Bone Tumours Flashcards
What is the commonest primary bone tumour in children and adolescents
Osteosarcoma
Peak age incidence of osteosarcoma
10-20yrs
Pathology of osteosarcoma
primary osseous malignant neoplasm composed of mesenchymal cells producing malignant osteoid and immature bone
Secondary causes of osteosarcoma
Rare complication of Pagets disease
Irradation
Clinical features of osteosarcoma
Pain worse at night (dull boring ache)
Mass/swelling
Joint effusion
Children/Adolescents
Is pain related to exercise in osteosarcoma
No
Which gender is osteosarcoma more common in
Males
Where majority of osteosarcoma appear
Knee (proximal tibia, distal femur)
Ix for osteosarcoma
X-ray HRCT MRI CT Bone scan Surgical biopsy
Which characteristic sign can be seen on x-ray in Osteosarcoma
Codmans Triangle
Rx for Osteosarcoma
Complete radial surgical resection:
Amputation
Neoadjuvant chemotherapy
Radiotherapy
Which gender is Ewing Sarcoma more common in
Males
Which age is Ewing Sarcoma most prevalent in
Teenagers
Young adults
Pathology of Ewing Sarcoma
Malignant round, blue cell tumour
Pathological features of Ewing Sarcoma
Small Round Blue cell tumour Monomorphic tumour cells Granular chromatin Necrosis
What type of reaction can be seen at the periosteum in Ewing Sarcoma
Periosteal onion skin reaction
Which chromosomal translocation is associated with Ewing Sarcoma
T11:T22
Which bones does Ewing Sarcoma typically affect
Pelvis Femur Tibia Ribs Spine
Clinical features of Ewing Sarcoma
Night bone pain
Swelling tenderness over area
Ix for Ewing Sarcoma
X-ray Bone scan PET MRI Biopsy: histological Dx CT chest/abdo/pelvis
Typical x-ray feature of Ewing Sarcoma
Periosteal onion skin reaction
Bone destruction
Does Ewing Sarcoma spread rapidly or slowly
Rapidly
Rx for Ewing Sarcoma
Chemotherapy Radiotherapy Surgery: Resection amputation
What is the key adverse prognostic factor at Dx for Ewing Sarcoma
Metastatic disease
Is the bone a common metastatic sight
Yes
3rd most common
Common primary sites for bone metastases
Prostate Thyroid Lung Kidney Breast GIT Melanoma
Clinical features of metastatic bone tumours
Bone pain worse at night
Progressive bone pain
Fracture
Swelling
Staging IX for metastatic bone disease
Bone scan X-ray CT MRI PET Biopsy
Is secondary or primary bone neoplasms more common
Secondary far more common
Primary bone neoplasms are actually quite rare
What is the commonest benign bone tumour
Osteochondroma
What are the two types of osteochondroma
- Solitary Osteocartilaginous Exotosis
2. Hereditary Multiple Exotoses/Osteochondroma
Describe solitary osteocartilaginous exotosis
When there is 1 tumour
Describe Hereditary Multiple Exotoses/Osteochondroma
Development of multiple osteochondromas
Variability in size, number and location
Which genes are associated with Hereditary Multiple Exotoses/Osteochondroma
EXT1 and EXT2
What type of inheritance is Hereditary Multiple Exotoses/Osteochondroma
Autosomal Dominant
Clinical features of osteochondroma
Hard painless mass
Do osteochondromas affect life expectancy
no as benign lesions
Rx for osteochondromas
Often do nothing
Surgery: excision if symptomatic
Do osteochondromas have the capability of malignant transformation
Yes but this is very rare
Which has a higher malignant transformation rate?
1. Solitary Osteocartilaginous Exotosis
OR
2. Hereditary Multiple Exotoses/Osteochondroma
Hereditary/multiple
Much higher ratw
What is an osteoid osteoma
Benign bone lesion
Clinical features of osteoid osteoma
Dull pain that worsens at night
Limping
Swelling
Common sites for osteoid osteoma
Long bones
E.g femur or tibia
Which gender is more affected with osteoid osteoma
Male
Common age for osteoid osteoma
10-25yrs
Why do osteoid osteomas cause pain
Because the nidus produces prostaglandins causing pain
X-ray features of osteoid osteoma
Long cortical scleoris
Central radiolucent nidus
Within nidus small nucleus calcification
Ix for Osteoid Osteoma
X-ray
CT: better for detection
Rx for osteoid osteoma
Analgesia (NSAIDs)
CT Guided radiofrequency ablation
What is the treatment problem with chondrosarcomas
They are relatively insensitive to radiotherapy and chemotherapy
What is a chondrosarcoma
Malignant tumour of cartilage
Which age is chondrosarcoma common in
Middle aged
Rx for chondrosarcoma
Surgery (with margin)
Definitive Dx for bone tumours
Biopsy
