MSK Cortex Pathology - Malignant bone tumours

Question 1

What is the most common type of malignant tumour affecting the bone?

Answer 1

Metastatic cancer

Question 2

Metastatic cancer affecting the bones tends to present with what symptoms?

Answer 2

Constant pain which may be severe and is usually worse at night. Systemic symptoms may also be present (weight loss, loss of appetite, fatigue)

Question 3

Malignant primary bone tumours typically show what signs on x-ray?

Answer 3

1. Periosteal reaction (raised periosteum producing new bone)
2. New bone formation (sclerosis as well as lysis from destruction)
3. Extension into the surrounding soft tissue envelope

Question 4

What is the most common form of primary bone tumour?

Answer 4

Osteosarcoma

Question 5

Where are osteosarcomas usually found?

Answer 5

Around the knee in 60% (others sites include the proximal femur, proximal humorous and pelvis) Most common in adolescence and young adults

Question 6

Describe a chondrosarcoma?

Answer 6

Cartilage producing primary bone tumour and is less common and less aggressive than osteosarcoma

Question 7

Where are chondrosarcomas usually found?

Answer 7

Pelvis or proximal femur and tends to occur in an older age group - mean age is 45

Question 8

What is fibrosarcoma?

Answer 8

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

Question 9

What is Ewing’s sarcoma?

Answer 9

Malignant tumour of primative cells in the marrow most commonly affecting 10-20 year olds

Question 10

What is Ewing’s sarcoma associated with?

Answer 10

Fever, raised inflammatory markers and a warm swelling - may be misdiagnosed as osteomyelitis

Question 11

What is a solitary myeloma known as?

Answer 11

Plasmacytoma

Question 12

What are the signs and symptoms of multiple myeloma?

Answer 12

Weakness, back pain, bone pain, fatigue, and weight loss and may have marrow suppression resulting in anaemia and recurrent infection. May present with a pathological fracture

Question 13

How is myeloma diagnosed?

Answer 13

Plasma protein electrophoresis - showing a high level of paraprotein
Early morning urine collection for Bence Jones protein assay

Question 14

What is the treatment for a solitary plasmacytoma?

Answer 14

Radiotherapy

Question 15

What is the treatment for multiple myeloma?

Answer 15

Chemotherapy

Question 16

What are the primary malignant tumours which commonly metastasise to bone? (in order of frequency)

Answer 16

Breast carcinoma
Prostate carcinoma
Lung carcinoma
Renal cell carcinoma
Thyroid adenocarcinoma