Skel Rad B Midterm (3)

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Skel Rad B Midterm (3)
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2010-08-15 18:41:37
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bone tumors
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  1. Osteoma
    • Primary- originates in bone
    • Bone forming- tumor formed from bone cells
    • Benign- controlled bone cell growth
    • #3 MC benign tumor
    • Frequency- common
  2. Location of Osteoma
    • MC structure in bone- cortex
    • MC bone region- metaphyseal
    • Common sites
    • - likes cranial vault
    • -affinity to sinus
    • --frontal
    • --ethmoid
    • -mandible
  3. Age for Osteoma
    • Unknown
    • Female 3:1
  4. Pain of Osteoma
    • None
    • Found incidentally
  5. Appearance of Osteoma
    • Size < 2cm
    • Dense compact bone mass
    • Looks like bone snowball
    • Trabecular or spongy-permeative
    • Ivory or compact- solid
    • Round or oval
    • Originate from & project away from cortex
    • Never found in medullary cavity
    • Radiopaque- white
    • Well defined cortical mass
    • Solitary
  6. Gardner's Syndrome
    • Syndrome of multiple harmartomanous tumors
    • Harmartoma- made of same cells as host tissue w/o organization or fxn
    • Have multiple osteomas
    • Have fibrous soft tissue tumors- usually abdominal
    • Have multiple colonic polyps
    • 100% malignant generation rate
    • Will have colon cancer
  7. Differential for Osteoma
    • Enosteoma or bone island- tumor like
    • Can look like osteoma
    • Have different locations (Bone islands do NOT occur in the skull-osteoma MC in skull)
    • Key-inside medullary cavity (osteoma is NEVER in medullary cavity)
    • -often against endosteal cortical surface
    • Different age group- MC in adults (osteoma- no age of incidence)
  8. Osteoid Osteoma
    • Primary- originates in bone
    • Bone forming- tumor formed from bone cells
    • Benign- controlled bone cell growth
  9. Location of Osteoid Osteoma
    • MC structure in bone- cortex
    • 3 structures in bone
    • -cortical- MC
    • -intramedullary- cancellous
    • -subperiosteal
    • MC bone region- metaphysis
    • Common sites
    • - Likes long tubular bones
    • -50% affinity to
    • --femur- trochanter, neck
    • --tibia
    • -10-15% in spine
    • --like posterior arch-lamina, pedicle, AP, SP
    • --60% lumbar
  10. Age for Osteoid Osteoma
    • Under 30
    • 2nd to 3rd decade incidence- 11-30 yoa
    • Peak in teenage years
    • Male - 2:1
  11. Pain with Osteoid Osteoma
    • YES
    • Focal or point pain- patient can point to it
    • Worse at night
    • Tend to have antalgic scoliosis- lean into
    • -on concave side of scoliosis
    • Relieved by OTC analgesics- aspirin
    • Removed nidus by surgery-low reccurence
    • Localized swelling
    • Limited motion
    • Painful limp
    • Stiffness & weakness of joint
  12. Appearance of Osteoid Osteoma
    • Radiolucent- dark
    • Size <2cm
    • Nidus <1 cm
    • Generates dense localized solid periosteal response
    • -may cover tumor
    • -looks like existing cortex- expansile density
    • Cortical bone thickening
    • Sclerosis
    • Shows up on bone scan
  13. Differential for Osteoid Osteoma
    • Form of osteomyelitis- bone infection
    • Brodie's abscess
    • -same pain
    • -same look- except halo rim of sclerosis
    • -localized radiolucent nidus
    • -key- nidus BIGGER than 2cm in diameter
  14. Osteoblastoma
    • Primary
    • Bone forming
    • Benign
  15. Location of Osteoblastoma
    • MC structure in bone- cortex
    • MC bone region- metaphysis
    • Common sites
    • -affinity to spine (30-50%)
    • --like posterior arch appendages- TP, SP, AP
    • -femur
    • -foot
    • -ankle
  16. Age for Osteoblastoma
    • Under 30 yoa
    • 1st to 7th decade of life- 1-70 yoa
    • Teenager- 70%
    • Male 2:1
    • Less common than osteoid osteoma- very rare
  17. Pain w/ Osteoblastoma
    • YES
    • Symptomatic-insidious pain
    • No fever
    • No trauma
    • Possible point tenderness
    • Not necessarily worse at night
    • May not be relieved by OTC drugs
    • Unresponsive to care after several months
    • May have motion restriction
    • Not easily palpable
    • Surgically removed
  18. Appearance of Osteoblastoma
    • Larger than osteoid osteoma- many cm in size
    • ALWAYS geographic grossly expansile lesion
    • Purely radiolucent to speckled calcification to sclerotic
    • May not cause scoliosis
  19. Differential for Osteoblastoma
    • Osteoid osteoma
    • Tumor like similar
    • Order of differential
    • -Aneurysmal bone cyst
    • --more common occurrence in spine
    • --have preceding trauma
    • -giant cell tumor
    • -osteoblastoma
    • Forms of osteomyelitis
    • Brodie's abscess
    • -similar pain
    • -same look
    • -localized radiolucent nidus
    • -nidus BIGGER than 2 cm
    • Ominous conditions for this age group
    • Do NOT have central spinal tendency
    • -Ewing sarcoma
    • -Osteosarcoma
    • -Infection- would have had fever sometime earlier
  20. Osteosarcoma
    • Primary
    • Bone forming
    • Malignant- uncontrolled bone cell growth
    • -#2 primary malignant bone tumor- 20%
    • Incidence- 4-5/million
  21. Types of Osteosarcoma's
    • Central-72%
    • -Sclerotic-75%
    • -Lytic-25% (moth eaten, permeative lysis)
  22. Location of Osteosarcoma
    • MC structure in bone- medullary
    • MC bone region- metaphysis
    • Common sites
    • -tubular bone
    • --loves distal femur
    • --knee joint (15%)
    • --shoulder joint
  23. Age for Osteosarcoma
    • Teenagers
    • 2nd to 3rd decade- 11-30 yoa
    • Under 30 yoa
    • -if under 40-metastasis or MM
    • -if under 30- Ewing, non-Hodgkins, osteosarcoma
    • Male 2:1
  24. Pain with Osteosarcoma
    • YES
    • Insidious onset
    • Progressively worsening pain
    • Persistent deep boring pain
    • Painful swelling
    • BAD in young patients
    • Uncommon tumor- poor outcome
    • Lab- increased alkaline phosphatse
  25. Appearance of Osteosarcoma
    • Radiodense- white
    • Alignment ok
    • -Shenton's ok
    • Bone NOT ok
    • -may be fuzzy geographic
    • -Codman's triangle below sclerosis
    • -permeative or mottled
    • -sclerotic calcification
    • -long zone of transition
    • -spiculated periosteal reaction- hard to see w/ sclerosis
    • --spicule- goes perpendicular
    • -can cross metaphysis by way of creating bridges across
    • --aka direct extension
    • --can extend to diaphysis
    • cartilage ok
    • -no jt space narrowing(if narrowed, infection or inflammatory)
    • Soft tissue mass
    • -tendency to create large mass
    • -creates bone in mass
    • -cumulus cloud appearance
    • -high metastasis tending to be in lung-75%
    • --aka cannonball lesion
  26. Differential for Osteosarcoma
    • Ewing sarcoma- pain & fever that mimics infection
    • -feel worse systemically
    • Non-Hodgkin's lymphoma-feel good
    • Leukemia- young
    • -primary vascular tumor
    • Neuroblastoma- very young
    • Osteomyelitis-infection
  27. Osteosarcomatosis
    • Multifocal (multiple osteosarcomas)
    • Under 10 yoa
    • Universal bad outcome (usually fatal)
    • Attacks tubular bone
    • Sclerotic
    • Mixed w/ lucency
  28. Parosteal Osteosarcoma
    • Primary
    • Bone forming
    • Malignant
    • 4%
  29. Location of Parosteal Osteosarcoma
    • MC structure in bone- cortex
    • MC bone region- metaphysis
    • Common sites
    • -distal femur- 50%
    • -proximal tibia & humerus- 25%
    • Parosteal- around bone
    • -growing from host
  30. Age for Parosteal Osteosarcoma
    4th to 5th decade- 31-50
  31. Pain w/ Parosteal Osteosarcoma
    • YES
    • Dull, achy
    • 5 year survival rate- 70% after amputation
  32. Appearance of Parosteal Osteosarcoma
    • Radiodense- white
    • Mushroom growth coming out of cortex
    • Has bony stalk- lobulated sessile
    • Has larger head on stalk
    • Has daughter tumors in soft tissue
    • Dense & sclerotic
    • Cleavage plane- string sign
  33. Differential for Parosteal Osteosarcoma
    Post-traumatic myositis ossificans- halo rim
  34. Periosteal Osteosarcoma
    • Primary
    • Bone
    • Malignant
    • 1%
  35. Location of Periosteal Osteosarcoma
    • MC structure in bone- cortex
    • MC bone region- metaphysis
    • Periosteal- around periosteum of bone
    • -not in medullary cavity
    • -sandwiched b/w periosteum & cortex
    • -does NOT invade host bone
  36. Pain with Periosteal Osteosarcoma
    • YES
    • Better prognosis than parosteal
  37. Appearance of Periosteal Osteosarcoma
    • Occurs underneath periosteum
    • Non-homgenous density
  38. Osteosarcoma of Jaw
    • 6%
    • Mandible
    • Sclerotic
    • Older patient group
  39. Post-radiation Osteosarcoma
    • 4%
    • Due to therapeutic radiation therapy
    • In radiated bone
  40. Osteosarcoma in Paget's Dx
    • 1%
    • Serious malignant degeneration of Paget's disease
    • Lytic central osteosarcoma
    • Order of development in Paget's disease
    • 1. Osteosarcoma- #2 primary malignant bone tumor
    • 2. Fibrosarcoma- #5
    • 3. Chondrsoarcoma- #3
  41. Chondroma/Enchondroma
    • Primary
    • Cartilage
    • Benign
    • Common- #2 MC benign tumor
    • Types
    • Chondroma- extrinsic
    • Enchondroma- intrinsic
  42. Forms of Chondroma/Enchondroma
    • Monostotic- single
    • Polyostotic- multiple
  43. Location of Chondroma/Enchondroma
    • MC structure in bone- medullary
    • MC bone region- metaphysis
    • Common sites- small tubular bones of hand
    • -Hand
    • --MC benign tumor of hand
    • -Phalanx
    • --More common on ulnar side
    • --Proximal end
  44. Age of Chondroma/Enchondroma
    • Before 30 yo
    • 2nd to 3rd decade incidence- 11-30
  45. Pain w/ Chondroma/Enchondroma
    • NO
    • Found by accident- traumatic determinism
    • Can degenerate into chondrosarcoma
    • -central- medullary
    • --typically form these
    • --will start to hurt
  46. Appearance of Chondroma/Enchondroma
    • Developmental lesion- quirk of development
    • Ectopically located in medullary cavity
    • Cartilage growing in wrong place
    • Radiolucent- dark
    • Geographic
    • Short zone of transition
    • Well defined border
    • Often expansile
    • Start eccentrically in bone
    • Have an affinity for calcium- like to calcify
    • -50% enchondromas will have
    • Speckled calcification aka snowflake calcification
    • Soft tissue enlargement
  47. Differential for Chondroma/Enchondroma
    • Fibrous dysplasia
    • -especially of polyostotic
    • -not purely radiolucent
    • Mostly smoky appearance
  48. Enchondromatosis
    • aka Ollier's disease
    • Polyostotic- multiple lesions
    • Can be quite deforming
    • Site- femur & tibia
    • -common malignancy areas- pelvic & shoulder
  49. Maffuci's Syndrome
    • Ollier's plus soft tissue hemangioma
    • Soft tissue hemangiomas- due to distended blood vessel
    • Produce phleobiths- calcification
    • Very rare
    • Site- hand
  50. Common cystic lesion in phalanges, tubular bone, hands, feet
    • Arthritis w/ synovial cysts
    • -especially gout, geode
    • Bone cyst
    • -tumor-like disorder
    • Enchondroma
    • -occasionally low-grade chondrosarcoma
  51. Uncommon cystic lesions in phalanges, tubular bone, hands, feet
    • Angioma
    • Cystic osteomyelitis
    • Leprosy
    • Metastasis
  52. Solitary Osteochondroma
    • aka exostosis- external bone growth
    • aka osteocartilaginous exostosis
    • Primary
    • Cartilage
    • Benign
    • #1 MC benign bone tumor
    • -50% of all benign bone tumors
    • -10-15% of all primary benign bone tumors
    • 3 forms
    • Solitary-MC
    • Few
    • Dozens- hereditary
  53. Location of Solitary Osteochondroma
    • MC structure in bone- BOTH
    • MC bone region- Metaphysis
    • Constantly stays as metaphysis even during growing years- migrates
    • Common sites- tubular bones
    • -femur
    • -tibia-
    • -humerus
    • -found in metaphysis of large tubular bone
  54. Age for Solitary Osteochondroma
    • Before 20- 75%
    • Male 2:1
  55. Pain w/ Solitary Osteochondroma
    • NO
    • Found by accident
    • Can feel it, but not hurt
    • Pain & growth- indicate malignancy
  56. Appearance of Solitary Osteochondroma
    • Dense & sclerotic
    • Ectopic epiphyseal tissue growing in wrong place
    • Growing off side of metaphysis
    • Key radiographic features
    • -Integral part of host bone
    • --cortex goes into lesion
    • --medullary cavity & trabeculation go into lesion
    • -Types of morphological shape
    • --Pedunculated- elongated stalk (bony part)
    • ---Most frequent
    • ---ALWAYS point away from nearest jt
    • ---knee, hip, ankle
    • -Sessile- broader, wider attachment
    • --do NOT point
    • --humerus & scapula
    • ---Luschka't tubercle- superior angle of scapula
    • Can get large in size
    • Hyaline cartilage cap surrounds bone
    • Stalk is bone
    • Cauliflower shaped cap is cartilage
    • If cap not calcified-not visible
  57. Differential for Solitary Osteochondroma
    • So distinct- NO differential
    • Parosteal or periosteal osteosarcoma
    • -symptomatic- painful
    • -appearance sclerotic
    • osteochondroma- no pain, mottled appearance
  58. Hereditary Multiple Exostosis
    • Inherited autosomal dominance
    • 2-10
    • Pain- NO
    • Metaphyseal deformity- aplasia
    • -especially in sessile type
    • Aclasia- secondary symptom
    • -rubs against muscle, nerve, blood vessel
    • Cartilage cap can become malignant- peripheral chondrosarcoma
    • Bayonet deformity- wrist
    • More lesions, more likely to be malignant
    • -2% for single exostosis
    • -20% for HME
    • Mottled appearance
  59. Chondromyxoid Fibroma
    • aka fibromyxoid chondroma
    • Primary
    • Cartilage
    • Benign
    • Incidence- less common
  60. Location of Chondromyxoid Fibroma
    • MC common structure in bone- medullary
    • MC bone region- Metaphysis
    • -can migrate to epiphysis
    • Common sites
    • -loves tibia- 50%
    • --proximal 1/3
  61. Age for Chondromyxoid Fibroma
    • Before 30
    • 2nd to 3rd decade incidence- 11-30
    • 5th to 6th decade incidence- 41-60
  62. Pain w/ Chondromyxoid Fibroma
    • YES
    • Symptomatic- painful
    • Found due to pain
    • Insidious onset
  63. Appearance of Chondromyxoid Fibroma
    • Endosteal scalloping
    • Soap bubble appearance
    • Geographic
    • Expansile
    • Eccentric oval or round
    • Well-defined margin
    • Short zone of transition
    • Radiolucent- white
    • Absence of arthritis
  64. Differential for Chondromyxoid Fibroma
    • Giant cell tumor- soap bubble & appears at metaphysis
    • Chondroblastoma- starts at metaphysis
    • Geode- arthritis
    • Osteoblastoma- radiodense & mottled
  65. Chondroblastoma
    • aka Codman's tumor
    • Primary
    • Benign
    • Incidence- less common
  66. Location of Chondroblastoma
    • MC structure in bone- 90% medullary, 10% cortical
    • MC bone region- epiphysis
    • -can migrate to metaphysis & apophysis
    • Common sites- long tubular bones
    • -femur
    • -pelvis
    • -knee
    • -shoulder
  67. Age for Chondroblastoma
    • Before 30
    • 2nd to 3rd decade incidence- 11-30
    • Male 2:1
  68. Pain w/ Chondroblastoma
    • YES
    • Mild, dull pain
    • Pain to adjacent bone
    • Found due to pain
    • Can be insidious onset
    • Local tenderness
    • Swelling
  69. Appearance of Chondroblastoma
    • Geographic
    • Ovoid
    • Fluffy cotton wool calcification- chicken wire calcification
    • Well defined margin
    • Short zone of transition
    • Radiolucent
    • Expansile
    • Thin sclerotic margin
  70. Differential for Chondroblastoma
    • Giant cell tumor- older age group
    • Chondromyxoid fibroma- starts at metaphysis
    • Geode- must have arthritis
    • Osteoblastoma- radiodense & mottled
  71. Chondrosarcoma
    • Primary
    • Cartilage
    • Malignant
    • #3 primary malignant bone tumor
    • 2 regions
    • Central- intramedullary
    • -much more common
    • Peripheral- external to bone
  72. 3 types of Chondrosarcoma
    • Primary- de novo & nothing pre-existing
    • -central region
    • -1/3 of chondrosarcomas originate by itself
    • Secondary- degenerate from something pre-existing such as benign version
    • -most likely from chondroma or osteochondroma
    • -may be central or peripheral
    • -2/3 of chondrosarcomas originate from pre-existing
    • Clear Cell
    • -central region
  73. Location of Chondrosarcoma
    • MC structure in bone- Both
    • MC bone region- metaphysis
    • Common sites
    • -Pelvis
    • -Proximal femur
    • --MC primary malignant bone tumor of hand, chest wall
    • --3rd MC primary malignant bone tumor of pelvis
  74. Age for Chondrosarcoma
    • B/w 40-60
    • 4th to 6th decade- 31-60
    • Male 2:1
  75. Pain w/ Chondrosarcoma
    • NO
    • Later have pain
    • 90% survival rate after surgery
  76. Appearance of Chondrosarcoma
    • Mottled appearance
    • Speckled calcification
    • Geographic
    • Soap bubble appearance
    • Grossly expansile
    • Cartilage cap continues to grow
    • Solid periosteal reaction
  77. Differential for Chondrosarcoma
    • Chondroblastoma
    • Giant cell tumor
  78. Giant Cell Tumor
    • aka osteoclastoma
    • Primary
    • Cartilage
    • Quasi-malignant- semi-controled cartilage cell growth
    • -80% benign
    • -more malginant in males
  79. Location of Giant Cell Tumor
    • MC structure in bone- medullary
    • MC bone region- epiphysis
    • -can migrate to metaphysis
    • Common sites- typically like large tubular bones
    • -femur- distal
    • -humerus- proximal
    • -radius- distal
    • --distal radius- greatest potential of malignancy
    • -posterior arch
    • -sacrum- MC common spinal site
    • --MC benign tumor of sacrum
    • -60% in distal knee
    • -MC neoplasm of patella
  80. Age for Giant Cell Tumor
    • B/w 20-40
    • 3rd to 4th decade incidence 21-40
    • Benign female 3:1
    • Malignant male 3:1
  81. Pain w/ Giant Cell Tumor
    • YES
    • Deep boring pain
    • Localized swelling
    • Tenderness
    • Insidious onset
    • Malignant- poor prognosis
    • -10% chance alive in 5 years
  82. Appearance of Giant Cell Tumor
    • Geographic
    • Soap bubble appearance
    • Grossly expansile
    • Well defined margins
    • Joint space preserved
    • Tumor goes up to edge of subarticular bone
  83. Differential for Giant Cell Tumor
    • Chondroblastoma- age
    • Central chondrosarcoma
    • Infection-can get into jt space
    • Geode- must have arthritis
  84. Ewing's Sarcoma
    • aka Round cell tumor
    • Primary
    • Marrow
    • Malignant
    • #4 MC primary malignant bone tumor
  85. Location of Ewing's Sarcoma
    • MC structure in bone- medullary
    • mc bone region- diaphysis
    • Common sites
    • -Affinity for diaphysis-large tubular bone 50%
    • --femur
    • --tibia
    • --humerus
    • --fibula
    • -flat bone-40%
    • --pelvis
    • Younger- peripheral skeleton
    • Older- axial skeleton
  86. Age for Ewing's Sarcoma
    • Under 30
    • Typically b/w 10-25
    • 2nd decade incidence- 11-20
    • MC primary malignant tumor in 1st decade- 1-10
    • Unusual for under 5
    • Male 2:1
    • Lower affinity in blacks
  87. Pain w/ Ewing's Sarcoma
    • NO
    • Insidious onset
    • Deep aching bone pain
    • Worsening pain
    • Systemically feel ill
    • Episodic fever
    • Mimics infection
    • Localized pain w/ swelling
    • Soft tissue mass palpable
    • Increase ESR
    • Leukocytosis
  88. Appearance Ewing's Sarcoma
    • In tubular bone
    • -moth eaten
    • -permeative osteolysis
    • Cortical saucerization- wide & shallow localized divot of bone destruction in periosteum
    • Laminated periosteal reaction- onion skin
    • Short spiculation- trimmed whisker appearance
    • In flat bone
    • -geographic
    • -soap bubble
  89. Metastasis of Ewing's Sarcoma
    • MC primary malignant bone tumor to metastasize to bone
    • Skip lesion
    • Secondary spread to lung
    • 5 year survival rate- 5%
  90. Differential for Ewing's Sarcoma
    • Lytic osteosarcoma
    • Leukemia
    • Osteomyelitis- more diaphyseal for infection
  91. Non-Hodgkin's Lymphoma
    • aka primary reticulum cell sarcoma
    • aka round cell tumor
    • Primary
    • Marrow
    • Malignant
    • Primary lymphoma occuring outside lymphatic system
    • Skeletal extranodal non-Hodgkin's lymphoma
  92. Location of Non-Hodgkin's Lymphoma
    • MC structure in bone- medullary
    • MC bone region- diaphysis
    • Common sites
    • -Large tubular bones
    • --Femur
    • --Tibia
    • --Humerus
    • Non-Hodgkin's- originates from B-cell lymphocyte
    • Hodgkin's- originate from T-cell lymphocyte
  93. Age for Non-Hodgkin's Lymphoma
    • Young adults
    • 3rd to 4th decade incidence-21-40 yoa
    • 50% before 40
    • Male 2:1
  94. Pain w/ Non-Hodgkin's Lymphoma
    • NO
    • Feels fine
    • Tremendous contraindication of symptoms vs what's going on in bone
    • Minor symptamatology
  95. Appearance of Non-Hodgkin's Lymphoma
    • Moth eaten
    • Permeative osteolysis
    • Laminated periosteum
    • Prone to pathological fractures-transverse
    • Spiculation
    • Pathologic fracture
    • Soft tissue mass
    • 5 year survival rate (48%)
  96. Differential for Non-Hodgkin's Lymphoma
    • Lytic osteosarcoma
    • Osteomyelitis-more diaphyseal for infection
    • Ewing's sarcoma- feel bad
  97. Multiple Myeloma
    • Primary- originates in marrow
    • Marrow- tumor formed in marrow
    • Malignant- uncontrolled marrow cell growth
    • Granddaddy of primary malignant bone tumors
    • -#1 MC primary malignant bone tumor
    • 30/million
  98. Location of Multiple Myeloma
    • MC structure in bone- medullary
    • MC bone region- metaphysis
    • Common sites
    • -multicentric- multiple bones
    • -Spine- common place
    • --lower thoracic or lumbar
    • --typically in body
    • --not usually in posterior arch
    • -long bone
    • -skull- raindrop
  99. Age for Multiple Myeloma
    • Over 40
    • Typically b/w 50 to 70 yoa (75%)
    • 5th to 7th decade incidence 41-70
    • Male 2:1
  100. Pain w/ Multiple Myeloma
    • YES
    • Deep bone pain- aggravated by exercise & weight bearing, better @ night, worse during day
    • Weakness
    • Low back pain
    • Fatigue
  101. 4 abnormalities associated with MM
    • Anemia
    • -normocytic, normochromic anemia
    • -nothing wrong w/ RBC
    • -elevated ESR
    • Deossification of red marrow bones
    • Abnormal serum & urinary proteins
    • -Marrow replaced w/ cancer cells
    • --see spike in serum electrophoresis
    • --monoclonal gammopathy- 1 group of same gamma globulin cells w/o antigenic stimulus
    • --confirmed w/ bone marrow biopsy
    • Renal disease
    • -Bence Jones proteins clogs kidney
  102. Appearance of Multiple Myeloma
    • Negative on bone scan
    • -plain film important for determination
    • Osteoporosis-thinning of cortex
    • Uniform vertebral collapse
    • Well defined margin
    • No sclerosis to margin
    • Radiolucent-dark
    • Vary in size, but less than 2 cm
  103. 4 presentations of osteolytic defects
    • Classical- punched out lesion
    • -MC presentation
    • Myelomatosis- osteopenia
    • -only exhibit loss of bone density
    • -may want to test person exhibiting osteoporosis for MM
    • --electrophoresis
    • --bone biopsy
    • --show up w/ compression fractures or unresponsive
    • Plasmacytoma- localized subacute geographic lesion
    • Extraosseous- external to bone marrow & appears in nasopharynx
    • -rare
    • -dysphagia, mouth breathing
  104. Solitary plasmacytoma
    More localized form of MM
  105. Sites for solitary plasmacytoma
    • Mandible
    • Ilium
    • Vertebra
    • Rib
    • Proximal femur
    • Scapula
  106. Age for Solitary Plasmacytoma
    50% before 50 yoa
  107. Pain w/ Solitary Plasmacytoma
    localized
  108. Appearance of Solitary Plasmacytoma
    • Geographic
    • Radiolucent
    • Highly expansile
    • Soap bubble
  109. Differential for Multiple Myeloma
    • Lytic osteosarcoma- not usually in spine & younger age
    • Osteomyelitis- more diaphyseal for infection
    • Ewing's Sarcoma- feel bad & not usually in spine
    • Non-Hodgkin's lymphoma- feels ok
    • Metastasis
  110. Vertebral Body Lesions mnemonic
    • MOM LOACH
    • Metastasis
    • Osteoblastoma
    • MM
    • Lymphoma
    • Osteoid osteoma
    • Aneurysmal bone cyst
    • Chordoma
    • Hemangioma
  111. Soap Bubble Lesions mnemonic
    • MEN MAC FOGS
    • Metastasis
    • Enchondroma
    • Non-ossifying fibroma
    • MM
    • Aneurysmal Bone Cyst
    • Chondroblastoma
    • Fibrous dysplasia
    • Osteoblastoma
    • Giant cell tumor
    • Simple bone cyst

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