Bone Tumours

Question 0

Name some benign bone tumours

Answer 0

Osteochondroma
Osteid osteoma
Chondroma
Fibrous dysplasia

Question 1

Name some malignant bone tumours

Answer 1

Osteosarcoma
Ewing’s sarcoma
Giant cell tumour (osteoclastoma)
Chondrosarcoma

Question 2

What is the most common malignant bone tumour?

Answer 2

Osteosarcoma

Question 3

How does osteosarcoma usually present?

Answer 3

Pain - constant, worse at night
Local tenderness
Local tissue inflammation
Swelling
Signs of lung metastasis

Question 4

Where does primary osteosarcoma usually affect?

Answer 4

Metaphyses of long bones

Especially distal femur, proximal tibia, proximal humerus

Question 5

How may secondary osteosarcoma arise?

Answer 5

In bone affected by paget’s disease

After irradiation

Question 6

How would you investigate osteosarcoma?

Answer 6

Bloods- ESR, alkaline phosphatase
Imaging- X-ray, CXR, CT/MRI
Bone biopsy

Question 7

What would you see on X-ray in osteosarcoma?

Answer 7

Alternating osteosclerosis and osteolysis, sunray spiculations, codman triangles

Question 8

What are sunray spiculations?

Answer 8

When new bone breaches the cortex and spreads outwards through the soft tissues, looks like a sun :)

Question 9

What are codman triangles?

Answer 9

When the periosteum gets lifted up and forms a triangle shape, due to the underlying tumour breaching the cortex.

Question 10

How would you treat osteosarcoma?

Answer 10

Resection and chemotherapy

Question 11

Give an example of a chemotherapy regimen that could be used to treat osteosarcoma

Answer 11

Doxorubicin
Cisplatin
Methotrexate

Question 12

What is the most common benign bone tumour?

Answer 12

Osteochondroma

Question 13

Match the following benign tumours with where they affect:

osteoid osteoma.
chondroma
osteochondroma
fibroma.
eosinophilic granuloma 

Cartilage
Bone
Fibrous tissue
Bone marrow

Answer 13

Bone: osteoid osteoma.
Cartilage: chondroma, osteochondroma.
Fibrous tissue: fibroma.
Bone marrow: eosinophilic granuloma

Question 14

Match the following malignant tumours with where they affect:

osteosarcoma.
Chondrosarcoma
fibrosarcoma.
Ewing's sarcoma
myeloma
malignant giant cell tumour

Bone marrow
Bone
Fibrous tissue
Cartilage
Uncertain

Answer 14

Bone: osteosarcoma.
Cartilage: chondrosarcoma.
Fibrous tissue: fibrosarcoma.
Bone marrow: Ewing's sarcoma, myeloma
Uncertain: malignant giant cell tumour.

Question 15

Where does osteochondoma usually affect?

Answer 15

Bone adjacent to epiphyseal growth plates e.g. Proximal femur, proximal humerus, knee

Question 16

How does osteochondroma usually present?

Answer 16

Adolescent
Painful mass
Cartilaginous overgrowth at epiphyseal growth plates

Question 17

What would you see on xray in osteochondroma?

Answer 17

Bony spur arising from cortex

Question 18

What are the complications of osteochondroma?

Answer 18

Compression of adjacent structures e.g. Nerve compression
Deformities
Malignant tansformation

Question 19

What is hereditary multiple exotoses and what is its significant when it comes to bone tumours?

Answer 19

It is a autosomal dominant inherited disease with a mild decrease in stature, intelligence and has multiple osteochondromas. Often it will have other skeletal abnormalities too e.g. Leg length discrepancy, angular deformities.

It increases the risk of malignant transformation of osteochondromas significantly (up to 10%)

Question 20

How would you treat osteochondroma?

Answer 20

Excision if causing symptoms or if it continues to grow after skeletal maturity (risk of malignant transformation)