Skel Rad B Midterm

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nakomarose
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29893
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Skel Rad B Midterm
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2010-08-14 23:25:45
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Skel Rad
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  1. Primary Benign bone forming tumors
    • Tumor originates in bone
    • Tumor formed from bone cells
    • Benign-controlled cell growth
    • All start with osteo
    • Osteoma
    • Osteoid Osteoma
    • Osteoblastoma
  2. Malignant bone forming tumors
    • Uncontrolled bone cell growth
    • Horrible prognosis
    • All called Osteosarcomas
    • Conventional osteosarcoma- 72%, Central sclerotic~75%, lytic~25%
    • Parosteal- 4%
    • Periosteal-1%
    • Multifocal/osteosarcmatosis-1%
    • Osteosarcoma of jaw-6%
    • Post radiation osteosarcoma-4%
    • Osteosarcoma in paget's dx-3%
    • Osteosarcoma degeneration from benign condition-1%
    • Telangiectatic-3%
    • Dedifferentiated chondrosarcoma-3%
    • Extraskeletal-<1%
  3. Cartilage forming tumor
    • Tumor formed from cartilage cells
    • Cartilage growing in wrong place
    • Cartilage normally forms physis & articular cartilage
    • Has chondro in name
    • ALWAYS radiolucent- dark
    • May have some calcium mixed in
    • Fondness for calcium
  4. Benign cartilage forming tumors
    • Chondroma/Enchondroma
    • Solitary osteochondroma
    • Chondromyxoid Fibroma/Fibromyxoid chondroma
    • Chondroblastoma
  5. Malignant cartilage forming tumors
    • Uncontrolled cartilage cell growth
    • 3 types
    • Primary chondrosarcoma- arise de novo-originates by itself
    • -1/3 of chondrosarcomas
    • Secondary chondrosarcoma-from pre-existing benign tumor(2/3)
    • -central chondrosarcoma-from enchondroma
    • -peripheral - from osteochondroma
    • Clear cell chondrosarcoma- mistaken fro chondroblastoma, low grade
    • Extra skeletal chondrosarcoma- rare
  6. Giant cell tumor of bone/osteoclastoma
    Exists on its own- quasimalignant
  7. Marrow tumors (Round cell tumors)
    • ALL malignant
    • Ewings sarcoma
    • NHL of bone/Reticulum cell carcinoma
    • Multiple Myeloma
    • -classical
    • -myelomatosis
    • -plasmacytoma
    • -Extra osseous MM
  8. Vascular & Connective tissue tumors
    • Benign- hemangioma
    • Malignant-fibrosarcoma
  9. Notochord remnant tumor
    Chordoma
  10. Metastatic tumors in bone
    • MC skeletal malignancy
    • Tumor originates external to bone
    • Spread of tumors from one place to another
    • 3 mechanisms of cancer cell spread
    • -Blood-hematogenous-MC mechanism of spread & MC spread to skeleton
    • -Lymphatic system
    • -Contiguous direct extension
    • Always malignant (MC malignant bone tumor)
    • Osteolytic mets
    • Osteoblastic mets
    • Mixed mets
  11. Tumorlike Conditions
    • Mimics tumor based on radiographic appearance
    • -geographic radiolucent-dark
    • -well defined
    • -sclerotic margin (thin or thick)
    • -short zone of transition
    • Solitary bone cyst/Unicameral bone cyst
    • Aneurysmal bone cyst
    • Fibrous cortical defect & nonossifying fibroma
    • Fibrous dysplasia
    • "Brown Tumor" of hyperparathyroidism
    • Pseudotumors of hemophilia
    • Large arthritic cysts/geode
  12. ABC's of how to look at a film
    • Alignment
    • -articular alignment
    • -bone alignment
    • Bone
    • -periosteal rxn
    • -trabeculation
    • -pattern of bone destruction
    • -shape change
    • -bone density
    • Cartilage
    • -joint space (uniform or nonuniform)
    • -symmetry (bilateral or unilateral)
    • Soft tissue
  13. CATBITES
    • Where we go looking for answers
    • Major categories of bone & joint disease
    • Congenital
    • Arthritis
    • Trauma
    • Blood
    • Infection
    • Tumor
    • Endocrine, nutritional, metabolic
    • Soft tissue
  14. Tumor
    • aka Neoplasm
    • Cellular growth
    • Benign- controlled cellular growth
    • Malignant- uncontrolled cellular growth- spreads from somewhere else- metastasis
    • Bone is multicellular tissue
    • Any cell can produce a tumor
  15. Skeletal metastasis
    • Doesn't kill
    • Makes miserable-painful with secondary major complications
    • Metastatic- spreads somewhere else
    • No benign metastatic tumors
  16. Tumor like
    • Looks like tumor but not
    • Mimics tumor based on radiographic appearance
    • Geographic radiolucent-dark
    • Well defined
    • Sclerotic margin- thin or thick
    • Short zone of transition
  17. Osteoma
    • Common tumor-#3 benign tumor
    • Intramembranous origin- skull, cranial vault
    • -favorite area- paranasal sinus
    • Asymptomatic-no pain
    • Frequency- see 1/year
    • Originate from & project AWAY from cortical surface
    • Never in medullary cavity
    • Dense sclerotic lesion
    • Usually solitary
    • Can be multipe- Gardner's syndrome
  18. Osteoid Osteoma
    • Less common
    • Symptomatic-very painful
    • Radiolucent
    • Less than 2cm in size
    • 10-15% in spine
    • Can be medullary, cortical, or subperiosteal
  19. Osteoblastoma
    • Rarest of 3 benign tumors
    • Symptomatic
    • 33-50% in spine
    • Like appendages of posterior arch- TP, SP, AP
  20. Central Osteosarcoma
    • Located in medullary cavity
    • 70-72%
    • Teenager patient group
    • -sclerotic central osteosarcoma 75% of central type
    • -lytic central osteosarcoma
  21. Parosteal osteosarcoma
    • par= around
    • Surface variant
    • 4% of osteosarcoma
  22. Periosteal osteosarcoma
    • Surface variant
    • 1% of osteosarcomas
    • Reasonable prognosis
  23. Osteosarcomatosis
    • Multifocal variant
    • 1% of osteosarcoma
  24. Osteosarcoma of Jaw
    • 6% of osteosarcoma
    • Older patient group- 30-40yoa
  25. Post-radiation Osteosarcoma
    • 4% of osteosarcoma
    • Due to therapeutic radiation- 3-4000 rad x 5 days x 6 weeks
  26. Osteosarcoma from Paget's Disease
    3% of Osteosarcomas
  27. Osteosarcoma from degeneration of previous benign lesions
    • 1% of osteosarcoma
    • i.e. fibrous dysplasia become OS
  28. Telangiectatic Osteosarcoma
    • Vascular dilation
    • 3% of osteosarcoma
  29. Dedifferentiated Osteosarcoma
    • Pathologist has difficulty differentiating its origin
    • 3% of osteosarcomas
  30. Chondroma
    • aka Enchondroma
    • Ectopic cartilage growing in wrong place
    • Can be medullary- enchondroma
    • Can be cortical- juxtacortical or cortical chondroma
    • #2 benign bone tumor
  31. Solitary osteochondroma
    • aka Exostosis
    • Cartilage is dominant part but contains bone
    • Ectopic epiphyseal tissue growing in wrong place- part of physis
    • Project away from bone
    • #1 benign bone tumor
  32. Chondromyxoid fibroma
    • aka fibromyxoid fibroma
    • Junk tumor- mucus, cartilage, fibrous tissue
    • Loves tibia
    • Symptomatic- very painful
    • Uncommon
  33. Chondroblastoma
    • Epiphysis is common region- bone ends
    • Also apophyseal areas
    • Symptomatic-very painful
  34. Central Chondrosarcoma
    • Inside bone- medullary
    • Originate from enchondroma
  35. Peripheral Chondrosarcoma
    • External to bone-cortical
    • Originate from solitary osteochondroma
  36. Giant cell tumor
    • aka Osteoclastoma
    • Soap bubble appearance
    • Radiolucent-dark
    • Classic geographic
    • Love metaphysis & epiphyseal area of long tubular bone
    • Symptomatic- painful
    • 80% benign
    • Quasi-malignant
  37. Ewing tumor
    • Laminated periosteal reaction
    • Under 30 yo
    • Typically teenagers
    • Can not generate bone
    • No affinity for calcium
    • Purely radiolucent-dark
    • MC malignant tumor in first decade
  38. Primary reticulum cell sarcoma
    • aka non-Hodgkin's Lymphoma
    • Lymphatically derived tumor originating in skeleton
    • Classified as extra-nodal lymphoma
    • Uncommon
  39. Multiple myeloma
    • punched out lesion
    • raindrop skull
    • MC primary malignant bone tumor
  40. Solitary plasmacytoma
    • subtype of MM
    • Geographic soap bubble lesion
  41. Myelomatosis
    • Subtype of MM
    • Lose bone density-osteopenia (>40 widespread osteopenia)
    • More common
  42. Classic Multiple Myeloma
    • Subtype of MM
    • Punched out lesion, small, <2cm, well defined, radiolucent
    • MC
  43. Extraosseous Multiple Myeloma
    • Subtype of MM
    • Very rare
    • Occurs in nasopharynx
  44. Metabolic bone disease causing diffused osteopenia
    • Osteoporosis
    • Hyperparathyroidism
    • Osteomalacia
    • Neoplasm
    • -Children-leukemia (MC cause of bone loss in children)
    • -Adult- MM
  45. Top 3 benign bone tumors
    • 1. Solitary osteochondroma
    • 2. Chondroma
    • 3. Osteoma
  46. Top 5 Primary Malignant Bone Tumors
    • MOCEF
    • 1. MM (30/million)
    • 2. Osteosarcoma (4-5/million)
    • 3. Chondrosarcoma
    • 4. Ewing's sarcoma
    • 5. Fibrosarcoma (1.5/million)
  47. Hemangioma
    • Common
    • Occurs in many places
    • Spine is common site
    • Not much in differential
  48. Fibrosarcoma
    • Very rare
    • #5 primary malignant bone tumor
    • Purely lucent- dark
    • Destructive
    • Can not generate bone
    • No affinity for calcium
  49. Chordoma
    • Originate from remnants of notochord
    • Site specific- spine, coccyx, sacrum
    • MC- clivus of Blumenbach of skull
    • Likes cervicals also- C2 body (3rd MC place)
    • Destructive
    • Slow growing
    • Malignant
    • Middle age
    • Fairly rare
  50. Solitary bone cyst
    • aka Unicameral bone cyst
    • asymptomatic- no pain
  51. Aneurysmal bone cyst
    Symptomatic-painful
  52. Enosteoma
    • aka Bone island
    • Similar to osteoma
    • Always found in medullary cavity
    • Dense sclerotic lesion
  53. Preferential site of origin
    • Most occur in metaphysis
    • Diaphysis
    • -Marrow tumor-marrow is first thing that changes
    • --Myelom
    • --Ewing's sarcoma
    • --Reticulum-cell carcinoma- non-Hodgkin's lymphoma
    • Epiphysis
    • -Chondroblastoma (primary cartilage forming benign tumor)
    • -Giant cell tumor (quasi-malignant)
    • --Primary tumor
    • --painful
    • --Originates from mature skeleton
    • --Originate metaphyseal
    • --Migrate to bone end
    • --Over 20 yoa
  54. Geode
    • MC cystic radiolucency in epiphysis- dark
    • Must have arthritis
  55. Preferential time of origin
    • 1. Benign tumor & tumor like happen almost ALWAYS before 30 yoa
    • -Exception- giant cell tumor to 30+ yoa
    • 2. Remember MOCEF for malignant
    • M=60+/- yoa
    • O=20+ yoa
    • C=50+/- yoa
    • E=20 yoa
    • F=40 yoa
    • Parosteal osteosarcoma=40+ yoa
    • Reticulum cell sarcomas=30+ yoa
  56. Metastasis
    • 70% of malignant tumors
    • Destructive by replacement
    • No decade immune to metastasis
    • 80% of all osseous metastasis found in axial skeleton
    • 90% in axial skeleton & skull
  57. Lytic Metastasis
    • 75%
    • Moth eaten typically
    • Can be geographic
    • Well or ill defined
    • Permeative
    • Punched out skull
    • 30-50% destruction before see on x-ray- may not be visible
  58. Blastic Meastasis
    15%
  59. Mixed Metastasis
    15%
  60. Male metastasis
    • 60% prostate- blastic
    • 25% lung- lytic
  61. Female metastasis
    70% breast- lytic
  62. Big 6 MC malignancies that spread to skeleton
    • Derived from past medical History
    • Breast
    • Lung
    • Prostate
    • Kidney
    • -Nephroblastoma aka Wilm's tumor
    • -#1 tumor in pediatric
    • Ewing's- primary malignant bone tumor
    • Neuroblastoma
    • -#2 malignancy in pediatric
    • -Under 5 yoa
    • -Average 2.5 yoa
    • -Originates in sympathetic chain or adrenal medulla
    • -Tend to end up in skeleton & cranial vault
  63. 4 Key Questions for tumors
    • Radiographic appearance- what does it look like
    • Location- where is it located
    • Symptoms- does it hurt
    • Age- how old are you

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