Bone Tumours

Question 1

What are the 4 main benign bone tumours?

Answer 1

Osteochondroma
Chondroma (enchondroma)
Osteoid osteoma
Chondroblastoma

Question 2

Describe osteochondroma

Which bones are they typically found on?

Answer 2

Cartilagenous bony projection on external surface of bone, usually near epiphyses, with marrow cavity continuous with original bone
Usually chondrocyte origin
ASSOCIATED WITH LOCAL PAIN

Question 3

Describe chondroma/enchondroma

Which bones are they typically found on?

Answer 3

Hyaline cartilage tumour arising in the medullary cavity

ASYMPTOMATIC BUT CAN LEAD TO FRACTURE

Question 4

Which two developmental disorders are associated with chondroma?

Answer 4

Ollier’s disease and Maffuci syndrome

Question 5

Which has the greater risk of malignant transformation - Ollier’s disease or Mafucci syndrome?

Answer 5

Mafucci

Question 6

Describe osteoid osteoma

How is it diagnosed and managed?

Answer 6

Osteoblastic tumour of neoplastic/infectious origin; appears as intense sclerotic halo

Question 7

List clinical features of osteoid osteoma

Answer 7

Swelling/tenderness
Males, children/young adults
Dull pain at night relieved by NSAID

Question 8

Describe chondroblastoma

Answer 8

Rare cartilagenous tumour within bone, usually epiphyses

Usually teenagers”chicken-wire calcification”

Question 9

List the 3 main benign + locally aggressive tumours

Answer 9

Giant cell tumour
Osteoblastoma
Chordoma

Question 10

Describe giant cell tumours

Answer 10

Osteoclast-derived tumour of long bones, usually knee

Radiolucent with multinucleated cells”soap-bubble” appearance on XR

Question 11

List the 3 main malignant bone tumours in order of most common - least common

Answer 11

Osteosarcoma
Chondrosarcoma
Ewing’s sarcoma

Question 12

Secondary bone tumours (metastatic) are more common than primary. True/False?

Answer 12

True

Question 13

What is the commonest benign bone tumour?

Answer 13

Osteochondroma

Question 14

What does an osteochondroma look like?

Answer 14

Bony outgrowth on external surface with cartilagenous cap

Question 15

What is the name given to an intramedullary, usually metaphyseal, cartilagenous tumour caused by failure of normal endochondral ossification?

Answer 15

Enchondroma

Question 16

What does an enchondroma look like?

Answer 16

Usually lucent but can have patchy, sclerotic appearance

Question 17

Which bones are usually affected by osteochondromas and enchondromas, respectively?

Answer 17

Long bones (femur, humerus, tibia)
Small bones of hands and feet

Question 18

What is the name given to a single-cavity benign fluid-filled cyst in a bone?

Answer 18

Simple bone cyst

Question 19

How do simple bone cysts probably arise?

Answer 19

Growth defect from the physis

Question 20

What do you call a bone cyst containing lots of chambers, usually filled with blood?

Answer 20

Aneurysmal bone cyst

Question 21

Where do giant cell tumours usually occur?

Answer 21

Around the knee and distal radius

Question 22

Are giant cell tumours painful?

Answer 22

Yes

Locally destructive

Question 23

What is the characteristic appearance of giant cell tumours on XR?

Answer 23

“Soap-bubble” appearance

Question 24

When does fibrous dysplasia of bone usually occur?

Answer 24

Adolescence, producing immature bone/fibrosis

Question 25

What name is given to a small nidus of immature bone surrounded by a sclerotic halo?

Answer 25

Osteoid osteoma

Question 26

What is the predominant clinical feature of osteoid osteoma?

Answer 26

Intense constant pain that is worse at night, relieved by NSAIDs

Question 27

List general treatment for benign bone tumours

Answer 27

Curettage (scraping) Bone grafting/cement Excision Radiofrequency ablation

Question 28

What is the most common primary bone tumour?

Answer 28

Osteosarcoma

Question 29

Most cases of osteosarcoma are seen in over 50s. True/False?

Answer 29

False | Most cases are seen in adolescence/early adulthood

Question 30

Where does osteosarcoma affect 60% of the time?

Answer 30

Knee

Question 31

Which is more common - chondrosarcoma or Ewing's sarcoma?

Answer 31

Chondrosarcoma

Question 32

Which age group is usually affected by chondrosarcoma?

Answer 32

45yr olds

Question 33

What is Ewing's sarcoma?

Answer 33

Malignant tumour of primative cells in the marrow

Question 34

Most cases of Ewing's sarcoma occur between the ages of 10 and 20. True/False?

Answer 34

True

Question 35

List general treatment for primary malignant bone tumours

Answer 35

Surgical excision | Chemotherapy

Question 36

List the primary malignant tumours that metastasise commonly to bone, from most to less frequent

Answer 36

``` Breast carcinoma Prostate carcinoma Lung carcinoma Renal cell carcinoma Thyroid adenocarcinoma ```

Question 37

List features suggestive of a benign soft tissue neoplasm

Answer 37

``` Small size Variable size Cystic lesions Well-defined Fluid-filled/fatty ```

Question 38

List features suggestive of a malignant soft tissue neoplasm

Answer 38

``` Large size Rapid growth Solid Ill-defined Irregular surface Systemic features ```

Question 39

What is the commonest benign soft tissue tumour?

Answer 39

Lipoma

Question 40

Where do ganglion cysts occur?

Answer 40

Around a synovial joint/synovial tendon sheath

Question 41

What is the classical sign of fibrous dysplasia?

Answer 41

Shepherd's crook

Question 42

What medication is used to treat fibrous dysplasia?

Answer 42

Biphosphonates

Question 43

What does an Ewings sarcoma look like?

Answer 43

Small round blue cell tumour, onion skin pattern

Question 44

What disease is Ewings sarcoma associated with?

Answer 44

Osteomyelitis

Question 45

How does a ganglion cyst feel?

Answer 45

Well defined, firm, fluid