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Musculoskeletal > Benign and Malignant Bone Tumours > Flashcards

Benign and Malignant Bone Tumours Flashcards

1
Q

What is the most common benign bone tumour?

A

Osteochondroma

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2
Q

What does an osteochondroma produce?

A

Bony outgrowth on the external surface of bone which is covered with a cartilaginous cap

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3
Q

Where do osteochondromas typically affect?

A

Epiphysis of long bones - most common around the knee

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4
Q

What are the negative effects of an osteochondroma?

A

They are usually asymptomatic and incidental findings

They may produce local pain

There is a small risk of malignant transformation

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5
Q

Any osteochondroma growing in size or producing local pain will be treated in what way?

A

Excisional biopsy

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6
Q

Multiple osteochondromas may be associated with what?

A

Underlying genetic disorder

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7
Q

What is an enchondroma?

A

An intramedullary metaphyseal (usually) cartilaginous tumour

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8
Q

What is the usual appearance of an enchondroma?

A

Usually lucent

May undergo mineralisation and have a sclerotic appearance

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9
Q

What are the usualy symptoms of an enchondroma?

A

Usually asymptomatic, but can weaken bones resulting in pathological fracture

can be part of syndrome - olliers (when multiple sites in body develop the tumours) or maffuci (comination of multiple tumours and angiomas)

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10
Q

Where do enchondromas typically affect?

A

Small tubular bones of the hands and feet

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11
Q

Given the benign nature of enchondromas, what is the treatment?

A

Currettage - they can be scraped out of bone

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12
Q

What is a simple bone cyst?

A

A solitary unicystic fluid filled neoplasm

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13
Q

What is the most probable cause for a simple bone cyst?

A

Growth defect in the physis

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14
Q

Where are simple bone cysts most commonly found?

A

Metaphyseal in long bones

They can also occur in the talus or calcaneus

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15
Q

What are the most common symptoms of a simple bone cyst?

A

Usually asymptomatic

May lead to weakness and pathological fracture

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16
Q

What is the treatment for a simple bone cyst?

A

Curettage and bone grafting

Stabilisation may be required

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17
Q

What is an aneurysmal bone cyst?

A

A lesion of bone containing many blood/serum filled chambers

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18
Q

The formation of aneurysmal bone cysts is thought to be down to what?

A

Small arteriovenous malformations

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19
Q

Where are aneurysmal bone cysts most commonly found?

A
  • Metaphyses of long bones
  • Flat bones (ribs, skull)
  • Vertebral bodies
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20
Q

What are the normal symptoms of an aneurysmal bone cyst?

A
  1. Pain (due to cortical expansion and bone destruction)
  2. Pathological fracture (due to bone weakness)
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21
Q

What is the treatment for an aneurysmal bone cyst?

A
  • Curettage and grafting
  • Bone cement
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22
Q

Giant cell tumours of bones have a predilection for which long bone regions?

A
  1. Methaphysis
  2. Epiphysis
  3. Can extend as far as subchondral region beside the joint
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23
Q

Where do giant cell tumours most commonly occur in bones?

A

Around the knee and in the distal radius

(can also occur in other long bones, pelvis and spine)

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24
Q

Why are giant cell tumours of bone often painful?

A

They are locally destructive to the cortex

They weaken bone and may cause pathological fracture

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25
Q

In terms of causation of the condition, how are giant cell tumours of bone characterised?

A

A translocation between chromosomes 1 and 2

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26
Q

What is the characteristic appearance of giant cell tumours on x-ray?

A

Soap-bubble appearance

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27
Q

Despite being benign, where can giant cell tumours of bone metastasize?

A

Lungs

Causes benign pulmonary giant cell tumour

(this occurs in 5% of cases)

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28
Q

What is the treatment for giant cell tumour of bone?

A

Intralesional excision

The use of phenol, bone cement or liquid nitrogen to destroy an remaining tumour

Aggressive lesions may need joint replacement

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29
Q

What is fibrous dysplasia?

A

A disease of bone resulting from a genetic mutation that causes lesions of fibrous tissue and immature bone

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30
Q

Which age group of patients is fibrous dysplasia most likely to affect?

A

Adolescents

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31
Q

Where are the most frequent sites for fibrous dysplasia?

A

Head and neck

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32
Q

What is the the underlying cause of fibrous dysplasia?

A

A genetic mutation causes an abnormality in protein in G protein signalling

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33
Q

Patients with polyostotic fibrous dysplasia have other symptoms involving which type of disorders?

A

Endocrine

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34
Q

Angular derformities with affected bone being wider with thinner cortices are as a result of what?

A

Defective bone mineralisation

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35
Q

Why may stress fractures occur in patients with fibrous dysplasia?

A

The bone is weakened due to defective mineralisation

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36
Q

Extensive involvement of the proximal femur in a patient with fibrous dysplasia causes which chracteristic deformity?

A

Shepherd’s crook deformity

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37
Q

Which medication may help to reduce pain in patients with fibrous dysplasia?

A

Bisphosphonates

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38
Q

How are pathological fractures stabilised in patients with fibrous dysplasia?

A
  1. Internal fixation
  2. Cortical bone grafts
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39
Q

Why is intralesional excision not generally used for fibrous dysplasia?

A

It has a high recurrence arte

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40
Q

What is an osteoid osteoma?

A

A small nidus of immature bone surrounded by an intense sclerotic halo which secretes prostaglandins causing great pain

41
Q

In which age group do osteoid osteomas most commonly affect and where in the body do the usually affect?

A

Adolescents

Proximal femur, diaphysis of long bones, vertebrae

42
Q

What is the predominant clinical feature of osteoid osteoma?

A

Constant pain, worse at night

43
Q

Classically, the pain from an osteoid osteoma is greatly relieved by what?

A

NSAIDs

44
Q

Which two non-invasive tests can confirm the diagnosis of an osteoid osteoma?

A
  1. Bone scan
  2. CT
45
Q

What is the treatment for osteoid osteoma?

A

NSAIDs

may spontaneously resolve

CT guided radiofrequency ablation or en bloc excision

46
Q

What is a Brodie’s abscess?

A

An intraossoeus abscess as a result of subacute osteomyelitis

This is usually as a result of S. aureus infection

This can present as a lytic lesion of bone

47
Q

Brown tumours are a result of what, and how do they appear on X-ray?

A

Hyperparathyroidism

Lytic lesions of bone

48
Q

Malignant primary bone tumours are most common which age?

A

Younger age groups

49
Q

Bony lesions usually relate to ___________

A

Bony lesions usually relate to metastasis

50
Q

Metastatic cancer of bone tends to produce _________ pain which is usually worse ____ _________

A

Metastatic cancer of bone tends to produce constant pain which is usually worse at night

51
Q

Which generalised systemic symptoms may be present with metastatic bone cancer?

A
  1. Loss of appetitie
  2. Weight loss
  3. Fatigue
52
Q

What is the most common form of primary bone tumour?

A

Osteosarcoma

53
Q

What is an osteosarcoma?

A

A malignant bone tumour producing bone

54
Q

The majority of osteosarcoma cases are asscociated with a mutation in which gene?

A

Retinoblastoma gene (a tumour suppressor)

55
Q

In which age of patient and location of the body are osteosarcomas most common?

A

Younger patients

Most commonly the knee

(can also be the proximal femur, proximal humerus and pelvis)

56
Q

Metastasis of an osteosarcoma via the blood is relatively ___________ and spread via the lymph nodes is __________

A

Metastasis of an osteosarcoma via the blood is relatively common and spread via the lymph nodes is rare

57
Q

10% of patients with osteosarcoma have which type of mestastasis upon diagnosis?

A

Pulmonary

58
Q

In a patient with osteosarcoma, how may lifespan be prolonged?

A

Chemotherapy

59
Q

What is a chondrosarcoma?

A

A cartilage producing primary bone tumour

60
Q

In which age group is a chondrosarcoma more common?

A

Older (mean age 45)

61
Q

Chondrosarcomas tend to be very ________ and _______ to metastasise

A

Chondrosarcomas tend to be very large and slow to metastasise

62
Q

Where are chondrosarcomas most commonly found?

A

Pelvis or proximal femur

63
Q

What is the treatment for chondrosarcoma?

A

Surgical resection

Radiotherapy and chemotherapy are not suitable

64
Q

What is Ewing’s sarcoma?

A

A primary bone tumour with an uncertain cell origin that is most common in teenagers

65
Q

Where do Ewing’s sarcomas most commonly manifest?

A

Long bones - especially the femur

66
Q

How are Ewing’s sarcomas characteristically described radiologically?

A

As having an “onion skin” pattern

67
Q

Tumours such as Ewing’s sarcoma are part of a group of tumours described as what?

A

Small round blue cell tumours

68
Q

Ewing’s sarcoma is associated with the ______ ___________ involving the _______ __________ gene on chromosome ____

A

Ewing’s sarcoma is associated with the t11;22 translocation involving the Ewing’s sarcoma gene on chromosome 22

69
Q

Why may Ewing’s sarcoma be misdiagnosed as what and what are the reasons for this?

A

Osteomyelitis

It presents with:

  1. Fever
  2. Raised inflammatory markers
  3. Warm swelling in affected area
70
Q

Ewing’s sarcoma tends to be sensitive to which treatments?

A
  1. Radiotherapy
  2. Chemotherapy
71
Q

The treatment of primary bone tumours usually involves what as well as radiotherapy and chemotherapy (if these are suitable)?

A

Surgical resection (of tumour and surrounding tissue)

72
Q

What is required for histological diagnosis and grading of a tumour prior to surgery?

A

Biopsy

73
Q

What is lymphoma?

A

A cancer of round cells of the lymphocytic system and macrophages which can occur as a primary bone tumour from bone marrow or lymphoma may mestastasise to bone

74
Q

A primary lymphoma of bone is referred to as which type of lymphoma?

A

Non-Hodgkins lymphoma

75
Q

Primary lymphoma tends to affect which bones?

A

Pelvis or femur

76
Q

What is the treatment of primary lymphoma in bones?

A

Surgical resection

77
Q

What may be present with metastatic lymphoma?

A
  1. Lymphadenopathy
  2. Splenomegaly
78
Q

What is the treatment for metastatic lymphoma?

A
  1. Chemotherapy
  2. Radiotherapy
79
Q

What is myeloma?

A

A malignant clonal proliferation of abnormal plasma cells which arises from bone marrow

80
Q

What is the name of myeloma that presents

a) As a solitary lesion
b) With multiple osteolytic lesions

A

a) Plasmacytoma
b) Multiple myeloma

81
Q

Abnormal cells in myeloma cause deposition of what type of protein and what is this process called?

A

Abnormal plasma cells deposit defective imunnoglobulin, this is known as amyloidosis, and more specifically AL amyloid as the deposited protein is the immunoglobulin light chain

82
Q

What is the typical age group of patients with myeloma?

A

45-65

83
Q

How may patients with multiple myeolma present?

A
  1. Weakness
  2. Back pain
  3. Bone pain
  4. Weight loss
  5. Fatigue
  6. Anaemia and recurrent infection (due to bone marrow supression)
84
Q

Diagnosis of myeloma often requires what?

A

Plasma protein electrophoresis

(shows paraprotein - monoclonal immunoglobulin or light chain)

Early morning urine collection for Bence Jones protein assay

85
Q

Why may metastases of myeloma not be picked up on a bone scan?

A

There is not usually an osteoblastic response to the osteoclastic response

86
Q

What is the treatment for:

a) Plasmacytoma
b) Multiple myeloma

A

a) Radiotherapy
b) Chemotherapy

87
Q

Name the top 5 primary malignant tumours which most commonly mestastasise to bone

A
  1. Breast cancer
  2. Prostate cancer
  3. Lung cancer
  4. Renal cell cancer
  5. Thyroid cancer

(adenopcarcinoma of the colon, bladder cancer and melanoma can rarely metastasise to bone)

88
Q

Describe how breast cancer metastases appear in bone

A

Blastic (sclerotic) or lytic

89
Q

How do prostate cancer metastases appear in bone?

A

Sclerotic masses

90
Q

Why are pathological fractures more likely to heal in prostate cancer metastases to bone?

A

There is high osteoblastic activity so sclerotic masses are quickly produced

91
Q

Which two therapies can reduce likelyhood of bony metastases in prostate cancer?

A
  1. Hormonal therapy
  2. Radiotherapy
92
Q

Lung cancer gives rise to what type og bony metastases in bone?

A

Lytic bone tumours

(mean survival is just 6 months when these are present)

93
Q

Renal cell carcinoma ausually gives rise to which type of bone metastases?

A

Large and very vascular lytic “blow out” bony metastases

94
Q

Why may surgery of biopsy be an issue with renan cell carcinoma metastasis to bone?

A

It can cause severe bleeding

95
Q

What is the treatment for renal cell carcinoma with one bony metastasis?

A

Resection (nephrectomy) - can be curative

96
Q

Which bones are most frequently implicated in bony metastases?

A
  1. Vertebrae
  2. Pelvis
  3. Ribs
  4. Skull
  5. Humerus
  6. Long bones of the lower limb
97
Q

Fractures or impending fractures as a result of bony metastases are treated in what way?

A

Stabilisation using long rods and intramedullary nails

98
Q

Painful lesions thought to be at risk of causing fractures can be treated in which ways?

A
  1. Bisphosphonates
  2. Radiotherapy (if radiosensitive)

Musculoskeletal (55 decks)

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