Bone Tumours Flashcards
What is the most common type of bone tumour?
Metastasis from elsewhere
What is the most common type of PRIMARY bone tumour?
Myeloma
Apart from myeloma, list the main types of bone tumour. Consider:
a) Benign bone tumours (4)
b) Malignant bone tumours (3)
BENIGN: Osteoma Osteocartilagenous exostosis Enchondroma Giant cell tumour
MALIGNANT:
Osteosarcoma
Chondrosarcoma
Ewing’s tumour
List the 5 most common primary tumours which cause bone metastases in adults.
List 2 which often cause bone metastases in children.
ADULTS: Lung cancer Prostate cancer Follicular thyroid cancer Kidney cancer Breast cancer
CHILDREN:
Neuroblastoma
Rhabdomyosarcoma
What are the 2 types of bone metastasis?
Lytic bone metastases
Sclerotic bone metastases
Describe the pathophysiology of lytic bone metastases. (2)
- Tumour cells release cytokines, which stimulate osteoclasts
- Osteoclasts resorb bone, creating lytic lesions
Describe the pathophysiology of sclerotic bone metastases. (1)
- Tumour cells induce new woven bone formation
On an x-ray, what are the features of:
a) Lytic metastases?
b) Sclerotic metastases?
LYTIC METS:
Translucent lesion
SCLEROTIC METS:
White, sclerotic lesion
Describe the clinical features of bone metastases. Consider:
a) General features (4)
b) Features in metastasis to long bones (1)
c) Features in metastasis to the spine (4)
GENERAL: Asymptomatic Bone pain Bone destruction Hypercalcaemia
LONG BONES:
Pathological fracture
SPINAL METASTASES: Vertebral collapse Spinal cord compression Nerve root compression Back pain
Which investigations would you do for bone metastases? (3)
X-ray
MRI
PET CT scan
Most bone metastases are multiple. Which types of primary cancer usually cause solitary bone metastases? (2)
Kidney cancer
Follicular thyroid cancer
Define myeloma.
What are the 2 types?
Def.: “a monoclonal proliferation of plasma cells”
Plasmacytoma (solitary myeloma)
Multiple myeloma
Describe the clinical features of myeloma. (6)
Bone lesions, e.g.
- Lytic foci
- General osteopenia
Bone marrow dysfunction, e.g.
- Anaemia
- Leukopenia
- Neutropenia
Immunoglobulin excess, e.g.
-Elevated ESR
Which investigations would you do for myeloma? (6)
Bone marrow aspirate:
-Proliferation of monoclonal plasma cells
Bloods:
- FBC (anaemia, WCC etc.)
- Serum electrophoresis (monoclonal band)
- In situ hybridisation
Urine:
-Bence Jones protein
X-ray:
- Skeletal survey
- Lytic lesions
- Pepperpot skull
List 2 consequences of myeloma.
Briefly explain why they happen.
Renal impairment (accumulation of immunoglobulin light chains)
Bone marrow failure (BM producing so many abnormal cells that it can’t produce normal cells anymore)
Define osteoid osteoma.
Small, benign osteoblastic proliferation
Describe the clinical features of an osteoma. (3)
Is it benign or malignant?
BENIGN
Pain, which is: -Worse at night -Relieved by aspirin Scoliosis Juxta-articular tumours, e.g. -Sympathetic synovitis
Define enchondroma.
Lobulated mass of cartilage within the medulla of bones
Describe the clinical features of an enchondroma. (4)
Is it benign or malignant?
BENIGN
Asymptomatic
Low cellularity
Soft tissue swelling
Pathological fracture
Define osteocartilagenous exostosis.
What is another name for this tumour?
Osteochondroma
Def.: “Benign outgrowths of cartilage with endochondral ossification, probably arising fro the growth plate”
List 1 cause of osteochondroma.
Multiple diaphyseal aclasis (hereditary multiple osteochondromas)
-autosomal dominant inheritance
Define osteosarcoma.
Malignant tumour whose cells form osteoid (un-mineralised organic component of bone) or bone
List 6 types of osteosarcoma which have a normal prognosis (although this prognosis is also pretty poor).
Osteoblastic Chondroblastic Fibroblastic Telangiectatic Small cell osteosarcoma Sclerotic osteosarcoma
List 3 types of osteosarcoma which have a worse prognosis than normal.
Paget’s osteosarcoma
Multifocal osteosarcoma
Post-irradiation osteosarcoma
List 3 types of osteosarcoma which have a slightly better prognosis than usual.
Parosteal osteosarcoma
Periosteal osteosarcoma
Low grade central osteosarcoma
What condition increases risk of osteosarcoma?
Paget’s disease of the bone
Describe the pathophysiology of Paget’s disease of the bone. (3)
- Increased osteoclast activity, causing increased bone formation
a. This forms structurally weak bone - New bone has a disorganised structure, making it structurally weak
- This can cause Paget’s osteosarcoma
a. Lytic lesions
Describe the clinical features of Paget’s disease of the bone. (8)
Bone pain Deformity Pathological fracture Osteoarthritis Deafness Spinal cord compression High cardiac output Paget's osteosarcoma
What sort of staining is used to diagnose Ewing’s tumour?
CD99 staining
