CORTEXT Pathology week 1 Flashcards
What are the 5 causes of benign bone tumours?
Neoplastic Developmental Traumatic Infectious Inflammatory
What is the most common benign bone tumour?
Osteochondroma
What is an osteochondroma and what are the symptoms?
A bony outgrowth on the external surface with a cartilagenous cap
Can cause localised pain
What is an enchondroma and what are the symptoms?
An intramedullary and usually metaphyseak cartilaginous tumor caused by failure of normal enchondral ossification at the growth plate
Many are incidental findings but can result in weakness and pathological fractures
What is a simple bone cyst and what are the symptoms?
A single cavity cyst filled with benign fluid in a bone likely a growth defect
Asymptomatic but can cause weakness or pathological fracture
What is an aneurysmal bone cyst and what are the symptoms?
Lots of chambers in a bone that may be filled with blood or serum
Usually painful
Risk of pathological fracture
What are the treatments for aneurysmal and simple bone cysts?
Curettage and bone grafting with or without stabilization
Where do giant cell tumours occur?
Around the knee and distal radius but can occur elsewhere
What are the symptoms of GCT?
Pain
Pathological fractures
What is the treatment for a GCT?
Intralesional excision with use of phenol, bone cement or liquid nitrogen
Very aggresive lesions may need joint replacement
What is fibrous dysplasia and what are the symptoms?
Disease of a bone usually occuring in adolescence where a genetic mutation results in lesions of fibrous tissue and immature bone
Stress fractures
What is an osteoid osteoma and what are the symptoms?
Small nidus of immature bone surrounded by an intense sclerotic halo
Intense constant pain
Worse at night
May resolve spotaneously
What is a Brodie’s abscess?
Subacute osteomyelitis
Are malignant bone tumours common?
No very rare
What does metastatic bone cancer tend to produce?
Constant pain Worse at night Weight loss Loss of appetite Fatigue
What do malignant primary bone tumours show on x-ray?
Aggressive and destructive signs Cortical destruction A periosteal reaction New bone formation Sclerosis Extension into surrounding soft tissue
What is the most common form of primary bone tumour?
Osteosarcoma
Who and where do osteosarcomas tend to affect?
Young people
Around the knees
Are osteosarcomas radiosensitive?
No
What is a chondrosarcoma?
A cartilage producing primary bone tumour
What are Fibrosarcomas and Malignant Fibrous Histiocytomas?
Fibrous malignant primary bone tumours which tend to occur in normal bone
What is the treatment of primary bone tumours?
Surgery to remove tumour and surrounding tisue
Amputation
Adjuvant chemotherapy and radiotherapy
What is used in the staging of primary bone tumours?
Bone scan
CT
MRI
Biopsy
What is Ewing’s sarcoma and what are the symptoms?
Malignant tumour of primative cells in the marrow
Fever
Raised inflammatory markers
Warm Swelling
What cancers are likely to metastasize to bone and are they slerotic or lytic?
Breast - sclerotic or lytic Prostate - Sclerotic Lung - Lytic Renal - Large lytic Thyroid
What are the two types of soft tissue swellings?
Diffuse
Local
What are examples of diffuse soft tissue swellings?
Synovitis
Oedema
What are examples of local soft tissue swellings?
Bursitis
Rheumatoid nodules
Infection
Cystic lesions
What are the 11 findings to look for on examination of soft tissue swellings?
Site Size Definition – well defined or ill defined Consistency – cystic, solid, soft, hard Surface – smooth or irregular Mobility or Fixity – to skin or deep tissues Temperature – abscess Transilluminable – fluid filled Pulsatility Overlying skin changes Local lymphadenopathy
What are features suggestive of benign soft tissue neoplasms?
Smaller size Fluctuation of size Cystic lesion Well-defined lesions Fluid-filled lesions Soft/fatty lesions
What are features suggestive of malignant soft tissue neoplasms?
Larger lesions Rapid groeth Solid lesion Ill-defined lesion Irregular surface Lymphadenopather Systemic upset
What imaging is used for soft tissue swellings?
MRI
Ultrasounds
Biopsy
What is the commonent benign soft tissue tumour?
Lipoma - neoplastic proliferation of fat
Found in the subcutaneous fat and can be large and ill-defined
What are malignant soft tissue tumours arising from connective tissues known as?
Sarcomas
What are 5 types of sarcoma and where do they orignate from?
Angiosarcoma - blood vessels Fibrosarcoma - Fibrous tissue Liposarcoma - fat Rhabdomyosarcoma - skeletal muscle Synovial sarcoma - synovial lining
Where does a ganglion cyst occur?
Around a synovial joint or tendon sheath
What are the characteristics of a ganglion cyst?
Well-defined
Firm
Readily transilluminate
What is a bursa?
A small fluid filled sac lined by synovium around a joint
What is bursitis?
Inflamed bursae
Why do abscesses on a limb occur?
Cellulitis
Bursitis
Penetrating wound
Infected sebaceous cysts
What is the end result of Osteochondritis and Avascular necrosis?
Localized necrosis of the bone as a result of ischaemia from a reduction in blood supply
Who gets osteochondritis?
Children and young adults
What may be the causes of osteochondritis/
Repeated physical activity with stress
Familial predispostion
Impact injuries
What does bone necrosis cause?
Compression Fragmentation or separation of the bone Flattening of a joint Pain Arthritis at young age
Where are common sites affected by compression?
2nd metatarsal head Navicular bone Lunate of the carpus Keinbock's disease Capitellum of the elbow Perthes disease of the hip
What is fragmentation with separation of bone and cartilage within a joint known as?
Osteochondritis dissecans
How is osteochondritis treated?
Osteotomy (surgical reallignment of the bone)
Pinning of unstable fragments
Removal of detached fragments
Who does Avascular necrosis usually affect and where?
Adults Femoral head Femoral condyles Head of humerus Capitellum Proximal pole of scaphoid
What can AVN be secondary to?
Fractures of the femoral neck, proximal humerus and talar neck
When the fracture disrupts the blood supply to an entire piece of bone
What are other causes of AVN?
Idiopathic Alcoholism Steroid abuse Primary hyperlipidaemia Thrombophilia Sickle cell disease Antiphospholipid deficiency in SLE Caisson's disease
What is the pathogenesis of AVN?
Necrosis of a bone segment Patchy sclerosis Subchondral collapse Irregularity of articular surface Secondary Osteoarthritis
What is the treatment of AVN?
Drilling under fluroscopy to decompress bone
Joint replacement
Fusion
