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MSK CORTEXT > 1- Pathology > Flashcards

1- Pathology Flashcards

1
Q

What are the symptoms of osteochondroma

A

Usually don’t cause any problems

May produce localised pain

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2
Q

Can osteochondromas malignantly transform

A

Very small risk

Signs include lesion that grows in size or produces significant pain

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3
Q

Benign bone tumours are more common than primary malignant ones - true or false

A

True

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4
Q

What are some potential causes of benign bone tumours

A 
Neoplasm 
Developmental 
Trauma 
Infection 
Inflammation
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5
Q

Enchondromas are usually asymptomatic - true or false

A

True

Often an incidental finding

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6
Q

What is a common complication of enchondroma

A

Weakening of the bone leading to pathological fracture

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7
Q

Which bones do simple bone cysts usually occur in

A

Long bones - proximal humerus and femur

Talus or calcaneus

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8
Q

What are the symptoms of a simple bone cyst

A

Usually asymptomatic

Can weaken the bone and cause pathological fracture

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9
Q

How do you treat enchondroma

A

If risk of fracture or one has already occurred you can scrape it out and fill with a bone graft to strengthen

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10
Q

How can you treat a simple bone cyst

A

If risk of fracture or one has already occurred you can scrape it out and fill with a bone graft to strengthen

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11
Q

What is thought to be the cause of aneurysmal bone cysts

A

Small arteriovenous malformations

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12
Q

Where do aneurysmal bone cysts occur

A

The metaphyses of many different long bones, flat bones (ribs, skull) and vertebral bodies

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13
Q

Describe the presentation of an aneurysmal bone cyst

A

Usually painful
Locally aggressive and causes cortical expansion and destruction
May cause pathological fracture

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14
Q

How do you treat an aneurysmal bone cyst

A

Curettage (scraping out) and grafting

Or use bone cement

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15
Q

Which region of a bone does a giant cell tumour tend to affect

A

Predilection for the metaphyseal region

Also tend to involve the epiphysis and can extend to the subchondral bone adjacent to the joint.

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16
Q

How does a giant cell tumour appear histologically

A

Consists of multi-nucleate giant cells

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17
Q

Can giant cell tumours metastasise

A

5% will metastasise to lung and cause benign pulmonary GCT

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18
Q

How do you treat giant cell tumours

A

Intralesional excision with use of phenol, bone cement or liquid nitrogen to destroy remaining tumour material & reduce the risk of recurrence.
Very aggressive lesions with cortical destruction may need joint replacement.

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19
Q

What is the cause of fibrous dysplasia

A

A genetic mutation which results in lesions of fibrous tissue and immature bone

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20
Q

What are the results of fibrous dysplasia

A

Defective mineralisation can lead to angular deformities, with the bone being wider with thinned cortices
Stress fractures can occur
Shepard’s crook deformity in the proximal femur

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21
Q

How do you treat fibrous dysplasia

A

Bisphosphonates may reduce pain
Pathological fractures should be stabilised with internal fixation
Bone grafts can improve strength

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22
Q

Which age group commonly gets osteoid osteomas

A

Adolescents

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23
Q

Which bones do osteoid osteomas usually affect

A

Proximal femur
The diaphysis of long bones
The vertebrae

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24
Q

How do you treat osteoid osteomas

A

NSAIDs for pain
May resolve spontaneously
May need CT guided radiofrequency ablation

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25
Q

Name 2 other conditions that can present with a lytic lesion of bone

A

Brodie’s abscess - subacute osteomyelitis

Hyperparathyroidism - Brown tumours

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26
Q

What are some red flag symptoms of malignant bone cancer

A

Constant pain - severe and often worse at night
Weight loss
Loss of appetite
Fatigue

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27
Q

Which groups should you be aware of malignant bone tumours

A

Over 60s - more likely to develop cancer so must investigate unexplained skeletal pain

Under 25s - unusual to have unexplained skeletal; pain so must investigate

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28
Q

What are some common signs of malignant primary bone tumours on x ray

A

Cortical destruction
Periosteal reaction - raised periosteum producing bone
New bone formation
Extension into the surrounding soft tissue envelope.

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29
Q

Which bones are more commonly affected by osteosarcoma

A

Knee - 60% of cases
Proximal femur
Proximal humerus
Pelvis

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30
Q

How does osteosarcoma spread

A

Usually haematogenous spread but can be lymphatic

10% of patients will have lung mets on diagnosis

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31
Q

How do you treat osteosarcoma

A

Adjuvant chemotherapy can prolong survival

Not radiosensitive

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32
Q

Chondrosarcoma’s are small and slow to metastasize - true or false

A

False

Often very large but are slow to metastasise

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33
Q

Which bones are commonly affected by chondrosarcoma

A

Pelvis

Proximal femur

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34
Q

Can you treat chondrosarcomas with radiation or chemo

A

Nope

not radiosensitive and unresponsive to current chemo

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35
Q

What does a chondrosarcoma produce

A

Cartilage

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36
Q

Describe fibrosarcoma and malignant fibrous histiocytoma

A

Fibrous malignant primary bone tumours
Tend to occur in abnormal bone - e.g. bone infarct, Paget’s
Often affects adolescents or young adults

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37
Q

Which symptoms might Ewing’s sarcoma be associated with

A

Fever
Raised inflammatory markers
A warm swelling

38
Q

Is Ewing’s sarcoma sensitive to common cancer treatments?

A

Yes

It tends to be radio‐ and chemo‐sensitive

39
Q

Why might amputations be used in treatment of bone tumours

A

Usually to prevent recurrence

Limb salvage attempted with adjuvant therapy first

40
Q

How do you stage a primary bone tumour

A

Bone scan - usually CT or MRI

CT of chest - look for mets

41
Q

Why is biopsy required

A

For histological diagnosis

Grading prior to surgery

42
Q

Lymphoma can occur as a primary bone tumour - true or false

A

True
Can originate from the marrow - Non Hodgkin’s
Lymphoma of any type can metastasize to the bone

43
Q

Where does primary lymphoma of bone tend to affect

A

Pelvis

Femur

44
Q

How do you treat primary lymphoma of bone

A

Surgical resection

45
Q

How do you treat metastatic lymphoma

A

Chemo

Radiotherapy

46
Q

Where does myeloma arise from

A

The bone marrow

47
Q

What is multiple myeloma

A

Multiple osteolytic lesions throughout the skeleton

48
Q

Which age group is most affected by multiple myeloma

A

Age 45-65

49
Q

What is the common presentation of multiple myeloma

A 
Weakness
Back pain
Bone pain
Fatigue 
Weight loss 
May have marrow suppression resulting in anaemia and recurrent infection
May present with pathologic fracture
50
Q

How do you treat multiple myeloma

A

Chemotherapy

51
Q

How do you treat a single lesion caused by myeloma

A

Radiotherapy

52
Q

How do you diagnose myeloma

A

Plasma protein electrophoresis
Bence Jones protein assay - early morning urine sample
Bone scans

53
Q

Which bones are most frequently involved in metastases

A 
Vertebra
Pelvis
Ribs
Skull
Humerus 
Long bones of the lower limb
54
Q

Which investigations should you do if you suspect metastases in the bone

A 
Breast exam 
PR exam - if appropriate 
CXR - if lung suspected 
Bloods - serum calcium, LFTs, plasma protein, FBC 
Bone scans
55
Q

How do you treat pathological fractures

A

Fractures or impending fractures are treated with stabilization using long rods
If there is joint destruction then joint replacement may be better

56
Q

How can you improve symptoms of spinal cord compression due to spinal mets

A

Radiotherapy

Surgical decompression

57
Q

Which soft tissue swelling are diffuse

A

Synovitis

Oedema

58
Q

Which soft tissue swelling are local

A 
Inflammatory ones - bursitis, rheumatoid 
Infection - abscess
Cystic lesions 
Benign neoplasms 
Malignant neoplasms
59
Q

What is a lipoma

A

Neoplastic proliferation of fat
Usually occurs in the subcutaneous fat
Can occur in muscle

60
Q

Describe a giant cell tumour of the tendon

A

Small firm swelling
Usually found on the flexor tendon sheath of a finger
May not be painful
Can erode bone if large enough

61
Q

What name is given to a giant cell tumour in the joint

A

Pigmented Villonodular Synovitis

Can cause pain and effusions

62
Q

What is the general name for tumours of connective tissues

A

Sarcomas

gain more specific names from the type of tissue they arise from

63
Q

Are sarcomas common

A

No - account for less than 1% of malignant tumours

64
Q

What is an angiosarcoma

A

A malignant tumour from blood vessels

65
Q

Which tissues do fibrosarcoma and malignant fibrous histiocytoma

A

Fibrous tissue

66
Q

What is a liposarcoma

A

malignant tumour arising from fat

67
Q

What is a rhabdomyosarcoma

A

malignant tumour arising from skeletal muscle

68
Q

What is a synovial sarcoma

A

malignant tumour originating in the synovial lining of joint and tendons

69
Q

Which age do sarcomas usually present

A

Between the ages of 50 and 70

70
Q

How do you treat sarcoma

A

Usually surgically with adjunctive chemotherapy and/or radiotherapy

71
Q

Describe the appearance of a ganglion cyst

A

Well-defined
Quite firm
Readily translucent

72
Q

What treatment would you give for a ganglion cyst

A

May require excision if there is local discomfort or comesis

73
Q

What can cause a ganglion cyst

A

Herniation or out-pouching of a weak portion of joint capsule or tendon sheath
Can be developmental
Or as a result of underlying joint damage leading to build up of pressure

74
Q

What types of ganglion cysts are caused by developmental issues

A

Juvenile Baker’s cyst

75
Q

What types of ganglion cysts are caused by joint damage and pressure

A

Adult Baker’s cyst
Mucous cyst of the DIP joint
Wrist ganglion

76
Q

What is a bursa

A

Small fluid filled sac lined by synovium around a joint

It prevents friction between tendons, bones, muscle and skin

77
Q

What is bursitis

A

Inflammation of a bursa

Usually occurs after repeated trauma or pressure

78
Q

What can cause a bursal abscess

A

Bacterial infection

79
Q

What can cause an abscess on a limb

A

Cellulitis
Bursitis
Penetrating wound
Infected sebaceous cysts

80
Q

How do you treat abscesses

A

Incision and drainage

Antibiotics will not get into it

81
Q

What is the general end result of osteochondritis and AVN

A

Bone undergoes localised necrosis

Due to ischaemia from a reduction in blood supply

82
Q

Which age group tends to be affected by osteochondritis

A

Children

Young adults

83
Q

What are some potential ‘causes’ of osteochondritis

A

Increased physical activity with repetitive stress
Familial predisposition
Recurrent impact or traction injury - causes bleeding

84
Q

What are the consequences of osteochondritis

A

Bone necrosis
Results in compression or separation of bone
Causes flattening of joints
Pain and progression to arthritis

85
Q

What are some common sites affected by compression in osteochondritis

A 
2nd metatarsal head 
Navicular bone 
Elbow 
Vertebrae 
Hip - Perthes
86
Q

What is osteochondritis dissecans

A

Fragmentation with separation of bone and cartilage

Can lead to pain, effusions and locking

87
Q

How can you treat osteochondritis dissecans

A

Pinning of the unstable fragments

Remove detached fragments

88
Q

How do you treat osteochondritis

A

If joint is damaged then osteotomy - surgical realignment of the bone
Can shift load from damaged area to undamaged

89
Q

What sites are prone to AVN

A 
Femoral head
Femoral condyles
Head of the humerus 
Capitellum
Proximal pole of the scaphoid 
Proximal part of the talus.
90
Q

What can cause AVN

A 
Fractures that disrupt the blood supply 
Many cases are idiopathic 
Alcoholism 
Steroid use 
Hyperlipidaemia
Thrombophilia
Sickle cell 
Anti-phospholipid
91
Q

How do you treat AVN

A

Dependent on stage
If articular surface is intact - drill to decompress bone
If surface is collapsed - joint replacement

MSK CORTEXT (13 decks)

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