Neoplastic conditions of bone and soft tissue Flashcards
What is a neoplasm
a group of cells which continue to proliferate indefinitely in an uncontrolled fashion
Name the 5 commonest types of bone tumours
Haemartomas Benign bone tumours Malignant bone tumours Haematological malignancies Metastases to bone
What are some examples of haemartomas
fibrous cortical defect
fibrous dysplasia
simple bone cyst
What are some benign tumours
aneurysmal bone cyst enchondroma osteochondroma chondroblastoma giant cell tumour osteoid osteoma/ osteoblastoma chondromyxoid fibroma
What are some examples of malignant bone tumours
osteosarcoma
Ewing’s sarcoma
Chondrosarcoma
Spindle cell sarcoma
What are some examples of Haematological malignancies
plasmacytoma/ myeloma
non-hodgkin’s lymphoma
What tumours metastasise to bone
epithelial cancers breast bronchus prostate thyroid and kidney
What is the key investigation for any patient with non-specific pain, particularly non-mechanical pain
plain Xray of the affected part
What radiological features warrant further investigation
bone destruction
new bone formation
periosteal reaction
soft tissue swelling
What bones are most commonly affected with metastases
Spine
pelvis
ribs
femur
What is the aim of orthopaedic management
relieve symptoms
restore function
supporting treatment from an oncologist
What is the median survival for a patient with bone metastases
3 months
What can be done to restore function in a patient with bone mets
Fixation of a bone either to prevent fracture or to fix a fracture
What technique is preferred for internal fixation devices in bone cancer
Intramedullary nails and bone cement rather than plate and screw
What are Hamartomata
Lesions of bone which are developments but which often heal with time
What is a fibrous cortical defect
asymtpomatic defect in the cortex of bone which heal with skeletal maturity
What is a fibrous dysplasia
A developmental abnormality of bone where the bone does not form properly and is weaker than normal
What are common in fibrous dysplasia
stress fractures
What do Xrays typically show of a fibrous dysplasia
ground glass appearance
What is the treatment for fibrous dysplasia
conservative but prophylactic stabilisation may be helpful if persistent symptoms are present
Bisphosphonates may help reduce symptoms also
Where do simple bone cysts arise
in long bones in the skeletally immature patient
What is the advice for a patient with a simple bone cyst
avoid contact sports until the cyst heals
What is an osteochondroma
benign bone tumour
Why do symptoms of osteochondromas exist
pressure on adjacent structures eg muscle cause pain
What is the risk of an osteochondroma becoming malignant
very low
What is the difference between an aneurysmal bone cyst and a simple bone cyst
Aneurysmal can also arise in axial bones
What is the treatment for aneurysmal bone cyst and why should they be treated
curettage
If left the bone cyst will progress
What are Enchondromas
Benign cartilage growths inside the bone
Where do enchondromas most commonly arise
Fingers but also the long bone
What do X-rays of Enchdonromas show
Popcorn calcification
What is the treatment for enchondromas
Asymptomatic - no treatment
Symptomatic - curettage
What is Ollier’s disease
when the patient suffers from multiple enchondromas affecting many bones
What is a chondroblastoma
a benign cartilage tumour which typically arises in the epiphysis of the femur, tibia and humerus
What is the treatment for chondroblastoma
curettage
What is an osteoid osteoma
bone forming tumour that typically arises in the cortex of a long bone
what is the most commonly affected site for an osteoid esteem
mid-tibia
What is the typical presentation for a patient with an osteoid osteoma
Prolonged pain especially at night
relieves with aspirin or other NSAIDs
What do X-rays of osteoid osteomas show
central nidus with dense sclerosis around it
What is the treatment for an osteoid osteoma
ablation of the nidus by radio frequency or heat ablation under CT guidance
Where do osteoblastomas arise
in the spine
Where do giant cell tumours arise
in the epiphysis after growth has finished
Where do giant cell tumours typically involve
the knee region with a lytic defect affecting either the femoral or tibial condyle extending right up to the joint line
Why are giant cell tumours called giant cell tumours
The multinucleate giant cells which are in the tumour and which are stimulated to destroy bone
What is the treatment for a giant cell tumour
Detailed curettage and can be supplemebted with adjuncts such as phenol or cryotherapy followed by either bone grafting or cementation
What is an osteosarcoma
A malignant neoplasm arising form bone cells which are undifferentiated and capable of forming bone, cartilage and collagenous tissue
Who is affected by osteosarcomas
Under 30s
boys more than girls
What is the commonest bone to be affected by an osteosarcoma
femur
also upper end of tibia and humerus
What is a typical feature on Xray of an osteosarcoma
destructive lesion in the metaphysis - usually translucent and often with reactive peristyle new bone or rays of ossification with the expanding tumour
What is the treatment for an osteosarcoma
chemotherapy - immediately treats the micro-metastases and shrinks the primary tumour
After 6-9 weeks, surgery is performed
Sometimes amputation is required
What are the 2 most important prognostic factors for osteosarcoma
Size of tumour and response to chemotherapy
What is a chondrosarcoma
a tumour that arises from chondroblasts and can only produce chondroid and collagen not bone
What bones are affected by chondrosarcoma
bones of the trunk and the proximal needs of long bones
What age are people more likely to develop a chondrosarcoma
over 30
Describe the radiological appearance of a chondromata
translucent area which may expand the bone and is often criss-crossed by spicules of calcification
What is the treatment for chondrosarcomas
Surfical excision is essential for a cure as they don’t respond to surgery or chemotherapy
What is the prognosis for a patient with a chondrosarcoma
depends - based on the grade of the tumour and the ability to completely surgically remove it
What is Ewing’s sarcoma
a malignant tumour arising in bone marrow
Where are Ewing’s sarcomas confined to
ends of long bones
What are the radiological features of Ewing’s sarcoma
bone destruction and often soft-tissue swelling
onion skin layers of new bone formation around he lesion
How can we make a diagnosis of Ewing’s sarcoma
Biopsy
What is the treatment for Ewing’s sarcoma
Chemotherapy –> dramatic response with necrosis of the tumour and reduction of symptoms
Surgical resection and radiotherapy
What is non-Hodgkin’s lymphoma
Destructive bone tumour of adults
What is the treatment of non-Hodgkin’s lymphoma
chemo and radio
What is a plasmacytoma
a solitary form of myeloma both being tumours of plasma cells
What is the treatment for a plasmacytoma
radiotherapy
What happens to the serum immunoglobulins in myeloma
the patient has elevated serum immunoglobulins
What are some highly suggestive features of malignancy
Lump >5cm Increasing in size recently painful deep to fascia recurrence after previous excision
What is the management of soft-tissue sarcomas
surgical excision with a wide margin around the tumour followed by radiotherapy
