Rad III MT1 - MOCE - Primary neoplasms

age for MM

50-70 yo

age for osteosarcoma

10-25 yo

MC primary bone malignacy for children?

osteosarcoma

age for chondrsarcoma?

40-60 yo

age for Ewing's?

10-25 yo

MC primary malignancy of the spine?

Multiple Myeloma

do enchondromas happen in younger or older people?

young

aka for MM

Kahler's Disease

what IG is secreted in MM?

IgG

what is the malignant clone of IgG for MM?

M-spike

Prelimary symtpoms?

anemia, fatigue, chronically sick

Labs

M-spike

Bens Jones proteinurea

hyperuricemia --> Gout as secondary effect

hypercalcemia

anemia

why would MM show hypercalcemia

malignant proteins release osteoclastic activating factor

gold standard for diagnosis of MM

sternal biopsy

what is #1 reason for death with MM

renal failure

what's the ratio change of albumin to globulin?

goes from 60/40 to 40/60

sex/race MC affected by MM?

black men

MC physical presenation of MM?

low back pain presenting like disc degeneration

% of pts that experience pathological MM fracture?

20%

first clinical Xray sign for MM?

generalized osteoporosis atyical for pt age and sex

which more commonly involves pedicles, mets or MM?

Mets

DDx for pathologic fx?

osteoporosis, lytic mets, MM

biconcavity of endplates is called?

Fish vertebra

what is plasmacytoma

localized form of MM

description for plasmacytoma

solitary, expansile, lytic bone lesion

is plasmacytoma always lytic

yes

where does plasmacytoma like to go?

mandible, ilium, vertebra, ribs, proximal femur/scapula, flat bones, C2

typical radiographic appearance for plasmacytoma

expansile soap bubble lesion with well-defined edges

what percet of patients with plasmacytoma develop MM

70%

DDx for soap bubble lesion

ABC - less than 20 yo

GCT - 20-40ish

Plasmacytom/blow out mets - 50+

DDX if pt is 45

GCT, plasmacytoma, blow out mets

tibia is a common location for GCT and ABC

true

where does GCT like to express itself?

metaphysis and articular surface

what is second most common primary malignant tumor of bone? and MC malignancy for childhood

osteosarcoma

what is osteosarcoma

derived from undifferentiated connective tissue

what gender is more likely to get osteosarcoma?

male, 2:1 to female

S/S of osteosarcoma

painful swelling, history of antecendent trauma, rarely seen w/loss of weight, fever, cachexia

Ddx of S/s for osteosarcoma to ewing's

ewing's will be hot, tender, swollen, fever, high WBC, child acting sick

osteosarcoma is how much more common than Ewing's

4x more common

Labs for osteosarcoma?

increased alkaline phosphatase

where is osteosarcoma found?

distal femur, proximal tib, proximal humerus, rare in spine?

is osteosarcoma common in the spine?

no

what part of the bone do you find osteosarcoma?

metaphysis

can osteosarcoma jump the growth plate?

yes

what percentage of osteosarcoma lesions sclerotic?

50%

what is the name sign for osteosarcoma?

cumulous cloud sign

what are the characteristics of osteosarcoma on xray?

sclerotic - solid, rough lobulated bone foramtion - cumulous cloud

lytic - bone destruction

metaphyseal, ill-defined moth eaten or sclerotic region

cortical destruction w/periosteal elevation

what is the MC periosteal response for osteosarcoma

sunray/sunburst, Codman's triangle

are ST masses common with osteosarcoma

yes - mass may ossify

would you use MRI/STIR sequence for osteosarcoma

yes

is metastasis common with osteosarcoma?

yes

where does osteosarcoma most commonly metastasize to

lungs 75%

what is it called when osteosarcoma mets to the lungs?

cannonball mets

treatment for osteosarcoma?

amputation or limb sparing technique

what percent chance is there that osteochondroma will turn malignant

1%

what percent of osteosarcoma will mets the bone?

50%

are labs diagnostic for osteosarcoma

no

what is the 3rd MC primary malignant tumor?

chondrosarcoma

what do chondrosarcomas usually come from

pre-existing benign tumor such as osteochondroma or enchondroma

age range for chondrosarcoma?

40-60

gender more commonly associated with chondrosarcoma

male, 2:1 to female

S/s of chondrosarcoma

pain, minor palpable swelling, potential ST extension

or asymptomatic

DDX for chondrosarcoma?

enchondroma - appear radiographically identical

what approach do we take with chondrosarcoma?

wait and watch method - slow growing

unusual lab finding for chondrosarcoma?

hyperglycemia

where is chondrosarcoma usually found?

pelvis and proximaal femur - 50%

what is the MC benign tumor of the hand

enchondroma

what is the MC primary malignant tumor of the hand

chondrosarcoma

chondrosarcoma goes where in tubular bones

diaphyseal or metaphyseal

rad features of chondrosarcoma

large radiolucent round/ovoid lesion w/ poorly defined margins

endosteal scalloping

scattered calcifcation in 2/3 of cases

how often will you see calcification in chondrosarcoma

2/3 of cases

periosteal response for chondrosarcoma

laminated or spiculated

what percent of chondrosarcoma lesions are purely lucent?

1/3

ST features common to chondrosarcoma?

large ST mass w/amorphous scattered calcifications is common

where does chondrosarcoma commonly mets to?

lung

treatment for chondrosarcoma?

local incision, limb sparing, amputation, radiation

do you have a good prognosis with chondrosarcoma?

90% survival after early surgery

can you differentiate chondrosarcoma from metaphyseal enchondroma?

NO

2nd MC tumor of sacrum

chondrosarcoma

do we see endosteal scalloping with chondrosarcoma

YES

can we have cortical destruction with chondrosarcoma

YES

what happens to the lobulations of hyaline cartilage in chondrosarcoma

outside of lobule will calcify

how much of the endosteum needs to be compromised before worry about chondrosarcoma?

more than 1/3

name sign for scattered calcifications of chondrosarcoma

popcorn, fluffy,

what image modality is best to see calcium visualization for chondrosarcoma

CT

4th MC primary malignant tumor

Ewing's sarcoma

2nd MC malignancy of bone for children?

Ewing's sarcoma

what is ewing's born of?

undifferentiated connectived tissue that should make marrow but doesn't

what cell type does ewing's stem from?

marrow stem cells - found in diaphysis

where is ewing's found in the bone

marrow rich diaphysis

classic phrase to describe ewing's on microscope?

small round blue cell tumor

age range for ewing's

10-25 yo

where does ewing's usually go?

peripheral skeleton

where does ewing's love?

femur

in 20-35 yo where does ewing's more commonly affect

axial skeleton

gender more affected by ewing's

male, 2:1 to female

race that ewing's usually affects

hyte pipo

systemic findings for ewing's

moderate fever, secondary anemia, area is red/hot/swollen

ewing's is MC in which bones

tubular bones - 50% and flat bones 40%

what is the MC malignant lesion of childhood to affect the ischium and pubis?

ewing's