Neoplastic conditions of bone and soft tissue

Question 1

What is a neoplasm

Answer 1

a group of cells which continue to proliferate indefinitely in an uncontrolled fashion

Question 2

Name the 5 commonest types of bone tumours

Answer 2

Haemartomas 
Benign bone tumours 
Malignant bone tumours 
Haematological malignancies 
Metastases to bone

Question 3

What are some examples of haemartomas

Answer 3

fibrous cortical defect
fibrous dysplasia
simple bone cyst

Question 4

What are some benign tumours

Answer 4

aneurysmal bone cyst 
enchondroma 
osteochondroma 
chondroblastoma 
giant cell tumour 
osteoid osteoma/ osteoblastoma 
chondromyxoid fibroma

Question 5

What are some examples of malignant bone tumours

Answer 5

osteosarcoma
Ewing’s sarcoma
Chondrosarcoma
Spindle cell sarcoma

Question 6

What are some examples of Haematological malignancies

Answer 6

plasmacytoma/ myeloma

non-hodgkin’s lymphoma

Question 7

What tumours metastasise to bone

Answer 7

epithelial cancers 
breast
bronchus 
prostate
thyroid and 
kidney

Question 8

What is the key investigation for any patient with non-specific pain, particularly non-mechanical pain

Answer 8

plain Xray of the affected part

Question 9

What radiological features warrant further investigation

Answer 9

bone destruction
new bone formation
periosteal reaction
soft tissue swelling

Question 10

What bones are most commonly affected with metastases

Answer 10

Spine
pelvis
ribs
femur

Question 11

What is the aim of orthopaedic management

Answer 11

relieve symptoms
restore function
supporting treatment from an oncologist

Question 12

What is the median survival for a patient with bone metastases

Answer 12

3 months

Question 13

What can be done to restore function in a patient with bone mets

Answer 13

Fixation of a bone either to prevent fracture or to fix a fracture

Question 14

What technique is preferred for internal fixation devices in bone cancer

Answer 14

Intramedullary nails and bone cement rather than plate and screw

Question 15

What are Hamartomata

Answer 15

Lesions of bone which are developments but which often heal with time

Question 16

What is a fibrous cortical defect

Answer 16

asymtpomatic defect in the cortex of bone which heal with skeletal maturity

Question 17

What is a fibrous dysplasia

Answer 17

A developmental abnormality of bone where the bone does not form properly and is weaker than normal

Question 18

What are common in fibrous dysplasia

Answer 18

stress fractures

Question 19

What do Xrays typically show of a fibrous dysplasia

Answer 19

ground glass appearance

Question 20

What is the treatment for fibrous dysplasia

Answer 20

conservative but prophylactic stabilisation may be helpful if persistent symptoms are present
Bisphosphonates may help reduce symptoms also

Question 21

Where do simple bone cysts arise

Answer 21

in long bones in the skeletally immature patient

Question 22

What is the advice for a patient with a simple bone cyst

Answer 22

avoid contact sports until the cyst heals

Question 23

What is an osteochondroma

Answer 23

benign bone tumour

Question 24

Why do symptoms of osteochondromas exist

Answer 24

pressure on adjacent structures eg muscle cause pain

Question 25

What is the risk of an osteochondroma becoming malignant

Answer 25

very low

Question 26

What is the difference between an aneurysmal bone cyst and a simple bone cyst

Answer 26

Aneurysmal can also arise in axial bones

Question 27

What is the treatment for aneurysmal bone cyst and why should they be treated

Answer 27

curettage | If left the bone cyst will progress

Question 28

What are Enchondromas

Answer 28

Benign cartilage growths inside the bone

Question 29

Where do enchondromas most commonly arise

Answer 29

Fingers but also the long bone

Question 30

What do X-rays of Enchdonromas show

Answer 30

Popcorn calcification

Question 31

What is the treatment for enchondromas

Answer 31

Asymptomatic - no treatment | Symptomatic - curettage

Question 32

What is Ollier's disease

Answer 32

when the patient suffers from multiple enchondromas affecting many bones

Question 33

What is a chondroblastoma

Answer 33

a benign cartilage tumour which typically arises in the epiphysis of the femur, tibia and humerus

Question 34

What is the treatment for chondroblastoma

Answer 34

curettage

Question 35

What is an osteoid osteoma

Answer 35

bone forming tumour that typically arises in the cortex of a long bone

Question 36

what is the most commonly affected site for an osteoid esteem

Answer 36

mid-tibia

Question 37

What is the typical presentation for a patient with an osteoid osteoma

Answer 37

Prolonged pain especially at night | relieves with aspirin or other NSAIDs

Question 38

What do X-rays of osteoid osteomas show

Answer 38

central nidus with dense sclerosis around it

Question 39

What is the treatment for an osteoid osteoma

Answer 39

ablation of the nidus by radio frequency or heat ablation under CT guidance

Question 40

Where do osteoblastomas arise

Answer 40

in the spine

Question 41

Where do giant cell tumours arise

Answer 41

in the epiphysis after growth has finished

Question 42

Where do giant cell tumours typically involve

Answer 42

the knee region with a lytic defect affecting either the femoral or tibial condyle extending right up to the joint line

Question 43

Why are giant cell tumours called giant cell tumours

Answer 43

The multinucleate giant cells which are in the tumour and which are stimulated to destroy bone

Question 44

What is the treatment for a giant cell tumour

Answer 44

Detailed curettage and can be supplemebted with adjuncts such as phenol or cryotherapy followed by either bone grafting or cementation

Question 45

What is an osteosarcoma

Answer 45

A malignant neoplasm arising form bone cells which are undifferentiated and capable of forming bone, cartilage and collagenous tissue

Question 46

Who is affected by osteosarcomas

Answer 46

Under 30s | boys more than girls

Question 47

What is the commonest bone to be affected by an osteosarcoma

Answer 47

femur | also upper end of tibia and humerus

Question 48

What is a typical feature on Xray of an osteosarcoma

Answer 48

destructive lesion in the metaphysis - usually translucent and often with reactive peristyle new bone or rays of ossification with the expanding tumour

Question 49

What is the treatment for an osteosarcoma

Answer 49

chemotherapy - immediately treats the micro-metastases and shrinks the primary tumour After 6-9 weeks, surgery is performed Sometimes amputation is required

Question 50

What are the 2 most important prognostic factors for osteosarcoma

Answer 50

Size of tumour and response to chemotherapy

Question 51

What is a chondrosarcoma

Answer 51

a tumour that arises from chondroblasts and can only produce chondroid and collagen not bone

Question 52

What bones are affected by chondrosarcoma

Answer 52

bones of the trunk and the proximal needs of long bones

Question 53

What age are people more likely to develop a chondrosarcoma

Answer 53

over 30

Question 54

Describe the radiological appearance of a chondromata

Answer 54

translucent area which may expand the bone and is often criss-crossed by spicules of calcification

Question 55

What is the treatment for chondrosarcomas

Answer 55

Surfical excision is essential for a cure as they don't respond to surgery or chemotherapy

Question 56

What is the prognosis for a patient with a chondrosarcoma

Answer 56

depends - based on the grade of the tumour and the ability to completely surgically remove it

Question 57

What is Ewing's sarcoma

Answer 57

a malignant tumour arising in bone marrow

Question 58

Where are Ewing's sarcomas confined to

Answer 58

ends of long bones

Question 59

What are the radiological features of Ewing's sarcoma

Answer 59

bone destruction and often soft-tissue swelling | onion skin layers of new bone formation around he lesion

Question 60

How can we make a diagnosis of Ewing's sarcoma

Answer 60

Biopsy

Question 61

What is the treatment for Ewing's sarcoma

Answer 61

Chemotherapy --> dramatic response with necrosis of the tumour and reduction of symptoms Surgical resection and radiotherapy

Question 62

What is non-Hodgkin's lymphoma

Answer 62

Destructive bone tumour of adults

Question 63

What is the treatment of non-Hodgkin's lymphoma

Answer 63

chemo and radio

Question 64

What is a plasmacytoma

Answer 64

a solitary form of myeloma both being tumours of plasma cells

Question 65

What is the treatment for a plasmacytoma

Answer 65

radiotherapy

Question 66

What happens to the serum immunoglobulins in myeloma

Answer 66

the patient has elevated serum immunoglobulins

Question 67

What are some highly suggestive features of malignancy

Answer 67

``` Lump >5cm Increasing in size recently painful deep to fascia recurrence after previous excision ```

Question 68

What is the management of soft-tissue sarcomas

Answer 68

surgical excision with a wide margin around the tumour followed by radiotherapy