Neoplastic Bone Disease Flashcards
What is the epidemiology surrounding bone tumours?
Bone cancers are much more uncommon than others (up to 60 times less common than lung. In adults, they are likely to be secondary cancers, while in children they are more likely to be primary cancers.
What is the best thing to do with someone who has a suspected bone cancer?
REFER!
- Early referral in the single most important factor in prognosis
How does someone with bone cancer usually present? What information should you elicit?
History:
- Pain
- Swelling
- Deformity
- Fracture
Questions:
- Age, site and duration
- History of trauma
- Multiple disease/associated symptoms
How should you investigate a case of suspected bone cancer?
X-Ray
- Size
- Margins
- Number
How does one diagnose a specific bone tumour?
Needle core biopsy
- With ultrasound/CT guidance
Open biopsies are used only for inaccessible tumours
Cytology is then examined
Give examples of neoplastic bone disease
- Osteosarcoma
- Chondrosarcoma
- Ewing’s sarcoma
- Giant cell (borderline malignancy)
Give examples of non-neoplastic bone tumours
- Osteoid osteoma
- Osteoma
- Enchondroma
- Osteochondroma
- Fibrous dysplasia
- Simple bone cyst
- Osteoblastoma
What are the epidemiological features of osteosarcoma? Radiological? Histological?
This affects adolescence, and is most commonly found in the knee (end of long bones).
On x-ray, there will be a classic Codman’s triangle (raised periosteum)
On histology, there will be malignant mesenchymal cells and the tissue will be AlkPhos positive
What are the epidemiological features of chondrosarcoma? Radiological? Histological?
This affects those in middle age (>40) and is most commonly found in the pelvis (axial skeleton).
On x-ray, there will be fluffy calcification in the affected area.
On histology, there will be malignant chondrocytes.
What causes Ewing’s sarcoma? What are the epidemiological features of Ewing’s sarcoma? Radiological? Histological?
A translocation of chromosomes 11 and 22 t(11;22) q(24;12)
This affects children and is highly malignant. It is most commonly found in the diaphysis or metaphysis of long bones or the pelvis.
On x-ray there will be onion skinning of the periosteum.
On histology, there will be sheets of small round blue cells, which are CD99+ve.
What are the epidemiological features of Giant cell bone tumours? Radiological? Histological?
These affect those in ages 20-40, with a higher predilection for females. They usually affect the knee.
On x-ray there will be lytic lesions
On histology, there will be osteoclast giant cells on the background of spindle cells.
What are the epidemiological features of osteoid osteoma? Radiological? Histological?
This usually affects adolescents and most commonly presents in the tibia/femur.
On x-ray there will be a radiolucent nidus
On histology, it will look like normal bone.
What are the epidemiological features of osteoma? Radiological? Histological? What syndromes associated?
This usually affects middle age, in the head and neck.
On x-ray, there will be a radiolucent nidus.
On histology, it will look like normal bone.
Associated with Gardner Syndrome:
- GI polyps
- Multiple osteomas
- Epidermoid cysts
What are the epidemiological features of enchondroma? Radiological? Histological? What syndromes associated?
This usually affects middle age, in the hands.
On x-ray, there will be cotton-wool/popcorn calcification.
On histology, it will look like normal cartilage
Associated with Ollier’s Syndrome:
- Multiple enchondromas
Associated with Maffuci’s Syndrome:
- Multiple enchondromas
- Haemangiomas
What are the epidemiological features of osteochondroma? Radiological? Histological? What syndromes associated?
This usually affects those in adolescence, most commonly in the long bones.
On x-ray, there will be a well defined protuberance from the bone
On histology, with will look like a cartilage capped bony outgrowth.
Associated with Hereditary Multiple Exostoses:
- Multiple exostoses
- Short stature
- Bone deformities.
