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Orthopaedics > Bone Tumours > Flashcards

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
Q

How can myeloma cause renal impairment?

A

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
Q

Name the three benign primary bone tumours.

A

Osteoid osteoma (benign version of osteosarcoma)
Chondroma (benign version of chondrosarcoma)
Giant cell tumour

27
Q

Name the three malignant primary bone tumours.

A

Osteosarcoma
Chondrosarcoma
Ewing’s tumour

28
Q

What is an osteoid osteoma?

A

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
Q

What is the defining feature of an osteoid osteoma?

A

Pain - worse at night, relieved by aspiring

Causes scoliosis is present in the spine

30
Q

Who is an osteoid osteoma most common in?

A

They are common at any age, but especially in adolescents

- M:F - 2:1

31
Q

What is the definition of an osteosarcoma?

A

A malignant tumour whose cells form osteoid (uncalcified bone) or bone

32
Q

Describe the aetiology of an osteosarcoma.

A

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
Q

What are the clinical features of an osteosarcoma.

A 
Asymptomatic 
Bone swelling
Bone pain
- persistent and constantly gets worse
Reduced joint function
34
Q

Describe the natural history of osteosarcoma.

A

Highly malignant
Metastasises early to the lung
Spreads quickly
50-60% long term survival

35
Q

How are osteosarcomas treated?

A 
4-5 cycles of chemotherapy 
Radiotherapy 
Conservative therapy 
- try and preserve as much function as possible 
Amputation - in severe cases
Endoprosthetic replacement
36
Q

Briefly describe the appearance of bone in an osteosarcoma.

A

Central bone necrosis
Caudmans triangle indicates the aggressive process
Tumour penetrates the bone cortex from the medullary cavity

37
Q

Name some of the osteosarcoma variants, and whether they are worse or better prognosis.

A 
Normal prognosis 
- osteoblastic 
- chondroblastic
- fibroblastic
Worse prognosis
- Paget's (common in older people)
- mulitfocal
- post-irradiation 
Better prognosis
- parosteal
- periosteal 
- low grade central
38
Q

What is Paget’s disease?

A

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
Q

What are the complications of Paget’s disease?

A 
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
Q

Describe Paget’s sarcoma.

A 
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
Q

Name three cartilaginous tumours.

A 
Benign
- enchondroma
- osteocartilaginous exostosis
Malignant 
- chondrosarcoma
42
Q

What is osteocartilaginous exostosis?

A

A benign outgrowth of cartilage with endochondral ossification
- probably derived from the growth plate

43
Q

How common is osteocartilaginous exostosis?

A

Very common in growing children
Sometimes (uncommonly) caused by multiple-diaphyseal aclasis
- autosomal dominant condition

44
Q

What does secondary chondrosarcoma arise from?

A

Benign lesions like enchondroma or exostosis that undergo malignant transformation

45
Q

Who is most likely to get a chondrosarcoma?

A

Middle aged or the elderly

Males to female; 2:1

46
Q

What is a chondrosarcoma?

A

A malignant cartilage forming tumour

  • slow development
  • commonly metastasises to the lung
47
Q

Where do chondrosarcomas commonly arise?

A 
Pelvis
Proximal ends of the femur
Humerous 
Ribs
Shoulder girdle
48
Q

What are the cellular differences between a chondroma and a chondrosarcoma?

A

More cells are present

Pleomorphism

49
Q

What is a Ewing’s sarcoma?

A

A rapidly growing malignant round cell tumour

  • composed of densly packed dmsll eclls with a round nuecli
  • most commonly a paediatric disease
50
Q

Where does a Ewing’s sarcoma commonly arise?

A

In the diaphysis of metaphysis of long bones

In flat bones of limb girdles

51
Q

What are the clinical features of a Ewing’s sarcoma?

A 
Pain - increasing in severity
- due to rapid growth 
Systemic illness
- fever
- anaemia
- low WCC 
- increased ESR

Orthopaedics (13 decks)

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