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Musculoskeletal MBCHB > Benign Bone Tumours > Flashcards

Benign Bone Tumours Flashcards

1
Q

Describe osteochondroma.

A

A benign lesion derived from aberrant cartilage from the perichondral ring; the most common benign bone tumour

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2
Q

What is the aetiology of osteochondroma?

A
  • Common in adolescents and young adults (10-20 years)
  • Can be caused by trauma
  • Can be solitary or multiple
    • Multiple osteochondromata can occur as an autosomal dominant hereditary disorder - Multiple Hereditary Exostosis (MHE)
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3
Q

What is the pathophysiology of osteochondroma?

A

produces a bony outgrowth on the external surface with a cartilaginous cap

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4
Q

What is the clinical presentation of osteochondroma?

A
  • Painless, hard lump
  • Commonly occur near the knee - distal femur/proximal tibia
  • May be symptoms with activity - pain from tendons, numbness from nerve compression
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5
Q

What is the investigation for osteochondroma?

A

Imaging (x-ray, MRI) - cartilage capped ossified pedicle

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6
Q

What is seen on this x-ray?

A

Osteochondroma

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7
Q

What is the management of osteochondroma?

A
  • Close observation - small risk of malignant transformation (<1%) so any lesion growing in size or causing pain may require excision
  • In MHE there are more tumours so higher change of malignancy
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8
Q

What is an enchondroma?

A

Intramedullary and usually metaphyseal cartilaginous tumour caused by failure of normal enchondral ossification at the growth plate; 2nd most common benign bone tumour

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9
Q

What is the aetiology of enchondroma?

A

Most commonly presents 20-50 years old

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10
Q

What is the typical presentation of enchondroma?

A
  • Can occur in the femur, humerus, tibia and small bones of the hand and feet
  • Many are incidental and usually asymptomatic but they can weaken the bone leading to pathological fracture
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11
Q

What are the investigations for enchondroma?

A
  • Imaging - x-ray, further imaging if needed
    • Lesion is usually lucent on imaging but can undergo mineralisation with a patchy sclerotic appearance
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12
Q

What is seen on this x-ray?

A

Enchondroma

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13
Q

What is the management of enchondroma?

A

Once a fracture has healed or if there is a risk of impending fracture they may be scraped out (curettage) and filled with bone graft to strengthen the bone

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14
Q

What is a simple bone cyst?

A

Single cavity benign fluid filled cyst in a bone.

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15
Q

What is the aetiology of a simple bone cyst?

A

Probably a growth defect in the physis and are therefore metaphyseal in long bones (usually in proximal humerus and femur), although they can occur in the talus or calcaneus

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16
Q

What is the presentation of a simple bone cyst?

A

May be asymptomatic and an incidental finding (usually x-ray of child/YA) but can weaken the bone leading to pathological fracture

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17
Q

What is the investigations of a simple bone cyst?

A

May be asymptomatic and an incidental finding (usually x-ray of child/YA) but can weaken the bone leading to pathological fracture

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18
Q

What is seen in these images?

A

Simple bone cyst

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19
Q

What is the management of a simple bone cyst?

A

Treatment with curettage and bone grafting +/- stabilisation may be required

20
Q

What is an aneurysmal bone cyst?

A

Consists of many chambers which are filled with blood or serum

21
Q

What is the aetiology of an aneurysmal bone cyst?

A
  • Thought to be due to a small arteriovenous malformation
  • Can occur in the metaphysis of many different long bones, flat bones and vertebral bodies
22
Q

What is the pathophysiology of an aneurysmal bone cyst?

A

The lesion is locally aggressive causing cortical expansion and destruction → pain

23
Q

What is the typical presentation of an aneurysmal bone cyst?

A
  • Painful mass/swelling
  • Pathological fracture
24
Q

What are the investigations of an aneurysmal bone cyst?

A

Chambers may be seen on xray

25
Q

What is seen on this x-ray?

A

Aneurysmal bone cyst

26
Q

What is the management of an aneurysmal bone cyst?

A

Curettage and grafting or use of bone cement

27
Q

What is a giant cell tumour of bone?

A

Benign tumour arising from the giant cells of the bone marrow

28
Q

What is the pathophysiology of giant cell tumour of the bone?

A
  • Occur in the metaphyseal region, tend to involve the epiphysis and can extend to the subchondral bone adjacent to the joint
  • Can be locally aggressive
29
Q

What is the typical presentation of giant cell tumour of the bone?

A
  • Painful mass/swelling
  • Commonly occur around the knee and in the distal radius but can occur in other long bones, the pelvis and the spine
  • May cause pathological fracture
30
Q

What is the investigation for a giant cell tumour of the bone?

A

X-ray - characteristic ‘soap bubble’ appearance
Histology - consist of multi-nucleated giant cells

31
Q

What is seen on the x-ray?

A

Giant cell tumour of the bone

32
Q

What is the management of giant cell tumour of bone?

A
  • Intralesional excision with use of phenol, bone cement or liquid nitrogen to destroy remaining tumour material and reduce the risk of recurrence
  • Very aggressive lesions with cortical destruction may need joint replacement
  • Considered benign but 5% can metastasize to the lung with benign pulmonary GCT
33
Q

What is fibrous dysplasia?

A

Benign, developmental disorder of bone that causes normal skeletal tissue to be replaced by fibrous tissue

34
Q

What is the aetiology of fibrous dysplasia?

A
  • Genetic mutation
  • Usually occurs in adolescence
35
Q

What is the pathophysiology of fibrous dysplasia?

A
  • Genetic mutation results in lesions of fibrous tissue and immature bone
  • Can affect one bone (monostotic) or more than one bone (polyostotic)
  • Defective mineralisation may result in angular deformities and the affected bone is wider with thinned cortices
36
Q

What is the presentation of fibrous dysplasia/

A
  • Bone pain and deformities
  • Pathological fractures
37
Q

What are the investigations for fibrous dysplasia?

A
  • Bone scan - show intense increase in uptake during development but the lesion usually becomes inactive
  • Extensive involvement of the proximal femur can produce a ‘shepherd’s crook’ deformity on x-ray
38
Q

What is seen on this x-ray?

A

Fibrous dysplasia

39
Q

What is the management of fibrous dysplasia?

A
  • Bisphosphonates may reduce pain
  • Pathological fractures should be stabilized with internal fixation and cortical bone grafts used to improve strength
  • Simple intralesional excision alone has a very high recurrence rate
40
Q

What is osteoid osteoma?

A

Benign bone-forming tumours that typically occur in children

41
Q

What is the aetiology of osteoid osteoma?

A
  • Most commonly occur in adolescence
  • Common sites include the proximal femur, the diaphysis of long bones and the vertebrae
42
Q

What is the presentation of osteoid osteoma?

A
  • Intense constant pain, worse at night due to the intense inflammatory response
  • Pain is greatly relieved by NSAIDs
43
Q

What are the investigations for osteoid osteoma?

A
  • The lesion may be seen on x-ray however bone scan (intense local uptake) and CT can confirm the diagnosis
  • CT: Small nidus of immature (woven) bone surrounded by an intense sclerotic halo (osteoblastic rim)
44
Q

What is seen on this image?

A

Osteoid Osteoma

45
Q

What is the management for osteoid osteoma?

A

the lesion may resolve spontaneously over time but some cases may require CT guided radiofrequency ablation or en bloc excision

Musculoskeletal MBCHB (21 decks)

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