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MBChB YR2 MSK > Disease Profiles: Tumours and Swellings > Flashcards

Disease Profiles: Tumours and Swellings Flashcards

1
Q

How would you manage an enchondroma which has previously caused a fracture or appears to be at risk of causing a fracture?

A

Enchondroma scraped out (curettage) and filled with bone graft to strengthen the bone

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2
Q

Name two benign lesions from which a chondrosarcoma can arise

A

Enchondroma, osteochondroma

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3
Q

Describe the appearance of bony metastases from a prostate cancer primary

A

Sclerotic

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4
Q

Describe the histology of a ganglion cyst

A

Space with myxoid material

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5
Q

Describe the management of myositis ossificans

A

Observation, intervene only if symptoms demand

If intervening, must wait until maturity of ossification (6-12 months), otherwise risk of recurrence

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6
Q

When is surgery indicated in bone metastasis?

A

Usually indicated regardless of prognosis as a paliative procedure

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7
Q

Describe the management of nodular fasciitis

A

None - reassurance, self-liming course

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8
Q

What is Ewing’s sarcoma?

A

Primary bone tumour of the endothelial cells of the bone marrow, characterised by bone loss

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9
Q

What is Multiple Hereditary Exostosis (MHE)?

A

Autosomal dominant hereditary disorder that causes the development of multiple osteochondroma

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10
Q

What are MRIs and CTs used for in investigating a primary bone tumour?

A

Dermine local extent of tumour and involvement of muscles, nerves and vessels

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11
Q

Which form of primary bone tumour are not radiosensitive and are unresponsive to adjuvant chemotherapy?

A

Chondrosarcomas

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12
Q

Which investigations would you perform in suspected fibrous dysplasia?

A

X-ray, bone scan

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13
Q

What is multiple myeloma?

A

Malignant disease of the plasma cells of the bone marrow

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14
Q

Describe the management of bursitis

A

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

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15
Q

Where do giant cell tumours of bone commonly occur?

A

Occur in the metaphyseal region, tend to involve the epiphysis and can extend to the subchondral bone adjacent to the joint

Commonly occur around the knee and in the distal radius but can occur in other long bones, the pelvis and the spine

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16
Q

What is a simple bone cyst?

A

Single cavity benign fluid filled cyst in a bone

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17
Q

What is chondrosarcoma?

A

Cartilage producing primary bone tumour - malignancy of chondrocytes

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18
Q

What is a ganglion cyst?

A

Outpouchings of the synovium lining of joints and filled with synovial fluid

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19
Q

What causes a ganglion cyst?

A

Weakness of the synovial joint - can be developmental (e.g. juvenile Baker’s cyst) or secondary to joint damage/arthritis (e.g. adult Baker’s cyst)

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20
Q

When might a giant cell tumour of bone require joint replacement?

A

Very aggressive lesions with cortical destruction

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21
Q

What is an osteoid osteoma?

A

Benign bone-forming tumor that typically occur in children

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22
Q

Which out of fibrosarcoma and malignant fibrous histiocytoma tends to affect adolescents/YAs?

A

Fibrosarcoma

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23
Q

Describe the clinical presentation of an enchondroma

A

Many are indicental and usually asymptomatic but they can weaken the bone leading to pathological fracture

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24
Q

Describe the clinical presentation of an osteoid osteoma

A

Intense constant pain, worse at night due to the intense inflammatory response

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25
Q

Which investigations would you perform in suspected myositis ossificans?

A

X-ray and MRI

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26
Q

Where do enchondromas occur?

A

Femur, humerus, tibia and small bones of the hand and feet

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27
Q

Where do aneurysmal bone cysts occur?

A

In the metaphyses of many different long bones, flat bones and vertebral bodies

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28
Q

What blood tests should be performed in suspected bone metastasis?

A

Serum calcium (for hypercalcaemia), LFTs (to look for liver mets), plasma protein electrophoresis (for myeloma), full blood count and U&E

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29
Q

Describe the management of a ganglion cyst

A

Usually resolve with time but excision may be required for localized discomfort or cosmesis

Needle aspiration may be attempted but recurrance is common

The historic treatment of striking the wrist with a heavy book (‘bible technique’) to burst the swelling is not advised

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30
Q

What causes an aneurysmal bone cyst?

A

Small arteriovenous malformation

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31
Q

Which patient groups are most likely to develop osteosarcoma?

A

Most cases seen in adolescence and early adulthood

2nd peak in the eldery assocaited with Paget’s

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32
Q

What can cause an abscess on a limb?

A

Cellulitis, bursitis, penetrating wound or infected sebaceous cysts

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33
Q

What is an enchondroma?

A

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

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34
Q

Which patient group is most likely to develop an osteoid osteoma?

A

Adolescence

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35
Q

Where do chondrosarcomas commonly develop?

A

Tend to be found in the pelvis or proximal femur

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36
Q

Describe the clinical presentation of myositis ossificans

A

History of trauma, initial soft swelling, harness develops over several weeks

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37
Q

What is a giant cell tumour of the tendon sheath?

A

Benign nodular tumour found on the tendon sheath of the hands and feet

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38
Q

Describe the management of a sebaceous cyst

A

May require excision and/or biopsy

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39
Q

What is myositis ossificans?

A

Abnormal calcification of a muscle haematoma following trauma

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40
Q

What is bursitis?

A

Inflammation of the synovium-lined sacs (bursa) that protect bony prominences and joints

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41
Q

Which patient group is most likely to develop an enchondroma?

A

Commonest in 20-50 year olds

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42
Q

What is polyostotic fibrous dysplasia?

A

More than one bone affected

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43
Q

What feature of an aneurysmal bone cyst causes pain?

A

Cyst is locally aggressive causing cortical expansion and destruction

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44
Q

Where is osteosarcoma most common?

A

60% involve the bones around the knee (distal femur/proximal tibia), other sites include proximal femur, proximal humerus and pelvis

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45
Q

What is osteosarcoma?

A

Malignant tumour which produces bone

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46
Q

What is an osteochondroma?

A

A benign lesion derived from aberrant cartilage from the perichondral ring which produces a bony outgrowth on the external surface with a cartilaginous cap

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47
Q

Which patient group is most likely to develop Ewing’s sarcoma?

A

Affects young people 5-25 years of age, most common age 10-20

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48
Q

Bony lesions may not show up on x-rays until more than what percentage of the cortical bone is lost?

A

50%

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49
Q

What causes bursitis?

A

Repeated pressure or trauma

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50
Q

How will an enchondroma appear on imaging?

A

Usually lucent but can undergo mineralisation with a patchy sclerotic appearance

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51
Q

Describe the clinical presentation of a bone metastasis

A

Bone pain, cancer red flags, may be pathological fracture

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52
Q

Describe the clinical presentation of fibrous dysplasia

A

Bone pain and deformities, pathological fractures

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53
Q

Describe the x-ray findings of a giant cell tumour of bone

A

Characteristic ‘soap bubble’ appearance

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54
Q

Where do simple bone cysts commonly occur?

A

Metaphyseal in long bones (usually in proximal humerus and femur), although they can occur in the talus or calcaneus

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55
Q

Describe the management of a mucous cyst

A

Based on symptoms - can be left alone and will disappear over time, excision if particularly deep/cracked nail ridges, or constant discharge

56
Q

Which patient group is most likely to develop multiple myeloma?

A

Elderly patients

57
Q

Describe the management of a bone cyst which appears to be at risk of causing a pathological fracture

A

Treatment with curettage and bone grafting +/- stabilisation

58
Q

What investigations would you perform for a benign bone lesion?

A

X-ray, further imaging if needed e.g. CT, MRI, bone scan

59
Q

Describe the pathophysiology of a giant cell tumour of the tendon sheath

A

Regenerative hyperplasia with inflammatory process

60
Q

Where does Ewing’s sarcoma commonly occur?

A

Usually found in diaphysis of long bones - distal femur, proximal tibia

61
Q

Describe the x-ray findings of an aneurysmal bone cyst

A

Chambers may be visible

62
Q

When may surgery be curative for renal cell carcinoma with bone metastasis?

A

If there is only a single bone metastasis and the primary tumour is amenable to resection

63
Q

Where do sebaceous cysts commonly occur?

A

Commonly occur on face, trunk and neck but can also occur on limbs

64
Q

Why do osteochondromas require close observation?

A

Small risk of malignant transformation (<1%) - any lesion growing in size or causing pain may require excision

65
Q

Describe the appearance of bony metastases from a renal cell carcinoma primary

A

Large and very vascular lytic ‘blow out’ bony metastases - can bleed tremendously with biopsy or surgery

66
Q

Describe the clinical presentation of a ganglion cyst

A

Well-defined round swellings which occur around a synovial joint or a synovial tendon sheath - commonly arise around the wrist, can also occur in feet and knees

Painless, may feel tight, mobile skin but cyst fixed to underlying structures

67
Q

What causes the angular deformities sometimes seen in fibrous dysplasia?

A

Defective mineralisation

68
Q

Why is a ganglion cyst not a true cyst?

A

No epithelial lining

69
Q

Describe the clinical presentation of nodular fasciitis

A

Rapidly growing lesion < 5cm, usually circumscribed

70
Q

What is nodular fasciitis?

A

Benign proliferation of fibroblastic and myofibroblastic cells

71
Q

Which out of osteosarcoma and chondrosarcoma is more common and more aggressive?

A

Chondrosarcoma

72
Q

Describe the histological findings of a giant cell tumour of bone

A

Consist of multi-nucleated giant cells

73
Q

Describe the management of fibrous dysplasia

A

Bisphosphonates may reduce pain

Stabilisation + bone grafts for pathological fractures

74
Q

Describe the clinical presentation of a simple bone cyst

A

May be asymptomatic and an incidental finding (usually x-ray of child/YA) but can weaken the bone leading to pathological fracture

75
Q

Describe the clinical presentation of a giant cell tumour of bone

A

Painful mass/swelling, may cause pathological fracture

76
Q

Describe the examination findings of a primary bone tumour

A

Swelling and erythema over joint (especially in Ewing’s sacroma)

Palpable mass

77
Q

Name 2 genetic causes of a primary bone tumour

A

Li Fraumeni syndrome (p53), familial retinoblastoma (RBI)

78
Q

What causes a simple bone cyst?

A

Growth defect in the physis

79
Q

Describe the management of a lipoma

A

Based on symptoms - can be left alone, excision if causing symptoms

80
Q

Describe the management of an aneurysmal bone cyst

A

Curettage and grafing or use of bone cement

81
Q

Describe the x-ray findings of a malignant bone tumour

A

Cortical destruction, a periosteal reaction, new bone formation (sclerosis and lysis), reactive cortical thickening (chondrosarcoma) and extension into the surrounding soft tissue envelope

82
Q

What causes fibrous dysplasia?

A

Genetic mutation results in lesions of fibrous tissue and immature bone

83
Q

Describe the clinical presentation of a giant cell tumour of the tendon sheath

A

Firm, discreet swelling, usually on volar aspect of digits but can occur in toes

May or may not be tender

84
Q

Describe the x-ray and MRI findings in myositis ossificans

A

Peripheral mineralisation

85
Q

Describe the clinical presentation of a primary bone tumour

A

Persistent, increasing pain usually not associated with movement

Pain is well localised and worse at night

Pathological fracture

86
Q

What are fibrosarcoma and malignant fibrous histiocytoma?

A

Fibrous malignant primary bone tumours which tend to occur in abnormal bone e.g. bone infarct, post radiation

87
Q

Describe the CT findings of an osteoid osteoma

A

Small nidus of immature (woven) bone surrounded by an intense sclerotic halo (osteoblastic rim)

88
Q

Describe the clinical presentation of an aneurysmal bone cyst

A

Painful mass/swelling, pathological fracture

89
Q

Describe the clinical presentation of an osteochondroma

A

Painless, hard lump, commonly near the knee (distal femur/proximal tibia)

May be symptoms with activity - pain from tendons, numbness from nerve compression

90
Q

List the five primary cancers which commonly metastasise to bone, in order of most to least common

A

Breast, prostate, lung, renal cell carcinoma, thyroid cancer

91
Q

Which x-ray views should be used in investigating a malignant bone tumour?

A

AP and lateral including joint above and below

92
Q

What are the 4 main features of multiple myeloma?

A

Hypercalcaemia, anaemia, renal impairment and bone pain

93
Q

Which patient group is most likely to develop nodular fasciitis?

A

Young adults

94
Q

What are lipomas?

A

Most common benign soft tissue tumour - neoplastic proliferation of fat

95
Q

Which site in the body do around 5% of giant cell tumour of bone metastasise to?

A

The lung - benign pulmonary GCT

96
Q

Which investigation would you perform in suspected nodular fasciitis?

A

Biopsy

97
Q

Which patient group is most likely to develop a mucous cyst?

A

Females, 40-60 years

98
Q

Which patient group is most likely to develop a chondrosarcoma?

A

Older age group - mean age 45

99
Q

What would a bone scan show in fibrous dysplasia?

A

Show intense increase in uptake during development but the lesion usually becomes inactive

100
Q

List some features of bone metastasis which indicate risk of impending pathological fracture, meaning skeletal stabilization or joint replacement may be required

A

Lesions which are very painful (especially on weight bearing), those which occupy >50% of the diameter of the bone, those with cortical thinning and those in ‘at risk areas’ (e.g. subtrochanteic area of the femur)

101
Q

Describe the clinical presentation of a mucous cyst

A

Painful raised swelling of DIP joint or just distal to the joint

Small initially but increase in size, as size increases skin becomes thin and may rupture

Can fluctuate in size If very large can damage the nail and cause a ridge

102
Q

Are the majority of chondrosarcoma high or low grade?

A

Low

103
Q

What would produce a ‘Shepard’s crook’ deformity on x-ray in a patient with fibrous dysplasia?

A

Extensive involvement of the proximal femur

104
Q

Describe the management of a giant cell tumour of the tendon sheath

A

Based on symptoms - can be left alone, excision if causing symptoms but there is risk of recurrence

105
Q

Which form of primary bone cancer can mimic infection - hot, swollen, tender joint or limb with raised inflammatory markers?

A

Ewing’s sarcoma

106
Q

Describe the clinical presentation of a lipoma

A

Can be discreet or less well defined, slow-growing, painless, can be large, no overlying skin changes, characteristic consistency

107
Q

Describe the management of an osteoid osteoma

A

Pain is greatly relieved by NSAIDs

Lesion may resolve spontaneously over time but some cases may require CT guided radiofrequency ablation or en bloc excision

108
Q

Which patient group is most likely to develop a malignant primary bone tumour?

A

More common in young patients - 10% of childhood cancers

109
Q

Describe the histological findings of nodular fasciitis

A

Very cellular, lots of mitoses figures, plump cells; stellate and spindle, tissue culture appearance, haemorrhage, mature towards periphery

110
Q

Which patient group is most likely to develop an osteochondroma?

A

Common in adolescents and young adults (10-20 years)

111
Q

What is an aneurysmal bone cyst?

A

Consists of many chambers which are filled with blood or serum

112
Q

Which form of primary bone tumour are not radiosensitive but adjuvant chemotherapy can prolong survival?

A

Osteosarcomas

113
Q

Describe the management of a primary bone tumour

A

Surgical removal of tumour and surrounding tissue, with joint reconstruction

Adjuvant chemotherapy/radiotherapy used if appropriate

Chemotherapy can improve survival

114
Q

What is a mucous cyst?

A

Outpouching of synovial fluid from DIP caused by early OA

115
Q

How will an osteochondroma appear on imaging?

A

Cartilage capped ossified pedicle

116
Q

List the features suggestive of a benign soft tissue neoplasm

A

Smaller size, fluctuation in size (malignant tumours don’t regress in size), cystic lesions, well‐defined lesions, fluid filled lesions and soft/fatty lesions

117
Q

What is fibrous dysplasia?

A

Benign, developmental disorder of bone that causes normal skeletal tissue to be replaced by fibrous tissue

118
Q

What are bunions?

A

Bursitis over the medial 1st metatarsal head in hallux valgus

119
Q

Describe the management of an abscess

A

Surgical excision and drainage

Rest, elevation, analgesia, splint

Antibiotics

120
Q

What is an abscess?

A

Discrete collection of pus

121
Q

Describe the appearance of bony metastases from a breast cancer primary

A

Blastic (sclerotic) or lytic

122
Q

Why are pathological fractures caused by a bony prostate metastasis likely to heal?

A

Osteoblastic activity (sclerotic masses)

123
Q

Describe the management of giant cell tumours of bone

A

Intralesional excision with use of phenol, bone cement or liquid nitrogen to destroy remaining tumour material and reduce the risk of recurrence

124
Q

How can the risk of pathological fracture of a prostate bony metastasis be reduced?

A

Radiotherapy and hormone manipulation

125
Q

Where does nodular fasciitis most commonly occur?

A

Upper extremity, history of prior trauma at the site in 25% of cases

126
Q

What is a giant cell tumour of bone?

A

Benign tumour arising from the giant cells of the bone marrow

127
Q

Name the bones which are most frequently involved with metastases

A

Vertebra, pelvis, ribs, skull and femurs

128
Q

What is monostotic fibrous dysplasia?

A

Only one bone affected

129
Q

Describe the clinical presentation of an abscess

A

Defined and fluctuant swelling, erythema, pain

History of trauma (e.g. bite, IVDU) or cellulitis

130
Q

Name 3 predisposing conditions for a primary bone tumour

A

Paget’s, fibrous dysplasia, multiple enchondromas

131
Q

Describe the appearance of bony metastases from a lung cancer primary

A

Lytic

132
Q

Which patient group is most likely to develop fibrous dysplasia?

A

Usually occurs in adolescence

133
Q

What is a sebaceous cyst?

A

Slow growing, painless, mobile discreet swellings formed by blockage of the sebaceous gland

They originate at hair follicles and fill with caseous materal (keratin)

134
Q

Where do osteoid osteomas commonly develop?

A

Proximal femur, the diaphysis of long bones and the vertebrae

135
Q

What percentage of patients with osteosarcoma have pulmonary metastases at diagnosis?

A

10-20%

MBChB YR2 MSK (36 decks)

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