Msk Bone Tumors

Front 1

Bubbly or lytic lesions

Back 1

FEGNOMASHIC - Fibrous Dysplasia, Enchondroma, Eosinophilic Granuloma, Giant Cell Tumor, Non-ossifying fibroma, osteoblastoma, Metastitc disease, Myeloma, Aneurysmal Bone Cyst, Solitary (unicamaral bone cyst), HPT, Infection, Chondroblastoma

Front 2

fibrous dysplasia

Back 2

no periosteal reaction, mention adamantinoma if in tibia or jaw; pelvis, proximal femur, ribs, skull, long lesion in long bone, expansile medullary lytic lesion, ground glass, well-defined sclerotic margin, bowing deformities, base of skull sclerotic, hot on bone scan, cherubism in mandible and maxilla, craniofacial in facial and frontal bones, pseudoarthrosis of tibia, Mccune Albright is polyostotic FD with café-au-lait spots with precocious puberty

Front 3

enchondroma

Back 3

must have calcifications except in phalanges, no periostitis; tubular bones, chondroid calcifications, endosteal scalloping, pain is malignant, Ollier’s enchondromatosis, Mafucci’s enchondromatosis with multiple ST hemangiomas

Front 4

EG

Back 4

age<30; lytic lesion can look aggressive, skull lesion beveled-edge appearance, sequestrum, floating tooth, vertebra plana, lung dz, pituitary, RES

Front 5

GCT

Back 5

epiphyses must be closed, must be epiphyseal and abut the articular surface in long bones, eccentric, well-defined but nonsclerotic border except in flat bones; long tubular bone > spine or sacrum, 50% at knee

Front 6

NOF

Back 6

age<30, no periostitis, cortically based; metaphysis

Front 7

osteoblastoma

Back 7

mention with ABC even if age>30, especially in posterior elements of spine

Front 8

mets

Back 8

age>40; renal and thyroid

Front 9

myeloma

Back 9

age>40; plasmacytoma in ilium and sacrum, cold on bone scan; vertebral bodies destroyed before pedicles, axial skeleton, long bones, punched-out lytic lesions, generalized osteopenia, skeletal survey more sensitive

Front 10

ABC

Back 10

age<30, expansile, eccentric, pain, fluid-fluid levels on MR; posterior elements of spine, metaphysis of long bones, pelvis

Front 11

SBC (Unicamaral Bone Cyst)

Back 11

age<30, central, no periostitis; proximal humerus, proximal femur, calcaneus, fallen fragment sign

Front 12

Hyperparathyroidism

Back 12

brown tumor, must have other evidence of HPT

Front 13

infection

Back 13

always mention

Front 14

chondroblastoma

Back 14

age<30, epiphyseal

Front 15

chondromyxoid fibroma

Back 15

mention with NOF, no calcified matrix

Front 16

Mention in every case of bubbly or lytic lesions

Back 16

Age<30 – infection, EG; age>40 – infection, mets, myeloma

Front 17

Multiple Lytic Lesions

Back 17

FEEMHI: fibrous dysplasia, enchondromas, EG, mets, myeloma, HPT, infection

Front 18

Benign Appearing Rib Lesions

Back 18

fibrous dysplasia, ABC, mets, myeloma, enchondroma, EG

Front 19

Lytic epiphyseal lesion (also apophyseal, carpal and tarsal bones, patella)

Back 19

chondroblastoma, infection, EG, GCT, geode; age>40 – add mets and myeloma and remove chondroblastoma

Front 20

Lytic lesion in posterior elements of spine

Back 20

OAT: osteoblastoma, ABC, TB

Front 21

Exclude these lytic lesions if age>30

Back 21

CANES: chondroblastoma, ABC, NOF, EG, SBC

Front 22

Lesions that have no pain or periostitis

Back 22

FENS: fibrous dysplasia, enchondroma, NOF, SBC

Front 23

Bony sequestrum

Back 23

FILE: fibrosarcoma, infection, lymphoma, EG, osteoid osteoma (mimic)

Front 24

Geodes

Back 24

CARD: CPPD, AVN, RA, DJD, trauma

Front 25

Sclerotic lesion age 20-40

Back 25

chondroblastoma, ABC, NOF, EG, SBC, fibrous dysplasia, infection, HPT (healing brown tumor), osteoid osteoma, giant bone island; age>40 – mets

Front 26

Endosteal scalloping

Back 26

ibrous dysplasia, enchondroma, cartilaginous tumor

Front 27

Wide zone of transition (permeative)

Back 27

mets + myeloma, reticulum cell sarcoma, Ewing’s sarcoma, infection, EG

Front 28

Malignant bone tumors: age<30

Back 28

Ewing Sarcoma, Osteosarcoma, Mets

Front 29

Ewing’s sarcoma

Back 29

diaphysis long bones > flat bones, aggressive, ST mass typical, medullary location

Front 30

osteosarcoma

Back 30

poorly defined intramedullary metaphyseal mass lesion extends through cortex, osteoid or chondroid matrix, aggressive periosteal reaction with Codman triangle or sunburst pattern

Front 31

osteosarcoma telangiectatic form

Back 31

purely lytic and simulates ABC, parosteal form is low-grade and seen in posterior distal femur with more mature ossification centrally

Front 32

mets in children

Back 32

neuroblastoma, leukemia/lymphoma, Wilm’s

Front 33

Malignant bone tumors: age>40

Back 33

mets + myeloma,chondrosarcoma

Front 34

chondrosarcoma

Back 34

pain, long bones, pelvis, ribs, clivus, most metaphyseal

Front 35

Malignant bone tumors: age 30-40

Back 35

GCT, Fibrosarcoma, Malignant Fibrous Histiocytoma, Reticulum Cell Sarcoma

Front 36

GCT

Back 36

if lung mets or recurrance

Front 37

parosteal osteosarcoma

Back 37

densest calcification is central

Front 38

fibrosarcoma

Back 38

almost always lytic

Front 39

malignant fibrous histiocytoma

Back 39

mention with fibrosarcoma, aggressive, large soft tissue mass

Front 40

reticulum cell sarcoma

Back 40

primary lymphoma of bone, looks like Ewing’s sarcoma, often asx

Front 41

Permeative lesion in child

Back 41

Ewing’s sarcoma, infection, EG

Front 42

Permeative lesion in older pt

Back 42

infection, mets, myeloma, malignant fibrous histiocytoma, reticulum cell sarcoma

Front 43

Soft tissue tumors

Back 43

MFH, liposarcoma (may or may not have fat), synovial sarcoma (usu extraarticular), synovial osteochondromatosis (multiple Ca++ loose bodies, jt effusion, erosions, destruction; knee, hip, elbow; mimics PVNS if not Ca++), pigmented villonodular synovitis (hemosiderin deposits lining synovium, erosions, jt destruction, no joint space narrowing), hemangiomas (phleboliths, cortical holes, striated vertebral body)

Front 44

Malignant transformation of bony lesions

Back 44

fibrous dysplasia – fibrosarcoma, OSA, MFH; Paget’s – OSA; osteomyelitis with draining sinus – SCC; radiation – OSA, chondrosarcoma, MFH; bone infarct – fibrosarcoma, MFH; Ollier’s – chondrosarcoma; Maffucci’s – chondrosarcoma; osteochondroma – chondrosarcoma

Front 45

Cortical holes (pseudopermeative lesion)

Back 45

osteoporosis (metacarpal cortex less then ¼ to 1/3 of metacarpal), radiation, hemangiomas

Front 46

Focal cortical thickening

Back 46

stress fracture, infection, osteoid osteoma

Front 47

Mets to bone

Back 47

PBKTL; P – mostly blastic, B – mixed, K – purely lytic, TL – mostly lytic