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Bone Tumours Flashcards

1
Q

When would you see immature, woven bone under a microscope?

A

In babies

In unhealthy adults (pathological sign)

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2
Q

What is the most common primary bone tumour?

A

Myeloma

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3
Q

Which metastatic carcinomas commonly metastasise to the bone?

A 
Bronchus cancer
Breast
Prostate
Kidney
Thyroid (follicular)
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4
Q

Which childhood cancers commonly metastasise to the bone?

A

Neuroblastoma

Rhabdomyosarcoma

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5
Q

Which bones are often metastasised to?

A

Long bones and the vertebrae (have a good blood supply)

  • femer
  • humerous
  • vertebrae - prostate cancer easily enters the spinal blood supply
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6
Q

Describe the effects on bone of metastases.

A 
Asymptomatic 
Bone pain
Bone destruction 
Long bones
- pathological fracture sue to bone lysis 
Spine
- vertebral collapse
- spinal cord compression
- nerve root compression
- back pain
- vertebral crush fracture
Hypercalcaemia 
- renal stones
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7
Q

Describe a compression fracture of the spine.

A

A vertebral bone that has decreased at least 15-20% in height due to a fracture

  • the affected vertebrae can extend into the spinal cord
  • an present with spinal cord symptoms
  • emergency
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8
Q

What are the two different ways metastases can affect the bone, and which is most common?

A

Lytic - most common

Sclerotic

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9
Q

How can lytic metastases be seen on X-Ray?

A

Blackened areas of lucency in the bone

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10
Q

Describe the effect lytic metastasis can have on bone.

A

These are typically quite aggressive
Osteoclast action is stimulated by cytokines from the tumour cells
- so the bone is degraded away
- calcium is released into the blood (hypercalcaemia)
- likely to cause a pathological fracture

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11
Q

Which cancers normally metastasise to cause sclerotic lesions?

A

Prostate cancer

Carcinoid tumour

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12
Q

Which cancers normally metastasise to cause lytic lesions?

A

Lung cancer
Thyroid cancer
Kidney cancer

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13
Q

Which cancers normally metastasise to cause mixed lesions?

A

Breast cancer
Testicular cancer
Ovarian cancer

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14
Q

What inhibits lytic bone metastases?

A

Bisphosphonates

- inhibit osteoclast action

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15
Q

Describe the appearance of a sclerotic lesion on an X-Ray.

A

Whiter than normal bone

- patches

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16
Q

Describe the effects of sclerotic metastases on bone.

A

Stimulation of osteoblasts to produce new, woven, lamellar bone

  • increased bone density produces the white sclerosis
  • osteoblast activity is induced by tumour cells
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17
Q

What are the most common causes of solitary bone metastases?

A

Renal and thyroid carcinomas

  • this type of metastasis isn’t at the terminal stage
  • long term survival is common
  • removed surgically
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18
Q

What is the pathology of a myeloma?

A

Malignant disorder of plasma cells
- monoclonal proliferation
- produced excessive identical antibodies
These mutated plasma cells invade bone and cause tumour sites

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19
Q

What are solitary and multiple tumours of myelomas called?

A

Solitary
- plasmacytomas
Mutliple
- multiple myelomas

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20
Q

What effect do myelomas have on bone?

A 
Bone lesions
- punched out areas of lytic foci 
Generalised areas of osteopenia 
- loss of bone mass
Bone marrow replacement as plasma cell component increases (5% is normal)
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21
Q

What effects on the system does myeloma have?

A

Mostly related to bone marrow replacement

  • anaemia (loss of red blood cells)
  • risk of infection increases (loss of WBC)
  • bleeding risk increases (loss of platelets)
22
Q

What tests can you perform to check for myeloma?

A 
ESR >100 
- because excess Ig clump to RBCs
Serum electrophoresis
- monoclonal band (accumulation of identical antibodies in the blood)
Urine tests
- excessive production of light body antibody fragments filter into the urine
Blood tests
- anaemia
- clotting
- ESR
- WCC 
Scleritic survey to look for punched out foci (pepper pot skull)
23
Q

Describe the appearance of plasma cells in a bone marrow aspirate when the person has myeloma.

A

Binucleated
Pleomorphic - different sizes
Prominent nuclei
Large numbers

24
Q

Why is in-situ hybridisation useful when diagnosing myeloma?

A

Because plasma cells increase in number in reactive conditions, this helps to tell the difference between a reactive condition and myeloma

  • plasma cells in reactive condition produce polyclonal antibodies (so Kappa and Lambda will stain)
  • plasma cells in myeloma only produce one light chain (monoclonal antibodies), so wither Kappa or Lambda are stained
25
How can myeloma cause renal impairment?
Light precipitate out into the renal tubules and cause myeloma kidney - renal failure - hypercalcaemia (from kidney damage and bone destruction) Amyloidosis - amyloid is an extracellular protein - light chains are a component of amyloid - so patients with myeloma can produce amyloid protein - this can then be deposited in the kidney (heart, spleen and GI)
26
Name the three benign primary bone tumours.
Osteoid osteoma (benign version of osteosarcoma) Chondroma (benign version of chondrosarcoma) Giant cell tumour
27
Name the three malignant primary bone tumours.
Osteosarcoma Chondrosarcoma Ewing's tumour
28
What is an osteoid osteoma?
A small, benign osteoblastic proliferation - can occur in any bone, especially long bones and the spine The small lesion has a central area of bone formation (nidus) enclosed in a sclerotic shell - nidus is made of woven bone and osteoblasts
29
What is the defining feature of an osteoid osteoma?
Pain - worse at night, relieved by aspiring | Causes scoliosis is present in the spine
30
Who is an osteoid osteoma most common in?
They are common at any age, but especially in adolescents | - M:F - 2:1
31
What is the definition of an osteosarcoma?
A malignant tumour whose cells form osteoid (uncalcified bone) or bone
32
Describe the aetiology of an osteosarcoma.
Age - peak around 10-25 Site - metaphysis of long bones (50% occur around the knee) Sex - 3:2, M:F Incidence - 2-3/million /year Usually presents late so is hard to treat
33
What are the clinical features of an osteosarcoma.
``` Asymptomatic Bone swelling Bone pain - persistent and constantly gets worse Reduced joint function ```
34
Describe the natural history of osteosarcoma.
Highly malignant Metastasises early to the lung Spreads quickly 50-60% long term survival
35
How are osteosarcomas treated?
``` 4-5 cycles of chemotherapy Radiotherapy Conservative therapy - try and preserve as much function as possible Amputation - in severe cases Endoprosthetic replacement ```
36
Briefly describe the appearance of bone in an osteosarcoma.
Central bone necrosis Caudmans triangle indicates the aggressive process Tumour penetrates the bone cortex from the medullary cavity
37
Name some of the osteosarcoma variants, and whether they are worse or better prognosis.
``` Normal prognosis - osteoblastic - chondroblastic - fibroblastic Worse prognosis - Paget's (common in older people) - mulitfocal - post-irradiation Better prognosis - parosteal - periosteal - low grade central ```
38
What is Paget's disease?
A disorder of excessive bone turnover - increased osteoclasis, increased bone formation - causes structurally weak bone - disorganised bone architecture Commonly affects the vertebrae, pelvis, skull and femer
39
What are the complications of Paget's disease?
``` Bone pain Deformity - bowing of the long bones Pathological fractures - due to structurally weak bone Osteoarthritis Deafness - bone thickening at the base of the skull Spinal cord copression High cardiac output - cardiac failure Paget's sarcoma ```
40
Describe Paget's sarcoma.
``` Second osteosarcoma peak in the elderly Usually lytic Common in long bones and the spine Very poor prognosis Metastasises early to the lungs and bone ```
41
Name three cartilaginous tumours.
``` Benign - enchondroma - osteocartilaginous exostosis Malignant - chondrosarcoma ```
42
What is osteocartilaginous exostosis?
A benign outgrowth of cartilage with endochondral ossification - probably derived from the growth plate
43
How common is osteocartilaginous exostosis?
Very common in growing children Sometimes (uncommonly) caused by multiple-diaphyseal aclasis - autosomal dominant condition
44
What does secondary chondrosarcoma arise from?
Benign lesions like enchondroma or exostosis that undergo malignant transformation
45
Who is most likely to get a chondrosarcoma?
Middle aged or the elderly | Males to female; 2:1
46
What is a chondrosarcoma?
A malignant cartilage forming tumour - slow development - commonly metastasises to the lung
47
Where do chondrosarcomas commonly arise?
``` Pelvis Proximal ends of the femur Humerous Ribs Shoulder girdle ```
48
What are the cellular differences between a chondroma and a chondrosarcoma?
More cells are present | Pleomorphism
49
What is a Ewing's sarcoma?
A rapidly growing malignant round cell tumour - composed of densly packed dmsll eclls with a round nuecli - most commonly a paediatric disease
50
Where does a Ewing's sarcoma commonly arise?
In the diaphysis of metaphysis of long bones | In flat bones of limb girdles
51
What are the clinical features of a Ewing's sarcoma?
``` Pain - increasing in severity - due to rapid growth Systemic illness - fever - anaemia - low WCC - increased ESR ```

Orthopaedics (13 decks)

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