MSK tumour pathology Flashcards
How common are skeletal tumours?
Uncommon
What are the categories of tumour which can affect the skeleton?
Myeloma (plasma cells) Metastases Benign Benign but locally destructive Malignant
What are the benign tumours affecting the skeleton?
Osteochondroma (exostosis)
Chondroma/enchondroma
Osteoid osteoma
Chondroblastoma
What is an osteochondroma?
Cartilage capped bony outgrowth on the external surface of the bone
How will an osteochondroma appear on imaging?
The bony outgrowth will be continuous with the normal bone
Which age group is affected by osteochondromas?
Young
Are males or females more affected by osteochondroma?
Equal distribution
Where on the bone do osteochondromas tend to develop?
Near epiphysis of long bones
When might an osteochondroma cause problems?
Can cause local pain or irritation
What is an (en)chondroma?
Hyaline cartilage tumour arising within the medullary cavity of bones
Which bones develop (en)chondromas?
Hands
Feet
In which two conditions might you see more than one (en)chondroma?
Ollier’s disease
Mafucci’s syndrome
Who gets (en)chondromas?
Young adult men
What are the enchondromas associated with in Mafucci’s syndrome?
Angiomas
What is Ollier’s disease?
Rare developmental disorder
Is ollier’s disease hereditory?
No
Where do the (en)chondromas arise in ollier’s disease?
Metaphyses
Diaphyses
Unilateral
What is the risk with Ollier’s disease?
Malignant transformation possible
What is the risk with Mafucci’s syndrome? How does this compare to ollier’s syndome?
Malignant transformation much higher than in ollier’s syndrome
Small peripheral bone lesions are less likely to be benign than large axial lesions. T/F
False - small peripheral lesions are more likely to be benign
Who gets osteoid osteoma?
Children and young adults
More common in males
Where are osteoid osteomas typically found?
Femur
Tibia
Hands & feet
Spine
Which cells do osteoid osteomas arise from?
Osteoblasts
How do osteoid osteomas typically appear on imaging?
Central vascular osteoid core
Peripheral sclerosis
Cortex of bone
How does osteoid osteoma present?
Pain worse at night Dull/achey Relieved with aspirin/NSAIDs \+/- spinal scoliosis \+/- soft tissue swelling
How are osteoid osteomas managed?
Self resolving within 3 years
Pain relief
Who gets chondroblastomas?
Teens
How common is chondroblastoma?
Rare
Chondroblastomas are benign. T/F
True - can be locally aggressive
Where in bones and in which bones do chondroblastomas present?
Epiphysis
Long bones
How doe chondroblastomas appear on imaging?
Well circumscribed osteolytic sphere
+/- extension from epiphysis
What type of calcification is characteristically seen with chondroblastomas?
Chicken wire
How are most benign bone tumours treated?
Biopsy and curettage + liquid nitrogen
List the three benign but locally aggressive bone tumours
Giant cell tumour
Osteoblastoma
Chordoma
Which cells do giant cell tumours arise from?
Osteoclasts
Which age groups get giant cell tumours?
25-40 y/o
Which sex is more prone to giant cell tumours?
Females
Which bones do giant cell tumours typically arise on?
Long bones
Very common around knee (distal femur)
How do giant cell tumours typically appear on imaging?
Dense around the periphery
Destroyed medullary cavity
Destroyed cortex
+/- soft tissue expansion
Nb - “soap bubble” appearance buzzword
What type of cells can be seen on histology of a giant cell tumour?
Multi-nucleated giant cells
Is an osteoblastoma single or multiple?
Single
Where and on which bones can an osteoblastoma be found?
Metaphysis
Diaphysis
Long bones
How does an osteoblastoma appear on imaging?
Central density
Well circumscribed
+/- peripheral sclerosis
How might an osteoblastoma present?
Pain
Swelling
Tenderness
How are benign but locally aggressive bone lesions treated?
Surgical excision
How common is chordoma?
Rare
Which cells do chordomas arise from?
Notochord embyrological remnants
Which age group presents with chordomas?
> 40 y/o
Which sex is more commonly affected by chordomas?
Females
On which bones are chordomas found?
Sacrococcygeal
Base of skull
(midline)
How do chordomas present on imaging?
Midline lesions
Bony lysis
+/- soft tissue mass
+/- focal calcifications
How are chordomas treated?
Difficult to resect
Radiation
Chemotherapy for late stage
List the three most common malignant tumours of the bone?
Osteosarcoma
Chondrosarcoma
Ewing’s sarcoma
What is the commonest primary malignant bone tumour?
Osteosarcoma
Which type of cells do osteosarcomas arise from?
Osteoblasts
Which age groups are affected by osteosarcomas?
Young adults
Which sex is affected by osteosarcoma?
Male more commonly
Where and on which bones are osteosarcomas typically found?
Epiphysis
Long bones (distal femur, proximal tibia and humerus)
Osteosarcoma is fast growing. T/F
True
What are the three subtypes of osteosarcoma?
Osteoblastic
Chondroblastic
Fibroblastic
How is osteosarcoma treated?
Biopsy, CT, bone scan
Chemo pre and post op
Surgical resection
Which type of cells do chondroblastomas arise from?
Chondrocytes
Chondroblastomas are commonly found within the pelvis. T/F
True
How are chondroblastomas treated?
Excision
What type of tumour is Ewing’s sarcoma?
Peripheral primitive neuroectodermal tumour (PPNT)
Where and in which bones does Ewing’s sarcoma arise?
Metaphysis
Diaphysis
Femur
Tibia
Humerus
Which age group is affected by Ewing’s sarcoma?
Teens
Which sex is more commonly affected by Ewing’s sarcoma?
Males
How is Ewing’s sarcoma treated?
Surgery
Radiotherapy
Chemotherapy
Which cancers commonly metastasise to bone?
Renal Thyroid Prostate Breast Lung (small cell)
Bone metastases are osteosclerotic. T/F
Osteolytic EXCEPT from prostate cancer
What is multiple myeloma?
Malignant cancer of plasma cells
Who gets multiple myeloma?
Old people
What is a common complication of multiple myeloma?
Kidney failure
and death
How does multiple myeloma appear on imaging?
Punched out
“Pepper pots”
