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

Localized form of plasma cell proliferation

Solitary plasmacytoma

Favorite spots for solitary plasmacytoma listed in most to least common

Vertebra

Pelvis

Skull

Sternum

Ribs

Typical presentation of solitary plasmacytoma

Soap bubbly, highly Expansile lesion

Solitary plasmacytoma tends to do what with the vertebra

Spare the posterior elements

Most solitary plasmacytoma`s develop into

Multiple myeloma

Solitary plasmacytoma example in the ilium

Another example of a solitary plasmacytoma example in the ilium

Multiple myeloma looks like what

Circumscribed osteolyic defects (punched out)

-they're lesions are often of similar size

If you do a bone scan of multiple myeloma it looks

Typically normal

MRI examination for multiple myeloma is sensitive for

Marrow changes

What are the 3 different radiologic features that multiple myeloma can have

Osteoporosis/osteopenia

Osteolyic defects "rain drop skull"

Osteoblastic lesions

What is the most common radiologic presentation of multiple myeloma

Osteoporosis/osteopenia

What is it called when multiple myeloma is in the skull

Rain drop skull

Multiple lytic defects results in a punched out appearance in the skull and this is called_____ during what disease

Rain drop skull during multiple myeloma

Rain drop skull

Another example of rain drop skull

Pathological fracture are most likely from what 3 things

Osteoporosis

Lytic Mets

Multiple myeloma

If you get a pathological fracture and then X ray of the skull and it has a rain drop appearance than what most likely caused the pathological fracture

Multiple myeloma

Examples of holes in the skull and what they are from slide

Myeloma is hard to differentiate form what?

Lytic metastasis

Myeloma has what on T1 and T2 MRI

Diffuse low T1

ISO (no change) to increased T2

Myeloma has what occur in the spine

Multiple pathological fractures/multiple wedge compression fractures

Myeloma has what else occur along side bone changes

Little soft tissue mass

What does myeloma look like in the spine on a T1 MRI

Bunch of little dark spots

MRI T1 rule of thumb? So what does this mean for pathological fractures in the spine

White is right on T1

-old fractures look bright

-new fractures look dark

What is the most likely cause of a pathological fracture in a child

Eosinophilic granuloma (EG)

A primary malignant tumor of undifferentiated connective tissue which forms neoplastic osteoid (bone)

Osteosarcoma

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

Osteosarcoma

What it's eh most common primary malignant bone tumor in children and young adults

Osteosarcoma

Age for osteosarcoma

Mainly 10-25 years

Over 60

Patients tend to be what with osteosarcoma

Tend to be taller than their peers

Clinical presentation of osteosarcoma

Painful swelling

-antecedent history of trauma (traumatic determination)

What does it mean for osteosarcoma to commonly have antecedent history of trauma (traumatic determination)

Patient usually comes in for trauma then its found or a trauma "sets off" the growth of the tumor

What type of pain does a patient feel with osteosarcoma

Initially insidious and transient becoming severe and persistent

Osteosarcoma can cause what in the joint

Minor resection of ROM

Examples of osteosarcoma just from observation

Osteosarcoma comes in what forms

Central

Parosteal (outside bone)

Secondary (from other pathology)

Multicentric (multiple locations)

Extraosseous

What is the most common form of osteosarcoma

Central

Osteosarcoma most commonly occur where

Around knee and proximal humerus

Most osteosarcomas occur where in the bone

Metaphysics next to the growth plate

-areas of growing bone

Osteosarcoma occurs in what type of bones before the age of 30

Cylindrical bones

Osteosarcoma occurs in what type of bones after the age of 50

Flat bones

Metastasis is common in osteosarcoma to which location

Lungs (On chest films or CT)

When you find osteosarcoma spread to the lungs, where do you typically see it as well

In the knee

Most osteosarcomas are what type

Sclerotic

Osteosarcoma typically occur where in bones

Metaphyseal region

-knee and proximal humerus

How doe osteosarcomas look

Ill defined dense ivory or sclerotic lesion, moth eaten, Permeative destructor with a long zone of transition

Spiculated/sunburst periosteal reaction/codmans

What occurs along side the bone damage with osteosarcoma

Large soft issue mass

Osteosarcoma

Another example of osteosarcoma

Example of osteosarcoma again, more subtle this time

Osteosarcoma in the proximal humerus

What is it called when there is bone produced in the soft tissue mass along side a tumor

Osteoid matrix

14 year old boy with pain and a mass above the knee

Young, pain, near knee, so osteosarcoma

What is the name for the imaging finding with osteosarcoma in the lungs

"Cannonball" osteosarcoma pulmonary metastasis

What are some things that could fall under secondary osteosarcoma

Paget's disease

Olliers disease

Ionizing radiation

Polyostotic fibrous dysplasia

Hereditary mutiple exostosis

Treatment for osteosarcoma

Multidrug therapy

What do you see on nuclear imaging with osteosarcoma

Increased activity (hypervasculatirty, new bone formation)

What do you see on SPECT with osteosarcoma

Soft tissue extension

What do you see on T1 and T2 MRI images of osteosarcoma

T1 shoes marrow involvement

T2 shows soft issue

Primary malignant tumor of chondrogenic origin

Chondrosarcoma

3rd most common primary malignant bone tumor and 2nd most common in adult

Chondrosarcoma

Chondrosarcoma arises from

Chondroblasts and collagenoblasts

Chondrosarcoma has 2 different forms, primary and secondary. Describe what a secondary Chondrosarcoma is

Complication of preexisting skeletal abnormality such as Osteochondroma or echondroma

Age for Chondrosarcoma

Usually over 50 (40-60)

Chondrosarcoma clinical features

Large soft tissue mass

Late development of pain

Duration of symptoms less than 2 yrs (have symptoms for awhile before discovered)

Cho on location for Chondrosarcoma

Pelvis

Radiographic features of Chondrosarcoma

Round or oval area of demineralization with ill defined margins

Endosteal scalloping

Popcorn matrix calcification in 2/3

Large soft tissue mass

What physical features of a tumor mean that it is cartilage based

Stippled

Floccluent

Ring and arc

Chondrosarcoma in the proximal humerus

Lytic destruction, some calcification, cortical thinning, all point to cartilage based tumor that looks aggressive... so this is what type of tumor most likely

Chondrosarcoma

What are the differential diagnosis for a Chondrosarcoma? What is the thing that would set it apart from the other 2?

Enchondroma or medullary infarct

-If there is pain then most likely a Chondrosarcoma cause the other 2 don't have pain associated with them

People with benign cartilage tumors (________ or __________) rarely have pain

Enchondroma or osteochondroma

People with __________ will have pain and many have swelling

Chondrosarcoma

Chondrosarcoma in the pelvis

Echondorma can turn into a

Chondrosarcoma (secondary Chondrosarcoma)

Primitive primary malignant tumor composed of tumor cells derived form connective tissue framework of bone marrow

Ewings sarcoma

4th most common primary malignant bone tumor and 2nd most common primary malignant bone tumor in children

Ewings sarcoma

Ewings sarcoma looks like and like?

Round cell tumor and like diaphysis

Ewings sarcomas are caused by

Chromosome translation, 11 and 22 swap

Ewings sarcoma age

10-25, peak around 15

Clinical features of Ewings sarcoma

Severe localized pain

The only primary malignant tumor that stimulates an infection

Leukocytes is

What is the only primary malignant tumor that stimulates an infections

Ewings sarcoma

Skeletal location of Ewings sarcoma

Long tubular bones

Diaphyseal is classic location

What is the classic radiographic feature of a Ewings sarcoma

Onion skin periosteal reaction

What is the most common primary malignancy to Mets to bone

Ewings sarcoma

Ewings sarcoma likes to spread to bone and where else

Lungs

Ewings sarcoma

What is another radiographic feature that can occur with Ewings sarcoma

Cortical saucerization

Another Ewings sarcoma

One more Ewings sarcoma