Neoplastic Bone Tumours

Question 1

What should you do as a GP if you suspect a patient to have a primary bone tumour

Answer 1

Refer URGENTLY to specialist centre

Question 2

How do you perform a bone biopsy

Answer 2

Needle - using Hamshidi needle under US/CT guidance

Open biopsy only if inaccessible/sclerotic lesion

Question 3

what is a benign condition that mimics bone tumour

Answer 3

Fibrous dysplasia

Question 4

Who is fibrous dysplasia more common in

Answer 4

female, young (<30)

Question 5

Where does fibrous dysplasia occur (which bone / how many bones)

Answer 5

any bone, more commonly mono-ostotic

Question 6

WGHat is the appearance of fibrous dysplasia on X ray

Answer 6

soap bubble osteolysis

Question 7

What is poly ostotic disease associated with

Answer 7

McCune Albright Sundrome (includes endocrine problems and cafe au lait spots)

Question 8

What are the three types of cartilagenous bone tumour

Answer 8

osteochondroma
Enchondroma
Chondroblastoma

Question 9

What are the three types of bone forming bone tumour

Answer 9

osteoid osteoma
Osteoblastoma
Osteoma

Question 10

Where do osteochondromas occur

Answer 10

AT THE ENDS OF LONG BONES (as this is a cartilaginous tumour!)

Question 11

What are osteochondromas like

Answer 11

cartilaginous sufrace THICK over normal bone

Question 12

WHAT occurs in Enchondroma

Answer 12

cartilagenous proliferation WITHIN the bone

Question 13

Where do Enchondroma occur (which bones)

Answer 13

hands / feet

Question 14

What does an X ray Enchondroma show

Answer 14

popcorn calcification

Question 15

what does Enchondroma histology show

Answer 15

well circumcised proliferation of cartilage

Question 16

What does an Enchondroma show macroscopically

Answer 16

may erode through cortex of bone

Does NOT burst through cartilaginous surface

Question 17

what occurs in giant cell tumour

Answer 17

BORDERLINE MALIGNANCY:

• benign features: well demarcated, does not come through articular surface of bone
• malignant feature: lots of BLEEDING

Question 18

where do giant cell tumours occur

Answer 18

end of long bones (around the knee)

Question 19

What is a giant cell tumour composed of

Answer 19

giant osteoclast cells

Question 20

What is the appearance of a giant cell tumour on X ray

Answer 20

lytic

Question 21

what is the histology of a giant cell tumour

Answer 21

spindle / ovoid cells

Question 22

Explain the three types of malignant bone tumour

Answer 22

osteosarcoma - forms bone
chondrosarcoma - forms cartilage
Ewing’s - mesenchymal (small round cell), undifferentiated

Question 23

where does Osteosarcoma occur

Answer 23

end of long bones

Question 24

What does an osteosarcoma look like on x ray

Answer 24

lytic, permeative, metaphysical 
elevated periosteum (Codman's triangle)

Question 25

What does an chondrosarcoma look like on x ray

Answer 25

lytic, with fluffy calcification

Question 26

What does an Ewing sarcoma look like on x ray

Answer 26

onion skinning within periosteum

sheets of small round cell

Question 27

who do Ewing sarcomas occur in

Answer 27

young people <20

Question 28

what is the chromosomal translocations in Ewing

Answer 28

t(11;22)

q(24,q12)

Question 29

What is a soft tumour

Answer 29

mesenchymal proliferating in any extra skeletal, non-epithelial tissue in the body

Question 30

What are the three types of soft tissue tumour

Answer 30

Liposarcoma
Spindle cell sarcoma
pleomorphic sarcoma

Question 31

What is the appearance of a liposarcoma

Answer 31

TUMOUR OF FAR – MYXOID appearance