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Orthopaedics > Bone tumours > Flashcards

Bone tumours Flashcards

1
Q

top 5 primary tumours that metstasise to bone

A

breast

prostate

lung

kidney

thyroid

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2
Q

common non-malignant tumours of bone and soft tisseu 3

A

enchondromas

osteochondroma

lipoma

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3
Q

how do myeloma and lymohas present 1

A

usually with MSK pain

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4
Q

red flag syx assoc w MSK malignancy in adults 4

A

night pain

unremitting pain

non-traumatic joint of limb pain

weight loss

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5
Q

Mx of malignant secondary bone lesions 7

A

Mx-range of oncology options:
-chemo
-radio (internal and external)
-mAB
-bisphosphonates
-surgery
-injecting bone cement into bones
-pain control

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6
Q

IX for secondary bone tumours 2

A

MRI and PET-CT

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7
Q

common sites of bone metastis that cause pain 4

A

spine

pelvis

hips

long bones

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8
Q

which primary bone tumour is more common in children

A

sarcoma

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9
Q

where do osteosarcomas present

A

in the metaphyseal portion of the bone

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10
Q

common presenation of sarcoma 4

A

limping child

progressive swelling around the knee

any progressive limb swelling

night pain

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11
Q

most common primary malignant bone tumour

A

multiple myeloma
-accounts for 45%

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12
Q

hallmark bone manifestation of multiple myeloma 1

A

multiple punched-oout osteolytic lesions

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13
Q

2nd most common primary malignant bone tumour

A

osteosarcoma

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14
Q

who gets primary osteosarcomas and where

A

typically adolescents
-aries in the metaphysis of the long bone (esp the knee)

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15
Q

who gets secondary osteosarcomas and where

A

typically 10-20yrs w peak in adolescent growth

-arises in bones affected by Pagets disease or post-irridation

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16
Q

difference between primary and secondary osteosarcoma

A

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

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17
Q

x-ray findings in osteosarcoma 2

A

bone destruction and new bone formation- sunburst pattern [45]

marked periosteal elevation- Codsmans tirangle [46]

(50%. of lesions around the knee)

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18
Q

what other imaging can be used in osteosarcoma diagnosis and why 2

A

staging MRI- assess for intramedullary spread

HRCT chest (high resolution)
-screen for lung mets
-ESP if raised ALP

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19
Q

treatment for osteosarcoma 2

A

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

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20
Q

predisosing factors for osteosarcoma 3

A

mutations of Rb gene (hence assoc w retinoblastoma)

Pagets disease of the bone

radiotherapy

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21
Q

define ewings sarcoma

A

malignant round-cell tumour of long bones (diaphysis) and limb girdles

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22
Q

who gets ewings sarcoma

A

typically adolescents

23
Q

what genetic abnormality is commonly seen in ewings sarcoma

A

T11:22 chromosomal translocation

24
Q

radiological features of ewings sarcoma 4

A

bone destruction

new bone formation in concentric layers- ‘onion ring’ sign [47]

soft tissue swelling

periosteal elevation

25
Q

treatment for ewings sarcoma 3

A

chemo
surg
radio

26
Q

key adverse prognositc factor for ewings sarcoma 1

A

mets at diagnosis

27
Q

what can cause chondrosarcoma 2

A

can be de novo or from malignant transformation of chondromas (cartilage tumours)

28
Q

what is chondrosarcoma assoc with 2

A

pain and a lump

29
Q

who gets chondrosarcoma

A

common in middle age

30
Q

where is affected by chondrosarcoma

A

axial tumour

31
Q

typical xray appearance of chondrosarcoma

A

popcorn calcifacation [48]
-(MRI/CT will better define tumour extent)

32
Q

treatment for chondrosarcoma 1

A

has no response to radio/chemo

treatment is excision

33
Q

commonest benign bone tumour

A

osteochondroma

34
Q

where does osteochondroma typically present 3

A

above the knee

proximal femur

humerus

35
Q

presentaion of osteochondroma 2

A

painful mass

associated with trauma

36
Q

x-ray appearance of osteochondroma

A

bony spur arising from cortex & usually pointing away from joint

37
Q

treatemtn for osteochondroma 2

A

remove if causing syx

any tumour continuing to grow after skeletal maturity must be removed

38
Q

what condition predisposes patients to osteochondroma
-inheritance pattern?
-appearance
-risk

A

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

39
Q

who gets osteochondroma

A

male <20yr

40
Q

define osteoid osteoma

A

painful benign bone lesion

41
Q

who gets osteoid osteoma and where

A

most commonnly in long bones (can also occur in spine)

and males 10-25yo

42
Q

appearance of osteoid osteoma on xray

A

local cortical sclerosis on XR
-w central radiolucent nidus[49]
-within nidis can be a small nuclear of calcification
-

43
Q

define nidus

A

the centre of an osteoid osteoma
-consists of growing tumour cells, bld vsls and osteoblasts/clasts

44
Q

what causes the pain in osteoid osteoma

A

the nidus releases prostaglandins that cause pain unrelated to activity

45
Q

treatement for osteoid osteoma 2

A

ibuprofen relieves pain caused by the nidus

CT guided biopsy and radio-frequency ablation
(plain XR may miss these allwasy CT)

46
Q

define chondromas

A

benign cartilaginous tumours arising from bone surfaces

47
Q

define enchondromata

A

a chondromas within the medulla

48
Q

presenation of chondromas

A

may cause local swelling

or

fracture

49
Q

Mx of chondromas 1

A

rarely needed

exclude conversion ot malignancy (chondrosarcoma)

50
Q

define giant cell tumour

A

bening tumour of multinucelated giant cells within a fibrous stroma

51
Q

peak incidence of giant cell tumour

A

20-40

52
Q

where do giant cell tumour appear

A

epiphyses of long bones

53
Q

appearance of giant cell tumour on XR

A

double bubble or soap bubble appearance [50]

Orthopaedics (15 decks)

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