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11. Orthopaedics > Bone Tumours > Flashcards

Bone Tumours Flashcards

1
Q

What is the most common type of bone tumour?

A

Metastasis from elsewhere

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2
Q

What is the most common type of PRIMARY bone tumour?

A

Myeloma

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3
Q

Apart from myeloma, list the main types of bone tumour. Consider:

a) Benign bone tumours (4)
b) Malignant bone tumours (3)

A 
BENIGN:
Osteoma
Osteocartilagenous exostosis
Enchondroma
Giant cell tumour

MALIGNANT:
Osteosarcoma
Chondrosarcoma
Ewing’s tumour

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4
Q

List the 5 most common primary tumours which cause bone metastases in adults.

List 2 which often cause bone metastases in children.

A 
ADULTS:
Lung cancer
Prostate cancer
Follicular thyroid cancer
Kidney cancer
Breast cancer

CHILDREN:
Neuroblastoma
Rhabdomyosarcoma

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5
Q

What are the 2 types of bone metastasis?

A

Lytic bone metastases

Sclerotic bone metastases

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6
Q

Describe the pathophysiology of lytic bone metastases. (2)

A
  1. Tumour cells release cytokines, which stimulate osteoclasts
  2. Osteoclasts resorb bone, creating lytic lesions
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7
Q

Describe the pathophysiology of sclerotic bone metastases. (1)

A
  1. Tumour cells induce new woven bone formation
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8
Q

On an x-ray, what are the features of:

a) Lytic metastases?
b) Sclerotic metastases?

A

LYTIC METS:
Translucent lesion

SCLEROTIC METS:
White, sclerotic lesion

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9
Q

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)

A 
GENERAL:
Asymptomatic
Bone pain
Bone destruction
Hypercalcaemia

LONG BONES:
Pathological fracture

SPINAL METASTASES:
Vertebral collapse
Spinal cord compression
Nerve root compression
Back pain
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10
Q

Which investigations would you do for bone metastases? (3)

A

X-ray
MRI
PET CT scan

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11
Q

Most bone metastases are multiple. Which types of primary cancer usually cause solitary bone metastases? (2)

A

Kidney cancer

Follicular thyroid cancer

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12
Q

Define myeloma.

What are the 2 types?

A

Def.: “a monoclonal proliferation of plasma cells”

Plasmacytoma (solitary myeloma)
Multiple myeloma

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13
Q

Describe the clinical features of myeloma. (6)

A

Bone lesions, e.g.

  • Lytic foci
  • General osteopenia

Bone marrow dysfunction, e.g.

  • Anaemia
  • Leukopenia
  • Neutropenia

Immunoglobulin excess, e.g.
-Elevated ESR

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14
Q

Which investigations would you do for myeloma? (6)

A

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
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15
Q

List 2 consequences of myeloma.

Briefly explain why they happen.

A

Renal impairment (accumulation of immunoglobulin light chains)

Bone marrow failure (BM producing so many abnormal cells that it can’t produce normal cells anymore)

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16
Q

Define osteoid osteoma.

A

Small, benign osteoblastic proliferation

17
Q

Describe the clinical features of an osteoma. (3)

Is it benign or malignant?

A

BENIGN

Pain, which is:
-Worse at night
-Relieved by aspirin
Scoliosis
Juxta-articular tumours, e.g.
-Sympathetic synovitis
18
Q

Define enchondroma.

A

Lobulated mass of cartilage within the medulla of bones

19
Q

Describe the clinical features of an enchondroma. (4)

Is it benign or malignant?

A

BENIGN

Asymptomatic
Low cellularity
Soft tissue swelling
Pathological fracture

20
Q

Define osteocartilagenous exostosis.

What is another name for this tumour?

A

Osteochondroma

Def.: “Benign outgrowths of cartilage with endochondral ossification, probably arising fro the growth plate”

21
Q

List 1 cause of osteochondroma.

A

Multiple diaphyseal aclasis (hereditary multiple osteochondromas)
-autosomal dominant inheritance

22
Q

Define osteosarcoma.

A

Malignant tumour whose cells form osteoid (un-mineralised organic component of bone) or bone

23
Q

List 6 types of osteosarcoma which have a normal prognosis (although this prognosis is also pretty poor).

A 
Osteoblastic
Chondroblastic
Fibroblastic
Telangiectatic
Small cell osteosarcoma
Sclerotic osteosarcoma
24
Q

List 3 types of osteosarcoma which have a worse prognosis than normal.

A

Paget’s osteosarcoma
Multifocal osteosarcoma
Post-irradiation osteosarcoma

25
Q

List 3 types of osteosarcoma which have a slightly better prognosis than usual.

A

Parosteal osteosarcoma
Periosteal osteosarcoma
Low grade central osteosarcoma

26
Q

What condition increases risk of osteosarcoma?

A

Paget’s disease of the bone

27
Q

Describe the pathophysiology of Paget’s disease of the bone. (3)

A
  1. Increased osteoclast activity, causing increased bone formation
    a. This forms structurally weak bone
  2. New bone has a disorganised structure, making it structurally weak
  3. This can cause Paget’s osteosarcoma
    a. Lytic lesions
28
Q

Describe the clinical features of Paget’s disease of the bone. (8)

A 
Bone pain
Deformity
Pathological fracture
Osteoarthritis
Deafness
Spinal cord compression
High cardiac output
Paget's osteosarcoma
29
Q

What sort of staining is used to diagnose Ewing’s tumour?

A

CD99 staining

11. Orthopaedics (13 decks)

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