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Histopathology 2 - Bone tumours Flashcards

1
Q

What is the preferred investigation for diagnosing bone tumours?

A

Core biopsy under radiological guidance

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2
Q

What is “shepherd’s crook deformity” a reference to?

A

Fibrous dysplasia involving the femoral head

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3
Q

Recall 4 tumour-like conditions of the bone that are not actually malignant

A
  1. Fibrous dysplasia
  2. Fibroma (can be ossifying/ non-ossifying)
  3. Reparative giant cell granuloma
  4. Simple bone cyst
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4
Q

How does osteochondroma mimic bone in appearance?

A

They have a cartilaginous surface overlying normal cortical + trabecular bone

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5
Q

In which bones is osteochondroma most likely to present?

A

Long bones

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6
Q

How will enchondroma appear on XR?

Which bones are affected?

A

“popcorn” pattern

usually affects the fingers/hands

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7
Q

Is a giant cell tumour of bone benign or malignant?

A

Borderline malignant

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8
Q

What is the typical age of presentation of osteochondroma?

A

20-40 years

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9
Q

What is the typical age of presentation of giant cell tumour of bone?

A

20-40 years

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10
Q

How do giant cell bone tumours appear under the microscope?

A

Osteoclasts on a background of ovoid cells

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11
Q

What are the 3 types of malignant bone tumour?

A

Osteosarcoma (bone-forming)
Chondrosarcoma (cartilage-forming)
Ewing’s sarcoma (undifferentiated mesenchymal)

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12
Q

Recall the typical age of presentation for each of the 3 types of malignant bone tumour

A

Osteosarcoma: <30 years
Chondrosarcoma: >40 years
Ewing’s sarcoma: <20 years

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13
Q

Recall the typical site affected for each of the 3 types of malignant bone tumour

A

Osteosarcoma: knee
Chondrosarcoma: pelvis/ proximal skeleton
Ewing’s sarcoma: long bones + pelvis

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14
Q

Recall the typical X ray appearance of each of the 3 types of malignant bone tumour

A

Osteosarcoma: Codman’s triangle
Chondrosarcoma: fluffy calcification
Ewing’s sarcoma: Onion-skinning of periosteum

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15
Q

What is a “Codman’s triangle”?

A

The triangular area of new subperiosteal bone that is created when a lesion, often a tumour, raises the periosteum away from the bone.

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16
Q

Which of the 3 types of malignant bone tumour has the best prognosis?

A

Chondrosarcoma

*the adult one**

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17
Q

What gene mutation is associated with Ewing’s sarcoma?

A

11:22 translocation

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18
Q

Which type of malignant bone tumour will stain for CD99 and MICC2?

A

Ewing’s sarcoma

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19
Q

Which patients are most at risk of developing Ewing’s tumour in soft tissue?

A

Immunocompromised patients

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20
Q

What are the 5 metabolic bone diseases

A

Osteoporosis

Osteomalacia/rickets

Hyperparathyoridism

Paget’s disease

Renal osteodystrophy

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21
Q

Compare the aetiology of the 5 metabolic bone diseases

A
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22
Q

DEXA score in osteoporosis

A

<2.5 SD: osteoporosis

1-2.5: osteopaenia

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23
Q

Osteoporisis vs osteomalacia: disease features

A

Osteoporisis: decreased bone mass

Osteomalacia: decreased bone mineralization

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24
Q

Disease features of paget’s disease

A

Lytic and sclerotic lesions

Phases:

a) lytic
b) mixed
c) osteosclerotic

**also causes deafness**

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25
Types of fractures seen in osteoporosis
Neck of femur Wrist - colle's fractures Vertebral fractures
26
Features of rickets/osteomalacia
Adults: bone pain/tenderness, proximal muscle weakness Children: Rachitic rosary Bowing of legs Bone pain frontal bossing pigeon chest delayed walking
27
Paget's disease epidemiology
\>50yo M=F
28
X-ray changes of osteoporiss
Usually none
29
X-ray changes of rickets/osteomalacia
* Looser's zones fractures (pseudo-fractures) * splaying of metaphysis * Bowing of legs in rickets
30
X-ray features of primary hyperparathyoridism i.e. osteitis fibrosa cystica
* Brown's tumours * Salt and pepper skull * sub-periosteal bone resoorption in phalanges
31
X-ray changes in paget's disease
* mixed lytic and scleortic lesions * skull * osteoporisis circumscirpta * cotton wool * vertebrae * picture frame * ivory vertebra * pelvis * sclerosis and lucency
32
Histology of osteoporisis
Loss of cancellous bone
33
Histology of rickets
Excess unmineralized bone (osteoid)
34
Histology of paget's disease
huge osteoclasts mosaic pattern of lamellar bone
35
Biochemical features of the 5 metabolic bone diseases
36
Gout vs pseudogout
Gout: caused by dietary factors Pseudogout: metabolic conditions (hyperPTH, DM, hypothyroid)
37
What organism causes osteomyelitis in a) adults b) children c) sickle cell patients
Adults- Staph aureus Children - h. influenzae, GBS Sickle cell patients - salmonella
38
X-ray changes of osteomyelitis
sub-periosteal new bone formation -early lytic destruction of bone - 10 days \*\*opposite to paget's where you get lytic first then sclerotic
39
Hand changes of osteoarthirtis
Heberdeens and bouchard's nodes B: PIP Heberdeens: DIP joint
40
Osteoarthirtis x-ray features
LOSS Loss of joint space Osteophytes Subchondral sclerosis Subchondral cysts
41
Which joint is spared in RA?
DIPJ
42
Characteristic deformities of RA
Characteristic deformities: ● Radial deviation of wrist and ulnar deviation of fingers. ● “swan neck” and “Boutonniere” deformity of fingers ● Swan neck = hyperextension of PIPJ & flexion of DIPJ ● Boutonniere = flexion of PIPJ & hyperextension of DIPJ ● “Z” shaped thumb ● Synovial swelling Extra-articular features: Pulmonary fibrosis, vasculitis, amyloidosis, pericarditis, subcutaneous nodules, DVT
43
Histopathology of RA
thickening of synovial membrane, hyperplasia of surface synoviocytes, intense inflammatory cell infiltrate & fibrin deposition & necrosis
44
X-ray changes of benign vs malignant bone diseases
45
What are the malignant bone tumours?
1. Osteosarcoma 2. Chondrosarcoma 3. Ewing's sarcoma 4. Giant cell (borderline malignancy)
46
Osteosarcoma: a) age b) bones affected c) histology d) x-ray appearance
- adolesence - knee - malignant mesenchymal cells **ALP+** - elevated periosteum (Codman's triangle), sunburst appearance
47
Chondrosarcoma
- \>40y - axial skeleton/femur/tibia/pelvis - histology- malignant chondorcytes - x-ray: lytic with fluffy calcification, axial skeleton \*\*think older ppl tend to get in axial areas\*\*
48
Ewing's sarcoma
- age \<20y - long bones , plevis - histology :sheets of small round cells, CD99+, t(11,22) - x-ray appearance: onion skinning of periosteum
49
Giant cell tumour
* 20-40y, F\>M * Bone: knee (epiphysis) * Histology: osteoclast-type, multinucleate giant cells on **bakcground of spindle/ovoid cells** * X-ray appearance: lytic/lucent lesions right up to articular surface
50
What is osteitis fibrosa cystica?
Changes due to bone resorption
51
What is Pott's disease?
TB of the spine may result in psoas abscess and severe skeletal deformity
52
most prevalent vector borne disease in the temperate Northern hemisphere
Lyme disease- spread by tick bites organism: Borrelia burgdorferi
53
54
What are the benign bone tumours?
1. osteoma 2. enchondroma 3. osteochondroma 4. fibrous dysplasia 5. simple bone cyst 6. osteoblastoma
55
Radiolucent nidus with sclerotic rim ‘Bull’s-eye
Osteoid osteoma (adolescence)
56
What is gardner's syndrome?
1. GI polyps 2. multiple osteomas 3. epidermoid cysts
57
What are the two types of osteoma?
a) adolescence (osteoid osteoma) **- pain at night, relived by aspirin** b) osteoma in middle age
58
What's the most common benign tumour of bone?
Osteochondroma
59
Lytic lesion Cotton wool/popcorn calcification Expansile, O ring sign
Enchondroma
60
Well defined bony protuberance from bone Cartilage capped bony spur on surface of bone ‘mushroom’ on xray
Osteochondroma
61
Soap bubble osteolysis Shepherd’s crook deformity on x-ray Chinese letter appearance on histology
Fibrous dysplasia
62
Lytic well defined lesion
Simple bone cyst
63
Speckled mineralisation
Osteoblastoma
64
Which tumour is ALP+?
Osteosarcoma
65
Buzzwords for benign bone diseases

Histopathology (18 decks)

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