Bone tumours

Question 1

What are signs of bone mets?

Answer 1

Bone pain, hypercalcaemia, pathological fracturess

Common primary: lung, prostate, thyroid, kidney, breast

Question 2

What’s the difference between sclerotic and lytic mets

Answer 2

Sclerotic: activate osteoblasts and cause reactive bone formation e.g. prostate and breast cancers

Lytic: activate osteoclasts and cause bone breakdown e.g. lung adenocarcinoma

Question 3

What are different types of primary bone tumours?

Answer 3

Myeloma

Benign: chondrosarcoma, osteoid osteoma

Malignant: osteosarcoma (primary and secondary due to Paget’s), chondrosarcoma, Ewing’s sarcoma

Question 4

What are the key features of osteoid osteoma?

Answer 4

Osteoblastic proliferation occuring in long bones and spine of adolescent males.

Pain which is worse at night

Imaging shows cortical sclerosis with central nidus

Do radiofrequency ablation

Question 5

What are the key features of chondroma?

Answer 5

Cartilage tumour occurring in medullary or cortical bone. Any bone, common hands and feet giving swelling.

Curettage and fill bone with cement

Question 6

What is osteocartilaginous exostosis?

Answer 6

Benign cartilage outgrowth common in adolescence. Can become malignant if it gets really big.

Question 7

What is osteosarcoma?

Answer 7

Malignant osteoid tumour, either primary or in bones with Paget’s

Question 8

What are key features of primary osteosarcoma?

Answer 8

Osteoblasts of long bones of adolescent males, pain.

Imaging can show Codman’s triangle

Treatment is with chemo and endoprosthetic replacement. Can be lung mets

Question 9

What are the key features of secondary osteosarcoma?

Answer 9

Occurs in Paget’s bone in elderly, seen in vertebrae, pelvis, skull, femur. Pain and deformity, high CO, deaf.

Lytic rather than sclerotic, with early mets to lung and bone.

Question 10

What are the key features of chondrosarcoma?

Answer 10

Occurs in middle aged/elderly with pain/lump in axial skeleton.

Can be primary or occur from chondroma/ osteocartilaginous exostosis.

Imaging show popcorn calcification.

Excise.

Question 11

What are the key features of Ewing’s sarcoma?

Answer 11

Malignant round cell tumour of long bones and limb girdles. Occurs in adolescents

t(11,22) translocation

early mets to lung/bone