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Orthopaedics > Bone Tumours > Flashcards

Bone Tumours Flashcards

1
Q

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

A

metastatic

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2
Q

Commonest type of benign bone tumour

A

Osteochondroma

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3
Q

Osteochondroma

A

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

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4
Q

Osteochondroma symptoms

A

Usually don’t produce symptoms!

Can cause local pain

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5
Q

Risk of malignant transformation of osteochondroma

A

1%

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6
Q

Osteochondroma Tx

A

Excisional biopsy - only if growing in size or causing pain

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7
Q

Multiple osteochondroma

A

Occurs as part of an autosomal dominant hereditary disease

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8
Q

Enchondroma

A

Benign intramedullary and usually metaphyseal cartilaginous tumour

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9
Q

Cause of enchrondromas

A

Failure of normal enchondral ossification at the growth plate

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10
Q

Radiological appearance of enchondromas

A

Lucent

- can undergo mineralisation and have a patchy sclerotic appearance

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11
Q

Enchondroma symptoms

A

Usually asymptomatic - can weaken bone and then produce pathological fractures

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12
Q

Most common locations for enchondromas

A

Femur
Humerus
Tibia
Small bones of hands and feet

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13
Q

Enchondroma Tx

A

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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14
Q

Simple bone cyst

A

A benign single cavity fluid filled cyst in bone

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15
Q

Cause of simple bone cysts

A

Growth defect from the physis

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16
Q

Most common locations for simple bone cysts

A

Metaphysis in long bones (femur and humerus)
Talus
Calcaneus

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17
Q

Simple bone cyst symptoms

A

Can be asymptomatic - incidental finding on xray

Weakness - pathological fractures

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18
Q

Simple bone cyst Tx

A

Curettage and bone graft +/- stabilisation

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19
Q

Aneurysmal bone cyst

A

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

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20
Q

cause of aneurysmal bone cysts

A

Small arteriovenous malformations

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21
Q

Most common locations for aneurysmal bone cysts

A 
Metaphyses of long bones 
Flat bones (ribs, skull) 
Vertebral bodies
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22
Q

Aneurysmal bone cyst symptoms

A

Pain - caused by local cortical expansion and destruction

Pathological fractures

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23
Q

Aneurysmal bone cyst symptoms

A

Curettage and bone graft

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24
Q

Giant cell tumours

A

Locally aggressive benign tumour that occurs after the physis has fused

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25
Q

Most common location of giant cell tumours

A

Knee

Distal radius

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26
Q

Giant cell tumour symptoms

A

Pain

Pathological fracture

27
Q

The characteristic appearance of giant cell tumours on xray

A

Soap bubble appearance

28
Q

Giant cell tumour Tx

A

Phenol, bone cement or liquid nitrogen to destroy tumour material

If aggressive lesion with cortical destruction - joint replacement

29
Q

Fibrous dysplasia

A

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

30
Q

Appearance of bone in fibrous dysplasia

A

affected bone is wider with thinned cortices

angular deformities

31
Q

shepherd’s crook deformity

A

extensive fibrous dysplasia in the proximal femur

32
Q

Fibrous dysplasia treatment

A

Bisphosphonates - reduce pain

Internal fixation and cortical bone graft - for pathological fractures

Intralesional excisions - not successful on its own - high recurrence rates

33
Q

Osteoid osteoma

A

benign tumour of immaure bone surrounded by an intense sclerotic halo

34
Q

Age group most common for osteoid osteoma

A

adolescence

35
Q

Most common locations for osteoid osteoma

A

proximal femur
diaphysis of bone bones
vertebrae

36
Q

Osteoid osteoma symptoms

A

intense pain worse at night

37
Q

Osteoid osteoma Ix

A

Xray

Bone scan and CT - diagnostic

38
Q

Osteoid osteoma Tx

A

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

39
Q

Brodie’s abscess

A

Subacute osteomyelitis

40
Q

Brown’s tumour

A

Benign bone tumour associated with hyperparathyroidism

41
Q

“red flags” of malignant bone tumours

A

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

42
Q

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

A

Muscular pain

43
Q

signs of a malignant bone tumour on x-ray

A

cortical destruction

periosteal reaction (raised periosteum producing bone)

new bone formation (sclerosis as well as lysis from destruction)

extension into surrounding soft tissue envelope

44
Q

most common malignant primary bone tumour

A

osteosarcoma

45
Q

what age group does osteosarcoma most commonly affect

A

adolescents and early adulthood

46
Q

most common site for osteosarcoma

A

knee

Others:
proximal femur
proximal humerus
pelvis

47
Q

what does an osteosarcoma produce

A

bone !

48
Q

most common spread of osteosarcoma, and to what location

A

haematogenous spread, most commonly to lungs

can also have lymphatic spread

49
Q

Tx of osteosarcoma

A

Tumour excision

these tumours are NOT radiosensitive

Adjuvant chemo to prolong survival

50
Q

chondrosarcoma

A

cartilage producing malignant primary bone tumour

51
Q

what age group does chondrosarcoma most commonly affect

A

older age group than osteosarcoma - mean age 45 y

52
Q

most common site for chondrosarcoma

A

pelvis

proximal femur

53
Q

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

A

a) low grade

they are slower to metastasise than osteosarcomas!

54
Q

Tx of chondrosarcoma

A

Tumour excision

they are not radiosensitive or responsive to adjuvant chemotherapy

55
Q

Fibrosarcoma

A

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

56
Q

what age group do fibrosarcomas most commonly affect

A

younger people

57
Q

Ewing’s sarcoma

A

malignant primary bone tumour of primitive marrow cells

58
Q

prognosis of Ewing’s sarcoma

A

bad :(

59
Q

what age group does Ewing’s sarcoma most commonly affect

A

Younger people - most cases between age 10 and 20

60
Q

Tx of Ewing’s sarcoma

A

Tumour excision

XRT and chemo sensitive

61
Q

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

A 
breast carcinoma 
prostate carcinoma 
lung carcinoma 
renal cell carcinoma 
thyroid adenocarcinoma
62
Q

bones most frequently involved in metastases

A 
vertebra 
pelvis 
ribs 
skull 
humerus 
long bones of lwoer limbs
63
Q

popcorn calcification of x-ray

A

chondroscarcoma

64
Q

onion peel sign

A

Ewing’s sarcoma

Orthopaedics (16 decks)

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