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Pathology 3 > MSK neoplasms > Flashcards

MSK neoplasms Flashcards

1
Q

epiphysis

A

top and bottom ends of bone

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2
Q

diaphysis

A

long middle part f the bone

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3
Q

metaphysis

A

interface between diaphysis and the epiphysis
(neck of bone)
in skeletally immature individuals - this is the site of the growth plate

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4
Q

cortex

A

thick outer shell of the bone
compact bone
cortical bone

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5
Q

medullary cavity

A

made of pongy bone and bone marrow

also called trabecular or cancellous bone

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6
Q

lamellar bone

A

mature bone

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7
Q

woven bone

A

osteoid (in context of a tumour producing immatuure bone)

immature/new bone

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8
Q

appendicular skeleton

A

shoulder and pelvic girdle, long bones, short tubular bones of the hands and feet

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9
Q

axial skeleton

A

skull, vertebral bodies and ribs

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10
Q

3 main categories of bone tumours

A
  • metastatic disease (most common)
  • haematolymphoid malignancies (plasma cell myeloma, primary bone lymphoma)
  • primary bone tumours (rare in comparison to metastases and haematolymphoid malignancies)
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11
Q

primary sites giving rise to metastases in bone

A

lung, breast, prostate, colorectal adenocarcinoma
malignant melanoma
thyroid (follicular) adenocarcinoma
renal cell carcinoma

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12
Q

2 groups of metastases to bone

A

osteolytic vs osteoblastic metastases

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13
Q

osteolytic metastases

A

bone destruction by tumour cells

cytokines released by the tumour stimulate osteoclastic bone resorption (by osteocllast cells)

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14
Q

osteoblastic (sclerotic) metastases

A

cytokines stimulate osteoblastic activity and new bone
typical of prostate and breast carcinoma
less common that oosteolytic

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15
Q

plasma cell myeloma definition

A

previously called multiple myeloma
bone marrow-based malignant neoplasm of plasma cells
forms multiple tumours throughout skeletal system

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16
Q

incidence of plasma cell myeloma

A

most common primary malignancy of bone

usually >50 years old M=F

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17
Q

clinica manifestation of bone pain, pathological fracture

A

multiple tumours in bone

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18
Q

clinical manifestation of hypercalcaemia

A

osteoclastic bone destruction

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19
Q

clinical manifestation of monoconal immunoglobulin in serum and urine (paraprotein/M protein)

A

clonal proliferation of plasma cells

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20
Q

clinical manifestation of renal failure

A

paraprotein deposits in kidney

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21
Q

clinical manifestation of susceptibility to infection

A

abnormal immunoglobulin

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22
Q

clinical manifestation of anaemia

A

chronic neoplastic disease

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23
Q

features of plasma cell myeloma

A

multiple lytic lesions throughout skeletal system (especially axial skeleton)
malignant proliferation of plasma cells forming tumorous masses within bone

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24
Q

features of bone tumours

A

relatively constant clinicopathological features across age group, are affected, radiological features and pathological features

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25
Q

define osteosarcoma

A

malignant mesenchymal neoplasm (sarcoma) producing bone matrix (osteoid/immature bone)

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26
Q

incidence of osteosarcoma

A

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)

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27
Q

osteosarcoma in adolescents

A 
primary oosteosarcoma 
majority idiopathic 
hereditary retinoblastoma 
Li-Fraumeni syndrome (p53 mutation) 
ionising radiation
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28
Q

osteosarcoma in older adults

A

secondary osteosarcoma
usually underlying benign bone disease
- paget’s diseasse, benign bone tumours, chronic osteomyelitis

29
Q

clinical presentation of osteosacroma

A

local pain (nocturnal, doesnt respond to simple analgaesics)
palpable mass
pathological fracture
constitutional symptoms (fever, anorexia, weight loss, metastatic disease)

30
Q

prognosis of osteosarcoma

A

80% 5 year survival for localised disease

30% 5 year survival for metastatic disease

31
Q

radiological clues of osteosarcoma

A

codman’s triangle

sunburst pattern

32
Q

slide features of osteosarcoma

A

malignant tumour cells producing osteoid matrix often in delicate pericellular lacelike pattern
(prominent in osteoblastic variant)

33
Q

osteoid osteoma

A

benign bone forming tumour
15% of all primary bone tumours
5-20s, M:F = 2:1

34
Q

site of osteoid osteoma

A

long bones (tibia/femur) within cortex

35
Q

clinical presentation of osteoid osteoma

A

nocturnal pain responsive to NSAIDs

36
Q

osteoid osteoma radiology appearance

A

small circumscribed cortical based lesioon
trabeculae of woven bone
plump osteoblastic rimming

37
Q

enchondroma

A

benign intramedullary cartilagenous neoplasm

38
Q

incidence of enchondroma

A

25% primary benign bone tumours

20s-30s, M=F

39
Q

site of enchondroma

A

small tubular bones of hands and feet (phalanges) > long bones

40
Q

risk factors for enchondroma

A

multiple lesions in ollier’s syndrome (non-inherited)

41
Q

clinical presentations for enchondroma

A

asymptomatic, incidental radiological finding

pain with pathological fracture

42
Q

prognosis of enchondroma

A

benign, treated with local curettage

43
Q

imaging of enchondroma

A

circumscribes cartilagenous lesion expanding medullary cavity of tubular bones
slide - nodules of hyaline cartilage, sharp interface with trabecular bone

44
Q

osteochondroma

A

benign pedunculated tumour of bone with cartilage cap overlying bony stalk
commonly called ‘exostosis’

45
Q

incicdence of osteochondroma

A

most common benign bone tumour

10-20 years M>F

46
Q

site of osteochondroma

A

metaphyseal surface of long bones

47
Q

risk factors for osteochondroma

A

multiple hereditary exostosis

autosomal dominant

48
Q

clinical presentation of osteochondroma

A

asymptomatic, usually incidental radiological finding

pain if impinging on nerve or fracture of stalk

49
Q

prognosis of osteochondroma

A

benign, conservative management

symptomatic cases cured with simple excision

50
Q

osteochondroma imaging

A

poedunculated lesion arising from metaphysis
ponts aw2ay from joint space
stalk contnuous with medullary cavity

51
Q

osteochondroma pathology sslide

A 
cartilage cap (neoplastic) 
merges with underlying bony stalk through enchondral ossification
52
Q

fibrous dysplasia

A

benign fibro-osseous tumour of bone

53
Q

incidence of fibrous dysplasia

A

7% of primary bone tumours

early-mid adulthood, M=F

54
Q

site of fibrous dysplasia

A

axial skeleton > long bones

55
Q

risk factors for fibrous dysplasia

A

polyostotic disease (McCune- Albright syndrome)

  • non-inherited
  • cafe-au-lait spots, endocrine abnoormalities
56
Q

clinical presentation of fibroous dysplasia

A

most are incidental radiological findings

57
Q

prognosis of fibrous dysplasia

A

benign (although low risk of malignant change)

58
Q

fibrous dysplasia imaging

A

well defned ground glass opacity within medullary cavity

varus deformity in femur - ‘shepard’s crook’

59
Q

fibrous dysplasia pathology slide

A

fibro-ossseous tumour
curvilinear arrays of woven bone
fibrous stroma wth bland spindle cells

60
Q

ewing sarcoma

A

highly malgnant small round blue cell tumoour

primitive neuroectodermal tumour (PNET)

61
Q

incidence of ewing sarcoma

A

10% of primary malignant bone tumours
10-15 years
M>F

62
Q

site of ewing sarcoma

A

long bones, pelvis

63
Q

clinical presentatioon of ewing sarcoma

A

painfull enlarging mass

systemic symptoms with metastatic disease

64
Q

prognoss of ewing sarcoma

A

5 year survival 75%, long term cure 50%

65
Q

ewing sarcoma appearance

A

destructive mass within the medullary cavty of bone or ssoft tissue

66
Q

ewing sarcoma in the microscope

A

prototypical small round blue cell tumour

67
Q

malignant soft tissue tumours

A

sarcoma

common paediatric cancer

68
Q

clincal presentation of soft tisue tumours

A

palpable mass for extremity tumours

abdominal distension for abdominal/retroperitoneal tumours

69
Q

red flags raising suspicion for sarcomas

A

tumoours size >5cm or enlarging mass
deap-sseated (deep to fascia, instramuscular
painful
multiple lesions

Pathology 3 (11 decks)

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