Bone Tumours

Question 1

What are the 5 types of tumours that metastasise to bone in adults? [5]

Answer 1

1. thyroid (follicular)
2. lung (bronchus)
3. breast,
4. prostate,
5. kidney

Question 2

What are the 2 types of tumours that metastasise to bone in children? [2]

Answer 2

1. neuroblastoma,
2. rhabdomyosarcoma

Question 3

Which types of bones typically get affected by metastatic disease? [3]

Answer 3

• Those with a good blood supply, e.g.
  
  • Long bones
  • Vertebral bones

Question 4

What are the general presenting features of bone metastases? [5]

Answer 4

1. often asymptomatic
2. bone pain
3. bone destruction
4. pathological fracture in long bones
5. symptoms of hypercalcaemia
   
   • fatigue
   • weakness
   • weight loss etc.

Question 5

What are the potential complications of spinal bone metastases? [4]

Answer 5

1. vertebral collapse,
2. spinal cord compression,
3. nerve root compression,
4. back pain

Question 6

What are the 2 types of bone metastases (histologically)? [2]

Answer 6

1. lytic
2. sclerotic

Question 7

Describe the features of lytic bone metastases under the following headings:

1. pathogenesis? [1]
2. which drug inhibits the pathogenic process? [1]
3. how does it show up on CXR? [1]

Answer 7

1. tumour cells release cytokines which stimulate osteoclast to resorb bone
2. bisphosphonates, e.g. alendronic acid
3. shows up on CXR as a low density dark colour since the bone is being destroyed

Question 8

Describe the features of sclerotic bone metastases under the following headings:

1. pathogenesis? [1]
2. causes? [3]
3. how does it show up on CXR? [1]

Answer 8

1. woven bone being deposited resulting in extra disorganised growth
2. causes:
   
   • prostatic carcinoma
   • breast carcinoma
   • carcinoid tumour
3. shows up white on CXR (↑ density)

Question 9

What is myeloma and what are 2 types? [3]

Answer 9

monoclonal proliferation of plasma cells

can be solitary (plasmacytoma) or multiple myeloma

Question 10

Describe the clinical effects of myeloma under the following headings:

1. features of bone lesions? [2]
2. blood abnormalities? [4]
3. features of immunoglobulin excess? [3]
4. features of renal impairment? [3]

Answer 10

1. bone lesions
   
   • punched out lytic foci
   • generalised osteopenia
2. marrow replacement
   
   • pancytopenia
   • anaemia
   • leucopenia → infections
   • thrombocytopenia → haemorrhage
3. immunoglobulin excess
   
   • ESR > 100
   • serum electrophoresis: monoclonal band
   • urine: immunoglobulin light chains
     
     • Bence Jones protein
4. renal impairment:
   
   • myeloma kidney: precipitated light chains in renal tubules
   • hypercalcaemia
   • amyloidosis

Question 11

What are the 3 types of benign primary bone tumours? [3]

Answer 11

1. Osteoid osteoma
2. Chondroma
3. Giant cell tumour

Question 12

What are the 3 types of malignant primary bone tumours? [3]

Answer 12

1. Osteosarcoma
2. Chondrosarcoma
3. Ewing’s tumour

Question 13

What is Paget’s disease and who gets it? [2]

Answer 13

disorder of excessive bone turnover affecting the elderly

Question 14

What are the pathological features of Paget’s disease? [4]

Answer 14

1. Increased osteoclasis (surgical destruction of the bone),
2. Increased bone formation,
3. Structurally weak bone
4. Disorganized bone architecture

Question 15

What structures commonly get affected by Paget’s disease? [4]

Answer 15

1. vertebrae,
2. pelvis,
3. skull,
4. femur

Question 16

What are the signs and symptoms of Paget’s disease? [7]

Answer 16

1. Bone pain
2. Deformity — bowing of long bones
3. Pathological fracture
4. Osteoarthritis
5. Deafness
6. Spinal cord compression
7. High cardiac output — cardiac failure

Question 17

What are the 3 types of cartilaginous tumours? [3]

Answer 17

1. Enchondroma
2. Osteocartilaginous exostosis
3. Chondrosarcoma

Question 18

What is Ewing’s sarcoma? [3]

Answer 18

Affects long bones (diaphysis or metaphysis) and flat bones of limb girdles and involves early metastases to lung, bone marrow and bone