Bone tumours Flashcards
Types of benign bone tumours
Neoplastic, Developmental, Traumatic, Infections and Inflammatory
Which benign tumour is the most common?
Osteochondroma
What are the risk of malignant transformation for an osteochondroma?
1%
What is an osteochondroma?
bony outgrowth with a cartilaginous cap with local pain
Why do multiple osteochondromas occur?
due to an autosomal dominant hereditary disorder
What is an enchondroma?
an intermedullary and usually metaphyseal cartilaginous tumour
When do enchondromas occur?
when normal enchondral ossification fails
What do enchondromas look like on X-ray?
lucent but become patchy sclerotic when they mineralize
what are the symptoms of an enchondroma?
asymptomatic but can weaken bone
What bones do enchondromas occur in?
femur, humerus, tibia and small bones
how do you treat an enchondroma?
curettage and filled with bone graft
what is a simple bone cyst?
a single cavity, fluid filled cyst
Why do simple bone cysts occur?
when there is a growth defect in physis
what bones do simple bone cysts occur in?
humerous, femur, talus and calcaneus
what are the symptoms of simple bone cysts?
asymptomatic but can cause weakness
who gets simple bone cysts?
children or young adults
how do you treat a simple bone cyst?
curettage and bone graft
what is an aneurysmal bone cyst?
multiple gaps in bone filled with blood or serum
why do aneurysmal bone cysts form?
small arteriovenous malformation
where do aneurysmal bone cysts occur?
metaphysis of long bones, flat bones and vertebral bodies
what causes aneurysmal bone cysts to become locally aggressive?
cortical expansion and destruction
what are the symptoms of aneurysmal bone cysts?
pain and weakened bone
How do you treat an aneurysmal bone cyst?
curettage and bone graft or bone cement
where do you find a giant cell tumour?
can be in the metaphysis, epiphysis or in subchondral bone in the knee, distal radius, long bones, pelvis and spine
how do giant cell tumours appear on an X-ray?
multi-nucleate giant cells with a soap bubble appearance
How likely is a metastasis to lung for a giant cell tumour?
5%
How do you treat a giant cell tumour?
intralesional excision with phenol/ bone cement or liquid nitrogen and some times you replace a joint
when does fibrous dysplasia occur?
in adolescence
what causes fibrous dysplasia?
genetic mutation
what is fibrous dysplasia?
lesions of fibrous tissue in immature bone
what types of fibrous dysplasia are there?
monostoic and polystoic
what causes angular deformities in fibrous dysplasia?
defective mineralisation
which tumour causes angular deformities?
fibrous dysplasia
which tumour causes a shepherd’s crook deformity?
fibrous dysplasia?
how do you treat fibrous dysplasia?
bisphosphates reduce pain, internal fixation and cortical bone grafts
what is an osteoid osteoma?
small nidus of immature bone surrounded by an intense sclerotic halo
when do osteoid osteomas occur?
adolescence
where do osteoid osteomas occur?
proximal femur, diaphysis of long bone and vertebrae
what are the symptoms of osteoid osteomas?
intense constant pain that’s worse at night
how would you treat pain from osteoid osteomas?
NSAIDs
how do you treat osteoid osteomas?
may resolve but may require CT guided radiofrequency ablation or en bloc excision
what is Brodie’s abscess?
lytic lesion of bone that’s a brown tumour
what causes Brodie’s abscess?
sub acute osteomyelitis and hyperparathyroidism
Benign or malignant: osteochondroma
Benign
Benign or malignant: enchondroma
Benign
Benign or malignant: simple bone cyst
Benign
Benign or malignant: aneurysmal bone cyst
Benign
Benign or malignant: giant cell tumour
Benign
Benign or malignant: fibrous dysplasia
Benign
Benign or malignant: osteoid osteoma
Benign
Benign or malignant: brodie’s abscess
Benign
Benign or malignant: osteosarcoma
Malignant
Benign or malignant: chondrosarcoma
Malignant
Benign or malignant: fibrosarcoma
Malignant
Benign or malignant: Ewing’s sarcoma
Malignant
Benign or malignant: lymphoma
Malignant
Benign or malignant: myeloma
Malignant
are malignant primaries rare or common?
rare
what age group do malignant tumours occur?
young patients
what are red flags for malignant tumours?
persistent unexplained pain
what does a malignant tumour look like?
substantial, ill-defined bony swelling
what does a malignant tumour look like on X-ray?
aggressive and destructive- cortical destruction, periosteal reaction and new bone formation and extension into surrounding soft tissue
what is an osteosarcoma?
malignant tumour producing bone
When do osteosarcomas usually occur?
adolescence and early adulthood
where do osteosarcomas most commonly affect?
around the knee
how do osteosarcomas spread?
haematogenously or lymphatically
how would you prolong survival in a patient with an osteosarcoma?
chemo
what is a chondrosarcoma?
cartilage producing primary that’s less aggressive than an osteosarcoma
what age group does a chondrosarcoma usually affect?
45 year olds
where does a chondrosarcoma affect?
pelvis or proximal femur
is a chondrosarcoma responsive to chemo or radio therapy?
no
is a chondrosarcoma quick or slow to metastasize?
slow
what is another name for Fibrosarcoma?
malignant fibrous histiocytoma
is a fibrosarcoma a primary or secondary tumour?
primary
where does a fibrosarcoma occur?
in abnormal bone
who gets a fibrosarcoma?
adolescence or young adults
Where do Ewing’s sarcomas occur?
primitive cells in the marrow
who does Ewing’s sarcoma usually affect?
10-20 years old
what condition often gets misdiagnosed as osteomyelitis?
Ewing’s sarcoma
Is Ewing’s sarcoma radio and chemo sensitive?
yes
Where does a non-Hodkins lymphoma metastasise from?
marrow or lymph to bone
where does a primary lymphoma usually affect?
pelvis or the femur
what is the survival mean for a lymphoma?
2 years
what is a myeloma?
malignant B cell proliferation
what is a single lesion of myeloma called?
plasmacytoma
what are multiple lesions of myeloma called?
multiple myeloma
what age group is most affected by myeloma?
45-65
what symptoms present in a myeloma?
weakness, backpain, fatigue, weight loss, anaemia and recurrent infection
how is a myeloma diagnosed?
by plasma protein electrophoresis and early morning urine collection for Bence Jones assay
are myelomas always detected on a bone scan?
no
what is the 5 year survival rate?
<30%
What type of lesion is a breast met?
blastic or lytic
What is the survival for a breast met to the bone?
24-26 months
what type of lesion is a prostate met?
sclerotic
what is the survival for a prostate met to the bone?
45% at 1 year
What type of lesion is a lung met?
Lytic
what is the survival for a lung met to the bone?
6 months on average
what type of lesion is a renal cell carcinoma met?
large lytic blow out
what is the survival for a renal CC met to the bone
12-18 months
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