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Musculoskeletal System > Bone cancers > Flashcards

Bone cancers Flashcards

1
Q

True or false: Primary bone tumours are more common than secondary ones.

A

False

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2
Q

What are the 3 most common primary malignant bone tumours?

A

1) Osteosarcoma (35%)
- mostly children and YA

2) Chondrosarcoma (25%)
- mostly older px

3) Ewing sarcoma (16%)
- mostly children and YA

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3
Q

What are 3 examples of osteogenic tumours?

A

1) Osteosarcoma
2) Osteoid osteoma
3) Osteoblastoma

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4
Q

What are 5 examples of cartilage tumours?

A

1) Chondrosarcoma
2) Chondroma
3) Chondroblastoma
4) Chondromyxoid fibroma (CMF)
5) Osteochondroma

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5
Q

What are 3 types of fibrogenic bone tumours?

A

1) Fibrous dysplasia
2) Desmoplastic fibroma
3) Fibrosarcoma

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6
Q

What are 2 types of fibrohistiocytic tumours?

A

1) Benign
2) Malignant

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7
Q

What are 2 types of giant cell rich bone tumours?

A

1) Benign
2) Malignant

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8
Q

What are 2 types of vascular bone tumours?

A

1) Angiosarcoma
2) Epithelioid Hemangioendothelioma

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9
Q

What are 2 types of haematopoetic bone tumours?

A

1) Myeloma
2) Lymphoma

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10
Q

What are 3 typical presentations of primary malignant bone tumours?

A

1) Pain
2) Mass and swelling
3) Pathological fracture
4) Loss of function

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11
Q

What is the gold standard for diagnosis and typing of bone tumours?

A

Biopsy (needle or incisional surgical biopsy)

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11
Q

What is the 1st line Ix for bone tumours?

A

X-ray

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12
Q

What are the benefits of using a MRI/CT for a suspected bone tumour?

A

Accurately outlines bone tumours and relations with other structure for pre-op assessment/surgery planning

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13
Q

What are the benefits of using a bone radionuclide bone scan for a suspected bone tumour?

A

Detect tumour spread to other bones

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14
Q

What are the benefits of using a PET scan for a suspected bone tumour?

A

1) Very sensitive for tumour spread
2) Can infer malignancy esp in post-op follow ups

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15
Q

What are 4 common Ix used for bone tumours?

A

1) X-ray
2) MRI/CT
3) Bone radionuclide bone scan
4) PET scan
5) Biopsy

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16
Q

What are 4 prognostic factors for primary malignant bone tumours?

A

1) Size
2) Grade
3) Stage
4) Location and margin clearance
- surgically resectable?
5) Response to chemotherapy (only for osteosarcoma and Ewing sarcoma)

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17
Q

Which of the osteogenic tumours are malignant?

A

Osteosarcoma

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18
Q

What is a osteosarcoma?

A

A mostly high-grade malignant bone tumor that produces osteoid directly from tumor cells

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19
Q

Osteosarcoma EPC:
M (</>) F
Age group:
a/w:

A

M > F
10-25 y/o
older px a/w precursor lesion (eg. paget’s)

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20
Q

What are 4 radiological findings associated with osteosarcoma?

A

1) Large
2) Destructive
3) Lytic/blastic
4) Permeative margins (may break through cortex and elevate periosteum)
5) Sunburst pattern

21
Q

Which part of the bone do osteosarcomas usually arise from?

A

Metaphysis of long bones (eg. distal femur, proximal tibia, proximal humerus)
- Medullary cavity then extends into cortex

22
Q

What is the histological appearance of osteosarcoma?

A

Lace-like pattern of OSTEOID - - produced by eosinophilic matrix entrapping anaplastic tumor cells

23
Q

Which of the chondroid tumours are malignant?

A

Chondrosarcoma

24
Q

What is the difference between a chondroblastic osteosarcoma and a chondrosarcoma?

A

Both malignant but chondrosarcoma cannot produce osteoid (only osteosarcoma can)

25
Q

Are chondrosarcomas chemosensitive?

A

No

26
Q

Chondrosarcoma EPC:
M (</>) F
Age group:
a/w:

A

M > F
30-60 y/o
a/w pre-existing bone tumours

27
Q

What are 3 macroscopic features of chondrosarcoma?

A

1) Large lobulated, pearly white or light blue
2) Focal calcification
3) Myxoid change (suggestive of malignancy)

28
Q

What are 2 histological features of chondrosarcoma?

A

1) Permeation of bone trabeculae
2) Soft tissue and marrow invasion

29
Q

Where do chondrosarcomas commonly metastasise to?

A

Lungs

30
Q

Osteochondromas are mainly (solitary/multiple)?

A

Solitary
- if multiple → usually multiple hereditary exostoses syndrome (EXT1/2 genes)

31
Q

Do osteochondromas often undergo malignant transfomations?

A

No

32
Q

What is a osteochondroma?

A

Exostosis
- most common benign bone tumours in long bones
- cartilage-capped tumour attached to underlying skeleton by bony stalk
(bone extension containing cortex and periosteum convered by thin cartilaginous cap)

33
Q

What are 3 types of chondromas?

A

By location:
1) Enchondroma
- within medullary cavity

2) Subperiosteal chondroma
- bone surface

3) Soft tissue chondroma
- inside soft tissue and no communication with adjacent bone

34
Q

What are 2 examples of non-hereditary multiple enchrondromas?

A

1) Ollier’s disease
2) Maffucci syndrome

35
Q

What are 2 heterozygous mutations that cause both syndromic and solitary enchondromas?

A

IDH1/2 genes

36
Q

Giant cell rich lesions of bones and joints are usually (benign/malignant).

A

All benign with very rare malignant

37
Q

What is a brown tumour?

A

Giant cell rich bone tumour a/w hyperparathyroidism

38
Q

What is pigmented villonodular synovitis?

A

Giant cell tumour of the joint

39
Q

What is the most common benign bone tumours arising in long bones?

A

Osteochondroma

40
Q

Giant cell tumours of the bone are often benign but ________________________.

A

Benign but locally aggressive with high rate of recurrence

41
Q

Giant cell bone tumour EPC:
M (</>) F
Age group:
Demographic:
Mostly (solitary/multiple)

A

F > M
30-50 y/o
more common in oriental countries
Mostly solitary

42
Q

Where are giant cell bone tumours most common?

A

Long tubular bones (esp knee)
- epiphyseal-metaphyseal region

43
Q

What are 3 histological features of giant cell bone tumour?

A

1) Abundant giant cells often w numerous nuclei
2) Stromal cells similar to giant cell
3) No osteoid formation

44
Q

Do giant cell bone tumours often undergo malignant transformation?

A

Extremely rare

45
Q

What is fibrous dysplasia?

A

Benign tumor reflecting a localized developmental arrest

46
Q

What are 2 forms of fibrous dysplasia?

A

Monostotic:
- involvement of a single bone (femur, tibia, ribs, jawbones, calvarium, and humerus are most commonly affected)

Polyostotic:
- involvement of multiple bones (Maybe syndromal)
i) Mazabraud syndrome: fibrous dysplasia (usually polyostotic) and soft tissue myxomas.
ii) McCune-Albright syndrome: polyostotic disease, associated with café-au-lait skin pigmentations and endocrine abnormalities, especially precocious puberty

47
Q

What is an example of an proto-oncogene that can cause fibrous dysplasia?

A

GNAS1

48
Q

What is the gross appearance of fibrous dysplasia?

A

Tan-white and gritty

49
Q

What are 3 histological features of fibrous dysplasia?

A

1) Curvilinear trabeculae of woven bone
2) Surrounded by moderately cellular fibroblastic proliferation
3) bone lack prominent osteoblastic rimming

Musculoskeletal System (22 decks)

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