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Year 5 Path Histopathology > Bone/Soft tissue Malignancy > Flashcards

Bone/Soft tissue Malignancy Flashcards

1
Q

What is a sarcoma?

A

Malignant Connective tissue tumor

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2
Q

What is the eipdemiology of malignant bone tumours?

A

Generally young adults/chidlren

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3
Q

What is the most common site of bone tumours?

A

Generally around knee, but different for different types of tumours

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4
Q

What is the initial investigation in an suspected bone tumour?
What are the expected findings?

A

X-Ray

  • Lytic features
  • extention of bone into soft tssue
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5
Q

What is the gold-standard for diagnosis of sarcomas?

A

Biopsy
- core Needle biopsy under radiological guidance

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6
Q

What are differentials for bone tumours?

A
  • fibrous dysplasia
  • Metaphyseal fibrous cortical defect
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7
Q

What is fibrous dysplasia?

A

Genetic mutation causing fibrous, weak tissues being layed down instead of mature bone

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8
Q

What is the epidemiology of Fibrous dysplasia

A

Usually F>M (because of McCune Albright syndrome is 10:1 F:M)
Presentation
- <10 if McCUne Albright syndrome (polyostic)
- 20-30 if single bone involved

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9
Q

What is McCune Albright syndrome?

A

A genetic syndrome caused by a G-protein activating mutation and subsequent continuous stimulation of endocrine functions

Causes Café au lait spots, fibrous dysplasia + endocrine dysfunctions

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10
Q

What is the commonest site of lesions in Fibrous dysplasia?

A

Can be any bone
More common
- Rib + proximal femur

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11
Q

X-ray shows a soap bubble osteolysis and Shepherd’s crook deformity - what disease is it likely to be?

A

Fibrous dysplasia

Shepherd’s crook deformity: coxa varus angulation of the proximal femur, classically seen in femoral involvement

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12
Q

A Bone histology shows chinese letters - what is the likely diagnosis going to be?

A

Fibrous dysplasia

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13
Q

What is an osteochrondroma?

A

Benign bone and Cartilage tumour
Most common benign bone tumours

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14
Q

What is the preferred site of osteochondroma?

A
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15
Q

Bone histology of a lesions shows

Cartilage capped “mushroom” bony outgrowth - what is the diangosis?

A

Osteochondroma

Show’s normal bone covered by cartilage

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16
Q

What is and enchondroma?

A

Benign tumour originatign from cartilage

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17
Q

What is the most common site for Enchondromas?

A

Usually presents in Hands (45%)

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18
Q

What does histology of an enchondroma show?

A

Normal cartilage
Calcified matrix

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19
Q

X-ray shows a Lytic lesion
Cotton wool calcification
Expansile and O ring sign - what is the likely diagnosis?

A

Enchondroma
Can overall look malignant on X-ray

20
Q

What is a Giant Cell tumour?
What is the epidemiology?

A

It is a borderline-malignant tumour (of bone, derived from the bone marrow) (usually locally agressive, but even though can metastasise, does not have to)

Usually in 20-40yo
F>M

21
Q

What are histological findings of a Giant cell tumour?

A

Osteoclasts and stromal cells (stromal cells are the malignant cells, but many osteoclasts giant cells seen)

“Soap bubble appearance”

“Giant multi-nucleate osteoclasts (Arrow)

22
Q

What is the x-ray appearance of a giant cell tumour?

A

Lytic/lucent lesions right up to articular surface (usually non-invasive)

23
Q

What is the usual distribution of metastatis bond tumours?

A

Usually do not go below the elbow or below the knee
It depends on the age group + primary malignancy

24
Q

What is the site distribution of Giant cell tumour?

A

Commonest Knee-epiphesis

25
Q

What are 5 common adult tumours that metastasis to bone?

A

Breast
Prostate
Lung
Kidney
Thyroid

26
Q

What are 5 common childhood tumours that metastasise to bone?

A
  • Neuroblastoma
  • Wilm’s tumour
  • Osteosarcoma
  • Ewings
  • Rhabdomyosarcom
27
Q

What is the site predelection of Osteosarcoma?

A

Majoirty ends of long bones (lower femur

28
Q

What is the epidemiology of osteosarcomas?

A

Peak in adolescencse (75% <20)

29
Q

What are histological findings of osteosarcomas?

A

Malignant mesenchymal cells
ALP +ve
Replacement of bone marrow with trabecular bone

30
Q

What are x-ray findings of osteosarcomas?

A

Elevated periosteum (Codman’s triangle- image)

Sunburst appearance

31
Q

What factors are used for the classification of osteosarcomas?

A
  1. Site within bone
  2. Differentiation
  3. Multicentricity
  4. Primary or secondar (metastasised)
32
Q

What is the prognosis of Osteosarcomas?

A

Overall poor - 5 year survival <60%

33
Q

What is the epidemiology of a chondrosarcoma?

A

Malignant cartilage producing tumour
Usually >40

34
Q

What is the site preference of chondrosarcomas?

A

Axial skeleton Femur/tibia/ pelvis

35
Q

What are X-ray findings of chondrosarcomas?

A

Lytic lesion with fluffy calcification

36
Q

What is the prognosis of chondrosarcoma diagnosis?

A

70% 5y survival (depends on grade & size)

37
Q

What is the histological presentation of chondrosarcomas?

A

Malignant chondrocytes (proliferation of cartilage)

38
Q

What is an Ewing’s sarcoma?

A

High malignant small round cell tumours (arising from neuroectodermal cells)

39
Q

What is the epidemiology of ewin’s sarcoma?

A

Usually young (<20)

40
Q

What is the site of ewing’s sarcoma?

A

Usually in long bones + pelvis

41
Q

What is the x-ray appearance of Ewin’s sarcoma?

A

Onion skinning of periosteum

42
Q

What is the histological appearance of ewing’s sarcoma?
What molecular test are doing to confirm the diagnois?

A

Sheets of small round cells CD99 +ve
T 11:22 translocation

A lot of other small-cells tumours will need to be excluded by immunohystophenotyping before diangosis

43
Q

What is a tumour of fat?

A

Liposarcoma

44
Q

What in an osteoma?
What ist the histological appearance?

A

Bony outgrowths attached to normal bone

Histologically:normal bone

45
Q

What is Gardner syndrome?

A

GI polyps + multiple osteomas + epidermoid cysts

46
Q

What is an osteoid osteoma?

A

Small benign bone forming lesion,
Histologically is normal bone (arising from osteoblasts)

night pain relieved by aspirin

47
Q

What are common x-ray findings in Osteoid osteomas?

A

Central nidus (luscent)
with sclerotic rim (opaque) ‘Bull’s-eye’

Year 5 Path Histopathology (19 decks)

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