cortex module Flashcards

1
Q

what is the most common benign bone tumour

A

The commonest is an osteochondroma which produces a bony outgrowth on the external surface with a cartilaginous cap.

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2
Q

what is an enchondroma

A

An intramedullary and usually metaphyseal cartilaginous tumour caused by failure of normal enchondral ossification at the growth plate.

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3
Q

what is a simple bone cyst (aka unicameral bone cyst)

A

A single cavity benign fluid filled cyst in a bone. They may be asymptomatic and an incidental finding on xray (usually a child or young adult) however they can cause weakness leading to pathological fracture. Again treatment with curettage and bone grafting with or without stabilization may be required.

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4
Q

what is an aneurysmal bone cyst

A

Contains lots of chambers which are filled with blood or serum. They are thought to be due to a small arteriovenous malformation. They can occur in the metaphyses of many different long bones, flat bones (ribs, skull) and vertebral bodies. The lesion is locally aggressive causing cortical expansion and destruction and is usually painful. Again there is a risk of pathological fracture. Treament is again with curettage and grafting or the use of bone cement.

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5
Q

what is a giant cell tumur

A

GCTs most commonly occur around the knee and in the distal radius but can occur in other long bones, the pelvis and the spine. They occur after the physis has fused and are locally destructive destroying cortex. They are painful and may cause pathological fracture. The aetiology is unknown but as the name suggests histologically they consist of muli‐nucleate giant cells. On Xray they have a characteristic “soap bubble” appearance. Although they are considered benign, 5% can metastasize to the lung with benign pulmonary GCT. Treatment is intralesional excision with use of phenol, bone cement or liquid nitrogen to destroy remaining tumour material and reduce the risk of recurrence. Very aggressive lesions with cortical destruction may need joint replacement.

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6
Q

what is fibrous dysplasia

A

Disease of a bone usually occurring in adolescence where a genetic mutation results in lesions of fibrous tissue and immature bone. It can affect one bone (monostotic) or more (polyostotic). Defective mineralization may result in angular deformities and the affected bone is wider with thinned cortices.

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7
Q

what is an osteoid osteoma

A

small nidus of immature bone surrounded by an intense sclerotic halo. They most commonly occur in adolescence and common sites include the proximal femur, the diaphysis of long bones and the vertebrae. The predominant clinical feature is intense constant pain, worse at night due to the intense inflammatory response. This pain is greatly relieved by NSAIDs. The lesion may be seen on xray however bone scan (intense local uptake) and CT can confirm the diagnosis. The lesion may resolve spontaneously over time but some cases may require CT guided radiofrequency ablation or en bloc excision.

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8
Q

metastatic cancer of the bone tends to produce what type of pain

A

constant pain which may be severe and is usually worse at night

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9
Q

what do malignant primary bone tumours show on an x-ray

A

aggressive and destructive signs including cortical destruction, a periosteal reaction, new bone formation and extension into the surrounding tissue

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10
Q

what is chondrosarcoma

A

A cartilage producing primary bone tumour and is less common and less aggressive than osteosarcoma. It tends to occur in an older age group (mean age 45). They can be very large and are slow to metastasize. They tend to be found in the pelvis or proximal femur. The prognosis is dependant on the histological grade with the majority being low grade. They are not radiosensitive and unresponsive to adjuvant chemotherapy thus far.

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11
Q

what are fibrosarcoma and malignant fibrous histiocytoma

A

Fibrous malignant primary bone tumours which tend to occur in abnormal bone (bone infarct, fibrous dysplasia, post irradiation, Paget’s disease). Fibrosarcona tends to affect adolescents or young adults.

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12
Q

what is Ewings sarcoma

A

A malignant tumour of primative cells in the marrow. It is the 2nd most prevalent primary bone tumour and has the poorest prognosis. Most cases occur between the ages of 10 and 20. It may be associated with fever, raised inflammatory markers and a warm swelling and may be misdiagnosed as osteomyelitis. It tends to be radio‐ and chemo‐sensitive.

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13
Q

what investigations are carried out for primary bone tumours

A
  • bone scan and CT chest
  • MRI and CT are good for determining the local extent of of the tumour and the involvement of muscles, nerves and vessels
  • biopsy is required for histological diagnoses
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14
Q

what is the treatment for a primary bone tumour

A
  • surgery to remove the tumour and surrounding tissue to reduce the risk of recurrence
  • chemotherapy
  • radiotherapy
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15
Q

what is a lymphoma (a cancer of round cells of the lymphocytic system/macrophages)

A

can occur as a primary bone tumour (as Non Hodgkins Lymphoma) from the marrow or lymphoma (any type) can metastasize to bone (in 20% of cases). Primary lymphoma of bone tends to affect the pelvis or femur and treatment is with surgical resection. With metastatic lymphoma lymphadenopathy or splenomegaly may be present and treatment is chemotherapy and radiotherapy. Survival of metastatic lymphoma is usually less than 2 years.

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16
Q

what is a myeloma

A

(a malignant B cell proliferation [antibodies]) arises from the marrow and can present as a solitary lesion (known as a plasmacytoma) or with multiple osteolytic lesions throughout the skeleton (known as multiple myeloma). Patients are typically aged 45‐65 and with multiple myeloma have weakness, back pain, bone pain, fatigue, and weight loss and may have marrow suppression resulting in anaemia and recurrent infection. Patients may present with pathologic fracture. Diagnosis is by plasma protein electrophoresis (showing a high level of paraprotein) and early morning urine collection for Bence Jones protein assay. Note that with these lytic lesions there is not usually an osteoblastic response to the osteoclastic bone resorption and metastases may not be detected on bone scan. A skeletal survey of xrays is required. Treatment of a solitary plasmacytoma is by radiotherapy whilst treatment of multiple myeloma is by chemotherapy. 5 year survival is less than 30%.

17
Q

what bones are most frequently involved with metastases

A
  • vertebra
  • pelvis
  • ribs
  • skull
  • humerus
  • long bones of the lower limb
18
Q

what are fractures of impending fractures treated with

A

stabilisation using long rods whilst if there is destruction of the joint the joint replacement may be a better option

surgery has a high risk of DVT and prophylaxis must be given

chemotherapy and radiotherapy may be given after surgery

19
Q

what are some examples of local swellings

A

inflammatory swellings (bursitis, rheumatoid nosules), infection (abscess), cystic lesions (ganglion, meniscal cyst, Baker’s cyst), benign neoplasms and malignant neoplasms.

20
Q

what are features suggestive of a benign, soft tissue neoplasm

A
  • smaller size
  • fluctuation in size (malignant tumours done regress in size)
  • cystic lesions
  • well defined lesions
  • fluid filled lesions and soft/fatty lesions
21
Q

what are features suggestive of potential malignant soft tissue neoplasm

A
  • larger lesion (>5cm)
  • rapid growth in size
  • solid lesion
  • ill defined lesion
  • irregular surface
  • associated lymphadenopathy
  • systemic upset (weight loss, loss of appetite, fatigue)
22
Q

what is the commonest benign soft tissue tumour

A

lipoma (neoplastic proliferation of fat)

23
Q

what are malignant soft tissue tumours arising from the connective tissues

A

sarcomas - most commonly present between the ages of 50 and 70 but can occur at any age. Again if there is doubt over the nature of a soft tissue swelling, referral to a specialist is recommended with imaging and biopsy as required. Once the diagnosis is established, the cancer is graded and staged whilst treatment is usually surgical with adjunctive chemotherapy and/or radiotherapy. Surgery usually involves radical or wide local excision with limb salvage surgery or amputation if a functional limb cannot be maintained.

24
Q

what is a ganglion cyst

A

Occurs around a synovial joint or a synovial tendon sheath. It may form as a result of herniation or out‐pouching of a weak portion of joint capsule or tendon sheath. The weakness can be developmental (eg juvenile Baker’s cyst) or as a result of underlying joint damage / arthritis with buildup of pressure within the joint (adult Baker’s cyst, mucous cyst of DIP joint, wrist ganglion). Ganglion cysts are well‐defined, may be quite firm and readily transilluminate. Excision may be required for localized discomfort or cosmesis.

25
Q

what is bursitis

A

A bursa is a small fluid filled sac lined by synovium around a joint which prevents friction between tendons, bones, muscle and skin. There are numerous bursae around different joints and bony prominences. Commonly inflamed bursae which usually occur after repeated pressure or trauma and which may present as a soft tissue swelling include pre‐patellar bursitis, olecranon bursitis and bunions (bursitis over the medial 1st metatarsal head in hallux valgus). Bacterial infection can cause a bursal abscess (usually from a small wound on the limb) and gout may cause a bursitis. With inflammatory bursitis the fluid component of the swelling usually subsides but a thickened bursal sac may be left. Recurrence may occur and excision may be required but problems can occur with scarring.

26
Q

what is avascular necrosis

A

An ischaemic necrosis of bone predominantly in adults. Several sites are particularly prone to AVN including the femoral head, the femoral condyles, the head of the humerus, the capitellum, the proximal pole of the scaphoid and the proximal part of the talus.

27
Q

what does arthropathy mean

A

disease of join