bone tumours Flashcards
what is the most common type of benign bone tumour?
osteochondroma
what is an osteochondroma?
- the most common benign bone tumour
- a bony outgrowth of the external surface of bone which is surrounded by a cartilaginous cap
what age group do osteochondromas typically affect?
10-30
where do osteochondromas typically occur?
the epiphysis of the long bones (most commonly around the knee)
what is multiple osteochondroma?
-autosomal dominant condition due to mutations in ETX1 and ETX2 genes
what is the treatment for osteochondroma?
-excisional biopsy
how does osteochondroma usually present?
- can be asymptomatic
- can cause localised pain/swelling
are enchondromas benign or malignant?
benign
what are enchondromas?
-benign, intramedullary, cartilaginous bone tumours that are most often found in the metaphysis (the area between the diaphysis and epiyphysis)
how do enchondromas typically present?
- can be asymptomatic
- usually weaken bone and cause pathological fractures
where are enchondromas typically found?
- long bones
- small bones of hands and feet
how do enchondromas appear on an Xray?
- usually appear lucent
- can appear as patchy sclerotic lesions
what is the management for enchondroma?
-curettage and bone graft
what disease causes multiple enchondromas?
Maffucci’s disease
what diseases cause enchondromas?
Ollier’s disease
Maffucci’s disease
what is a simple bone cyst?
-a benign single cavity, fluid-filled cyst in the bone
where are simple bone cysts commonly found?
- metaphysis of long bones
- talus and calcanus of foot
what causes a simple bone cyst?
-growth defect in the physis (growth plate)
what is the investigations for simple bone cyst?
-may be an incidental finding on an Xray
what is the treatment for a simple bone cyst?
-curettage and bone grafting with or without stabilisation
what is an aneurysmal bone cyst?
- a benign bone cyst
- lesions of bone containing may blood/serum filled chambers
what causes aneurysmal bone cysts?
-small arteriovenous malformation
where do aneurysmal bone cysts typically occur?
in metaphysis of long bones, flat bones (skull and ribs) and vertebral bodies
how do aneurysmal bone cysts present and why?
very painful as they cause cortical expansion and destruction
what is the treatment for aneurysmal bone cysts?
-curettage, bone grafting and may need to use bone cement
what is an osteoid osteoma?
- benign bone tumour
- small nidus of immature bone surrounded by intense sclerotic halo that secretes prostaglandins
who is more commonly affected by an osteoid osteoma?
-adolescents
where do osteoid osteoma commonly occur?
- proximal femur
- vertebra
- diaphysis of long bones
how does osteoid osteomapresent?
-constant, dull pain, worse at night that is greatly relieved by NSAIDs
what is used to confirm the diagnosis of an osteoid osteoma?
- CT scan
- bone scan
what treatment is given for osteoid osteoma?
- NSAIDs for pain relief
- can be self resolving, if not then CT radiofrequency ablation may be used
what is a giant cell tumour?
-a rare, aggressive but benign tumour
where do giant cell tumours usually occur?
- most commonly around the knee and in distal radius
- can also occur in other long bones, the pelvis and spine
how do giant cell tumours present?
- occur as physis has fused and are locally destructive so destroy the cortex
- painful
- can cause pathological fractures
occur in:
- typically distal radius and knee
- long bones
- pelvis
- spine
what investigations are done for giant cell tumours?
Xray= will show a soap bubble appearance
Bone biopsy= will show large multinucleated giant cells
what investigations are done for giant cell tumours?
Xray= will show a soap bubble appearance
Bone biopsy= will show large multinucleated giant cells
what is the treatment for giant cell tumours?
- intra lesional excision
- may need joint replacement for very aggressive tumours
what is fibrous dysplasia?
-a benign bone condition that causes normal bone to be replaced with fibrous tissue
what causes fibrous dysplasia?
-a genetic condition
what parts of the body does fibrous dysplasia tend to affect?
- femur
- tibia
- humerus
- pelvis
- skull
- ribs
how does fibrous dysplasia present?
- bone curvature
- bone deformity
- bone fractures
- bone pain
- swelling
what investigations are done for fibrous dysplasia?
bone scan
what is the treatment for fibrous dysplasia?
- biphosphonates to relieve pain
- internal fractures stabilised
what is Brodie’s abscess?
-a benign and subacute form of osteomyelitis that is contained to a localised area and walled off by fibrous and granulation tissue
what causes Brodie’s abscess?
-staph aureus
what investigations can be done for Brodie’s abscess?
Xray will show lytic lesion of bone
what is Brown tumour?
-a benign focal bone lesion caused by increased osteoclastic activity, fibroblastic proliferation and found in patients with uncontrolled hyperparathyroidism
what disease is linked with Brown Tumour?
-hyperparathyroidism
where do Brown tumours commonly present?
- maxilla
- mandible
where do Brown tumours commonly present?
- maxilla
- mandible
how do Brown’s tumours present on an Xray?
-as a lytic lesion of bone
what is the most common malignant bone tumour?
-osteosarcoma
what is an osteosarcoma?
- it is the most common malignant bone tumour
- bone producing tumour
- every malignant tumour that produces bone is classed an an osteosarcoma until proven otherwise
who is typically affected by osteosarcoma?
<20
where do osteosarcomas typically present?
> 50% occur in the knee
where do osteosarcomas typically metastases to?
the lung
how do osteosarcomas typically spread?
- mainly through the blood
- also can spread through lymphatics
how does osteosarcoma present?
- constant pain
- weight loss
- worse at night
- fatigue
what is a chondrosarcoma?
- a malignant cartilage producing tumour
- it is not as aggressive or common as osteosarcoma
who does chondrosarcoma usually affect?
-the average age is 45 years
where does chondrosarcoma usually occur?
- pelvis
- proximal femur
how does chondrosarcoma usually present?
- constant pain
- swelling
- fracture due to weakened bone
- if pressing on spinal cord they may experience weakness, numbness or incontinence (urination or defecation)
what is the treatment for chondrosarcoma and why?
- surgery
- as they are very large and slow to metastasise
- they also do not respond to radiotherapy or adjuvent chemotherapy
what is the second most common malignant bone tumour?
Ewings sarcoma
which malignant bone tumour has the worst prognosis?
Ewing’s sarcoma
what is Ewing’s sarcoma?
- the second most common malignant bone tumour
- bone tumour with the worst prognosis
- small round blue cell tumour
what causes Ewing’s sarcoma?
translocation mutation between. chromosome 11 and 22
where does Ewings sarcoma typically present?
long bones
-most commonly in femur
how does Ewings sarcoma present on an Xray?
-it looks like onion skin
what is the treatment for Ewing’s sarcoma?
- suregery to remove the tumous
- radiotherapy and chemotherapy
what is a lymphoma?
-a malignant tumour of the round cells of lymphatic system and macrophages
how do lymphomas present?
- night sweats
- unexplained weight loss
- fever
- lymphadenopathy
- fatigue
what is the treatment for lymphoma?
primary: surgery
metastatic: chemotherapy or radiotherapy
what is the survival rate for lymphoma?
usually <2 years
what is a myeloma?
-a malignant bone tumour caused by clonal proliferation of abnormal plasma cells which arise from bone marrow
what would you call a myeloma that presents as a solitary lesion and what would you call a myeloma that presents as multiple lesions?
solitary: plasmacytoma
multiple: multiple myeloma
how does myeloma present?
- weakness
- backpain
- fatigue
- weight loss
- anaemia
what is the treatment for myeloma?
plasmacytoma:
-surgery
multiple myeloma:
-chemotherapy
what investigations are done for myeloma?
Plasma protein electrophesis:
-showing high levels of paraprotein
Early morning urine collection for Bence Jones protein assay
