Bone Tumours Flashcards
Which is more common:
a) primary
b) metastatic
bone cancer?
metastatic
Commonest type of benign bone tumour
Osteochondroma
Osteochondroma
a benign bony outgrowth on the external knee surface with a cartilaginous cap
Osteochondroma symptoms
Usually don’t produce symptoms!
Can cause local pain
Risk of malignant transformation of osteochondroma
1%
Osteochondroma Tx
Excisional biopsy - only if growing in size or causing pain
Multiple osteochondroma
Occurs as part of an autosomal dominant hereditary disease
Enchondroma
Benign intramedullary and usually metaphyseal cartilaginous tumour
Cause of enchrondromas
Failure of normal enchondral ossification at the growth plate
Radiological appearance of enchondromas
Lucent
- can undergo mineralisation and have a patchy sclerotic appearance
Enchondroma symptoms
Usually asymptomatic - can weaken bone and then produce pathological fractures
Most common locations for enchondromas
Femur
Humerus
Tibia
Small bones of hands and feet
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
Simple bone cyst
A benign single cavity fluid filled cyst in bone
Cause of simple bone cysts
Growth defect from the physis
Most common locations for simple bone cysts
Metaphysis in long bones (femur and humerus)
Talus
Calcaneus
Simple bone cyst symptoms
Can be asymptomatic - incidental finding on xray
Weakness - pathological fractures
Simple bone cyst Tx
Curettage and bone graft +/- stabilisation
Aneurysmal bone cyst
A benign cyst with lots of chambers filled with blood or serum
cause of aneurysmal bone cysts
Small arteriovenous malformations
Most common locations for aneurysmal bone cysts
Metaphyses of long bones Flat bones (ribs, skull) Vertebral bodies
Aneurysmal bone cyst symptoms
Pain - caused by local cortical expansion and destruction
Pathological fractures
Aneurysmal bone cyst symptoms
Curettage and bone graft
Giant cell tumours
Locally aggressive benign tumour that occurs after the physis has fused
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
