benign tumours

Question 1

what is osteochondroma

Answer 1

bony outgrowth with a cartilaginous cap on the external surface

Question 2

what is does osteochondroma usually affect

Answer 2

long bones near the growth plates in those aged 10-30

Question 3

what is the most common type of benign bone tumour

Answer 3

osteochondroma

Question 4

what is the cause of osteochondroma

Answer 4

idiopathic

multiple osteochondroma = autosomal dominant disorder

Question 5

what are the symptoms of osteochondroma

Answer 5

usually asymptomatic

pain

Question 6

what is the risk of malignant transformation

Answer 6

small (1%)

Question 7

what is the treatment of osteochondroma

Answer 7

if lesion is growing in size or causing pain it may require excision biopsy

Question 8

what is Enchondroma, where do they occur

Answer 8

intramedullary and usually metaphyseal cartilaginous tumour

femur, humerus, tibia, small bones of the hands and feet

Question 9

describe an Enchondroma

Answer 9

lucent lesion but can undergo mineralisation with a patchy sclerotic appearance

Question 10

what are the causes of Enchondroma

Answer 10

failure of normal Enchondromal ossification at the growth plates

as part of a syndrome

Question 11

what syndromes can cause Enchondroma

Answer 11

Ollier’s

Maffuci

Question 12

what is Ollier’s syndrome

Answer 12

rare, non-hereditary sporadic disorder where Enchondromas develop close to growth [late cartilage

Question 13

what is Maffuci’s syndrome

Answer 13

sporadic disease characterised by the presence of multiple Enchondromas associated with cavernous haemangiomas and pleobolith (small calcifications within a vein)

Question 14

what are the symptoms of Enchondroma

Answer 14

asymptomatic

weekend bone may result in pathological fracture

Question 15

what is a simple bone cyst, what is it also known as

Answer 15

single cavity, fluid filled cyst within the bone

aka unicameral bone cyst

Question 16

where do simple bone cysts occur

Answer 16

the metaphyseal in long bones (usually the proximal humerus and femur)

can also occur in the talus or calcaneus

Question 17

what causes simple bone cyst

Answer 17

growth defect from the physis

Question 18

what are the symptoms of simple bone cyst

Answer 18

asymptomatic

can cause weakness resulting in pathological fracture

Question 19

what is an aneurysmal bone cyst

Answer 19

many chambers filled with blood or serum within the bone

Question 20

where do aneurysmal bone cysts occur

Answer 20

in the metaphyses of many long bones, flat bones, and vertebral bodies

Question 21

what is the cause of aneurysmal bone cyst

Answer 21

small, arteriovenous malformation

Question 22

describe the actions of an aneurysmal bone cyst and what this causes

Answer 22

locally aggressive causing cortical expansion and destruction resulting in pain

Question 23

what are the symptoms of an aneurysmal bone cyst

Answer 23

pain

pathological fracture

Question 24

where do a giant cell tumours occur

Answer 24

around the knee and in the distal radius

can occur in long bones, pelvis, and spine

Question 25

when do giant cell tumours occur

Answer 25

after the physis has fused

Question 26

what are the symptoms of giant cell tumours (GCT)

Answer 26

pain pathological fracture 5% metasise to the lung causing benign pulmonary GCT

Question 27

what are the investigations of giant cell tumours, what can be seen in them

Answer 27

x-ray = soap bubble (BUZZWORD)

Question 28

what is the treatment of giant cell tumours

Answer 28

intralesional excision + phenol/bone cement/liquid nitrogen (kills remaining tumour material to prevent recurrence)

Question 29

what are the types of giant cell tumours, what do they affect

Answer 29

pigmented villonodular synovitis (PNVS) = large joints giant cell tumour of tendon sheath (GCTS) = digits

Question 30

describe pigmented villonodular synovitis (PNVS)

Answer 30

destructive and diffuse so are difficult to excise and often reoccur

Question 31

describe giant cell tumour of tendon sheath

Answer 31

small nodules that are easily excised by occasionally reoccur

Question 32

what is fibrous dysplasia and what causes it

Answer 32

lesions od fibrous tissue and immature bone due to genetic mutation

Question 33

when does fibrous dysplasia occur, and what does it affect

Answer 33

usually in adolescence can affect one bone (monostoic) or multiple (polystoic)

Question 34

what are the symptoms of fibrous dysplasia

Answer 34

defective mineralisation causes angular deformities stress fractures shepherd crook deformity

Question 35

describe the bone in fibrous dysplasia

Answer 35

wider but with thinned cortices

Question 36

soap bubble appearance is a buzzword for what condition

Answer 36

Giant cell tumour

Question 37

what is the investigation for fibrous dysplasia

Answer 37

bone scans = intense increase in uptake during development before lesion becomes inactive

Question 38

what is the treatment of fibrous dysplasia

Answer 38

bisphopshates = reduce pain

Question 39

shepherds crook deformity is a buzzword for what condition

Answer 39

fibrous dysplasia

Question 40

what is an osteoid osteoma

Answer 40

a small nidus of immature bone surrounded by sclerotic halo

Question 41

where do osteoid osteomas occur

Answer 41

proximal femur diaphysis of long bones vertebrae

Question 42

when do osteoid osteomas occur

Answer 42

adolescence

Question 43

what are the symptoms of osteoid osteomas

Answer 43

constant, intense pain worse at night

Question 44

what are the investigations of osteoid osteomas

Answer 44

X-ray Boen scan = intense local uptake CT

Question 45

what is the treatment of osteoid osteomas

Answer 45

NSAIDs = pain relief may spontaneously resolve CT guided radio frequency ablation

Question 46

what is a brodies abscess

Answer 46

subacute osteomyelitis which is contained to a localised area and walled off by fibrous and granulation tissue

Question 47

what is the cause of a brodies abscess

Answer 47

staph aureus

Question 48

what can a brodies abscess present with

Answer 48

lytic lesion of bone

Question 49

what is a brown tumour

Answer 49

a bone lesion which arises in setting of excess osteoclast activity. it is not a true neoplasm but may mimic it

Question 50

where does a brodies abscess commonly affect

Answer 50

maxilla and mandible

Question 51

what is the cause of a brodies abscess

Answer 51

hyperparathyroidism

Question 52

what is the treatment of abscesses

Answer 52

antibiotics + drainage

Question 53

what is a bursitis

Answer 53

inflammation of the bursa

Question 54

what is a bursa, what is its function

Answer 54

a small fluid filled sac lined by synovium around a joint prevents friction between tendons, bones, muscles and skin

Question 55

what are the causes of bursitis

Answer 55

repeated pressure or trauma | bacterial infection

Question 56

what is the treatment of bursitis

Answer 56

the swelling will usually subside on it's own but a thickened burial sac may remain excision may be required but can cause problems with scarring

Question 57

describe a ganglion cyst, where do they occur

Answer 57

occurs around a synovial joint or tendon sheath. well-defined, readily transilluminate and may be firm no epithelial lining (not a true cysts)

Question 58

what is the cause of a ganglion cyst

Answer 58

herniation or out-pouching of a weak portion a joint capsule or tendon sheath

Question 59

what cause the weakness which allows a ganglion cyst to occur

Answer 59

developmental e.g. juvenile baker cyst | underlying joint damage/arthritis with a build up of pressure within the joint e.g. adult baker cyst

Question 60

describe the histology of a ganglion cyst

Answer 60

space within mixed material | may have secondary inflammatory changes

Question 61

what is the treatment for ganglion cysts

Answer 61

excision if causing discomfort or for cosmesis

Question 62

what is the most common benign soft tissue tumour

Answer 62

lipoma

Question 63

what is a lipoma

Answer 63

neoplastic proliferation of fat which usually occurs in the subcutaneous fat but can occur in the middle

Question 64

describe the histology of a lipoma

Answer 64

resembles normal fat | nuclei are small and at the edge

Question 65

describe a angiolipoma

Answer 65

usually multiple and peripheral vascular with fibrin thrombi painful