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54 Cards in this Set
- Front
- Back
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What lesion is part of a group of diseases known as histiocytosis X, or Langerhans cell histiocytosis?
a. lymphoma b. leukemia c. eosinophilic granuloma d. osseus metastasis e. multiple myeloma |
c. EG
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What is the circled phenomenon in the EG Langerhans cell?
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Birbeck's granule
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What feature is shown on the bottom image that is unique to eosinophilic granuloma in the skull?
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hole within a hole
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The photo above is an example of fracture in anterior body wall (hard to see). What lesion causes this, and what are the 3 names for the vertebrae at the arrow?
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1. Eosinophilic granuloma
2. Vertebra plana, silver-dollar vertebra, coin-on-edge vertebra |
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What lesion is shown in the photo above?
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Eosinophilic granuloma (within the mandible)
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What is the term used to describe the phenomenon in EG above?
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floating teeth sign
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In EG, what general area of the spine is most commonly involved? Least involved?
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Thoracic most common, cervicals least common
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What is the term for EG in a skull's feature showing centrally located residual bone?
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button sequestrum
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Can EG ever degenerate or morph into a malignancy of bone?
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No - it is not a true neoplasm
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What are some differential diagnoses for EG?
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Ewing's
Osteosarcoma Osteomyelitis Leukemia/Lymphoma |
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What is the age range for EG? What is the specific age of most common involvement?
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0-30 years old (rarely ever over 30)
Most commonly between 5-10 years of age. |
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Approximately 40% of cases are associated with skin lesions such as: papules, erosions, ulcerations, and purpura.
a. Lymphoma b. Leukemia c. Osteomyelitis d. EG e. Osseus Mets |
d. EG
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True/False?
EG often presents with systemic pain and swelling clinically. |
False - localized pain and swelling
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In EG (especially in the vertebral body), what is the preferred method of treatment?
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Don't touch - spontaneous resolution
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How often does secondary malignant bone tumors occur compared to primary malignant bone tumors? (ratio)
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25 to 1
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Regarding metastasis to bone, what does BPLKT stand for?
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B-Breast, P-Prostate, L-Lung, K-Kidney, T-Thyroid
80% of secondary bone mets originated from here, in descending order: BPLKT |
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In a child, where is the most likely location to find secondary mets?
a. long bones b. axial skeleton |
a. long bones (more red marrow)
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In an adult, where is the most likely location to find secondary mets?
a. long bones b. axial skeleton |
b. axial skeleton
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With secondary bone mets coming from the prostate, what vertebral segments are most likely to be involved?
a. cervical b. thoracics c. lumbar d. sacral |
d. sacral (this is an exception to the rule)
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In adults, what vertebral segment is most likely to get secondary bone mets?
a. cervical b. thoracics c. lumbar d. sacral |
c. lumbars (except when from prostate cancer)
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__________ refers to the mechanism by which neoplastic cells separate from the primary tumor and gain access to the systemic circulation.
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Intravasation
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Regarding successful secondary bone mets spread, is it more likely to spread in arteries or venous systems?
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venous systems - arterial channels seem to possess immunity
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Most secondary bone mets tumors are __________ (osteolytic/osteoblastic) primarily?
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osteolytic
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What type of primary tumor causes osteoBLASTIC effects in secondary bone metastasis? (Where does the tumor cells originate from?)
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Prostate
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Which of the following are common secondary bone mets lab findings? MACA
a. hydroxyprolinemia b. elevated alkaline phosphatase c. hydroxyprolinuria d. decreased PTH e. hypercalcemia |
a, b, c, e
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Which of the following can secondary bone mets look like on plain film?
a. geographic b. moth-eaten c. permeative d. all of the above e. none of the above, it's usually blastic |
d. all of the above
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If you knew this was secondary bone mets, what is the location of the primary tumor based on the characteristics of the vertebral bodies?
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Prostate - because almost all secondary bone mets is lytic except when from the prostate.. It's then blastic, aka solid white!
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What is the radiographic name for the extremely white/blastic vertebral body shown here? (Secondary bone mets from prostat)e.
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Ivory vertebra apperarance
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Explain why the middle blastic vertebrae is not an example of Paget's disease (assuming the age of patient matched up).
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Pagets causes bone to appear blastic, but it also causes bone to expand. Since these VB's are symmetrical, Pagets is ruled out. Diff Dx: Bone Mets & Lymphoma
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True/False?
Secondary bone metastasis often has a periosteal reaction. |
False - usually doesn't
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True/False?
Secondary bone metastasis never has a periosteal reaction. |
False - although it USUALLY doesn't.. It can.
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Explain why these lesions on the skull are more likely to be secondary lytic mets instead of Multiple Myeloma.
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MM = raindrop skull - SYMMETRIC lesions in size. This image has varied size thus it's more likely to be lytic bone mets.
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Does this image have high sensitivity or high specificity?
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High sensitivity, low specificity (note: it is secondary bone mets)
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What is the imaging feature displayed here in the right hemi-pelvis? ____-___ metastasis
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Blow-out metastasis
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What are the 4 common primary locations of tumors that will display "blow-out metastasis" in bone?
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RATS
Renal, Adrenal, Thyroid, Skin |
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When secondary bone mets presents distal to the knee or the elbow, where is the tumor most likely originating from?
(Hint: 2 places) |
GI tract
bronchogenic carcinoma |
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When secondary bone mets presents distal to the knee or elbow, what is this called? _____ metastasis
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Acral
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Non-Hodgkin's lymphoma occurs at a __:__ rate compared to Hodgkin's lymphoma.
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3:1
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What is the age range for N-HL (non hodgkin's)? Gender predeliction?
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20-50 YOA
Males (we always get hosed) |
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True/False?
NonHodgkin's lymphoma usually has a soft tissue mass associated with it. |
True
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What is the pattern of destruction seen in NonHodgkin's Lymphoma?
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poorly-defined, aggressive, lytic, medullary based but spreading to cortex, soft tissue mass, occasional periosteal reaction
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If you suspect NH Lymphoma, and the patient is over 40 years of age.. What are your two leading differentials?
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Secondary Mets
Multiple Myeloma |
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Name this lesion
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Non Hodgkin's Lymphoma
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Hodgkin's Lymphoma histologically are identified by having what large cells, often with bi-lobed nuclei giving an "owl's eyes" appearance?
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Reed-Sternberg cells
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Where does Hodgkin's lymphoma often appear at in the body?
a. distal femur b. proximal tibia c. radioulnar joint d. vertebrae e. clavicle |
d. vertebrae
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What kind of pattern does Hodgkin's Lymphoma usually show on plain film?
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Lytic, mixed and blastic (basically anything is possible)
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If Hodgkin's lymphoma is sclerotic in the spine, what is the term for this view in plain film x-rays?
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ivory vertebrae
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What's the term for this vertebrae's sclerotic appearance? Name 3 differentials for it.
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Ivory vertebrae
1. lymphoma 2. osseus metastasis 3. Paget's (although since it's not expansile, HIGHLY UNLIKELY) |
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T/F?
Non Hodgkin's Lymphoma and Leukemia form solid cancerous masses in the body. |
False. NH Lymphoma does, but leukemia never does.
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With Leukemia, is an older patient more likely to develop the acute or chronic type?
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chronic
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What is the most common childhood malignancy?
a. Leukemia b. Non Hodgkin's Lymphoma c. Secondary mets d. Ewing's Sarcoma e. Paget's |
a. Leukemia
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Non-Hodgkin's lymphoma is most likely to occur in the upper or lower extremities?
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lower
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The black bands in the distal femur are indicative of what disease?
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Acute Leukemia
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The lines to the left of the image, just inferior to the growth plate.. What are they called in a patient with Leukemia?
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Harris growth arrest lines
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