Bone tumours

Question 1

What should all bone tumours be assumed to be?

Answer 1

Primary tumour

Question 2

What periosteal reaction on XR suggests malignancy?

Answer 2

Rapid growth, warmth, tenderness and ill defined edges suggest malignancy- hazy and diffuse borders on XR.

Question 3

What investigations should be used in those with a tumour in the bone?

Answer 3

○ FBC - myeloid and infection
○ LFTs- ALP indicator of bone damage and may also have metastasized to the liver
○ Thyroid function test - could be thyroid ca
○ U&Es- looking for increased Ca and Phosphate as well as kidney damage
○ CRP
○ Myeloma screening -Bence Jones proteins
○ PSA in men

Question 4

What is an osteosarcoma? What condition is it associated with?

Answer 4

• Malignancy of osteoblasts

- More common in adolescents with paget’s disease due to rapid bone recycling

Question 5

How do osteosarcoma present?

Answer 5

• Presents with pain and swelling over affected bone and may be loss of weight bearing in LL.
• Pain is constant and gets worse with progression
• Usually metaphyseal tumours of long bones

Question 6

What are found on XR in osteosarcoma?

Answer 6

• Wide or absent margins
• Periosteal reaction - sunburst and Codman’s triangle.
• Cortex breached and often into surrounding tissue

Question 7

What is the treatment of osteosarcoma?

Answer 7

• Chemotherapy

- Bone resection

Question 8

What is ewing sarcoma?

Answer 8

• Cancer caused by malignancy of neural tube cells - primitive neuroectodermal cells
• More common in 10-20y/o

Question 9

What are the symptoms of Ewing Sarcoma?

Answer 9

• Symptoms - more common presenting with back problems and may mimic osteomyelitis – warm painful enlarging lump

Question 10

What are the XR finding of Ewing sarcoma?

Answer 10

• Osteolytic lesions and some sclerotic - mixed

- Periosteal reaction with lamellated bone growth – onion skin periosteal reaction

Question 11

What is the treatment of Ewing sarcoma?

Answer 11

• Surgical removal - best outcome

- chemo/radio therapy

Question 12

What is a chondrosarcoma?

Answer 12

• Malignancy of the cartilage
• More likely to occur in middle to old age
• More common in proximal bones - pelvis, femur, humerus and ribs
• Present with a dull ache

Question 13

What is a chondrosarcoma Xr finding?

Answer 13

• Invasion and soft tissue extension

- Lytic lesion with fluffy popcorn calcification

Question 14

What is multiple myeloma?

Answer 14

B cell lymphoproliferative disorder of the marrow with plasma cells predominating- effects bone due to marrow cell proliferation and increased osteoclastic activity leading to lytic lesions.
- Plasmacytoma - solitary tumour in one bone.

Question 15

What is a non ossifying fibroma?

Answer 15

Commonest benign lesion of bone - developmental defect

Asymptomatic and almost always encountered in children as an accidental finding

Question 16

What are the XR findings of non ossifying fibroma?

Answer 16

XR - oval radiolucent area in or adjacent to the cortex- appears cystic but is a solid lesion of fibrous tissue.

Question 17

What is the management of non ossifying fibroma?

Answer 17

Heal spontaneously and don’t need treatment unless cause of pathological #.

Question 18

What is fibrous dysplasia?

Answer 18

Developmental disorder in which areas of trabecular bone are replaced by fibrous tissue, osteoid and woven bone
May affect one bone, one limb or lots of bones
Those with many lesions can experience a change to fibrosarcoma

Question 19

What are the XR findings of fibrous dysplasia?

Answer 19

cystic areas in metaphysis or shaft have hazy appearance. Weight bearing bones may be bent.

Question 20

What is an osteoid osteoma?

Answer 20

Benign tumour of osteoid and newly formed bone.
Small and usually encased in dense bone
Seen in pts over 30y/o- femur or tibia

Question 21

What are the osteoid osteoma XR findings?

Answer 21

tiny radiolucent area which in the diaphysis are surrounded by dense bone and thickened cortex but in metaphysis show less cortical thickening

Question 22

What is a chondroma?

Answer 22

Islands of cartilage may persist in metaphysis of bone- sometimes they grow and take on characteristics of benign tumour.
CF- often asymptomatic - seen in all ages.

Question 23

What are the indications of surgery or treatment in a chondroma?

Answer 23

only if painful,enlarging or caused pathological #- removed by curettage and then filled by bone graft

Question 24

What are osteochrondromas?

Answer 24

Developmental lesion which starts as a small overgrowth of cartilage at the end of physeal plate and develops by endochondral ossification into bony tuberance covered by cartilage

Question 25

What is a bony cyst?

Answer 25

True solitary or unicameral bone cyst - occurs in children in metaphysis of the long bones and tends to heal spontaneously

Question 26

What is the management of bony cysts?

Answer 26

avoid activities that might lead to fracture and active cysts should be aspirated and injected with steriod

Question 27

What is an aneurysmal bone cyst?

Answer 27

Cystic tumour which occurs in the spine and metaphysis of long bones in young adults.
May expand and cause thinning of the cortex

Question 28

What is the management of a aneurysmal bony cyst?

Answer 28

should be thoroughly curetted and then packed with bone graft.