Bone tumours

Question 1

Malignant bone tumours

Answer 1

Multiple myeloma (most common)
Osteosarcoma
Ewing’s sarcoma
Chondrosarcoma

Question 2

Benign bone tumours

Answer 2

Osteochondroma (most common)
Osteoid osteoma
Chondroma
Fibrous dysplasia of bone

Question 3

Bone sarcoma presentation

Answer 3

Non-mechanical bone/joint pain
Bone pain at night
Bony swellings
Pathological fractures

Question 4

Multiple myeloma defining feature

Answer 4

Multiple punched out osteolytic lesions on radiography

Question 5

Osteosarcoma presentation

Answer 5

1˚ Typically adolescents in metaphyses of long bones, especially knee
2˚ often follows irradiation/Paget’s disease adolescents
Pt presents with pain first, 50% tend to be knee

Question 6

Osteosarcoma imaging findings

Answer 6

Sunray spiculation (bone destruction + new forming)
Periosteal elevation (Codman's triangle)
Staging uses intramedullary spread with MRI + CT for metastases

Question 7

Osteosarcoma treatment + prognosis

Answer 7

Neoadjuvant chemo prior to surgery

60-70% 5yr survival

Question 8

What is Ewing’s sarcoma

Answer 8

Round-cell tumour of long bones (typically diaphysis) + limb girdles, presents in adolescents

Question 9

Ewing’s sarcoma XR features

Answer 9

Bone destruction
Onion ring sign (new bone forming in concentric layers)
Soft-tissue swelling
Periosteal elevation (Codman’s triangle)

Question 10

Ewing’s sarcoma treatment + prognosis

Answer 10

Chemo, surgery + radiotherapy required

55% 5yr survival if no mets, 22% with mets

Question 11

Chondrosarcoma causes

Answer 11

de novo or from chondroma malignant transformation

Question 12

Chondrosarcoma presentation

Answer 12

Pain/lump on axial skeleton of middle aged

Question 13

Chondrosarcoma imaging

Answer 13

XR shows popcorn calcification

MRI/CT for extent of tumour

Question 14

Chondrosarcoma treatment

Answer 14

No response to chemo/radiotherapy

Surgical excision is only therapy, local recurrence if inadequate surgery

Question 15

Limb-sparing surgical reconstruction

Answer 15

Replacement of excised bone tumour with metal/polyethylene endoprosthesis/bone allograft as alternative to amputation
85% of pts have limb salvaged following chemotherapy for 1˚ bone tumours

Question 16

Osteochondroma presentation

Answer 16

Usually affects knee, proximal femur/humerus

Presents as painful mass associated with trauma

Question 17

Osteochondroma imaging

Answer 17

Xray shows bony spur arising from cortex, usually pointing away away from joint

Question 18

Osteochondroma treatment

Answer 18

Remove if causing symptoms (e.g. pressure on other structures)
Remove if growing after skeletal maturity - malignancy risk

Question 19

Osteoid osteoma presentation

Answer 19

Painful benign bone lesion, occurs mainly in long bones/spine of 10-25 yr old males
Nidus of osteoid osteoma produces prostaglandins which causes pain unrelated to activity

Question 20

Osteoid osteoma imaging

Answer 20

Local cortical sclerosis on XR with central radiolucent nidus (central area), which may contain small calcified area
Plain XR may miss these tumours, CT is best

Question 21

Osteoid osteoma treatment

Answer 21

Prostaglandin inhibitors e.g. ibuprofen

CT guided biopsy + radiofrequency ablation

Question 22

What is a Chondroma

Answer 22

Benign cartilagenous tumour arising from bone surfaces/medulla (enchondromata if within medulla)
Causes local swelling/#

Question 23

Chondroma treatment

Answer 23

Rarely needed unless malignant (chondrosarcoma)

Question 24

What is fibrous dysplasia of bone + complications

Answer 24

Developmental abnormality where bone incorrectly formed

May cause pain/inc risk of #

Question 25

Fibrous dysplasia of bone treatment

Answer 25

Surgical stabilisation may be needed

In polyostic form bisphospanates may help with symptoms

Question 26

Sarcoma vs carcinoma

Answer 26

Sarcoma is malignant neoplasm arising from mesenchymal cells (connective + non-epithelial tissue)
Carcinomas affect epithelial tissues

Question 27

Any soft tissue lump considered to be malignant soft tissue sarcoma if

Answer 27

Any one from:
Bigger than 5cm
Increasing in size
Deep to deep fascia
Painful

Question 28

Soft tissue sarcoma imaging

Answer 28

MRI then needle biopsy

Pathological diagnosis + gene expression profiling to target chemo

Question 29

Soft tissue sarcoma treatment

Answer 29

Excision with wide margins, then radiotherapy

Adjuvant chemotherapy with doxorubicin/trabectedin

Question 30

Soft tissue sarcoma prognosis

Answer 30

Related to histological grade, size, depth of tumour
<50% 5yr survival for high-grade large deep
Children respond better to chemo, higher survival rate