Bone Tumours Flashcards
List the malignant bone tumours
Osteosarcoma Chondrosarcoma Myeloma -1% of all malignancies Metastases Ewing's sarcoma 2% of enchondromas
List the non-malignant bone tumours
Osteoblastoma Osteochondroma Giant cell tumour Osteoid osteomas Most enchondromas
Tissue type of osteosarcomas
Pleomorphic osteoid producing osteoblasts
Osteoblastoma cell type
Osteoblasts
Osteochondroma cell type
Growth plate cells
Chondrosarcoma cell type
Chondrocytes
Myeloma cell type
Plasma cells of bone marrow
Metastases main cell types
Lung Prostate Breast Thyroid Renal
Ewing’s sarcoma cell type
Neuroectodermal
Giant cell tumour cell type
Osteoclasts
Osteoid osteomas cell type
Osteoblasts
Enchondroma cell type
Cartilage
Main presentations of osteosarcomas
Chronic inflammatory response Bone pain -worse at night Pulmonary symptoms if Mets Fever Swelling
Osteoblastoma main presentations
Nidus of over 1.5cm Avascular necrosis Spinal nerve compression Slow progressive pain Not relieved by NSAIDs Swelling Muscle Atrophy Limp
Osteochondroma main presentations
Palpable, non tender, bony lump that is firm and immobile potentially causing spinal nerve compression and avascular necrosis
Chondrosarcoma main presentations
Chronic inflammatory response with pulmonary symptoms if Mets are present
Myeloma main presentations
Localised bone pain
Pathological fracture
Fatigue
Aneamia
Mets main presentations
Chronic inflammatory response with primary cancer symptoms
Ewing’s sarcoma presentation
Chronic inflammatory response
Giant cell tumour presentation
Pain and swelling
Osteoid osteomas presentation
Nidus of less than 1.5cm
Worse pain at night
May block sinuses and nasal cavity with polypatous growth
Pain relieved by NSAIDs
Enchondroma presentation
Incidentally found
X ray findings of osteosarcoma
Lytic bone lesions
Sunburst spicules
Codman’s triangle - very destructive if this appears
X ray findings of osteoblastomas
Eroded ring of surrounding bone
Lytic or mixed lytic-blastic lesion with radiolucent nidus > 2cm
Reactive sclerotic bone
X-ray findings of osteochondroma
Lateral bony projection (exostosis) with a hyaline cartilage cap
X-ray findings of chondrosarcoma
Lytic patchy lesions that look moth eaten in the medullary cavity
Reactive thickening of the cortex
Popcorn lesions may be seen
X-ray findings of myeloma
Punched out lytic lesions in metaphysis
Ewing’s sarcoma X ray findings
Onion Skinning
Giant cell tumour X ray findings
Multicystic bone lesion (soap bubbles) extending to cartilage through epiphysis
Osteoid osteomas x-ray findings
Intensely reactive bone around radiolucent nidus
Enchondroma X ray findings
Lobular growing pattern (popcorn lesions) with central calcifications within the bone (stopped)
Main age for osteosarcoma
Mainly adolescents but also elderly
Osteoblastoma main age
10-30 years
Osteochondroma main age
<25 years old
Chondrosarcoma main age
Elderly
Myeloma main age
Over 40s
Ewing’s sarcoma main age
10-20
Giant cell tumour main age
30-50
Osteoid osteomas main age
Less than 25
Enchondroma main age
20-50
Which tumours affect males more than females
Osteoblastoma Osteochondroma Chondrosarcoma Myeloma Mets Ewing's Osteoid osteomas
Which tumours affect females more than males
Giant cell tumours
Which cancers are treated with surgery, radiotherapy and chemotherapy?
Myeloma (no surgery) Osteosarcoma Chondrosarcoma Mets Ewing's sarcoma
Chemotherapeutic drug for bone tumours
Methotrexate
Osteochondroma and osteosarcoma treatment
Surgery if symptomatic
Giant cell tumour treatment
Surgically removed with curretage, grafting and may require denosmuab
Genetic link for osteosarcoma
Retinoblastoma suppressor gene
Osteoblastoma genetic link
FAP gene
Osteochondroma genetic link
Autosomal dominant, mutation in EXT gene
Loss of regulation in Indian hedgehog protein
Ewing’s sarcoma genetic link
t(11:22) translocation
Main bones affected by osteosarcoma
| Distal femur | Proximal tibia | Proximal humerus | Proximal femur ↓ Pelvis
Main bones affected by osteoblastoma
Mandible
Axial
Skull
Facial bones
Main bones affected by osteochondroma
Distal femur
Proximal tibia
Ilium
Scapula
Main bones affected by chondrosarcoma
Axial skeleton
Pelvis
Long bones
Main bones affected by myeloma
Spine and ribs
Main bones affected by Ewing’s sarcoma
Femur Sacrum Humerus Tibia Diaphyses
Main bones affected by giant cell tumours
Distal femur
Proximal tibia epiphysis
Main bones affected by Osteoid osteomas
Long bone diaphyses
Main bones affected by enchondroma
Medullary cavity of long bones
Associated diseases of osteosarcomas
Retinoblastoma
Paget’s
Long term survival of osteosarcomas
76%
What % of osteosarcomas give pulmonary mets
10-20%
Most common benign tumour
Osteochondroma
Chondrosarcoma long term survival rate
Slow growing
50-75%
Myeloma 5 year and 10 year survival rate
30%
11%
Myeloma median survival rate
3 years
Most common primary bone tumour
Myeloma
5 year survival of Ewing’s sarcoma
60-85%
Giant cell tumour links
Bony trauma
% of giant cell tumours that become malignant
2%
What are Osteoid osteomas surrounded by
Sclerotic bone tissue producing prostaglandins
Most common hand malignancy
Enchondroma
Important test for osteosarcoma
Raised alkaline phosphatase
Important test for myeloma
Raised serum creatinine
Important test for Ewing’s sarcoma
Increased ESR
Important test for giant cell tumour
Decreased ROM
Histology of osteosarcomas
Tumour cells show atypia and produce Lacey osteoid
Histology of osteoblastoma
Similar to osteoid osteomas but with more giant cells
Histology of osteochondroma
Necrosis in growth plate
Histology of myeloma
Round plasma cells with eccentric nucleus and prominent nucleolus
History of chondrosarcoma
Disorganisation with blue collagen balls
Histology of Ewing’s sarcoma
Small, round, blue cells
Histology of giant cell tumour
Numerous multinucleated giant cells
Eccentric lytic epiphyseal/metaphyseal lesion that often extends into the distal epiphysis and borders subchondral bone
Histology of osteoid osteomas
Benign appearance
No growth potential
Central nidus composed of more organised osteoid and lined by osteoblasts
Histology of enchondromas
Bland
End organ damage ‘CRAB’ pneumonic
Calcium raised
Renal insufficiency
Aneamia
Bone lesions
