BONE METASTASIS Flashcards
What is this lesion? What’s condition is it classically seen in?
Osteosclerotic (osteoblastic) lesion
Prostate cancer
What is this lesion? What condition is it commonly seen in?
Osteolytic lesion
Multiple myeloma
Primary bone tumours are more likely in which demographic? Explain why
Children and young adults (esp male)
Growth plates have dividing cells, boys are taller
What are the three main ways in which primary bone tumours present?
- Incidental finding
- Bone pain
- Pathological fracture
What is shown in the x-ray?
Osteoid osteoma
benign bone tumour with central osteoid core (radiolucent: clear), surrounded by reactive bone
found at surface of cortex/diaphysis
Which gene mutation is associated with the development of osteomas? An osteoma in these patients may proceed the development of which symptoms?
ACP gene mutation: Gardener’s syndrome, variant of familial adenomatous polyposis (FAP)
May preceed development of colon symptoms
What is the most common primary bone tumour? Which cells are affected?
Osteosarcoma
Malignant bone tumour of osteoblasts
In treating osteosarcoma, what should you presume about all patients? How does this influence treatment?
Presumed all patients have metastasis, treatment with surgery alone (amputation or resection) leads to poor survival rates
Chemotherapy may be given before surgery to shrink tumour and is always given as part of treatment
Which primary bone tumour has the youngest age of presentation of all bone tumours?
Ewing sarcoma
→ mainly affects children (80% of cases <20)
What is the most likely diagnosis of this patient? What is the treatment? What is the overall survival?
Ewings sarcoma
- Treat with surgery, chemotherapy, radiation
- 5 year survival: 70% in localised disease; 33% if metastasis at diagnosis
- Ewings sarcoma is aggressive with early metastasis
The presentation of a Ewings sarcoma can mimic the presentation of which other bone condition? How do you differentiate?
Osteomyelitis: both present with painful mass over bone, which is warm and swollen and patient may have fever and leucocytosis
Bone cultures and tumour aspiration will be sterile
85% of cases of Ewing sarcoma are associated with which genetic mutation?
Genetic translocation between chromosomes 11 and 22
Which bone tumour is benign but locally aggressive? Explain why and describe where this tumour normally occurs in a bone
Giant cell tumour (osteoclastoma)
Multinucleated giant osteoclasts cause lots of local bone resorption
Occurs in epiphyses: most important tumour that occurs in this region
A tumour arising laterally from a growth plate at the metaphysis is what type of tumour?
Osteochondroma
benign: can rarely undergo malignant conversion to chondrosarcoma
Tumour is this most likely to be?
Chondroma: benign tumour of cartilage
Occurs in small bones
What should you check first in someone that presents with bone pain/fractures? How does this help you reach a differential diagnosis?
Calcium + parathyroid hormone levels
- Normal calcium + PTH: primary bone condition e.g. osteoporosis, tumours
- Low calcium + high PTH: most likely vitamin D deficiency
- High calcium + high PTH: hyperparathyroidism
Review causes of long bone tumours according to location
Prior radiation increases risk of which type of bone cancer?
Osteosarcoma
