Malignant neoplasms

What is the most common primary malignancy of bone?

Multiple myeloma; malignant proliferation of plasma cells infiltrating bone marrow

What are physical characteristics of multiple myeloma?

>50 y.o., cachexia, weight loss, anemia

What are radiological characteristics of multiple myeloma?

Multiple dark densities that are similar in size (“punched out lesion”); can cause pathological collapse (vertebral plana); associated with “rain drop skull”

What would you see on lab testing for multiple myeloma?

M spike on the immunuelectrophoresis; reversal of the albumin/globulin ratio; bence jones proteinuria; elevated ESR

What is a special test for multiple myeloma?

Bone scan:cold

What is the most common malignant tumor of bone?

Metastatic disease (lytic and blastic)

What are physical characteristics of lytic metastasis?

> 40 y.o.; recent unexplained weight loss; skeletal pain worse at night

What are radiological characteristics of lytic metastasis?

Trabeculae reabsorbed turns the bone darker in color; moth eaten or permeative pattern of destruction; “eat” away pedicle of bone; has a “swiss cheese” appearance in the skull

What will alkaline phosphatase levels look like for lytic metastasis?

Normal or mildly elevated

What are characteristics of blastic metastasis?

> 40 y.o.; ivory white vertebrae; no cortical thickening or bone enlargement

What will alkaline phosphatase levels look like for blastic metastasis?

Markedly elevated

What is the most common form of metastasis in ages 20-40?

Hodgkin’s disease

What are characteristics of Hodgkin’s disease?

Ivory white vertebrae with anterior body scalloping; uni-lateral hilar lymphadenopathy in caucasian males seen on the PA chest view

What would you find on a biopsy of Hodgkin’s disease?

Reed sternberg cells

What are characteristics of Paget’s (aka osteitis deformans)?

Males >50 y.o.; causes cortical thickening, picture frame vertebrae, increase bone density, coarsened trabeulae, bone expansion, bowing deformities

What is stage 1 Paget’s?

Lytic or destructive

What is stage 2 Paget’s?

Combined

What is stage 3 Paget’s?

Sclerotic

What is stage 4 Paget’s?

Malignant (osteosacroma)

What labs would be increased for Paget’s?

Alkaline phosphatase and urinary hydroxyproline

What is the most common malignancy found in children?

Osteosarcoma; age group 10-30

What are characteristics of an osteosarcoma?

Causes a periosteal reaction that is spiculated/radiating/sunburst in appearance

What labs would be elevated in osteosarcoma?

Alkaline phosphatase

What are characteristics of a chondrosarcoma/fibrosarcoma?

> 40 y.o.; creates a spiculated/radiating/sunburst periosteal reaction of bone

Where is an Ewing’s sarcoma most commonly found?

Diaphysis of long bones; 10-25 y.o.

What are radiological characteristics of a Ewing’s sarcoma?

Permeative lesion that causes a multi-paralleled onion skin (laminated) type of periosteal reaction; bone expansion, Codman’s triangle, saucerization

Where is the most common location for a chordoma?

Sacrum; second most common location is in the skull

What are characteristics of a chordoma?

> 40 y.o.; aberrant notochordal cell tumor