Bone Tumours Flashcards
What are the five causes of benign bone tumours?
Neoplastic Infection Inflammation Traumatic Developmental
What are the seven benign bone tumours important to know?
Osteochondroma Enchondroma Simple bone cyst Aneurysmal bone cyst Osteoclastoma/Giant Cell Tumour Fibrous dysplasia Osteoid Osteoma
What is an osteochondroma?
Bony outgrowth with a cartilage cap.
Where are osteochondromas commonly found?
Metaphysis of long bones.
What age group tend to get osteochondromas?
Teenagers
How does an osteochondroma present?
Can be painful and very rarely malignant (1%)
What is the most common benign bone tumour?
Osteochondroma
What is an enchondroma?
Failure of normal ossification of growth plate. Name means within cartilage.
Where are enchondromas found?
Metaphysis cartilage of long bones.
How does enchondroma present?
Usually asymptomatic but can weaken bone.
How can enchondroma be treated?
Excise and replace with bone graft.
What is a simple bone cyst?
Single cavity fluid filled cyst.
Where are simple bone cysts found?
Metaphysis of long bones
What age group is susceptible to simple bone cysts?
5-15
How does a simple bone cyst present?
Asymptomatic but can weaken bones.
How can simple bone cysts be treated?
Excise and replace with bone graft.
What is an aneurysmal bone cyst?
A cyst with lots of chambers filled with blood or serum.
What causes an aneurysmal bone cyst?
Malformation of blood vessels.
Where are aneurysmal bone cysts normally found?
Metaphysis of long bones, flat bones and vertebral bodies.
How do aneurysmal bone cysts present?
Locally aggressive and painful with a risk of fracture.
How do you treat an aneurysmal bone cyst?
Excise and replace with bone graft.
What is an osteoclastoma?
Giant Cell Tumour with unknown aetiology.
Where do osteoclastomas/GCT present?
Epiphysis and subchondral bone.
What age group is affected by osteoclastoma/GCT
20-40. Occurs once joints are fused.
How does an osteoclastoma/GCT present?
Locally aggressive and looks like ‘Soap bubble’ on XR. Painful and can cause fracture.
How do you treat an osteoclastoma/GCT?
Excise then use phenol, bone cement or liquid nitrogen to finish.
What is fibrous dysplasia?
Lesion of fibrous tissue and immature bone. Can be mono- or polyosteotic.
How does fibrous dysplasia present?
Angular deformities (‘Shepherds crook’ in femur), thinning of cortex and fractures.
How do you treat fibrous dysplasia?
Bisphosphonates for pain
Fix fractures and bone graft for strength.
What is osteoid osteoma?
Nidus of immature bone surrounded by sclerosis.
Where is osteoid osteoma normally round?
Proximal femur.
What age group is osteoid osteoma normally found?
Adolescents
How does osteoid osteoma normally present?
Intense pain worse at night due to inflammatory response.
How do you treat osteoid osteoma?
NSAIDs for pain
Ablate though can reverse with time.
Are malignant bone cancers common compared to those of other organs?
No
What are the red flags for malignant bone cancer?
Constant pain worse at night. Weight loss Fatigue Loss of appetite <25 or >60 YO
What signs of a malignant bone tumour may you see on an XR?
Cortical destruction Raised periosteum Sclerosis Lysis Invasion into soft tissue
What is the standard way of treating malignant bone tumours?
Excision with 3-4cm margin.
What are the six malignant bone tumours we need to know?
Osteosarcoma Chondrosarcoma Fibrosarcoma/Malignant fibrous histiocytoma Ewing's Sarcoma Non-Hodgkin Lymphoma Myeloma
What is an osteosarcoma?
A bone producing malignant tumour. Most common malignant bone tumour.
What age group are osteosarcomas often seen?
10-25
Where do osteosarcoms often occur?
Bones around knee, femur, humerus and pelvis
What does osteosarcoma look like?
Large. Can be sclerotic or fleshy. Metastasis through blood.
How do you treat osteosarcoms?
Excise. Not radio sensitive but is chemosensitive.
What is a chondrosarcoma?
Cartilage producing bone tumour.
What age group is most affected by chondrosarcoma?
Middle age. ~45.
Where are chondrosarcomas normally found?
Pelvis and proximal femur.
How do chondrosarcomas normally present?
Large painful swellings. Slow to metastasize.
How do you treat chondrosarcoma?
Excise. Not chemo or radio sensitive.
What is a fibrosarcoma/malignant fibrous histiocytoma?
Malignant bone tumours of fibrous tissue.
Where do fibrosarcoma/malignant fibrous histiocytomas commonly occur?
Abnormal bones such as:
Infarcted. fibrous dysplastic or affected by Paget’s disease.
Metaphysis of long bones.
What age groups are affected by fibrosarcoma/malignant fibrous histiocytoma?
Adolescents and young adults.
What are Ewing’s sarcomas?
Malignancy of primitive cells in bone marrow. 2nd most common malignant bone tumour and has worst outcome.
Where are Ewing’s sarcomas normally found?
Starts in medulla but swiftly progresses to cortex.
How do Ewing’s sarcomas present?
Large soft tissue masses.
Pain and swelling, fever, elevated WCC
Metastasis to lung and other bone
How do you treat Ewing’s sarcoma?
Excise.
Chemo and radio sensitive.
What is a non-Hodgkin lymphoma?
Occurs from lymphatics in bone marrow and can metastasis to bone. Very aggressive.
What bones are most affected by non-Hodgkin lymphoma?
Pelvis and femur
How do you treat non-Hodgkin lymphoma?
Chemo and radiotherapy.
What is myeloma?
Tumour of B cells in bone marrow.
Can get mono or polylesions
What age group is affected my myeloma?
45-65
How does myeloma present?
Weakness, back pain, fatigue, anaemia and infection
What five cancers tend to metastasize to bone?
Prostate carcinoma Lung carcinoma Thyroid adenocarcinoma Breast carcinoma Kidney cell carcinoma