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Week 11- Musculoskeletal > Bone tumour > Flashcards

Bone tumour Flashcards

1
Q

What are osteoblasts?

A
  • Bone forming cells
  • Make the matrix
  • type 1 collagen, ground substance, calcium hydroxyapatite
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2
Q

What are osteocytes?

A

Mature bone cells

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3
Q

What are osteoclasts?

A

Bone resorbing cells

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4
Q

Where is mature lamellar bone?

A

Normal mature bone in the skeleton, may be compact or cancellous

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5
Q

Where is immature woven bone?

A
  • Foetus
  • Fracture
  • bone tumour
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6
Q

What is the most common primary bone tumour?

A

Myeloma

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7
Q

What are the most common metastatic carcinomas spreading to bone?

A
  • Bronchus
  • Breast
  • Prostate
  • kidney
  • Thyroid (follicular)
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8
Q

What tumours in childhood can affect bone?

A

Neuroblastoma, rhabdomyosarcoma

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9
Q

Which bones are more likely to be affected by cancer?

A

Those with a good blood supply: femur, femoral head, humerus, pelvis

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10
Q

What are the effects of metastases to bone?

A
  • Often asymptomatic
  • bone pain
  • bone destruction
  • pathological fracture in long bones
  • spinal metastases> vertebral collapse, spinal cord compression, nerve root compression, back pain
  • Hypercalcaemia (thirst, abdominal pain)
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11
Q

What is the mechanism of bone destruction?

A
  • Osteoclasts, not tumour cells
  • Osteoclasts are stimulated by cytokines from tumour cells
  • inhibited by bisphosphonates
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12
Q

Explain sclerotic metastases

A
  • Prostatic carcinoma, breast carcinoma
  • Sclerotic (bright) on X ray
  • Reactive new bone formation induced by the tumour cells
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13
Q

Explain solitary bone metastases

A
  • Typically renal and thyroid carcinoma

* Surgical removal is often valuable

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14
Q

What is myeloma

A
  • Malignant primary bone tumour
  • Monoclonal proliferation of plasma cells in the bone marrow
  • Solitary (plasmacytoma) or multiple myeloma if many
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15
Q

What are the clinical effects of myeloma?

A

•Lytic bone lesions - bone pain and fracture
•Marrow replacement: anaemia, infection, bleeding
•immunoglobulin excess:
- serum electrophoresis: monoclonal band
- urine: immunoglobulin light chain (bence jones)

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16
Q

What are the effects of marrow replacement by tumour?

A
  • Pancytopenia
  • Anaemia
  • Leucopenia - increased infections
  • Thrombocytopenia: haemorrhage
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17
Q

What are the benign primary bone tumours?

A
  • Osteoid osteoma
  • Chrondroma
  • Osteocartilagenous exostosis (combination of bone and cartilage)
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18
Q

What are the malignant primary bone tumours?

A
  • Osteosarcoma
  • Chrondrosarcoma
  • Ewing’s tumour
  • Myeloma
19
Q

What is osteoid osteoma?

A
  • Small, benign osteoblastic proliferation

* Pain worse at night, relieved by aspirin

20
Q

What is osteosarcoma?

A

Malignant tumour whose cells form osteoid or bone

21
Q

What is the peak age of osteosarcoma?

A

10-25, second peak in adulthood

22
Q

What is the typical site of osteosarcoma

A
  • Metaphysis of long bones

* 50% around the knee

23
Q

How does osteosarcoma present?

A
  • bone pain
  • swelling
  • Pathological fracture
  • Often delayed presentation
24
Q

What is the natural history of osteosarcoma?

A
  • Highly malignant
  • Haematogenous spread
  • Early lung metastases
  • 5 year survival pre chemo 15-20%, modern survival 50-60%
25
Q

Describe imaging in osteosarcoma

A
  • Look for lytic destructive lesion
  • Cortical destruction with soft tissue mass
  • Codman trinangle: old cortex being lifted up by new cortex being produced in response to tumour
26
Q

What is the treatment of osteosarcoma?

A
  • neoadjuvant chemotherapy
  • Followed by local excision, limb sparing
  • Further chemotherapy
  • May then have radiotherapy for local control
27
Q

What are the cartilaginous tumours?

A

•Benign:

  • enchondroma
  • osteocartilaginous exostosis

•Malignant:
- chrondrosarcoma

28
Q

What is osteocartilaginous exostosis?

A
  • Benign outgrowth of cartilage with end-chondral ossification
  • Probably derived from the growth plate
  • Very common, usually adolescence
  • Metaphysis of long bones
29
Q

How is osteocartilaginous exostosis treated?

A

Surgical resection

30
Q

What is enchondroma?

A
  • Lobulated mass of cartilage within the medulla
  • > 50% in hands, feet, long bones
  • Often asymptomatic in long bones
  • in hands - swelling and pathological fracture
  • Low cellularity, often surrounded by plates of lamellar bone
31
Q

What is chondrosarcoma?

A
  • primary or from pre-existing enchrondroma or exostosis (secondary)
  • Central, within the medullary canal or peripheral on bone surface
  • predominantly middle aged and elderly, male>females
32
Q

Where are the common sites of chrondrosarcoma?

A
  • Axial skeleton
  • Pelvis
  • Ribs
  • Shoulder girdle
  • Proximal femur and humerus
33
Q

How does chondrosarcoma present?

A
  • Bone pain
  • Swelling
  • pathological fracture
  • Neurological symptoms
34
Q

What is the appearance of chrondrosarcoma on imaging?

A
  • Popcorn calcifications
  • lytic
  • May get cortical destruction with soft tissue mass
35
Q

What mutations are associated with chondrosarcoma?

A

IDH1 and IDH2

36
Q

What is the peak age of Ewing sarcoma?

A

5-15 years

37
Q

Where are the common sites of Ewing sarcoma?

A
  • Long bone

* flat bones of limb girdles

38
Q

Metastases of Ewings sarcoma

A
  • Early metastases to lung, bone marrow and bone

* Micrometastases

39
Q

What is the presentation of Ewing sarcoma?

A
  • Pain
  • Swelling
  • Night sweats
  • Weight loss
  • Fever
40
Q

What is the appearance of Ewing sarcoma on Xray?

A
  • Moth eaten appearance
  • lytic lesion
  • Periosteal new bone formation - onion skinning
41
Q

How is the diagnosis of Ewing sarcoma made?

A

Biopsy

42
Q

What is the associated mutation with Ewing sarcoma?

A

•90% show translocation between chromosomes 11 and 22

43
Q

What is the treatment of Ewing sarcoma?

A
  • Neoadjuvant chemotherapy (doxorubicin, cyclophosphamide, vincristine)
  • Surgery
  • Further chemo
  • May need radiotherapy

Week 11- Musculoskeletal (11 decks)

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