Bone Tumours Flashcards
What is this?
Describe what you see?
- Compact bone
- Osteocytes are the white cells
- Haversian systems surround the osteocytes
What is this?
Describe what you see
- Cancellous bone
- arranged in trabeculae
- white spaces are marrow cavity
What type of bone is seen in childhood fractures and bone tumours?
Woven bone
What type of cells form woven bone?
Osteoblasts
How common are secondary bone tumours?
Very common
How common are bone myelomas?
Most common primary bone tumour
How common are primary bone tumours?
Rare
What type of cancers metastasise to bone?
- Lung (bronchus)
- Breast
- Prostate
- Kidney
- Thyroid (follicular)
What are the childhood cancers which metastasise to bone?
- Neuroblastoma
- Rhabdomyosarcoma
What are the effects of cancer metastasis to bone?
- Asymptomatic
- Bone pain
- Hypercalcaemia
- Pathological fracture of long bones
What are the effects of cancer metastasising to the spine?
- Back pain
- Vertebral collapse
- Spinal cord compression
Describe PET CT?
- Anatomical detail can be achieved alongside functional data
- e.g. this is a metastatic deposit in femur
What are the different types of bone mets?
- Lytic (majority)
- Sclerotic
What is this?
- X-ray of lytic bone metastasis
- Translucent area on pelvis
What is the mechanism of bone destruction caused by bony mets?
- Osteoclasts
- Stimulated by cytokines released from tumour cells
- Inhibited by bisphophonates
Waht is pictured here?
- Sclerotic bone mets
- Opacification of left pubis
- Likely to be from prostate cancer
What can sclerotic bone mets be caused by?
- Carcinoid tumour
- Breast carcinoma
- Prostatic carcinoma
How do sclerotic metastasis form on bone?
Reactive bone formation induced by tumour cells
Describe solitary bone mets?
- Renal and thyroid carcinomas
- Long survival
- Surgical removal
Describe Myeloma?
- Most common malignant primary bone tumour
- Monoclonal proliferation of plasma cells
- Solitary or multiple myeloma
What is another name for a solitary myeloma?
Plasmacytoma
What are the clinical effects of myeloma?
- Bone lesions
- Punched out lytic foci
- Osteopenia
- Marrow replacement
- Anaemia
- Infectious
- Immunoglobulin excess
- ESR > 100
- Bence Jones protein in urine
What is this?
- ‘Pepper pot’ skull
- Punched out foci
- Classical feature of myeloma
Describe histoloy of plasma cells?
- Eccentric nucleus
- Clock face
- Clear area on cytoplasm
What is pictured here?
- Histology of meyloma
- Lots and lots of plasma cells
What are the Benign Primary Bone tumours?
- Chondroma
- Giant cell tumour
- Osteoid osteoma
What are the Malignant Primary Bone tumours?
- Osteosarcoma
- Ewing’s tumour
- Chondrosarcoma
Describe Osteoid Osteoma?
- Osteoblastic prolfieration
- Spine and long bones
- Pain, worse at night
- Relieved by aspirin
What is pictured here?
Classical radiological appearance of Osteoid Osteoma
Describe Osteosarcoma?
- Metaphysis of long bones
- Around the knee
- Early lung metastasis
Classical
Classical presentation of (left) Osteosarcoma
What is the prognosis of Osteosarcoma?
50-60% 5 year suvival now than chemotherapy has been developed
What are the worse prognosis variants of osteosarcoma?
- Paget’s disease
- Multifocal osteosarcoma
- Post-irradiation osteosarcoma
What is this?
- Bad osteosarcoma on x-ray
- humerus
Describe Paget’s disease?
- Disorder of excessive bone turnover
- Structurally weak bone
Who does Paget’s disease commonly affect?
What bones does Paget’s disease commonly affect?
Elderly, anglo-saxon
- Skull
- Pelvis
- Femur
- Vertebrra
Describe the clinical manifestations of Paget’s disease?
- Bone pain
- Deformity of long bones
- Pathological fractures
- Osteoarthritis
- Deafness
- Spinal cord compression
- Cardiac failure due to high CO
- Paget’s sarcoma
Describe Paget’s sarcoma?
- Second osteosarcoma peak in elderly
- Lytic
- Long bones
- Very poor prognosis due to early metastases to lung and bone
Name the bone forming tumours?
- Osteoid osteoma (benign)
- Osteocarcoma (malignant)
Name the cartilaginous tumours?
- Enchondroma (benign)
- Osteocartilaginous exostosis (benign)
- Chondrosarcoma (malignant)
Describe Enchondroma?
- Lobulated cartilage within medulla
- Hands, feet, long bones
- Low cellularity
- Surrounded by plates of lamellar bone
What are the symptoms of Enchondroma affected the long bones?
Asymptomatic
What are the symptoms of Enchondroma affected the hands?
- Swelling
- Pathological fracture
Describe Osteocartilaginous exostosis?
- Cartilage with endochondral ossification
- Cartilage cap
- Derived from growth plate
Describe Multiple-diaphyseal aclasis?
- Autosomal dominant
- Multiple osteocartilaginous exostosis
Osteocartilaginous exostosis
Describe Chondrosarcoma?
- Malignant cartilage tumour
- Primary or secondary to beign cartilage tumour
- Withhin medullary canal or on bone surface
Where do Chondrosarcomas tend to affect?
- Ribs
- Pelvis
- Shoulder girdle
- Chondrosarcoma
- chalky calcifications
Describe Ewing’s sarcoma?
- Tends to be in children
- Long bones, flat bones
- Early metastasis to lung, bone, marrow
- 50-60% 5 year survival
Name the genetic abnormality involved in Ewings sarcoma?
11:22 translocation
