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27 Cards in this Set
- Front
- Back
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osteoma
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benign
M/C in male 50 - 60 Opaque (blastic) or dense skull & face (sinuses) asymptomatic TX: shaving associated with Gardner's Syndrome |
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Enostosis
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benign
male and female bone islands, speculated border thru-out skeleton asymptomatic DDX- osteoblastic metastasis associated with Osteopoikilosis |
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Osteoid Osteoma
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benign
m/c in male 10 - 25 intracortical, lucent nidus (<1cm) surrounded by sclerosis 50% femur & tibia (20% hands & feet) diaphysis ext. to metaphysis pain @ night gets better with aspirin, swelling, decreased ROM DDX infection, stress fracture TX: NSAIDS, en bloc resection, ablation special feature on scintigraphy = double density sign T2 = high |
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Osteoblastoma
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benign
m/c male 10 - 30 geographic, lytic/mixed, cortical thinning, nidus (>2cm) Lumbar spine - neural arch ext. to body, metadiaphyseal local pain DDX-osteoid osteoma, ABC, enchondroma fibrous dysplasia TX- curettage (small); grafting & radiation (large) simulates malignancy |
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Osteosarcoma
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malignant
m/c male 10 - 25 mixed lytic-blastic, cumulus cloud, intramedullary, periosteal rxn (sunburst) 40% femur (50-75% about knee) metaphysis ext. dia/epiphysis pain & swelling, dec. ROM, warmth & pyrexia increased alk phos DX- Ewing's sarcoma, metastasis amputation (60%metastasis) T1 = low, T2 = high |
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Osteochondroma
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benign
m/c male less than 20 yoa osteocartilaginous excrescence - pedunculated or sessile "coat hanger" - orients away from joint 30% femur asymptomatic; complications: fx, osseous deformity, vascular injury, bursa form., neuro compromise, malignant transform 1 - 25% Associated with HME, osteochondromatosis, m/c benign skeletal tumor T1 = low, T2 = high |
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Enchondroma
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benign
M/F 10 - 30 yoa geographic, medullary, scalloping --> cortical thinning 40-65% hands (25% lower extremity) metaphysis painless- (pain = malignant transformation) DDX: SBC, GCT, chondroblastoma, osteoblastoma TX none (curettage & cement packing) Associated with Ollier's Disease, Maffucci's Syndrome T1 = low, T2 = high |
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Chondroblastoma
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benign
m/c male 10 - 25 geographic, lytic, eccentric, medullary femur, tibia, humerus & ilia, epiphysis ext. to metaphysis pain refers to joint, swelling DDX- GCT, infection, TX: curettage & bone packing, resection 2nd m/c benign patellar T1 = low, T2 = high |
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Chondrosarcoma
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malignant
m/c male 40 - 60 expansile, lytic, ill-defined, scalloping, cotton wool or arcs & rings, periosteal rxn (laminated or speculated) 50% pelvis & proxl femur, metaphysis pain with swelling, soft tissue mass DDX: enchondroma, metastatic disease TX: amputation, radical resection (metastasis to lungs) degeneration of Ollier's (50%) & HME (20%) m/c primary malignant hand tumor; 3rd m/c pelvis malignancy T2 = high |
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Non-Ossifying Fibroma
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benign
m/c male 8 - 20 large, well-defined, eccentric, cortical thinning 90% lower extremity - tibia (55% about the knee) metaphysis asymptomatic pathological fx --- spontaneous regression (NO malignant potential), curettage T1 & T2 = low signa |
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Fibrosarcoma
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malignant
M/F 30 - 50 yoa motheaten, cortical dissolution, (periosteal rxn rare) long bones about knee, 40% femur, diametaphysis local pain, 33% pathological fx, large soft tissue mass TX: amputation, 70% DDX: metastasis |
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Giant Cell Tumor
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benign
m/c female 20 - 30 yoa eccentric, 60% lytic, 40% soap-bubble, cortical thinning (NO sclerotic border) 75% long bones (50% knee & distal radius) metaphysis ext. to epiphysis, vertebral body local pain & swelling, dec. ROM, neuro effects (spinal/sacral lesion), ext. to soft tissue DDX:chondroblastoma, ABC, fibrous dysplasia, Brown tumor of HPTH TX: excision, liquid nitrogen, grafting & radiation, bone packing m/c benign sacrum tumor; m/c patellar neoplasm T1 = low, T2 = high |
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Simple (Unicameral) Bone Cyst
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benign
m/c male less than 14 yoa geographic, lytic, scalloping/thin cortical "fallen-fragment sign" 75% proximal humerus & femur (pelvis & calcaneus) metaphysis asymptomatic, 60% pathological fx DDX: chondroblastoma, enchondroma, TX:curettage & bone packing, steroid injection active - in metaphysis latent - in diaphysis T1 = low, T2 = high |
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Aneurysmal Bone Cyst
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benign
m/c female 5 - 20 eccentric, well-defined, lytic, cortical thinning 80% long bones & spine (neural arch & body) metaphysis ext. to diaphysis acute pain, pathological fx, neural compromise (spinal lesion) long bone: DDX: GCT, enchondroma, osteoblastoma, in spine GCT, osteoblastoma, hemangioma TX: curettage, steroid injection, radiation (inc. risk of sarcoma) often secondary to acute fx m/c benign clavicle tumor |
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Ewing's Sarcoma
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malignant
m/c male 10 - 25 ill-defined, motheaten, periosteal rxn (laminated or hair-on-end) 50% long bones (22% femur), flat bones (21% pelvis) metadiaphyseal pain with swelling, soft tissue mass, fever, anemia, leukocytosis DDX: osteosarcoma, osteomyelitis, lymphoma, infection 30% metastasis (lungs & bones) TX : radiation & chemo T1 = low, T2 = high |
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Hemangioma
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benign
m/c female over 40 spine: "corduroy cloth", skull: geographic, lytic, "spoked-wheel" 75% spine (body) & skull (frontal/parietal bones) asymptomatic DDX: osteoporosis, Paget's disease TX: Leave Alone! If large, en bloc resection, radiation, decompression m/c benign tumor of the spine; CT: "polka-dot" on axial T1 & T2 = high signal |
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Fibrous Cortical Defect
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benign
male 4 - 8 small, eccentric, geographic, rim of sclerosis 90% lower extremity - posteromedial distal femur (55% about the knee) metaphysis asymptomatic --- spontaneous regression (NO malignant potential) T1 & T2 = low signal |
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Lipoma
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benign
both 5 - 70 (mean:30) well-defined, lucent, sclerotic border, may have "target" appearance fibula, femur, tibia, calcaneus; metaphyseal 60% aching pain, 40% asymptomatic SBC, ABC, fibrous dysplasia, enchondroma, clear cell chondrosarcoma Leave Alone! Curettage with packing if symptomatic T1 = high |
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Chordoma
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malignant male 40 - 70 sacral: inc. retrorectal space
(>2cm) on lateral view, irregular osseous destruction, calcification; occipital: clivus & sella turcica destruction, calcification; vertebral: body destruction, IVD involvement, body collapse 50-60% sacrococcygeal, 25- 40% spheno-occipital, 15% vertebral (C2) sacral: pain & numbness, incontinence, large soft tissue mass, constipation, paresthesia; occipital: HA, blurred vision, diplopia, mm. weakness, pituitary dysfxn, CN impinged; vertebral: pain & numbness, weakness, paralysis chondrosarcoma, metastasis; sacral: GCT, plasmacytoma, ABC; occipital: intracranial lesions; vertebral: plasma cell myeloma, lymphoma, GCT, infection radiation, high recurrence rate with resection, 6 year survival rate after dx metastasis via vascular dissemination (40%) only 1o malignant bone tumor that crosses the IVD |
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Hodgkin's Lymphoma
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malignant male 20 - 50 lytic (majority), 15% sclerotic
- ivory vertebra, 10% mixed thoracolumbar vertebral body, pelvis, scapula, sternum, ribs, femur lymphadenopathy, hepatosplenomegaly, fever, night sweats, weight loss, pain metastasis, Multiple Myeloma, EG, Ewing's sarcoma chemotherapy & radiation better prognosis than NHL |
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Malignant Lymphoma
(Non-Hodgkin's, Reticulum Cell Sarcoma) |
malignant male 20 - 50 poorly defined, osteolytic,
cortical destruction, laminated periosteal rxn (minimal) femur, tibia, humerus (40% about the knee), pelvis, ribs, scapula, & vertebrae; diametaphyseal lymphadenopathy, hepatosplenomegaly, fever, night sweats, weight loss, dull & achy pain not relieved by rest metastasis, Multiple Myeloma, EG, Ewing's sarcoma chemotherapy & radiation 30% involve bone |
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Multiple Myeloma
(Kahler's Disease) |
malignant male
(black) 50 - 70 osteopenia (density loss & cortical thinning), punchedout lesions, vertebral plana - complete body collapse, <3% ivory vertebra; raindrop skull, permeative motheaten pattern sites of red marrow, thoracolumbar spine (body destruction & neural arch sparing), skull, ribs, clavicle, scapula, humeral & femoral diaphyses bone pain, anemia, hepatomegaly, bruising, weight loss, amyloidosis (cardiac & renal failure), thrombocytopenia, etc definitive dx: bone marrow aspiration; metastasis, lymphoma, fibrosarcoma chemotherapy & radiation form of plasma cell dyscrasia (others: amyloidosis & Waldenstrom's macroglobulinemia); Fanconi's syndrome (renal disease) most common 1o malignant tumor of bone; lab findings: inc. ESR, hypercalcemia, dec. P, inc. creatinine, inc. IgG, reversed A:G ratio, Bence Jones' proteins, uric acid T1 = low, T2 = hyperintense; bone scan: cold spots "headless bone scan" |
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Leukemia
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malignant acute: 2
- 5 chronic 35 - 55 osteopenia, loss of trabecular pattern, Harris growth arrest lines (radiodense) at epiphysis, radiolucent metaphyseal bands, indistinguishable cortex any region, any bone weak, lethargic, loss of appetite, inc. ESR, lymphadenopathy, splenomegaly, anemia, migratory polyarthalgia, amyloidosis, gout post-menopausal or senescent osteoporosis in older patient AL is most common childhood malignancy T1 = high |
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Eosinophilic
Granuloma |
benign < 20
(peak: 5 - 10) solitary, round/oval, welldemarcated, osteolytic, endosteal scalloping, solid/laminated periosteal rxn. skull: hole-within-a-hole, button sequestrum; mandible: floating teeth sign; spine: vertebral plana - silver dollar vertebra, posterior elements sparing skull, thoracic spine, mandible, pelvis, ribs, long bones (crosses growth plate); monostotic presentation skin lesions, inc. ESR, local pain & swelling, fever, neural compromise Ewing's sarcoma, osteosarcoma, osteomyelitis, leukemia, lymphoma, fibrous dysplasia radiation, corticosteroid injection, resection & curettage, chemotherapy if polyostotic; can be self-limiting Histiocytosis X (Langerhans Cell Histiocytosis) EG: single system, single lesion; Letterer-Siwe: multi system, multi lesion; Hand-Schuller- Christian: single system, multi lesion |
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Fibrous Dysplasia
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benign both, P
(E): female M: 14, P: 11, P (E): 8 ground glass appearance, endosteal scalloping, bowing; monostotic: lucent, geographic, sclerotic border, NO periosteal rxn; polyostotic: pseudofractures on convex surface monostotic: 75% ribs, proximal femur, tibia & skull; 10% pelvis & humerus, diametaphyseal; polyostotic: femur, skull, humerus, ribs & long bones, diaphysis monostotic: asymptomatic, polyostotic: bowing deformity - shepherd's crook deformity, pathological fx; leontiasis ossea - lion face, coast of Maine café-au-lait spots, early onset puberty, inc. alk phos. great imitator of bone diseast anti-resorptive drugs, glucosteroids, monostotic: leave alone; malignant transformation is rare McCune-Albright syndrome (endocrine), Cherubism - expansion of mandible or maxilla (lion face), Mazabraud syndrome with polyostotic form 70% monostotic, 27% polyostotic, 3% polyostotic with endocrinopathy; most common benign lesion of ribs |
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Paget's Disease
(Osteitis Deformans) |
malignant male > 40 coarse, thick trabeculae,
cortical thickening, skull: osteoporosis circumscripta (stage 1), cotton-wool (stage 2/3); spine: enlarged, picture frame appearance, ivory vertebra (stage 3), corduroy cloth, body collapse; pelvis: brim sign (stage 3); long bones: blade-of-grass, bowing deformity (shepherd's crook & saber shin) asymmetric, polyostotic presentation; pelvis, sacrum, lumbar spine, skull, proximal long bones (femur); readily involves epiphysis, crosses IVD and articulations dull pain, hat/shoe size changes, ureteric colic, anemia, high output cardiac failure, neuromuscular complications, path. Fx (m/c in cortex of legs), inc. alk phos & hydroxyproline, inc. uric acid osteoblastic metastasis, lymphoma, hyperparathyroidism, fibrous dysplasia (not everyone progresses thru each stage) calcitonin, bisphosphonate, or mithramycin therapy 1-20% malignant transformation to osteosarcoma; GCT, metastasis, myeloma & lymphoma observed in Stage 4 Stage 1: osteolytic, begins in epiphysis; Stage 2: mixed, disorganized bone; Stage 3: osteoblastic, "ivory-hard", Stage 4: neoplastic degeneration |
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Metastasis
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malignant > 50 15% osteoblastic (prostate,
breast, GI, lung), 75% osteolytic (breast, lung); spine: body collapse, ivory vertebra; skull: button sequestrum; pelvis/sacrum: snowball appearance; tubular bones: cookie-bite sign, horizontal fx lines areas of red marrow; spine (vertebral body, pedicle), pelvis, ribs, sternum, femur, humerus & skull hematogenous spread (m/c), direct extension, or lymphatic spread. Bone pain with bouts of remission, weight loss, cachexia, soft tissue mass, hypercalcemia, inc. hydroxyproline, inc. alk phos blow-out metastasis: lytic, expansile. R - renal, A - adrenal, T - thyroid, S - skin 75% from breast, prostate, lung & kidney; 60% of men from prostate, 70% of women from breast; kids: neuroblastoma, Ewing's, osteosarcoma; Wilm's tumor most common malignant tumors of skeleton |
