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Lecture Notes- Orthopaedics and Fractures > Neoplastic conditions of bone and soft tissue > Flashcards

Neoplastic conditions of bone and soft tissue Flashcards

1
Q

What is a neoplasm

A

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

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2
Q

Name the 5 commonest types of bone tumours

A 
Haemartomas 
Benign bone tumours 
Malignant bone tumours 
Haematological malignancies 
Metastases to bone
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3
Q

What are some examples of haemartomas

A

fibrous cortical defect
fibrous dysplasia
simple bone cyst

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4
Q

What are some benign tumours

A 
aneurysmal bone cyst 
enchondroma 
osteochondroma 
chondroblastoma 
giant cell tumour 
osteoid osteoma/ osteoblastoma 
chondromyxoid fibroma
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5
Q

What are some examples of malignant bone tumours

A

osteosarcoma
Ewing’s sarcoma
Chondrosarcoma
Spindle cell sarcoma

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6
Q

What are some examples of Haematological malignancies

A

plasmacytoma/ myeloma

non-hodgkin’s lymphoma

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7
Q

What tumours metastasise to bone

A 
epithelial cancers 
breast
bronchus 
prostate
thyroid and 
kidney
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8
Q

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

A

plain Xray of the affected part

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9
Q

What radiological features warrant further investigation

A

bone destruction
new bone formation
periosteal reaction
soft tissue swelling

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10
Q

What bones are most commonly affected with metastases

A

Spine
pelvis
ribs
femur

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11
Q

What is the aim of orthopaedic management

A

relieve symptoms
restore function
supporting treatment from an oncologist

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12
Q

What is the median survival for a patient with bone metastases

A

3 months

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13
Q

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

A

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

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14
Q

What technique is preferred for internal fixation devices in bone cancer

A

Intramedullary nails and bone cement rather than plate and screw

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15
Q

What are Hamartomata

A

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

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16
Q

What is a fibrous cortical defect

A

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

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17
Q

What is a fibrous dysplasia

A

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

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18
Q

What are common in fibrous dysplasia

A

stress fractures

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19
Q

What do Xrays typically show of a fibrous dysplasia

A

ground glass appearance

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20
Q

What is the treatment for fibrous dysplasia

A

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

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21
Q

Where do simple bone cysts arise

A

in long bones in the skeletally immature patient

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22
Q

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

A

avoid contact sports until the cyst heals

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23
Q

What is an osteochondroma

A

benign bone tumour

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24
Q

Why do symptoms of osteochondromas exist

A

pressure on adjacent structures eg muscle cause pain

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25
Q

What is the risk of an osteochondroma becoming malignant

A

very low

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26
Q

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

A

Aneurysmal can also arise in axial bones

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27
Q

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

A

curettage

If left the bone cyst will progress

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28
Q

What are Enchondromas

A

Benign cartilage growths inside the bone

29
Q

Where do enchondromas most commonly arise

A

Fingers but also the long bone

30
Q

What do X-rays of Enchdonromas show

A

Popcorn calcification

31
Q

What is the treatment for enchondromas

A

Asymptomatic - no treatment

Symptomatic - curettage

32
Q

What is Ollier’s disease

A

when the patient suffers from multiple enchondromas affecting many bones

33
Q

What is a chondroblastoma

A

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

34
Q

What is the treatment for chondroblastoma

A

curettage

35
Q

What is an osteoid osteoma

A

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

36
Q

what is the most commonly affected site for an osteoid esteem

A

mid-tibia

37
Q

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

A

Prolonged pain especially at night

relieves with aspirin or other NSAIDs

38
Q

What do X-rays of osteoid osteomas show

A

central nidus with dense sclerosis around it

39
Q

What is the treatment for an osteoid osteoma

A

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

40
Q

Where do osteoblastomas arise

A

in the spine

41
Q

Where do giant cell tumours arise

A

in the epiphysis after growth has finished

42
Q

Where do giant cell tumours typically involve

A

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

43
Q

Why are giant cell tumours called giant cell tumours

A

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

44
Q

What is the treatment for a giant cell tumour

A

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

45
Q

What is an osteosarcoma

A

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

46
Q

Who is affected by osteosarcomas

A

Under 30s

boys more than girls

47
Q

What is the commonest bone to be affected by an osteosarcoma

A

femur

also upper end of tibia and humerus

48
Q

What is a typical feature on Xray of an osteosarcoma

A

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

49
Q

What is the treatment for an osteosarcoma

A

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

50
Q

What are the 2 most important prognostic factors for osteosarcoma

A

Size of tumour and response to chemotherapy

51
Q

What is a chondrosarcoma

A

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

52
Q

What bones are affected by chondrosarcoma

A

bones of the trunk and the proximal needs of long bones

53
Q

What age are people more likely to develop a chondrosarcoma

A

over 30

54
Q

Describe the radiological appearance of a chondromata

A

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

55
Q

What is the treatment for chondrosarcomas

A

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

56
Q

What is the prognosis for a patient with a chondrosarcoma

A

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

57
Q

What is Ewing’s sarcoma

A

a malignant tumour arising in bone marrow

58
Q

Where are Ewing’s sarcomas confined to

A

ends of long bones

59
Q

What are the radiological features of Ewing’s sarcoma

A

bone destruction and often soft-tissue swelling

onion skin layers of new bone formation around he lesion

60
Q

How can we make a diagnosis of Ewing’s sarcoma

A

Biopsy

61
Q

What is the treatment for Ewing’s sarcoma

A

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

62
Q

What is non-Hodgkin’s lymphoma

A

Destructive bone tumour of adults

63
Q

What is the treatment of non-Hodgkin’s lymphoma

A

chemo and radio

64
Q

What is a plasmacytoma

A

a solitary form of myeloma both being tumours of plasma cells

65
Q

What is the treatment for a plasmacytoma

A

radiotherapy

66
Q

What happens to the serum immunoglobulins in myeloma

A

the patient has elevated serum immunoglobulins

67
Q

What are some highly suggestive features of malignancy

A 
Lump >5cm
Increasing in size 
recently painful 
deep to fascia 
recurrence after previous excision
68
Q

What is the management of soft-tissue sarcomas

A

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

Lecture Notes- Orthopaedics and Fractures (23 decks)

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