Histopathology 2: Neoplastic Bone Disorders Flashcards
X-ray: Codman’s Triangle at end of long bones
Histology: Malignant mesenchymal cells
Diagnosis?
Osteosarcoma
X-ray: Lytic lesions with fluffy calcification
Histology: Malignant chondrocytes
Diagnosis?
Chondrosarcoma
X-ray: Onion skinning of periosteum
Histology: Sheets of small round cells
Karyotype: shows t(11;22)
Diagnosis ?
Ewing’s sarcoma
X-ray: Lytic appearance in the epiphysis of knee
Histology: Giant cells look like osteoclasts, spindle/ovoid cells
Diagnosis?
Giant cell tumour
X-ray: Soap bubble osteolysis, Shepherd’s crook deformity
Histology: Chinese letters
Diagnosis ?
Associated syndrome ?
Fibrocystic dysplasia
Albright syndrome
List the triad of features Albright syndrome?
- Polyostotic dysplasia
- cafe au lait spots
- Precocious puberty
X-ray: Mushroom protuberance from Bone
Histology: Cartilage capped bony outgrowth
Diagnosis?
Osteochondroma
X-ray: popcorn calcification
Histology: Proliferation of cartilage
Diagnosis ?
Enchondroma
X-ray: Bulls eye appearance of radioleucent nidus with sclerotic rim
Histology: normal bone arising from osteoblasts
Diagnosis ?
Osteoid Osteoma
Which benign bone tumour causes pain at night which is relieved by Aspirin ?
Osteoid osteoma
In which syndrome do you get Osteomas, GI polyps and epidermoid cysts ?
Gardner syndrome
Parts of the bone
long part = diaphysis (dying is long man)
end part = epiphysis
outside - inside = periosteum - cortex - medulla
list 5 tumour- like condition
- fibrous dysplasia
- metaphysial fibrous cortical defect/ non-ossifying fibroma
- reparative giant cell granuloma
- ossifying fibroma
- simple bone cyst
Age group that Primary malignant bone tumours are more common
children and young adults
Where are bone tumours most common?
around the knee (distal femur or proximal tibia)
What part of the bone are metaphysis, diaphysis, and epiphysis?
- diaphysis: long part (dying is long man)
- epiphysis: EEEnds
- metaphysis: middle/in between diaphysis and epiphysis
How to biopsy bone tumour
Needle core biopsy - using Jamshidi needle
done with USS or CT guidance
Soap bubble X-ray appearance, which bone tumour?
Fibrous Dysplasia
What bone tumour do you get in McCune Albright Syndrome, and which other Sx do you get?
polyostotic fibrous dysplasia (soap bubble lesion)
Other Sx: endocrine problems + café au lait spots
Name if you see Fibrous Dysplasia in the Femoral Head
Shepherd’s Crook
Benign bone tumours (6)
Cartilaginous differentiation
- Osteochondroma
- Enchondroma
- Chondroblastoma
Bone Forming
- Osteoid osteoma
- Osteoblastoma
- Osteoma
Benign bone tumour with overgrowth of cartilage AND bone
Osteochondroma - mainly occur at the ends of long bones
Osteochondromas mimic the normal tubular bones- they have a cartilaginous surface overlying the normal cortical and trabecular bone
Benign bone tumour - cartilaginous proliferation WITHIN the bone
Which bone do they mainly affect?
X-ray sign
Enchondromas
hands with some in the feet
X-ray: popcorn calcification’
Benign Bone Tumours May erode through the cortex of the bone but do NOT invade through what?
NOT burst through the articular (cartilaginous) surface
Where on the bone does Ewing Sarcoma form?
diaphysis/ metaphysis of long bones, pelvis
X-ray feature of onion skinning for which tumour?
Histology for this
Ewing sarcoma
Histology: small round cells
5-year survival for Ewing sarcoma
75%
Chromosomal translocation of Ewing sarcoma
translocation 11;22 (EWSR1/ Fli1) (q24;q12)
X-ray lesion of fluffy calicification which bone tumour?
Which are the main bones affected?
What does the tumour produce?
Chondrosarcoma
axial skeleton, pelvis, proximal femur, proximal tibia
Produces cartilage
X-ray of Giant Cell Tumour (Borderline Malignancy of bone)
Histology
lytic appearance
osteoclasts on a background of spindle/ ovoid cells
Tumour of bone characterised by the presence of osteoclasts
Giant Cell Tumour (giant cells = osteoclasts - these are not neoplastic)
Can be locally aggressive, may recur and can metastasise through the blood vessels (to the lungs)
What is the most common malignant bone tumour?
Which bones are they rarely found?
Tumours that metastasise to the bone
Below elbow and knee
Adult cancers that spread to the bone (+ how to remember)
REMEMBER: 1-2-2-2-1
- Thyroid
- Breast
- Lung
- Kidney
- Prostate
Carcinoma is which type of tumour?
Epithelial cell tumour
3 Malignant Bone Tumours (and what each produces)
- Osteosarcoma (bone forming)
- Chondrosarcoma (cartilage forming)
- Ewing’s sarcoma/ PNET (primitive peripheral neuroectodermal tumour)
What is a Malignant bone-forming tumour?
Which bone do you mainly find it?
Osteosarcoma (most common bone sarcoma)
- at the ends of long bones (e.g.60% occur around the knee) - lower femur or upper tibia
- Older people get in in their jaw
Key sign of osteosarcoma on X-ray
Elevated periosteum (Codman’s triangle)
Examples of soft tissue tumours (3)
Soft tissue tumour: mesenchymal proliferations which occur in the extra-skeletal, non-epithelial tissues of the body- excluding the meninges and lymphoreticular system. Can be found anywhere, but mostly in large muscles of the extremities
- Myxoid Tumours- Liposarcoma (have myxoid appearance)
- Spindle Cell Sarcoma (tissue can originate from nerve, muscle, fibrous tissue)
- Pleomorphic Sarcoma
Staging of soft tissue tumours
**INSERT THE PICS OF STAGING, FOLLOWED BY PROGNOSTIC FACTORS OF SOFT TISSUE TUMOURS**
