Bone Tumor Systematic Approach Quiz

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Questions and Answers

Which term is used for osteonecrosis within the diaphysis or metaphysis?

  • Osteosarcoma
  • Avascular osteonecrosis
  • Gaucher's disease
  • Bone infarct (correct)

What is the typical presentation of bone infarcts on imaging?

  • Central lesion in metaphysis or diaphysis with a well-defined serpentiginous border (correct)
  • Peripheral lesion with fuzzy borders
  • Periosteal reaction with a soft tissue mass
  • Central lesion in epiphysis

What imaging feature characterizes bone infarcts on both T1 and T2 weighted images?

  • Low signal intensity (correct)
  • Enhancement after i.v. Gadolinium
  • Absence of fat signal
  • High signal intensity

What is the main cause of bone infarcts?

<p>Corticosteroid use (D)</p>
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In which type of lesions do we see aggressive periosteal reactions and soft tissue masses?

<p>Mixed osteolytic and sclerotic lesions (D)</p>
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What type of lesion is characterized by a thick cartilage cap, lytic peripheral part with subtle calcifications, and a zone of high signal intensity on T2-weighted images?

<p>Osteoid osteoma (D)</p>
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Which condition may show a periosteal and endosteal reaction leading to reactive sclerosis, obscuring the central nidus in certain localizations?

<p>Osteoid osteoma (A)</p>
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Which bone tumor is characterized by a highly malignant formation with a permeative pattern of the transition zone, irregular cortical destruction, and interruption of the periosteum?

<p>Osteosarcoma (D)</p>
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What type of lesion may manifest as a large tumor mass infiltrating a significant portion of the bone and extending into the soft tissues?

<p>Osteosarcoma (A)</p>
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Which condition can present with a mix of lytic and sclerotic components, often with cortical soft tissue extension and elevation of periosteum from underlying bone?

<p>Osteosarcoma (B)</p>
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Which condition can present as an osteolytic lesion with sharp margins and may have septa and ridges?

<p>Brown tumors from hyperparathyroidism (D)</p>
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What is the typical presentation of chondroblastoma?

<p>A well-defined osteolytic lesion in the tarsal bone, patella, or epiphysis of a long bone in a 20-year old with joint pain and swelling (A)</p>
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Which bone lesion is characterized by being expansile, well-defined, and filled with blood?

<p>Solitary Bone Cyst (SBC) (D)</p>
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What is the radiological hallmark of chondrosarcoma?

<p>Formation of a chondroid (cartilagenous) matrix with stippled or popcorn-like calcifications (A)</p>
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Which pathology can mimic bone tumors and has a broad spectrum of radiographic features, occurring at any age?

<p>Infection or osteomyelitis (A)</p>
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What is the typical appearance of a bone island on imaging?

<p>Round or oval benign lesion consisting of mature bone tissue within the medullary cavity (D)</p>
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Which disease can lead to avascular osteonecrosis resulting in osteolytic lesions and permeative cortical destruction patterns?

<p>Bone infarct (B)</p>
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How can an enchondroma be differentiated from chondrosarcoma?

<p>Presence of peripheral low signal intensity due to calcifications (D)</p>
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Which bone pathology is characterized by a true cyst, frequently presents with a fracture, and has a predilection for the proximal humerus and femur?

<p>Solitary Bone Cyst (SBC) (B)</p>
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Which bone tumor is almost always low-grade and known for its primary presentation in the proximal long bones, around the knee, pelvis, and shoulder girdle?

<p>Chondrosarcoma (C)</p>
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Which type of bone lesion typically presents as a solitary, benign tumor producing osteoid and bone?

<p>Osteoblastoma (B)</p>
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In which age group is bone metastasis more common?

<p>Over 40 (A)</p>
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Which bone tumor is characterized by multiple lytic 'punched out' lesions in the axial skeleton and diaphysis of long bones?

<p>Multiple Myeloma (C)</p>
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Which type of lesion will not show any uptake on a bone scan?

<p>Bone infarct (A)</p>
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Which type of bone tumor can be discriminated by the patient being over the age of 40?

<p>Multiple Myeloma (C)</p>
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Which type of bone tumor is typically located centric in long bones?

<p>Enchondroma (A)</p>
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Which type of mineralization pattern is typically seen in osseous tumors like osteoid osteomas?

<p>Rings-and-arcs (B)</p>
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Which type of bone tumor is characterized by a chondroid matrix with rings-and-arcs pattern?

<p>Chondrosarcoma (A)</p>
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Which type of bone tumor is commonly eccentrically located in long bones?

<p>Giant cell tumor (GCT) (D)</p>
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Which type of bone tumor primarily arises from the periosteum?

<p>Parosteal osteosarcoma (D)</p>
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Which type of bone lesion may show uniform cortical bone destruction?

<p>Benign lesion (D)</p>
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In ballooning, the addition of new bone occurs at the same rate as the destruction of which cortical bone surface?

<p>Endosteal cortical bone (A)</p>
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Which term is used to describe the smooth and uninterrupted 'neocortex' formed in ballooning?

<p>Neoplastic cortex (B)</p>
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What is a feature of more aggressive lesions like giant cell tumor (GCT) with regards to ballooning?

<p>Focal interruption in the neocortex (B)</p>
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Which condition can present with endosteal scalloping of the cortical bone?

<p><strong>Chondromyxoid myxoma</strong> (D)</p>
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Avascular osteonecrosis typically affects which part of the bone?

<p><strong>Epiphysis</strong> (D)</p>
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Mixed lytic-sclerotic lesions are commonly seen in which type of tumor or condition?

<p><strong>Chondrosarcoma</strong> (C)</p>
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Osteolytic tumors are characterized by which of the following?

<p><strong>Destruction of the bone cortex</strong> (B)</p>
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Bone infarcts may present with what imaging feature on both T1 and T2 weighted images?

<p><strong>Double line sign</strong> (D)</p>
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Complete destruction of cortical bone may be seen in high-grade malignant lesions and which other type of lesions?

<p><strong>Fibrous dysplasia (FD)</strong> (C)</p>
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Flashcards

Bone Infarct

Osteonecrosis specifically located within the diaphysis or metaphysis of a bone.

Imaging of Bone Infarcts

On imaging, bone infarcts typically appear as a central lesion in the metaphysis or diaphysis with a well-defined serpentiginous border.

Bone Infarcts on MRI

Bone infarcts show low signal intensity on both T1 and T2 weighted imaging.

Main Cause of Bone Infarcts

The primary cause of bone infarcts is often corticosteroid use.

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Imaging Mixed Osteolytic and Sclerotic Lesions

Aggressive periosteal reactions and soft tissue masses are characteristics of mixed osteolytic and sclerotic lesions.

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Characteristics of Osteoid Osteoma

A lesion characterized by a thick cartilage cap, a lytic peripheral part with subtle calcifications, and a zone of high signal intensity on T2-weighted images.

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Osteoid Osteoma Reaction

Osteoid osteoma may show a periosteal and endosteal reaction leading to reactive sclerosis, which can obscure the central nidus in certain localizations.

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Defining Osteosarcoma

A highly malignant formation with a permeative pattern of the transition zone, irregular cortical destruction, and interruption of the periosteum.

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Osteosarcoma Mass

Osteosarcoma can manifest as a large tumor mass infiltrating a significant portion of the bone and extending into the soft tissues.

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Osteosarcoma Presentation

Osteosarcoma can present with a mix of lytic and sclerotic components, often with cortical soft tissue extension and elevation of the periosteum from the underlying bone.

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Brown Tumors Imaging

Brown tumors from hyperparathyroidism present as osteolytic lesions with sharp margins and may have septa and ridges.

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Typical Chondroblastoma Presentation

A well-defined osteolytic lesion in the tarsal bone, patella, or epiphysis of a long bone in a 20-year old with joint pain and swelling.

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Solitary Bone Cyst (SBC) Description

An expansile, well-defined lesion filled with blood.

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Radiological Hallmark of Chondrosarcoma

The radiological hallmark of chondrosarcoma is the formation of a chondroid (cartilaginous) matrix with stippled or popcorn-like calcifications.

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Infection Mimicking Bone Tumors

Infection, or osteomyelitis, can mimic bone tumors and has a broad spectrum of radiographic features, occurring at any age.

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Appearance of a Bone Island

A round or oval benign lesion consisting of mature bone tissue within the medullary cavity.

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Avascular Osteonecrosis Imaging

Avascular osteonecrosis can manifest as osteolytic lesions and permeative cortical destruction patterns.

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Enchondroma vs. Chondrosarcoma Differentiation

Enchondroma can be differentiated from chondrosarcoma by the presence of peripheral low signal intensity due to calcifications.

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Characteristics of Solitary Bone Cyst (SBC)

A true cyst that frequently presents with a fracture and has a predilection for the proximal humerus and femur.

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Chondrosarcoma Location and Grade

Chondrosarcoma is almost always low-grade and primarily presents in the proximal long bones, around the knee, pelvis, and shoulder girdle.

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Defining Osteoblastoma

A solitary, benign tumor that produces osteoid and bone.

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Age Group for Bone Metastasis

Bone metastasis is more common in individuals over 40 years old.

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Multiple Myeloma Lesions

Multiple Myeloma is characterized by multiple lytic 'punched out' lesions in the axial skeleton and diaphysis of long bones.

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Bone Infarcts on Bone Scan

Bone infarcts will not show any uptake on a bone scan.

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Age for Multiple Myeloma

Multiple Myeloma can be discriminated by the patient being over the age of 40.

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Enchondroma Location

Enchondroma is typically located centrally in long bones.

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Rings-and-Arcs Mineralization

The 'rings-and-arcs' mineralization pattern is typically seen in osseous tumors like osteoid osteomas.

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Chondrosarcoma Mineralization Pattern

Chondrosarcoma is characterized by a chondroid matrix with a rings-and-arcs pattern.

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Giant Cell Tumor Location

Giant Cell Tumor (GCT) is commonly eccentrically located in long bones.

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Origin of Parosteal Osteosarcoma

Parosteal osteosarcoma primarily arises from the periosteum.

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