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Musculoskeletal > Bone Tumours > Flashcards

Bone Tumours Flashcards

1
Q

What is the commonest primary bone tumour in children and adolescents

A

Osteosarcoma

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2
Q

Peak age incidence of osteosarcoma

A

10-20yrs

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3
Q

Pathology of osteosarcoma

A

primary osseous malignant neoplasm composed of mesenchymal cells producing malignant osteoid and immature bone

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4
Q

Secondary causes of osteosarcoma

A

Rare complication of Pagets disease

Irradation

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5
Q

Clinical features of osteosarcoma

A

Pain worse at night (dull boring ache)
Mass/swelling
Joint effusion

Children/Adolescents

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6
Q

Is pain related to exercise in osteosarcoma

A

No

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7
Q

Which gender is osteosarcoma more common in

A

Males

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8
Q

Where majority of osteosarcoma appear

A

Knee (proximal tibia, distal femur)

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9
Q

Ix for osteosarcoma

A 
X-ray
HRCT 
MRI 
CT 
Bone scan 
Surgical biopsy
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10
Q

Which characteristic sign can be seen on x-ray in Osteosarcoma

A

Codmans Triangle

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11
Q

Rx for Osteosarcoma

A

Complete radial surgical resection:
Amputation

Neoadjuvant chemotherapy
Radiotherapy

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12
Q

Which gender is Ewing Sarcoma more common in

A

Males

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13
Q

Which age is Ewing Sarcoma most prevalent in

A

Teenagers

Young adults

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14
Q

Pathology of Ewing Sarcoma

A

Malignant round, blue cell tumour

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15
Q

Pathological features of Ewing Sarcoma

A 
Small 
Round 
Blue cell tumour 
Monomorphic tumour cells 
Granular chromatin 
Necrosis
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16
Q

What type of reaction can be seen at the periosteum in Ewing Sarcoma

A

Periosteal onion skin reaction

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17
Q

Which chromosomal translocation is associated with Ewing Sarcoma

A

T11:T22

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18
Q

Which bones does Ewing Sarcoma typically affect

A 
Pelvis 
Femur 
Tibia 
Ribs 
Spine
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19
Q

Clinical features of Ewing Sarcoma

A

Night bone pain

Swelling tenderness over area

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20
Q

Ix for Ewing Sarcoma

A 
X-ray 
Bone scan 
PET 
MRI 
Biopsy: histological Dx 
CT chest/abdo/pelvis
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21
Q

Typical x-ray feature of Ewing Sarcoma

A

Periosteal onion skin reaction

Bone destruction

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22
Q

Does Ewing Sarcoma spread rapidly or slowly

A

Rapidly

23
Q

Rx for Ewing Sarcoma

A 
Chemotherapy 
Radiotherapy 
Surgery: 
Resection 
amputation
24
Q

What is the key adverse prognostic factor at Dx for Ewing Sarcoma

A

Metastatic disease

25
Q

Is the bone a common metastatic sight

A

Yes

3rd most common

26
Q

Common primary sites for bone metastases

A 
Prostate 
Thyroid 
Lung 
Kidney 
Breast
GIT 
Melanoma
27
Q

Clinical features of metastatic bone tumours

A

Bone pain worse at night
Progressive bone pain
Fracture
Swelling

28
Q

Staging IX for metastatic bone disease

A 
Bone scan 
X-ray 
CT
MRI 
PET 
Biopsy
29
Q

Is secondary or primary bone neoplasms more common

A

Secondary far more common

Primary bone neoplasms are actually quite rare

30
Q

What is the commonest benign bone tumour

A

Osteochondroma

31
Q

What are the two types of osteochondroma

A
  1. Solitary Osteocartilaginous Exotosis

2. Hereditary Multiple Exotoses/Osteochondroma

32
Q

Describe solitary osteocartilaginous exotosis

A

When there is 1 tumour

33
Q

Describe Hereditary Multiple Exotoses/Osteochondroma

A

Development of multiple osteochondromas

Variability in size, number and location

34
Q

Which genes are associated with Hereditary Multiple Exotoses/Osteochondroma

A

EXT1 and EXT2

35
Q

What type of inheritance is Hereditary Multiple Exotoses/Osteochondroma

A

Autosomal Dominant

36
Q

Clinical features of osteochondroma

A

Hard painless mass

37
Q

Do osteochondromas affect life expectancy

A

no as benign lesions

38
Q

Rx for osteochondromas

A

Often do nothing

Surgery: excision if symptomatic

39
Q

Do osteochondromas have the capability of malignant transformation

A

Yes but this is very rare

40
Q

Which has a higher malignant transformation rate?
1. Solitary Osteocartilaginous Exotosis
OR
2. Hereditary Multiple Exotoses/Osteochondroma

A

Hereditary/multiple

Much higher ratw

41
Q

What is an osteoid osteoma

A

Benign bone lesion

42
Q

Clinical features of osteoid osteoma

A

Dull pain that worsens at night
Limping
Swelling

43
Q

Common sites for osteoid osteoma

A

Long bones

E.g femur or tibia

44
Q

Which gender is more affected with osteoid osteoma

A

Male

45
Q

Common age for osteoid osteoma

A

10-25yrs

46
Q

Why do osteoid osteomas cause pain

A

Because the nidus produces prostaglandins causing pain

47
Q

X-ray features of osteoid osteoma

A

Long cortical scleoris
Central radiolucent nidus
Within nidus small nucleus calcification

48
Q

Ix for Osteoid Osteoma

A

X-ray

CT: better for detection

49
Q

Rx for osteoid osteoma

A

Analgesia (NSAIDs)

CT Guided radiofrequency ablation

50
Q

What is the treatment problem with chondrosarcomas

A

They are relatively insensitive to radiotherapy and chemotherapy

51
Q

What is a chondrosarcoma

A

Malignant tumour of cartilage

52
Q

Which age is chondrosarcoma common in

A

Middle aged

53
Q

Rx for chondrosarcoma

A

Surgery (with margin)

54
Q

Definitive Dx for bone tumours

A

Biopsy

Musculoskeletal (13 decks)

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