Msk - Bone Lesions

Front 1

benign bone tumor which settles with aspirin at night

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osteoid osteoma

Front 2

Are osteoid osteomas typically large lesions?

Back 2

N.

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osteoid osteoma

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osteoid osteoma

Front 5

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osteoid osteoma

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FEGNOMASHIC:F =E = G =

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fibrous dysplasia,enchondroma / eosinophilic granuloma,giant cell tumour

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FEGNOMASHIC: NO

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nonossifying fibroma, osteoid osteoma

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FEGNOMASHIC: M= A= S=

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metastasis/myeloma, aneurysmal bone cyst, solitary bone cyst.

Front 9

FEGNOMASHIC: H= , I= , C= .

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hyperparathyroidism, infection, chondroblastoma.

Front 10

When determining differential diagnosis for bone tumors, what are the first things you ask yourself?

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1. morphology 2. age

Front 11

what 4 arthropathies are associated with subchondral geodes?

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RA, DJD, CPPD, AN.

Front 12

osteoid osteoma tends to arise in which age group? {__-__} years.

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10-20

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where is osteoid osteoma most commonly found? {proximal/distal cortex/medulla of ____ or _____}

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proximal cortex of femur or tibia

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describe the typical appearance of osteoid osteoma {focal area of ___ ____ with a central _____ _____}

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focal area of cortical thickening with a central radiolucent nidus.

Front 15

Fibrous displasia looks like

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can look like almost anything.

Front 16

What syndrome is fibrous dysplasia associated with? (other than Mazabraud syndrome)

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McCune-Albright Syndrome

Front 17

What is the classic triad defining McCune Albright syndrome

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polyostotic fibrous dysplasia, endocrine dysfunction, cutaneous hyperpingmentation.

Front 18

the other name for cutaneous hyperpigmentation

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cafe au lait spots

Front 19

What is the typical symptom of endocrine dysfunction in Maccune Allbright syndrome?

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precocious puberty.

Front 20

The most common cystic lesion of the phalanges

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enchondroma

Front 21

this is a

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osteochondroma

Front 22

It is difficult to differentiate between an enchondroma and a {___ ____}

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Bone infarct

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enchondroma

Front 24

well defined, densely sclerotic serpinginous boarder without scalloping is a characteristic of a {_}, not a {_}

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bone infarct, enchondroma

Front 25

What differentiates an enchondroma from a chondrosarcoma?

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pain

Front 26

Is histology useful for differentiating chondrosarcoma from enchondroma? What could be reassuring? {_}. {_}.

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no. MRI.

Front 27

Multiple enchondromas is called {_________'s} disease.

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Ollier's

Front 28

What four bony lesions occasionally have bone sequestra?

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Osteomylitis, lymphoma, fibrosarcoma, eosinophilic granuloma.

Front 29

What is the typical age of a patient with eosinophlic granuloma? { __.}

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< 30.

Front 30

To where do giant cell tumors rarely metastasize? {_.}

Back 30

lung.

Front 31

Where do giant cell tumours occur?

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epyphysis

Front 32

Are giant cell tumors usually large or small?

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large.

Front 33

for GCT: the zone of transition is {_}, T/F - the boarder is sclerotic {_}

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narrow. F.

Front 34

What is the most common benign bone lesion encountered by radiologists?

Back 34

Nonossifying fibroma

Front 35

What is the typical age of a patient with a nonossifying fibroma? {_} and what is the penetrance? {__%}

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young. 20%.

Front 36

Do nonossifying fibromas typically involve the cortex?

Back 36

Y

Front 37

Describe the boarder of a nonossifynig fibroma

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sclerotic, thin.

Front 38

Is periostitis associated with a non-ossifying fibroma and is the lesion painful? {_, _.}

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N, N.

Front 39

Is osteoblastoma a common lesion?

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N.

Front 40

Diffuse calvarial hyperostosis can be caused by which drug?

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phenytoin

Front 41

What are the 4 subtypes of fibrous dysplasia

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monostotic polyostotic craniofacial fibrous dysplasia cherubism (mandible and maxilla affected only)

Front 42

Malignant differential of fibrous dysplasia in the tibia or mandible

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adamantinoma

Front 43

What is a langerhans cell?

Back 43

antigen presenting cell (dendritic cell) found in the skin and mucosa.

Front 44

what differentiates a Langerhans cell from a histiocyte?

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Birbeck granules. (looks like a tennis raquet).

Front 45

unifocal langerhans cell histiocytosis is also known as?

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eosinophilic granuloma

Front 46

What is the Hand-Schuller-Christian triad?

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diabetes insipidus, exopthalmos, lytic bone lesions

Front 47

What is Letterer-Siwe disease? {multi/uni focus, system, _ _}

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multifocal, multisystem Langerhans histiocytosis.

Front 48

What is pulmonary langerhans cell histiocytosis?

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A not-completely seperate disorder almost always (95%) seen in adult smokers (20-40 years old) and sometimes resulting in progressive pulmonary fibrosis.

Front 49

How do you differentiate benign or malignant GCT?

Back 49

recurrence.

Front 50

How many appearances does eosinophilic granuloma have and is it associated with pain?

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many, sometimes

Front 51

what is one useful descriminator and two less useful descriminator for EG? {__, __stotic. _ _}

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age, monostotic. Bony sequestrum.

Front 52

What is the other common presentation of enchomdroma ?

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Irregular speckled calcification in the distal femur.

Front 53

What is the age prediliction of enchondroma? {_ age, but usually _}

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Any age, but usually adults.

Front 54

What is "benign fibrous cortical defect synonomous with?.

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non-ossifying fibroma

Front 55

DDx for a lesion with no periostitis or pain

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fibrous dysplasia enchondroma NOF SBCEG (sometimes has pain)

Front 56

DDx for an epiphyseal lesion

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geodeinfectionchondroblastoma GCT

Front 57

DDx for multiple bone lesions

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fibrous dysplasia EG enchondroma mets / myeloma HPT infection

Front 58

In what location are solitary bone cysts found?

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Invariably central, never epiphysial, often proximal humerus or proximal femur.

Front 59

What is the age prediliction for SBC?

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< 30.

Front 60

What featre of HPT must be seen to diagnose a brown tumour?

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subperiostial resorbtion: phalanges, distal clavicles, medial aspect of proximal tibias. Looser's zone fractures.

Front 61

An aneurysmal bone cyst is virtually always . . . {_ or _}

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aneurysmal or expansile

Front 62

What is the characteristic appearance of an ABC on MRI?

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multiple cavities with fluid levels. (almost pathognomonic)

Front 63

What is the age prediliection for an ABC?

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less than 30 years old.

Front 64

Are ABC's associated with pain?

Back 64

yes.

Front 65

What is a typical location of an ABC and where can they occur?

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Typically posterior elements of the spine, but can occur anywhere.

Front 66

What are ABC discriminators?

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must be expansile patients must be younger than 30 years of age.

Front 67

does a non-ossifying fibroma involve the cortex?

Back 67

yes, it will replace it with fibrous tissue.

Front 68

where do non-ossifying fibroma's occur?

Back 68

usually around the knee but can occur in any long bone.

Front 69

What is the DDx of a lytic bone lesion in the epiphysis of a young patient (< 30 years)

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infection (most common) chondroblastoma GCT rare - ABC and EG

Front 70

what diseases are associated with subchondral cysts (geodes)

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degenerative joint disease (must be associated with joint space narrowing, subchondral sclerosis and osteophyte formation) rheumatoid arthritis calcium pyrophosphate dihydrate deposition disease (CPPDDD) avascular necrosis

Front 71

Chondrobastoma discriminators

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patient must be younger than 30 years must be epiphyseal.

Front 72

What can never be excluded in a patient younger than 30 years?

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Eosinophilic granuloma infection

Front 73

What can never be excluded in a patient over 40 years old?

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metastatic disease infection

Front 74

What are 4 useful radiologic criteria for determining whether a lesion is malignant or benign?

Back 74

cortical destruction - not really periostitis - difficult to differentiate "aggressive" from "benign" orientation of the lesion - not helpful at all zone of transition - yes!

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Back 75

osteoid osteoma

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osteoid osteoma

Front 77

Salient features of osteoid osteoma

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* nidus (meshwork of dilated vessels and osteoclasts) * fibrovascular rim * surrounding reactive sclerosis

Front 78

Can a non-ossifying fibroma involve the cortex

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yes, the cortex may be replaced by benign fibrous tissue.

Front 79

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fibrous dysplasia

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fibrous dysplasia - polystotic form

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Fibrous dysplasia - monostotic

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Giant Cell Tumour

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Giant cell tumour

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non-ossifying fibroma

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Giant cell tumour of bone

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Aneurysmal bone cyst

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healing non-ossifying fibroma

Front 88

Other name for a solitary bone cyst

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unicameral bone cyst

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simple bone cyst (unicameral)

Front 90

T2 weighted. Lesion returns low signal on T1.

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unicameral (simple) bone cyst

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unicameral (simple) bone cyst

Front 92

T2 image. T1 signal was low also

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non-ossifying fibroma

Front 93

What are the MRI appearances of non-ossifying fibroma?

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T1 low signalT2 variable. intermediate to high initially, then low as the lesion ossifys.

Front 94

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osteochondroma

Front 95

Back 95

Frontal view of the left shoulder shows expansion of the proximal left humeral diametaphysis with a ground glass matrix and adjacent cortical thinning. There is a left proximal humeral bony excrescence as well as a protrusion of the cortex medially. In addition, there is a bony protuberance projecting from the medial mid left scapula. These findings are suggestive of Hereditary multiple exostoses (HME), which is characterized by the presence of multiple osteochondromas.

Front 96

define excrescence

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abnormal outgrowth

Front 97

identify this lesion

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enchondroma

Front 98

p

Back 98

enchondroma

Front 99

p

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enchondroma

Front 100

T1, lesion high signal on T2. Note surrouding

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enchondroma

Front 101

Back 101

renal cell carcinoma

Front 102

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chondroblastoma

Front 103

What is the tissue of origin for chondroblastoma

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-Usually benign, cartilaginous tumor

Front 104

What is the key radiologic feature?

Back 104

-Epiphyseal lytic lesion in children and teens

Front 105

is a chondrobastoma usually painful?

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Yes.

Front 106

osteoid osteoma epidemiology (__ to __ years, M:F)

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10 to 25 years, 3:1

Front 107

enchondroma is a

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benign tumour of hyaline cartilage

Front 108

what gives an enchondroma its characteristic "speckled appearance"

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chondroid matrix

Front 109

What disease and what syndrome are multiple enchondromas (and hemangiomas) associated with?

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Ollier disease, Maffuci syndrome

Front 110

"automatics" where patient is younger than 30 years old?

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eosinophilic granuloma infection

Front 111

"automatics" if patient is more than 30 years old

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metastasis infection

Front 112

Discriminator for fibrous dysplasia

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No periosteal reaction

Front 113

If fibrous dysplasia is suspected in the tibia ___ should also be considered

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adamantinoma

Front 114

Enchondroma descriminators

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Calcification, no pain

Front 115

Eosinophilic granuloma discriminators

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younger than 30.

Front 116

Giant cell tumour descriminators

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epiphyses closed, abuts articular surface, well defined with non-sclerotic margin.

Front 117

Non ossifying fibroma descriminators

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younger than 30, no periostitis.

Front 118

Aneurysmal bone cyst descriminators

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expansile, younger than 30.

Front 119

Solitary bone cyst

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central, younger than 30.

Front 120

Chondroblastoma descriminators

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epiphyseal, younger than 30.

Front 121

4 criteria useful for determining malignant nersus benign lesions:

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cortical destruction, periostitis, axis, zone of transition.

Front 122

most important descriminator of bone malignancy

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zone of transition

Front 123

mallignant tumours will appear to have a ___ zone of transition on MRI

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narrow

Front 124

benign periostitis appears as

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cortical thickening

Front 125

malignant periostitis characterised by {sun___, amo___, co___ ____, o___ s___}

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sunburst, amorphous, codman triangle, onion skin.

Front 126

The only two childhood malignant tumour of bone

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osteosarcoma, Ewings sarcoma

Front 127

Common malignant tumours of bone in adulthood

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metastasis, myeloma, chondrosarcoma.

Front 128

most common malignant bone tumour

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osteosarcoma

Front 129

In what circumstances might osteosarcoma be found in an older person?

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padget's disease, radiation induced

Front 130

T/F: parosteal osteosarcoma is more aggressive.

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F

Front 131

cortical desmoid occures at the insertion / origin of { __ __ of __ or __ __}

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medial head of gastrocnemius or adductor magnus

Front 132

benign avulsion injury of distal femur

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cortical desmoid

Front 133

p

Back 133

myositis ossificans

Front 134

3 "knee jerk" diagnoses for a permeative lesion in a child:

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Ewing sarcoma, infection, eosinophilic granuloma.

Front 135

Is Ewings sarcoma usually symptomatic

Back 135

Y

Front 136

Low grade chondrosarcoma appears very similar histiologically to:

Back 136

enchondroma

Front 137

Differentials for lytic lesion with aggressive features in an older patient

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metastasis, plasmacytoma, fibrosarcoma, malignant fibrous histiocytoma, infection.

Front 138

What are the two most common soft tissue tumours?

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MFH and liposarcoma

Front 139

Osteochondroma

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Cartilage-capped osseous excrescence with continuous cortex and marrow extending from underlying bone.

Front 140

Chondroblastoma

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Benign cartilage tumor arising in epiphysis of skeletally immature individuals

Front 141

parosteal

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pertaining to the outer surface of the periosteum

Front 142

Leterer-Siwe Disease

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Multifocal, multiorgan LCH.

Front 143

3 Types of Langerhans cell histiocytosis

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1) Leterer-Siwe Disease 2) Uni/multifocal Unisystem. 3) Pulmonary LCH

Front 144

melorheostosis

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flowing segmental ossification (dripping candle wax sign)

Front 145

Back 145

periosteal chondroma (juxtacortical chondroma)

Front 146

What angle is this?

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Bohler angle

Front 147

9 year old boy

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Askin tumour