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Musculoskeletal > Bone tumours > Flashcards

Bone tumours Flashcards

1
Q

What is the commonest benign bone tumour?

A

Osteochondroma

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2
Q

What is the tumour assocated with osteochondroma?

A

A bony outgrowth on the external surface with a cartilaginous cap

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3
Q

What symtpoms are associated with osteochondroma?

A

Localised pain

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4
Q

When should an osteochondroma be excised and why?

A

Small chance of turning malignant

Should excise if growing in size or causing pain

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5
Q

What is an enchondroma?

A

An intramedullary and usually metaphyseal cartilaginous tumour

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6
Q

What causes enchondroma?

A

Failure of normal enchondral ossification at the growth plate

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7
Q

Where do enchondroma tend to occur?

A

Femur

Humerus

Tibia

Small bones of hands and feet

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8
Q

What is the appearance of enchondroma on imaging?

A

Usually lucent but can undergo mineralization with a patchy sclerotic appearance

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9
Q

What is a complication of enchondroma?

A

Asymptomatic but can weaken bone causing pathological fractures

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10
Q

What is the treatment avaliable for enchondroma and when is it used?

A

Once a fracture has healed or if there is a risk of impending fracture they may be scraped out (curettage) and filled with bone graft to strengthen the bone

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11
Q

What is a simple bone cyst?

A

A single cavity benign fluid filled cyst in a bone

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12
Q

Where do bone cysts occur?

A

Proximal humerus and femur

Talus
Calcaneus

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13
Q

What is an aneurysmal bone cyst?

A

A cyst that contains lots of chambers which are filled with blood or serum

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14
Q

Where do aneurysmal cysts occur?

A

The metaphyses of many different long bones, flat bones (ribs, skull) and vertebral bodies

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15
Q

What are the characteristics of an aneurysmal cyst?

A

Locally agressive causing cortical expansion and destruction and is usually painful, with an increased risk of pathological fracture

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16
Q

What is the characteristic appearance of a giant cell bone tumour on Xray?

A

Soap bubble appearance

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17
Q

Where do giant cell tumours of bone tend to occur?

A

Knee

Distal radius

Other long bones

Pelvis

Spine

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18
Q

Where in bone do giant cell tumours occur?

A

Usually metaphyses, but sometimes epiphyses and can spread to subchondral bone

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19
Q

What are the characteristics of a giant cell bone tumour?

A

Locally invasive, destroying cortex

Benign

Can metastasise to lung

Occur after physis has fused

20
Q

What is the treatment for giant cell bone tumour?

A

Intralesional excision with use of phenol, bone cement or liquid nitrogen to destroy remaining tumour material and reduce the risk of recurrence

21
Q

What is fibrous dysplasia?

A

A disease of a bone usually occurring in adolescence where a genetic mutation results in lesions of fibrous tissue and immature bone

22
Q

In fibrous dysplasia, what do the bones look like and why?

A

Defective mineralization may result in angular deformities and the affected bone is wider with thinned cortices

23
Q

What deformity can occur in extensive involvement of the proximal femur in fibrous dysplasia?

A

Shepard’s crook deformity

24
Q

What are the complications of fibrous dysplasia?

A

Pain

Stress fractures

Deformity of bones e.g. Shepard’s crook deformity

25
Q

What does fibrous dysplasia show on bone scan?

A

Intense increase in uptake during development but the lesion usually becomes inactive

26
Q

How is fibrous dysplasia treated?

A

Bisphosphonates to reduce pain

Pathological fractures should be stabalised with internal fixation and cortical bone grafts to improve strength

27
Q

What is an osteoid osteoma?

A

A small nidus of immature bone surrounded by an intense sclerotic halo

28
Q

At what age does osteoid osteoma tend to occur?

A

During adolescence

29
Q

What common sites does osteoid osteoma affect?

A

Proximal femur

The disphysis of long bones

Vertebrae

30
Q

What is the predominant clinical feature in osteoid osteoma?

A

Intense constant pain, worse at night due to the intense inflammatory response

31
Q

What signs on Xray indicate a malignant bone tumour?

A

Cortical destruction

Aperiosteal reaction (raised periosteum producing bone),

New bone formation (sclerosis as well as lysis from destruction)

Extension into the surrounding soft tissue envelope

32
Q

What is the most common form of malignant primary bone tumour?

A

Osteosarcoma

33
Q

Why is osteosarcoma named as it is?

A

It is a malignant tumour producing bone

34
Q

What age groups are most commonly affected by osteosarcoma?

A

Adolescents and young adults

35
Q

Where is the most common site of bone involvemnent in osteosarcoma?

A

60% of tumours involve the knee

36
Q

What sites can osteosarcoma occur at?

A

Knee

Pelvis

Proximal femur

Proximal humerus

37
Q

What is the usual form of metastatic spread from osteosarcoma?

A

Usually haematogenous

Sometimes lymphatic

38
Q

What treatment can prolong surivival in osteosarcoma?

A

Chemotherapy

39
Q

What is a chondrosarcoma?

A

A cartilage producing primary bone tumour and is less common and less aggressive than osteosarcoma

40
Q

What is the mean age of patient affected by chondrosarcoma?

A

45

41
Q

What are the characteristics of chondrosarcoma?

A

Very large

Very slow to metastasise

42
Q

What is Ewing’s sarcoma?

A

A malignant tumour of endothelial cells in the marrow

43
Q

Which type of malignant bone tumour has the poorest prognosis?

A

Ewing’s sarcoma

44
Q

At what age to most cases of Ewing’s sarcoma occur?

A

10 - 20

45
Q

What is Ewing’s sarcoma commonly mistaken for and why?

A

Osteomyelitis

Fever, raised inflammatory markers and a warm swelling

Musculoskeletal (19 decks)

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