Benign and Malignant Bone Tumours Flashcards
Osteochondroma
Most common benign tumour
Bony outgrowth on the external surface of bone which is surrounded by a cartilaginous cap
Osteochondroma Common Sites
Epiphysis of long bones
Most commonly around the knee
Osteochondroma Symptoms
Asymptomatic
Local Pain
osteochondroma Treatment
If growing in size or producing pain
- Excisional Biopsy
Osteochondroma Associations
Multiple osteotomy may be associated with an underlying genetic disorder
Small risk of malignancy
Enchondroma
Intramedullary metaphysical cartilaginous tumour
Enchondroma Common Sites
Small tubular bones of hands and feet
Enchondroma Symptoms
Asymptomatic
Can weaken bones leading to pathological fracture
Enchondroma Appearance on Imaging
Usually Lucent but may undergo mineralisation to give a sclerotic appearance
Enchondroma Treatment
Curettage
Simple Bone Cyst
Unicystic Solitary Fluid Filled Neoplasm
Simple Bone Cyst Aetiology
Growth defect in physis
Simple Bone Cyst Common Sites
metaphysical in long bones
Talus
Calcaneus
Simple Bone Cyst Symptoms
Asymptomatic
Can lead to weakness and pathological feature
Simple Bone Cyst Treatment
Curettage
Bone Grafting
Stabilisation may be required
Aneurysmal Bone Cyst
Lesion of bone containing many blood/ serum filled chambers
Aneurysmal Bone Cyst Aetiology
Small Atriovenous Malformations
Aneurysmal Bone Cyst Common Sites
metaphysis of long bones
Flat bones
Vertebral bodies
Aneurysmal Bone Cyst Symptoms
Pain
- Due to cortical expansion and bone destruction
Pathological feature
- Due to bone weakness
Aneurysmal Bone Cyst Treatment
Curettage
Grafting
Bone cement
Giant Cell Tumour Common Sites
metaphysis
Epiphysis
Around the knee
Giant Cell Tumours Symptoms
pain
- as locally destructive to cortex
Pathological fracture
Giant Cell Tumours Aetiology
Translocation between chromosome 1 and 2
Giant Cell Tumours Appearance soon Imaging
‘Soap Bubble’
Giant Cell Tumours Associations
Can metastasis to lungs
- benign pulmonary Ct
Giant Cell Tumour Treatment
Intralesional excision
- Use off phenol, bone cement or. liquid nitrogen to destroy any remaining tumour
Aggressive forms may need joint replacement
Fibrous Dysplasia
A disease of bone resulting from a genetic mutation that causes lesion of fibrous tissue and immature bone
Fibrous dysplasia epidemiology
Adolescents
Fibrous Dysplasia Common Sites
Head and neck
Fibrous Dysplasia Aetiology
Genetic mutation causes abnormalities in proteins involved in the G-protein signalling pathway
Fibrous Dysplasia Symptoms
Endocrine Symptoms
Stress fractures
- Due to angular deformities
Shepherd’s Crook Deformities
- Due to extensive involvement of the proximal femur
Fibrous Dysplasia Treatment
Biphosphonates
Stabilisation of pathological fractures
- internal fixation
- cortical bone grafting
NO intralesional excision due to high recurrence rate
Osteoid Osteoma
Small nidus of immature bone surrounded by an intense sclerotic halo which secretes prostaglandins
Osteoid Osteoma Epidemiology
Adolescents
osteoid osteoma common sites
Proximal femur
Diaphysis of long bones
Vertebrae
osteoid Osteoma Symptoms
Constant pain
- worse at night
Osteoid Osteoma Investigations
Bone Scan
CT
Osteoid Osteoma Treatment
NSAIDs
Excision
Brodies Abscess
Intraosseous abscess as a result of subacute osteomyelitis
Brodies Abscess Aetiology
Staph Aureus Infection
Brodies Abscess Appearance on Imaging
Lytic Lesion
Brodies Abscess Symptoms
Localized pain
- Night time
- Relieved by NSAIDs
Brodies Abscess Common Sites
Metaphysis of long bones
Brodies Abscess Treatment
Surgical Exacuation and curettage
- Under antibiotic cover
Brown Tumours Aetiology
Hyperparathyroidism
Brown Tumours Appearance on Imaging
Lytic Lesion
Brown Tumours Treatment
Treatment of parathyroidism
osteosarcoma
Most common primary malignant bone tumour
Malignant bone tumour that produces bone
osteosarcoma Associations
Retinoblastoma gene
Osteosarcoma Epidemiology
Younger patients
Osteosarcoma common sites
Knee
metastases common
- through haematogenous sprea
- 10% have pulmonary metastases at time of diagnosis
Osteosarcoma Symptoms
Constant. pain worse at night
Loss of appetitie
Weight loss
Fatigue
Osteosarcoma treatment
Chemotherapy
- Palliative/ prolonging
Chondrosarcoma
Cartilage producing primary bone tumour
Chondrosarcoma epidemiology
Older patients (~45)
Chondrosarcoma Symptoms
Back or thigh pain
Sciatica
Bladder symptoms
Unilateral Oedema
Chondrosarcoma Common Sites
Proximal femur
Pelvis
- Very large and slow to metastasise
Ewing’s sarcoma
Primary bone tumour of uncertain origin
Small round blue cell tumour
Ewing’s sarcoma Epidemiology
-Teenagers
Ewing’s sarcoma Aetiology
Associated with translocation between chromosomes 11 and 22 involving the Ewing sarcoma gene moon C22
Ewing’s sarcoma Common Sites
Long bones
- Femur
Ewing’s sarcoma Symptoms
Fever
Raised inflammatory markers
Warm swelling in affected area
Ewing sarcoma on X-ray
Onion Skin
Ewing sarcoma Treatment
Chemotherapy
Radiotherapy
Lymphoma
Cancer of round cells of the lymphocytic system and macrophages which can occur as a primary bone tumour from bone marrow or the lymphoma may metastasise to bone
Primary lymphoma of bone
Non-Hodgkin’s lymphoma
Affects pelvis or femur
Surgical resection
Metastatic Lymphoma
lymphadenopathy
Splenomegaly
Treatment: Chemotherapy and radiotherapy
Myeloma
Malignant clonal proliferation of abnormal plasma cells which arise from bone marrow
Myeloma Types
Solitary Lesion
- Plasmacytoma
Multiple Lesions
-0 Multiple Myeloma
Myeloma Epidemiology
Aged 45-65
Myeloma Symptoms
Weakness Back pain Bone pain Weight loss Fatigue Anaemia
myeloma Diagnosis
Plasma Protein Electrophoresis
Early morning urine collection for Bence Protein Assay
Myeloma appearance on imaging
no metastases may be seen on bone scan as there is not usually an osteoblastic response to the osteoclastic activity
Myeloma Treatment
Plasmacytoma
- Radiotherapy
Multiple Myeloma
- Chemotherapy
Primary Bone Tumour Mets
Vertebrae Pelvis Ribs Skull Humerus Long bones of lower limb
Mets from other sites
Breast
Prostate
Lung
Renal
breast metastases
Sclerotic or lytic
Prostate metastases
Sclerotic
Pathological features more likely to heal due to high osteoblast activity
Hormonal therapy and radiotherapy can reduce chance of mets
Lung metastases
Lytic
Renal Metastases
Large vascular lytic ‘blow out’ mets
Surgery or biopsy may cause severe bleeding
1 bony met may be treated with nephrectomy.
