Malignant Skeletal Tumors Flashcards Preview

Tri 6 - Tumors > Malignant Skeletal Tumors > Flashcards

Flashcards in Malignant Skeletal Tumors Deck (40)
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1

• Malignant proliferation of plasma cells that infiltrate bone
marrow
• aka Kahler’s disease
• m/c primary malignant bone tumor

Multiple Myeloma

2

• 50-70 yo
• Anemia due to diseased hematopoietic tissue by
proliferating plasma cells (FATIGUED)
• Osteopenia in bones with red bone marrow
• Abnormal serum and urinary proteins
• Renal disease

Multiple Myeloma

3

• Pain is the cardinal symptom
• Back pain
• At first pain is intermittent, then becomes more constant
• Pain worse during day, and aggravated by activity
• Low back pain may be initially misdiagnosed as disc
or sciatic nerve problems
• Pain becomes more severe and prolonged

Multiple Myeloma

4

Slight strain may produce pathologic compression fractures that may result in
paraplegia

Multiple Myeloma

5

• Unexplained Osteoporosis
• Spine is m/c affected along with other red marrow
containing bones such as flat bones
• Weight loss
• Cachexia
• Anemia

Multiple Myeloma

6

Assessment of Multiple of Myeloma

Aspiration and Biopsy of bone marrow usually of sternum and ilium ******

7

Round cell disorder which reflects microscopic
appearance of nuclei
increased osteoclastic activity

Multiple Myeloma

8

proteinacious renal casts with
surrounding inflammatory infiltrate leading to renal
failure

Bence Jones

9

T/F: w/ Multiple Myeloma: Patients usually die of pneumonia and
respiratory failure, however may also die of renal
failure

TRUE

10

– mc seen in nasopharynx, with nasal cavity, oral cavity, tonsils, sinuses and larynx also affected
– May erode into adjacent bony structures

Extraosseous Plasmacytoma

11

Plasma cells release osteoclastic activating factor, therefore osteoblasts are deficient in ______ patients, and thus a negative bone scan since a bone scan depends upon osteoblastic activity

Multiple Myeloma

12

Punched Out Lesions
– Multiple round lytic lesions
– Raindrop skull
– Uniform size of lesions in MM, and more
nonuniform size in metastatic disease

Multiple Myeloma: Radiologic Hallmark

13

Wrinkled Vertebrae: pathologic fx, vertebra plana, spinal cord compression
Pedicle Sign:
– Pedicles spared due to deficiency of red marrow
– Pedicle sign is not a reliable sign for MM

Multiple Myeloma

14

earliest radiographic sign of Multiple Myeloma

Osteoporosis

15

______ is highly sensitive to marrow infiltration by
myeloma

MRI
T1: Low signal intensity lesions T2: High signal intensity lesions

16

There are multiple variably-sized white nodules within the bone marrow. These are accumulations of malignant plasma cells in this case of

multiple myeloma

17

• LOCALIZED form of plasma cell proliferation
• Less common than MM
• ~50% are <50 yo
• Localized pain

Solitary Plasmacytoma

18

Geographic radiolucent lesion, often highly expansile, with a soap bubble appearance

Solitary Plasmacytoma

19

Solitary Plasmacytoma is typically seen in what bone

tibia

20

Multiple punched-out lesions in a patient with multiple myeloma

Multiple Myeloma:
Raindrop Skull

21

POEMS

(polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) syndrome may demonstrate sclerotic lesions on radiographs, but this is responsible for fewer than 1% of myeloma cases

RARE

22

Second mc primary malignant bone tumor
20% of all primary bone tumors
10-25 yo

Central Osteosarcoma

23

Undifferentiated connective tissue and forms of
neoplastic osteoid
Likes long bones, primarily knee and shoulder
58% occur around knee

Central Osteosarcoma

24

Painful swelling at site of lesion (85%)
• May have previous trauma to area
• Pain is initially insidious and transitory, but eventually becomes more severe and persistent
• May take 6 months or longer to DX tumor

Central Osteosarcoma

25

T/F: Weight loss, fever, cachexia are UNUSUAL in Central Osteosarcoma

TRUE

26

Incidence arising in Paget’s bone is high 44% for what sarcoma

Secondary Osteosarcoma

27

Elevation of Alkaline Phosphatase is positive for a pt with what dz

paget's disease which may involve secondary osteosarcoma

28

– Pulmonary metastasis via hematogenous route
– Usually see multiple ossified pulmonary lesions
– Represents sarcomatous pulmonary bone growths

Central Osteosarcoma:
Cannonball Metastases

29

Subpleural nodules that have undergone excavation lead to rupture into pleural space

Central Osteosarcoma:
Spontaneous Pneumothorax

30

Common Presentation:
– Focal lesion in metaphysis
– Mottled, permeative lesion
– Poorly defined zone of transition
OR:
– Dense ivory or sclerotic lesion filling medullary
space

Central Osteosarcoma