Bone tumours Flashcards
Malignant bone tumours
Multiple myeloma (most common)
Osteosarcoma
Ewing’s sarcoma
Chondrosarcoma
Benign bone tumours
Osteochondroma (most common)
Osteoid osteoma
Chondroma
Fibrous dysplasia of bone
Bone sarcoma presentation
Non-mechanical bone/joint pain
Bone pain at night
Bony swellings
Pathological fractures
Multiple myeloma defining feature
Multiple punched out osteolytic lesions on radiography
Osteosarcoma presentation
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
Osteosarcoma imaging findings
Sunray spiculation (bone destruction + new forming) Periosteal elevation (Codman's triangle) Staging uses intramedullary spread with MRI + CT for metastases
Osteosarcoma treatment + prognosis
Neoadjuvant chemo prior to surgery
60-70% 5yr survival
What is Ewing’s sarcoma
Round-cell tumour of long bones (typically diaphysis) + limb girdles, presents in adolescents
Ewing’s sarcoma XR features
Bone destruction
Onion ring sign (new bone forming in concentric layers)
Soft-tissue swelling
Periosteal elevation (Codman’s triangle)
Ewing’s sarcoma treatment + prognosis
Chemo, surgery + radiotherapy required
55% 5yr survival if no mets, 22% with mets
Chondrosarcoma causes
de novo or from chondroma malignant transformation
Chondrosarcoma presentation
Pain/lump on axial skeleton of middle aged
Chondrosarcoma imaging
XR shows popcorn calcification
MRI/CT for extent of tumour
Chondrosarcoma treatment
No response to chemo/radiotherapy
Surgical excision is only therapy, local recurrence if inadequate surgery
Limb-sparing surgical reconstruction
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
Osteochondroma presentation
Usually affects knee, proximal femur/humerus
Presents as painful mass associated with trauma
Osteochondroma imaging
Xray shows bony spur arising from cortex, usually pointing away away from joint
Osteochondroma treatment
Remove if causing symptoms (e.g. pressure on other structures)
Remove if growing after skeletal maturity - malignancy risk
Osteoid osteoma presentation
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
Osteoid osteoma imaging
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
Osteoid osteoma treatment
Prostaglandin inhibitors e.g. ibuprofen
CT guided biopsy + radiofrequency ablation
What is a Chondroma
Benign cartilagenous tumour arising from bone surfaces/medulla (enchondromata if within medulla)
Causes local swelling/#
Chondroma treatment
Rarely needed unless malignant (chondrosarcoma)
What is fibrous dysplasia of bone + complications
Developmental abnormality where bone incorrectly formed
May cause pain/inc risk of #
Fibrous dysplasia of bone treatment
Surgical stabilisation may be needed
In polyostic form bisphospanates may help with symptoms
Sarcoma vs carcinoma
Sarcoma is malignant neoplasm arising from mesenchymal cells (connective + non-epithelial tissue)
Carcinomas affect epithelial tissues
Any soft tissue lump considered to be malignant soft tissue sarcoma if
Any one from: Bigger than 5cm Increasing in size Deep to deep fascia Painful
Soft tissue sarcoma imaging
MRI then needle biopsy
Pathological diagnosis + gene expression profiling to target chemo
Soft tissue sarcoma treatment
Excision with wide margins, then radiotherapy
Adjuvant chemotherapy with doxorubicin/trabectedin
Soft tissue sarcoma prognosis
Related to histological grade, size, depth of tumour
<50% 5yr survival for high-grade large deep
Children respond better to chemo, higher survival rate
