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LR Musculoskeletal CORTEXT > 1 - Pathology > Flashcards

1 - Pathology Flashcards

1
Q

What is the most common benign bone tumour?

A

Osteochondroma

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2
Q

List 7 benign tumours of the bone

A
  • Osteochondroma
  • Enchondroma
  • Simple bone cyst
  • Aneurysmal bone cyst
  • Giant cell tumour
  • Fibrous dysplasia
  • Osteoid osteoma
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3
Q

Describe osteochondroma - appearance, symptoms and possible treatment (benign bone tumour)

A
  • Produces a bony outgrowth with a cartilaginous cap
  • Usually causes local pain but no other symptoms
  • Small (1%) risk of malignant transformation so excisional biopsy of growing lesions may be necessary
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4
Q

Describe enchondroma - appearance, cause, symptoms, possible treatment (benign bone tumour)

A
  • Cartilaginous tumour, usually found in the medullary cavity of the metaphyses of the femur, humerus, tibia and small bones of hands and feet
  • Usually translucent or patchy, sclerotic appearance
  • Caused by a failure of normal cartilage ossification at the growth plate
  • Usually asymptomatic but can weaken the bones and cause fracture
  • Bone may be scraped out (curettage) and filled with bone graft to strengthen bone
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5
Q

Describe simple bone cysts - appearance, cause, most common location, symptoms, possible treatments (benign bone tumour)

A
  • A single, benign, fluid-filled cyst in a bone
  • Most likely caused by a growth defect of the metaphyses
  • Usually present in proximal humerus or femur
  • May be asymptomatic or lead to pathological fracture
  • Treatment with bone curettage and bone grafting may be required
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6
Q

Describe aneurysmal bone cysts - appearance, cause, location, symptoms, treatment (benign bone tumour)

A
  • Appears as multiple chambers filled with blood or serum on x-ray
  • Cause thought to be a small arteriovenous malformation
  • Can occur in metaphyses of long bones, flat bones (ribs, skull) and vertebrae
  • Symptoms include pain due to local cortical expansion and pathological fracture
  • Treatment is with curettage and bone grafting
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7
Q

Describe giant cell tumours - appearance, most common locations, cause, symptoms, treatment options (benign bone tumour)

A
  • Appear as multi-nucleate giant cells on histology and characteristically ‘soap-bubble’ in appearance on xray
  • Most common in metaphysis, epiphysis and subchondral bone of knee and distal radius
  • Unknown cause
  • Symptoms include pain, pathological fracture or metastasis to the lungs
  • Treatment is intra-lesional excision and destruction of tumour material
  • Joint replacement may be required as disease can be locally destructive
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8
Q

Describe fibrous dysplasia of bone - description, cause, symptoms, treatment options (benign tumour)

A
  • A disease of adolescence resulting in lesions of fibrous tissue and immature bone
  • Caused by genetic mutation
  • Symptoms include angular deformities, wider bones with thinned cortices, proximal femur can have ‘shepherd’s crook’, pathological fractures
  • Biophosphonates may reduce pain
  • Pathological fractures can be stabilised with bone grafting
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9
Q

Describe osteoid osteoma - appearance, most common age and site affected, symptoms, investigations, treatments (benign bone tumour)

A
  • A small nidus of immature bone surrounded by an intense sclerotic halo
  • Most common in adolescence, affecting the proximal femur, diaphysis of long bones and the vertebrae
  • Most prominent symptom is intense constant pain worse at night
  • Xray may show the lesion but bone scan and CT can confirm the diagnosis
  • Pain is greatly relieved by NSAIDs and lesion may resolve spontaneously overtime
  • Some cases may require CT-guided RF ablation
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10
Q

Malignant primary bone tumours are common/rare

Metastatic bone tumours are common/rare

A

Rare

Common

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11
Q

What are the typical ‘red flag’ symptoms of bone cancer?

A
  • Constant bone pain which is worse at night
  • Weight loss
  • Fatigue
  • Loss of appetite
  • Aged 60+ years
  • Aged <25 years with unexplained skeletal pain
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12
Q

How can a malignant bone tumour appear on xray?

A
  • Ill-defined bony swelling
  • Cortical destruction
  • Periosteal reaction (inflamed periosteum)
  • Sclerosis and lysis of bone
  • Extension into surrounding soft tissue
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13
Q

What is the most common malignant primary bone tumour?

A

Osteosarcoma

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14
Q

Describe osteosarcoma - description, common people and locations affected, metastatic spread, treatment (malignant primary bone tumour)

A
  • Malignant tumour producing bone
  • Most common in adolescence and early adulthood affecting the knee (60%), femur, humerus or pelvis
  • Haematogenous or lymphatic metastases - often to the lungs
  • Adjuvant chemotherapy can prolong survival (they are not radiosensitive)
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15
Q

What is the second most common primary malignant bone tumour?

A

Ewing’s sarcoma

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16
Q

Describe Ewing’s sarcoma - description, who is affected, symptoms, treatment (malignant primary bone tumour)

A
  • Malignant tumour of the primative cells in the marrow
  • Usually occurs in 10-20 y/o’s
  • Symptoms include fever, warmth, swelling and raised inflammatory markers
  • It is radio and chemo-sensitive but has the worst prognosis out of all the primary bone tumours
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17
Q

Describe chondrosarcoma - description, most common location and people affected, metastases, treatment (malignant primary bone tumour)

A
  • Cartilage producing primary bone tumour which is less common and less aggressive than osteosarcoma
  • Often occurs in ~45 y/o’s in the pelvis or proximal femur
  • They are large and slow to metastasise
  • Tumours are not radiosensitive and are unresponsive to adjuvant chemotherapy
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18
Q

List 2 fibrous malignant primary bone tumours and who they most commonly affect

A

Fibrosarcoma and malignant fibrous histiocytoma

Tend to affect adolescents and young adults with abnormal bone e.g., Paget’s disease, fibrous dysplasia, bone infarct

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19
Q

What are the investigations for primary malignant bone tumours? (3)

A

Bone scan (checks for metastases)

MRI/CT (local involvement)

Biopsy (for histological diagnosis and grading prior to surgery)

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20
Q

How can primary malignant bone tumours be treated?

A
  • Surgical removal of tumour and biopsy tract
  • Joint replacement
  • Adjuvant chemo and radiotherapy
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21
Q

What is the 5 year survival rate of primary bone tumours with adjuvant therapy?

A

80%

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22
Q

What is a lymphoma and how do they occur?

A

A cancer of round cells of the lymphocytic system/macrophages

They can occur as…

  • A primary bone tumour of the marrow (Non-Hodgkins Lymphoma)
  • Lymphoma metastases to bone
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23
Q

Which bones are most commonly affected by primary lymphoma?

A

Pelvis or femur

24
Q

How is primary lymphoma treated?

A

Surgical resection

25
Q

How is metastatic lymphoma managed and what is the survival rate?

A

Chemo and radiotherapy

Survival is usually < 2 years

26
Q

What is myeloma and what is the typical age group affected?

A

Malignant B cell proliferation arising from the bone marrow

Typically seen in aged 45-65

27
Q

In what 2 ways can myeloma present?

A

As…

  • A solitary lesion (a plasmacytoma)
  • Multiple osteolytic lesions throughout the skeleton (multiple myeloma)
28
Q

What is the typical presentation of multiple myeloma?

A 
Weakness
Back pain
Bone pain
Fatigue
Weight loss
Anaemia
Recurrent infection
29
Q

What is the typical presentation of multiple myeloma?

A 
Weakness
Back pain
Bone pain
Fatigue
Weight loss
Anaemia
Recurrent infection
Pathological fracture
30
Q

How are solitary and multiple myelomas treated?

A

Solitary - radiotherapy

Multiple - chemotherapy

31
Q

What is the 5 year survival of multiple myeloma?

A

<30%

32
Q

List the primary malignant tumours which most often commonly metastasise to bone (5)

A 
Breast carcinoma
Prostate carcinoma
Lung carcinoma
Renal cell carcinoma
Thyroid adenocarcinoma
33
Q

Which bones are most often affected by metastases?

A 
Vertebrae
Pelvis
Ribs
Skull
Humerus
Long bones of lower limb
34
Q

What features are suggestive of a benign soft tissue neoplasm? (6)

A
  • Small size
  • Fluctuating size (malignant tumours don’t regress)
  • Cystic lesions
  • Well-defined lesions
  • Fluid-filled lesions
  • Soft/fatty lesions
35
Q

What features are suggestive of a malignant soft tissue neoplasm?

A
  • Large lesions (>5cm)
  • Rapid growth in size
  • Solid lesion
  • Ill-defined lesion
  • Irregular surface
  • Lymphadenopathy
  • Systemic upset (weight loss, loss of appetite, fatigue)
36
Q

What structures can be involved in benign soft tissue tumours?

A
  • Any non-bony connective tissue e.g., cartilage
  • Nerves
  • Vessels
37
Q

What is the most common benign soft tissue tumour?

A

Lipoma

38
Q

Describe lipoma - description, appearance, location (benign soft tissue tumour)

A
  • A neoplastic proliferation of fat
  • Large and may not be well defined
  • Usually occurs in subcutaneous fat but can also occur in muscle
39
Q

Describe giant cell tumours of the tendon sheath

A

Small benign swellings usually found on the flexor tendon sheath of a finger

They may or may not be painful and can erode bone if large enough

40
Q

What is meant by a sarcoma? Are they common?

A
  • Malignant soft tissue tumours arising from connective tissue
  • Uncommon (<1% of cancers)
41
Q

List 5 sarcomas

A
  • Angiosarcoma (blood vessels)
  • Fibrosarcoma (fibrous tissue)
  • Liposarcoma (fat)
  • Rhabdomyosarcoma (skeletal muscle)
  • Synovial sarcoma (synovial lining of joints or tendons)
42
Q

When do sarcomas most commonly present?

A

Aged 50-70

43
Q

How are soft tissue swellings investigated? (2)

A
  • Imaging (MRI/US)

- Biopsy + histology

44
Q

What is the typical treatment for a malignant soft tissue tumour?

A

Surgical excision + adjunctive chemo/radiotherapy

45
Q

What is a ganglion cyst?

How is it treated?

A
  • A cyst occurring around a synovial joint or tendon sheath due to joint weakness
  • Surgical excision may be required for discomfort or cosmetic purposes
46
Q

What is bursitis?

A

Inflammation of a bursa (a small fluid-filled sac around a joint which prevents friction)

47
Q

What are the possible causes of bursitis?

A
  • Repeated pressure
  • Trauma
  • Bacterial infection
  • Gout
48
Q

What is the main similarity between osteochondritis and avascular necrosis (AVN)?

A

The both result in an area of bone undergoing local necrosis as a result of reduced blood supply and ischaemia

49
Q

What is osteochondritis?

A

A joint condition where bone beneath the cartilage of a joint dies due to lack of blood supply

50
Q

What patient group is osteochondritis most common in?

A

Children and young adults due to increased physical activity and repetitive stress

51
Q

What is avascular necrosis (AVN)?

A

Death of bone tissue due to a loss of blood supply and subsequent ischaemia

52
Q

What are the main causes of AVN? (4)

A
  • Secondary to fractures
  • Alcoholism
  • Steroid abuse
  • Idiopathic
53
Q

How might AVN present on imaging?

A
  • Patchy sclerosis
  • Subchondral collapse
  • Irregular articular surfaces
54
Q

AVN can cause…

A

Osteoarthritis (or worsen already osteoarthritic joints)

55
Q

What are the treatment options for AVN?

A
  • Drilling to decompress the bone
  • Joint replacement
  • Joint fusion

LR Musculoskeletal CORTEXT (2 decks)

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