Approach to patient with a bone lesion Flashcards
What percentage of primary bone tumors in adults, excluding myeloma and lymphoma, is reported?
0.2%
Reflects the rarity of primary bone tumors in adults.
What is the percentage of childhood malignancies that are primary bone tumors?
5%
Indicates a higher prevalence of bone tumors in children compared to adults.
What are the three main components used for the final diagnosis of bone tumors?
- Clinical presentation
- Imaging characteristics
- Histopathologic findings
List the categories of bone tumors according to the WHO classification.
- Bone forming
- Cartilage forming
- Marrow tumors
- Vascular tumors
- Others
What type of tumor is an Osteoma?
Benign
Osteomas are typically benign bone-forming tumors.
What type of tumor is Chondrosarcoma?
Malignant
Chondrosarcoma is classified as a malignant cartilage-forming tumor.
What are common symptoms to consider in the history of a patient with a possible bone tumor?
- Progressive pain
- Night pain/pain at rest
- Persistent pain
- Not responding to NSAIDs
- Constitutional symptoms (fatigue, weight loss, appetite loss)
What factors are important for the diagnosis of bone tumors?
- Age of patient
- Location of tumor in body
- Location of tumor in specific bone
- Radiological appearance
What are the characteristics to examine in a mass during a local examination?
- Size
- Shape
- Consistency
- Colour
- Translucency
- Temperature
What is indicated by a wide zone of transition in bone lesions?
Malignancy or infection
A wide zone indicates aggressive growth and poorly defined margins.
What are the two patterns of periosteal reaction?
- Benign type
- Aggressive type
Describe the characteristics of a benign periosteal reaction.
- Thick
- Wavy
- Uniform
- Chronic
What type of tumors are associated with an aggressive periosteal reaction?
- Malignant tumors
- Benign lesions with aggressive behavior (e.g., infection)
What does cortical destruction indicate in bone lesions?
- Common finding
- Not distinctive between malignant and benign lesions
What is a narrow zone of transition indicative of?
Usually benign conditions
A sharply outlined sclerotic margin suggests slow growth.
What does a wide zone of transition suggest about bone lesions?
Aggressive growth
It is often seen in malignant tumors.
What types of mineralisation are found in bone tumors?
- Chondroid matrix
- Osteoid matrix
- Fibrous matrix
What does the acronym FOGMACHINES stand for in the differential diagnosis of lytic/blastic bone lesions?
- F: fibrous dysplasia or fibrous cortical defect
- O: osteoblastoma
- G: metastasis or myeloma
- A: aneurysmal bone cyst
- C: chondroblastoma or chondromyxoid fibroma
- H: hyperparathyroidism (brown tumour)
- I: infection (osteomyelitis)
- N: non-ossifying fibroma
- E: enchondroma or eosinophilic granuloma
- S: simple bone cyst
What is the purpose of a Bone Scan in the investigation of bone tumors?
To check for bony metastasis and skip lesions
What laboratory tests are important to exclude metastasis, infection, inflammation, and arthritis?
- FBC with a differential count
- Peripheral blood smear
- ESR, CRP
- CMP, LFT, LDH
- Prostate Specific Antigen
- Parathyroid hormone assay
- Serum Protein Electrophoresis (SPEP)
- Urinalysis (Bence Jones Proteins)
What is the significance of performing a biopsy in the diagnosis of bone tumors?
Pathological diagnosis more accurate if guided by work-up
What is the Enneking system used for?
Staging bone tumors
It is developed by the Musculoskeletal Tumour Society (MSTS).
What should be established for effective management of bone tumors?
- Differential diagnosis
- Determine local and systemic spread
- Biopsy
- Stage
- Definitive treatment
