Bone tumours Flashcards
top 5 primary tumours that metstasise to bone
breast
prostate
lung
kidney
thyroid
common non-malignant tumours of bone and soft tisseu 3
enchondromas
osteochondroma
lipoma
how do myeloma and lymohas present 1
usually with MSK pain
red flag syx assoc w MSK malignancy in adults 4
night pain
unremitting pain
non-traumatic joint of limb pain
weight loss
Mx of malignant secondary bone lesions 7
Mx-range of oncology options:
-chemo
-radio (internal and external)
-mAB
-bisphosphonates
-surgery
-injecting bone cement into bones
-pain control
IX for secondary bone tumours 2
MRI and PET-CT
common sites of bone metastis that cause pain 4
spine
pelvis
hips
long bones
which primary bone tumour is more common in children
sarcoma
where do osteosarcomas present
in the metaphyseal portion of the bone
common presenation of sarcoma 4
limping child
progressive swelling around the knee
any progressive limb swelling
night pain
most common primary malignant bone tumour
multiple myeloma
-accounts for 45%
hallmark bone manifestation of multiple myeloma 1
multiple punched-oout osteolytic lesions
2nd most common primary malignant bone tumour
osteosarcoma
who gets primary osteosarcomas and where
typically adolescents
-aries in the metaphysis of the long bone (esp the knee)
who gets secondary osteosarcomas and where
typically 10-20yrs w peak in adolescent growth
-arises in bones affected by Pagets disease or post-irridation
difference between primary and secondary osteosarcoma
Primary osteosarcoma, originates in bone cells and is not directly associated with another cancer or disease.
Secondary osteosarcoma also originates in bone cells but is associated with either a skeletal disease or treatment from another condition (typically cancer
x-ray findings in osteosarcoma 2
bone destruction and new bone formation- sunburst pattern [45]
marked periosteal elevation- Codsmans tirangle [46]
(50%. of lesions around the knee)
what other imaging can be used in osteosarcoma diagnosis and why 2
staging MRI- assess for intramedullary spread
HRCT chest (high resolution)
-screen for lung mets
-ESP if raised ALP
treatment for osteosarcoma 2
historically limp amputated
-still has 80% recurrence rates
-try and do limb salvage surgery
neoadjuvant chemo (prior to surgery)
standard therapy is limb salvage surgery and neoadjuvant chemo
predisosing factors for osteosarcoma 3
mutations of Rb gene (hence assoc w retinoblastoma)
Pagets disease of the bone
radiotherapy
define ewings sarcoma
malignant round-cell tumour of long bones (diaphysis) and limb girdles
who gets ewings sarcoma
typically adolescents
what genetic abnormality is commonly seen in ewings sarcoma
T11:22 chromosomal translocation
radiological features of ewings sarcoma 4
bone destruction
new bone formation in concentric layers- ‘onion ring’ sign [47]
soft tissue swelling
periosteal elevation
treatment for ewings sarcoma 3
chemo
surg
radio
key adverse prognositc factor for ewings sarcoma 1
mets at diagnosis
what can cause chondrosarcoma 2
can be de novo or from malignant transformation of chondromas (cartilage tumours)
what is chondrosarcoma assoc with 2
pain and a lump
who gets chondrosarcoma
common in middle age
where is affected by chondrosarcoma
axial tumour
typical xray appearance of chondrosarcoma
popcorn calcifacation [48]
-(MRI/CT will better define tumour extent)
treatment for chondrosarcoma 1
has no response to radio/chemo
treatment is excision
commonest benign bone tumour
osteochondroma
where does osteochondroma typically present 3
above the knee
proximal femur
humerus
presentaion of osteochondroma 2
painful mass
associated with trauma
x-ray appearance of osteochondroma
bony spur arising from cortex & usually pointing away from joint
treatemtn for osteochondroma 2
remove if causing syx
any tumour continuing to grow after skeletal maturity must be removed
what condition predisposes patients to osteochondroma
-inheritance pattern?
-appearance
-risk
hereditary muoltiple exostoses
-Autosomal dominant
-causes short stature and forearm, ankle and knee deformity
up to 10% of osteochondroma will become malignant in these patients
who gets osteochondroma
male <20yr
define osteoid osteoma
painful benign bone lesion
who gets osteoid osteoma and where
most commonnly in long bones (can also occur in spine)
and males 10-25yo
appearance of osteoid osteoma on xray
local cortical sclerosis on XR
-w central radiolucent nidus[49]
-within nidis can be a small nuclear of calcification
-
define nidus
the centre of an osteoid osteoma
-consists of growing tumour cells, bld vsls and osteoblasts/clasts
what causes the pain in osteoid osteoma
the nidus releases prostaglandins that cause pain unrelated to activity
treatement for osteoid osteoma 2
ibuprofen relieves pain caused by the nidus
CT guided biopsy and radio-frequency ablation
(plain XR may miss these allwasy CT)
define chondromas
benign cartilaginous tumours arising from bone surfaces
define enchondromata
a chondromas within the medulla
presenation of chondromas
may cause local swelling
or
fracture
Mx of chondromas 1
rarely needed
exclude conversion ot malignancy (chondrosarcoma)
define giant cell tumour
bening tumour of multinucelated giant cells within a fibrous stroma
peak incidence of giant cell tumour
20-40
where do giant cell tumour appear
epiphyses of long bones
appearance of giant cell tumour on XR
double bubble or soap bubble appearance [50]
