Bone Tumours Flashcards by Catherineh Hunter

Which is more common:
a) primary
b) metastatic
bone cancer?

metastatic

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Commonest type of benign bone tumour

Osteochondroma

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Osteochondroma

a benign bony outgrowth on the external knee surface with a cartilaginous cap

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Osteochondroma symptoms

Usually don’t produce symptoms!

Can cause local pain

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Risk of malignant transformation of osteochondroma

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Osteochondroma Tx

Excisional biopsy - only if growing in size or causing pain

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Multiple osteochondroma

Occurs as part of an autosomal dominant hereditary disease

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Enchondroma

Benign intramedullary and usually metaphyseal cartilaginous tumour

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Cause of enchrondromas

Failure of normal enchondral ossification at the growth plate

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Radiological appearance of enchondromas

Lucent

- can undergo mineralisation and have a patchy sclerotic appearance

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Enchondroma symptoms

Usually asymptomatic - can weaken bone and then produce pathological fractures

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Most common locations for enchondromas

Femur
Humerus
Tibia
Small bones of hands and feet

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Enchondroma Tx

Curettage to scrape out tumour and filled with bone graft

- only done once a pathological fracture has healed or if risk of impending fracture

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Simple bone cyst

A benign single cavity fluid filled cyst in bone

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Cause of simple bone cysts

Growth defect from the physis

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Most common locations for simple bone cysts

Metaphysis in long bones (femur and humerus)
Talus
Calcaneus

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Simple bone cyst symptoms

Can be asymptomatic - incidental finding on xray

Weakness - pathological fractures

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Simple bone cyst Tx

Curettage and bone graft +/- stabilisation

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Aneurysmal bone cyst

A benign cyst with lots of chambers filled with blood or serum

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cause of aneurysmal bone cysts

Small arteriovenous malformations

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Most common locations for aneurysmal bone cysts

Metaphyses of long bones 
Flat bones (ribs, skull) 
Vertebral bodies

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Aneurysmal bone cyst symptoms

Pain - caused by local cortical expansion and destruction

Pathological fractures

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Aneurysmal bone cyst symptoms

Curettage and bone graft

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Giant cell tumours

Locally aggressive benign tumour that occurs after the physis has fused

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Most common location of giant cell tumours

Knee | Distal radius

Giant cell tumour symptoms

Pain | Pathological fracture

The characteristic appearance of giant cell tumours on xray

Soap bubble appearance

Giant cell tumour Tx

Phenol, bone cement or liquid nitrogen to destroy tumour material If aggressive lesion with cortical destruction - joint replacement

Fibrous dysplasia

A disease of bone occurring in adolescence due to genetic mutation, resulting in lesions of fibrous tissue and immature bone

Appearance of bone in fibrous dysplasia

affected bone is wider with thinned cortices | angular deformities

shepherd's crook deformity

extensive fibrous dysplasia in the proximal femur

Fibrous dysplasia treatment

Bisphosphonates - reduce pain Internal fixation and cortical bone graft - for pathological fractures Intralesional excisions - not successful on its own - high recurrence rates

Osteoid osteoma

benign tumour of immaure bone surrounded by an intense sclerotic halo

Age group most common for osteoid osteoma

adolescence

Most common locations for osteoid osteoma

proximal femur diaphysis of bone bones vertebrae

Osteoid osteoma symptoms

intense pain worse at night

Osteoid osteoma Ix

Xray | Bone scan and CT - diagnostic

Osteoid osteoma Tx

May resolve spontaneously over time CT guided radiofrequency ablation NSAIDS - pain relief

Brodie's abscess

Subacute osteomyelitis

Brown's tumour

Benign bone tumour associated with hyperparathyroidism

"red flags" of malignant bone tumours

constant bone pain that is worse at night systemic symptoms - weight loss, loss of appetite, fatigue unexplained skeletal pain

what are malignant primary bone tumours in the young often misdiagnosed as?

Muscular pain

signs of a malignant bone tumour on x-ray

cortical destruction periosteal reaction (raised periosteum producing bone) new bone formation (sclerosis as well as lysis from destruction) extension into surrounding soft tissue envelope

most common malignant primary bone tumour

osteosarcoma

what age group does osteosarcoma most commonly affect

adolescents and early adulthood

most common site for osteosarcoma

knee Others: proximal femur proximal humerus pelvis

what does an osteosarcoma produce

bone !

most common spread of osteosarcoma, and to what location

haematogenous spread, most commonly to lungs | can also have lymphatic spread

Tx of osteosarcoma

Tumour excision these tumours are NOT radiosensitive Adjuvant chemo to prolong survival

chondrosarcoma

cartilage producing malignant primary bone tumour

what age group does chondrosarcoma most commonly affect

older age group than osteosarcoma - mean age 45 y

most common site for chondrosarcoma

pelvis | proximal femur

Most chondrosarcomas tend to be: a) low grade b) high grade based on histological classification?

a) low grade they are slower to metastasise than osteosarcomas!

Tx of chondrosarcoma

Tumour excision | they are not radiosensitive or responsive to adjuvant chemotherapy

Fibrosarcoma

fibrous malignant primary bone tumours that tend to occur in abnormal bone (bone infarct, fibrous bone, Paget's)

what age group do fibrosarcomas most commonly affect

younger people

Ewing's sarcoma

malignant primary bone tumour of primitive marrow cells

prognosis of Ewing's sarcoma

bad :(

what age group does Ewing's sarcoma most commonly affect

Younger people - most cases between age 10 and 20

Tx of Ewing's sarcoma

Tumour excision | XRT and chemo sensitive

list the primary malignant tumours that most commonly metastasise to bone in order of frequency

``` breast carcinoma prostate carcinoma lung carcinoma renal cell carcinoma thyroid adenocarcinoma ```

bones most frequently involved in metastases

``` vertebra pelvis ribs skull humerus long bones of lwoer limbs ```

popcorn calcification of x-ray

chondroscarcoma

onion peel sign

Ewing's sarcoma