Term
| what is the incidence of skeletal metastasis and primary malignancy? |
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Definition
70% mets 30% primary malignancy |
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Term
| what are the m/c malignant tumors? |
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Definition
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Term
| where does skeletal mets arise from? (6) |
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Definition
primary extraskeletal site:
breast lung prostate kidney thyroid bowel |
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Term
| what are the primary sites of mets in women? |
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Definition
breast 70% lung thyroid kidney uterus |
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Term
| what are the primary sites of mets in men? |
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Definition
prostate 60% lung 25% thyroid kidney bowel |
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Term
| what are the primary sites of mets in kids? |
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Definition
neuroblastoma ewing's osteosarcoma lymphoma |
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Term
a) ...% of all pts with malignancy will get skeletal mets. b) often the...... c) lesions tend to be.... d) solitary lesions in only ...% of cases. |
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Definition
a) 20-35% b) cause of death c) multiple d) 10% |
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Term
a) breast cancer incidence per 100,000 in m & f? b) % who develop bone mets? c) % who develop pathologic fxs? |
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Definition
a) m=0.8, f=108.8 b) 50-85 c) 50-55 |
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Term
a) lung cancer incidence m/f? b) % who dev. bone mets c) % who develop pathologic fx? |
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Definition
a) m=82.5 f=37.8 b) 30-50 c) 9 |
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Term
a) prostate cancer incidence m b) % who dev bone mets c) % who dev p.f. |
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Definition
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Term
a) renal cancer incidence m/f b) % who dev. bone mets c) % who dev. p.f. |
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Definition
a) m=11.6, f=5.6 b) 30-50 c) 11 |
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Term
a) thyroid cancer m/f b) % who dev bone mets c) % who dev p.f. |
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Definition
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Term
a) colon cancer m/f b) % who dev bone mets c) % who dev p.f. |
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Definition
a) m=42.3, f=31.4 b) 6 c) 5 |
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Term
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Definition
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Term
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Definition
nocturnal bone pain pathologic fracture history of cancer unexplained weight loss anemia fever soft tissue mass deformity |
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Term
nocturnal bone pain patho fx hx cancer unexplained weight loss anemia fever st mass deformity |
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Definition
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Term
a) metastasis can occur .... b) pain is c) symptoms |
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Definition
a) 15 years later b) persistent, not relieved by rest c) may be minimal |
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Term
3 ways of examining skeletal mets |
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Definition
rectal exam breast exam skin exam |
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Term
lab results of skeletal mets |
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Definition
elevated: ESR serum calcium (lytic) often normal alkaline phosphatase (blastic) acid phosphatase (prostate mets) PSA |
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Term
| 3 pathways of extension of skeletal mets |
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Definition
direct lymphatic hematogenous |
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Term
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Definition
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Term
| radiologic pattern of disease of skeletal mets |
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Definition
osteolytic 75% osteoblastic 15% mixed 10% |
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Term
a) elevated in lytic process? or often normal? b) elevated in blastic processes? c) elevated in prostate mets? |
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Definition
a) serum calcium b) alkaline phosphatase c) acid phosphatase |
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Term
| in skeletal mets, where do osteoblastic lesions occur? |
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Definition
stomach testes breast prostate colon (ST BPC) |
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Term
| in skeletal mets where do osteolytic lesions occur? |
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Definition
(LRTS BPC) lung renal thyroid skin breast prostate colon |
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Term
bone scan a) ...% bone destruction necessary b) sensitive/specific for bone lesions? |
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Definition
a) 3-5% b) sensitive NOT specific |
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Term
radiographs a) ....% bone destruction necessary b) sensitive/specific for bone lesions? |
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Definition
a) 30-50% b) non-sensitive, non-specific |
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Term
CT a) sensitive/specific for bone lesions? |
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Definition
a) sensitive and specific for bone lesions |
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Term
whats the best imaging for bone marrow and soft tissue? |
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Definition
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Term
target sites of skeletal mets? |
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Definition
axial skeleton (80%) skull prox limbs rare beyond elbow or knees |
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Term
| if skeletal mets occurs beyond the elbows and knees whats it called? |
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Definition
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Term
| what % of skull lesions are blastic? |
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Definition
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Term
| what occurs in skeletal mets in the SPINE? |
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Definition
osteolytic pedicle destruction winking owl sign vs. blind vertebra vertebral body destruction/fracture/collapse osteoblastic/osteolytic cookie bite lesion in cortex blow out metastasis pancoast tumor |
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Term
if you see ivory vertebrae >45 increased density not enlarged no anterior scalloping some alkaline phosphatase a whole lotta PSA |
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Definition
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Term
if you see ivory vertebrae age >50 increased density very enlarged no anterior scalloping a whole lotta alkaline phosphatase no psa |
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Definition
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Term
if you see ivory vertebrae age 20-40 increased density not enlarged a whole lotta anterior scalloping some alkaline phosphatase no psa |
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Definition
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Term
what kind of lesion is blow out metastasis? |
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Definition
expansile osteolytic lesion |
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Term
| what is the acronym for blow out mets? |
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Definition
RATS renal cell carcinoma adrenal (pheochromomytoma) thyroid carcinoma skin (melanoma) |
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Term
DTQ what is M/C in acral mets? |
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Definition
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Term
a) what is acral mets? b) loc c) M/C |
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Definition
a) mets distal to elbow and knee b) foot and hand c) lung (bronchocarcinoma), breast, kidney |
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Term
| list in order the primary malignant bone tumors |
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Definition
1. mm 27% 2. osteosarc 20% 3. chondrosarc 10% 4. ewings 7% 5. lymphoma 3% 6. chondroma 1% |
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Term
| what is the M/C primary malignant tumor of bone? |
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Definition
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Term
a) mm is ...% of biopsied bone tumors b) mm is ...% of hematologic malignancies |
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Definition
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Term
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Definition
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Term
| what are 3 complications of mm? |
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Definition
pathologic fx bacterial infection especially lung (10%) secondary amyloidosis (15%) |
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Term
what is the cardinal initial symptom in mm? |
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Definition
bone pain relieved by rest aggravated by weight bearing |
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Term
| what are some symptoms of mm? |
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Definition
bone pain weakness and fatigue fever and weight loss bleeding neurological signs |
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Term
| what is the diagnostic criteria for mm? |
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Definition
10% abnormal, atypical or immature plasma cells in bone marrow plus 1: serum or urine M-protein spike bence jones proteinuria osteolytic bone lesions osteoporosis biopsy proven plasmacytoma |
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Term
|
Definition
vertebrae 69% ribs 59% skull 40% pelvis 40% femur 24% humerus 30% clavicle 15% scapula 13% |
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Term
| what is the gross pathology of mm? |
|
Definition
| plasma cell infiltration of bone |
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Term
| what are the early findings in mm? |
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Definition
normal x-ray DIFFUSE OSTEOPENIA could see a fx |
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Term
| what are the late imaging findings in mm? |
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Definition
punched-out lesions vertebral collapse diaphyseal osteolytic lesions pedicles may be spared (affects BODY) rare sclerotic vertebrae bone scan often normal |
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Term
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Definition
lytic mets mm affect body and is rarely sclerotic lytic mets affects pedicle |
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Term
DTQ what part of the bone does mm affect? |
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Definition
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Term
| what does mm look like in the skull? |
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Definition
punched out lytic lucencies raindrop skull |
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Term
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Definition
radiotherapy chemotherapy bone marrow transplant thalidomide 90% die within 3 years |
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Term
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Definition
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Term
a) ....% of plasmacytoma's develop into mm b) 3 xray findings of plasmacytoma |
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Definition
a) 70% b) geographic, soap bubble, highly expansile |
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Term
these are types of what lesion? central.conventional multicentric secondary parosteal telangiectatic extraosseous |
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Definition
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Term
| what is the 2nd M/C primary malignant bone tumor?% |
|
Definition
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|
Term
|
Definition
Ewings central osteosarc- metaphysis, 2nd m/c to mets to bone. ewings- diaphysis, 1st m/c to mets to bone. |
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Term
| who gets central osteosarcomas? |
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Definition
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Term
| what part of the bone does central osteosarc like? |
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Definition
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Term
painful swelling of involved limb what lesion? |
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Definition
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|
Term
| .....% of central osteosarc's occur in the spine |
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Definition
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Term
| lab findings for central osteosarc? |
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Definition
| elevated alkaline phosphatase |
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|
Term
| locations of central osteosarc? |
|
Definition
femur 46% tibia 21% humerus 11% pelvis 7% spine <7% IN METAPHYSIS |
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|
Term
what % of central osteosarcs are sclerotic, lytic, and mixed? |
|
Definition
50% sclerotic 25% lytic 25% mixed |
|
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Term
| central osteosarcs can metastasize to where? |
|
Definition
lung - cannon ball lesions skeleton - 2nd m/c to mets to bone after ewings. |
|
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Term
| what are the xray findings of central osteosarc? |
|
Definition
ivory osteoblastic lesion cumulus cloud appearance - lobulated mass permeative osteolytic metaphyseal-tubular bones periosteal rxn -sunburst, codmans, laminated cortical destruction soft tissue mass |
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Term
| tx and prognosis of central osteosarc? |
|
Definition
80% survival rate chemotherapy amputation limb salvage surgery |
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Term
| what is a secondary osteosarcoma and what does it originate from? |
|
Definition
malignant degeneration of benign process from:
pagets fibrous dysplasia osteochondroma |
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Term
a) how does the primary form of chondrosarcoma arise? b) how does the secondary form arise and from what? |
|
Definition
a) de novo b) malignant degeneration from enchondroma and osteochondroma |
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Term
| what are the 2 types of chondrosarcomas? |
|
Definition
central (intramedullary) peripheral (surface of bone) |
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Term
PTQ what is the 3rd M/C malignant bone tumor? % |
|
Definition
|
|
Term
|
Definition
|
|
Term
| what are some CF of chondrosarcs? |
|
Definition
pain late in disease large soft tissue mass severe pain after pathologic fx |
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Term
|
Definition
pelvis 24% femur 24% humerus 10% ribs 8% |
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Term
DTQ where on the bone do chondrosarcs hang out? |
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Definition
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|
Term
which lesion? round radiolucencies 66% popcorn or arc and rings calcification 33% purely osteolytic large soft tissue mass laminated or spiculated periosteal bone rxn mets to lungs |
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Definition
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|
Term
| where do low-grade chondrosarcoma's arise? |
|
Definition
in an enchondroma (osteochondroma) |
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