

-Tumor (primary- ABC, osteoblastoma. Soft tissue- neurofibroma. Secondary- lytic Mets

-infection

Surgical

Missing pedicle with contralateral hypertrophy means

Developmentally absent

Example of missing pedicle with contra lateral hypertrophy

Missing pedicle without contralateral hypertrophy so it means its most likely form lytic Mets

Reasons for pathological collapse of vertebra

Lytic metastatic carcinoma

Multiple myeloma

Traumatic fracture (osteoporosis)

Reasons for pathological collapse of vertebra listed from most to least likely

Osteoporosis (traumatic fracture)

Lytic Mets

Multiple myeloma

-remember from last exam!!

Pathological collapse at L5, also list the reasons from most likely to least likely

Osteoporosis

Lyitc mets

Multiple myeloma

There is a 40 year old female with a pathological fracture in the spine, what is not likely the cause and why? List the causes for this case in order of most to least likely

Most likely not osteoporosis cause she's only 40

-lytic Mets

-multiple myeloma

-osteoporosis

Order of things need to be done if the pathological fracture looks like its from osteoporosis

Nothing more

Order of things need to be done if the pathological fracture if from lytic Mets

Bone scan

MRI

Biopsy

Order of things need to be done if the pathological fracture is from multiple myeloma

PEP (protein electrophoresis)

Skeletal survey

MRI

Biopsy (need >10% of plasma cells)

Most likely cause of a pathological fracture in a kid

Eosinophilic granuloma

Another name for pathological fracture

Vertebra plana

Pathological fracture in kid, name what it is most likely from

Most likely from eosinophilic granuloma

If a fracture is dark on T1 then it means

It's a new fracture

Old fractures on T1 look

Bright (same as the normal bones)

Rope 3 causes that could cause a solitary ivory vertebra

Paget's disease

Hodgkin's lymphoma

Osteoblastic metastasis

If an ivory vertebra is enlarged than it is most likely from what

Paget's disease

Example of ivory vertebra from Paget's disease

What is the most common reason in a 20-40 age range for ivory vertebra

Lymphoma

Example of ivory vertebra

Different joint diseases

Degenerative joint disease/OA

Inflammatory- seropostives (RA) seronegatives (AS, psoriatic, reactive)

Metabolic- Gout, CCPD

Infection

What type of joint diseases show shiny corner sign

Seronegative (AS< psoriatic, reactive)

-all have HLAB27

Endplate sclerosis exaggerated by DJD is called

Hemispherical spondylosclerosis

Shiny corner (reactive sclerosis)

Sclerosis of the left ischium and femoral neck

Sclerosis of the anterior aspect of the left 6th rib

There is sclerosis in the pelvis, the pelvis is a male so this means most likely?

It's blastic Mets from prostate cancer

Extensive blastic Mets on a bone scan

Extensive blastic Mets on an X ray in a pelvis

Osteoblastic metastases in a woman with breast cancer

What is well differentiated mature bone tissue within the marrow

Bone island

What is another name for a bone island

Enostosis

Bone island

Name for multiple bone islands

Osteopoikilosis

Osteopoikilosis loves what location

Ischial tuberosities of the pelvis

If blastic Mets is a clinical possibility when looking at an X ray and you cant tell if its that or a bone island than a blood test will look for?

Alkaline and acid phosphatase levels as as well as PSA and a digital rectal exam

Bone island in the proximal humerus

Mixed lytic and blastic Mets from breast primary cancer

Expansile lytic destructive changes in the glenoid region of the scapula..... what is the most likely cause too

Thyroid or renal cancer

Soap bubbly highly expansive lytic destructive changes in the proximal aspect of the radius..... this is most likely from

Thyroid or renal Mets

What MRI modality is the most sensitive to finding metastasis

T1 (it will be a low signal)

What MRID modality is decent at finding metastasis and how does it look

T2 is variable, ( it will be a high signal)

What do you look for on MRI with metastasis

Lesion that is oblique, angled or round

Pedicular involvement (lytic Mets likes to destroy pedicels)

Extradural mass, multiplicity

No pathological fracture and degenerative signal is linear, _______ on T1 and ______ on T2

Low on T1

High on T2

What is the T1 rule of thumb

White is right concerning bone marrow

On T1 MRI, CSF should be what color

Dark

Lytic Mets shown on T1 MRI

Another example of lytic Mets shown on T1 MRI

Primary cause for lytic Mets in females is

Breast

Most bone malignancies are

Secondary

Most common metastasis to bone is what type

Lytic

What accounts for 30% of all malignancies

Primary malignant neoplasia

What is the order of primary malignant neoplasia when it comes to most to least common

Multiple myeloma

Osteosarcoma

Chondrosarcoma

Ewings sarcoma

What are the primary malignant neoplasia for adults

Multiple myeloma a

Chondrosarcoma

What is the most common primary malignant neoplasia for adults

Multiple myeloma

What is the second most common primary malignant neoplasia for adults

Chondrosarcoma

What is the most common primary malignant neoplasia for young people

Osteosarcoma

What is the second most common primary malignant neoplasia in young people

Ewings sarcoma

What is a malignant proliferation of plasma cells, which infiltrate the bone marrow

Multiple myeloma

-blood tumor that infiltrates the bone marrow

What is the most common primary malignant tumor of bone

Multiple myeloma

What is the third most prevalent blood cancer that happens to occur in the bone

Multiple myeloma

Multiple myeloma usually occurs at what age

5-8th decade

Most between ages 50-70 (mid to older life)

Malignant proliferation of plasma cells

Multiple myeloma

Multiple myeloma is what type of tumor

Round cell tumor (rebound nuclei and rounded lesions)

Multiple myeloma is 2x more common in ________ and lowest in _________

More common in African Americans

Asian Americans

Clinical features of multiple myeloma

Pain is initial symptom

Unexplained weight loss

Anemia

Renal disease

Respiratory disease

Why do you get renal problems with multiple myeloma

Lots of calcium deported into blood (from bone destruction)