MSK neoplasms Flashcards
epiphysis
top and bottom ends of bone
diaphysis
long middle part f the bone
metaphysis
interface between diaphysis and the epiphysis
(neck of bone)
in skeletally immature individuals - this is the site of the growth plate
cortex
thick outer shell of the bone
compact bone
cortical bone
medullary cavity
made of pongy bone and bone marrow
also called trabecular or cancellous bone
lamellar bone
mature bone
woven bone
osteoid (in context of a tumour producing immatuure bone)
immature/new bone
appendicular skeleton
shoulder and pelvic girdle, long bones, short tubular bones of the hands and feet
axial skeleton
skull, vertebral bodies and ribs
3 main categories of bone tumours
- metastatic disease (most common)
- haematolymphoid malignancies (plasma cell myeloma, primary bone lymphoma)
- primary bone tumours (rare in comparison to metastases and haematolymphoid malignancies)
primary sites giving rise to metastases in bone
lung, breast, prostate, colorectal adenocarcinoma
malignant melanoma
thyroid (follicular) adenocarcinoma
renal cell carcinoma
2 groups of metastases to bone
osteolytic vs osteoblastic metastases
osteolytic metastases
bone destruction by tumour cells
cytokines released by the tumour stimulate osteoclastic bone resorption (by osteocllast cells)
osteoblastic (sclerotic) metastases
cytokines stimulate osteoblastic activity and new bone
typical of prostate and breast carcinoma
less common that oosteolytic
plasma cell myeloma definition
previously called multiple myeloma
bone marrow-based malignant neoplasm of plasma cells
forms multiple tumours throughout skeletal system
incidence of plasma cell myeloma
most common primary malignancy of bone
usually >50 years old M=F
clinica manifestation of bone pain, pathological fracture
multiple tumours in bone
clinical manifestation of hypercalcaemia
osteoclastic bone destruction
clinical manifestation of monoconal immunoglobulin in serum and urine (paraprotein/M protein)
clonal proliferation of plasma cells
clinical manifestation of renal failure
paraprotein deposits in kidney
clinical manifestation of susceptibility to infection
abnormal immunoglobulin
clinical manifestation of anaemia
chronic neoplastic disease
features of plasma cell myeloma
multiple lytic lesions throughout skeletal system (especially axial skeleton)
malignant proliferation of plasma cells forming tumorous masses within bone
features of bone tumours
relatively constant clinicopathological features across age group, are affected, radiological features and pathological features
define osteosarcoma
malignant mesenchymal neoplasm (sarcoma) producing bone matrix (osteoid/immature bone)
incidence of osteosarcoma
most common primary malignant tumour of bone (excluding haematolymphoid tumours)
rare in adults, within top 10 paediatric cancers
M>F
bimodal age (10-20s, and >50)
osteosarcoma in adolescents
primary oosteosarcoma majority idiopathic hereditary retinoblastoma Li-Fraumeni syndrome (p53 mutation) ionising radiation
osteosarcoma in older adults
secondary osteosarcoma
usually underlying benign bone disease
- paget’s diseasse, benign bone tumours, chronic osteomyelitis
clinical presentation of osteosacroma
local pain (nocturnal, doesnt respond to simple analgaesics)
palpable mass
pathological fracture
constitutional symptoms (fever, anorexia, weight loss, metastatic disease)
prognosis of osteosarcoma
80% 5 year survival for localised disease
30% 5 year survival for metastatic disease
radiological clues of osteosarcoma
codman’s triangle
sunburst pattern
slide features of osteosarcoma
malignant tumour cells producing osteoid matrix often in delicate pericellular lacelike pattern
(prominent in osteoblastic variant)
osteoid osteoma
benign bone forming tumour
15% of all primary bone tumours
5-20s, M:F = 2:1
site of osteoid osteoma
long bones (tibia/femur) within cortex
clinical presentation of osteoid osteoma
nocturnal pain responsive to NSAIDs
osteoid osteoma radiology appearance
small circumscribed cortical based lesioon
trabeculae of woven bone
plump osteoblastic rimming
enchondroma
benign intramedullary cartilagenous neoplasm
incidence of enchondroma
25% primary benign bone tumours
20s-30s, M=F
site of enchondroma
small tubular bones of hands and feet (phalanges) > long bones
risk factors for enchondroma
multiple lesions in ollier’s syndrome (non-inherited)
clinical presentations for enchondroma
asymptomatic, incidental radiological finding
pain with pathological fracture
prognosis of enchondroma
benign, treated with local curettage
imaging of enchondroma
circumscribes cartilagenous lesion expanding medullary cavity of tubular bones
slide - nodules of hyaline cartilage, sharp interface with trabecular bone
osteochondroma
benign pedunculated tumour of bone with cartilage cap overlying bony stalk
commonly called ‘exostosis’
incicdence of osteochondroma
most common benign bone tumour
10-20 years M>F
site of osteochondroma
metaphyseal surface of long bones
risk factors for osteochondroma
multiple hereditary exostosis
autosomal dominant
clinical presentation of osteochondroma
asymptomatic, usually incidental radiological finding
pain if impinging on nerve or fracture of stalk
prognosis of osteochondroma
benign, conservative management
symptomatic cases cured with simple excision
osteochondroma imaging
poedunculated lesion arising from metaphysis
ponts aw2ay from joint space
stalk contnuous with medullary cavity
osteochondroma pathology sslide
cartilage cap (neoplastic) merges with underlying bony stalk through enchondral ossification
fibrous dysplasia
benign fibro-osseous tumour of bone
incidence of fibrous dysplasia
7% of primary bone tumours
early-mid adulthood, M=F
site of fibrous dysplasia
axial skeleton > long bones
risk factors for fibrous dysplasia
polyostotic disease (McCune- Albright syndrome)
- non-inherited
- cafe-au-lait spots, endocrine abnoormalities
clinical presentation of fibroous dysplasia
most are incidental radiological findings
prognosis of fibrous dysplasia
benign (although low risk of malignant change)
fibrous dysplasia imaging
well defned ground glass opacity within medullary cavity
varus deformity in femur - ‘shepard’s crook’
fibrous dysplasia pathology slide
fibro-ossseous tumour
curvilinear arrays of woven bone
fibrous stroma wth bland spindle cells
ewing sarcoma
highly malgnant small round blue cell tumoour
primitive neuroectodermal tumour (PNET)
incidence of ewing sarcoma
10% of primary malignant bone tumours
10-15 years
M>F
site of ewing sarcoma
long bones, pelvis
clinical presentatioon of ewing sarcoma
painfull enlarging mass
systemic symptoms with metastatic disease
prognoss of ewing sarcoma
5 year survival 75%, long term cure 50%
ewing sarcoma appearance
destructive mass within the medullary cavty of bone or ssoft tissue
ewing sarcoma in the microscope
prototypical small round blue cell tumour
malignant soft tissue tumours
sarcoma
common paediatric cancer
clincal presentation of soft tisue tumours
palpable mass for extremity tumours
abdominal distension for abdominal/retroperitoneal tumours
red flags raising suspicion for sarcomas
tumoours size >5cm or enlarging mass
deap-sseated (deep to fascia, instramuscular
painful
multiple lesions
