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Medical Sciences B > Neoplastic lesions of bone & cartilage > Flashcards

Neoplastic lesions of bone & cartilage Flashcards

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USMLE® Step 1 flashcards
1
Q

List the developmental and congenital anomalies of the cervical spine

A
  • occipitalisation
  • posterior ponticle
  • odontoid anomalies
  • block vertebra
  • cervical ribs
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2
Q

List the tumour-like neoplastic lesions of bone and cartilage?

A

Tumour-like:
• paget’s disease
• fibrous dysplasia

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3
Q

List the benign neoplastic lesions of bone and cartilage?

A
  • solitary osteochondromas
  • hereditary multiple exostoses
  • solitary enchondroma
  • multiple enchondromatosis
  • osteoma
  • osteoid osteoma
  • bone island
  • other (bone cyst, giant cell tumour, fibrous xanthoma, chondroblastoma, osteoblastoma, haemangioma)
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4
Q

List the malignant neoplastic lesions of bone and cartilage?

A 
Primary  
Multiple myeloma
•  Osteosarcoma
•  chondrosarcoma
•  Ewing's sarcoma
•  fibrosarcoma
•  non-hodgkin's lymphoma of bone

Metastatic

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5
Q

What is Paget’s disease?

A
  • abnormal destruction of bone with abnormal reparative process
  • results in deformities
  • unknown aetiology
  • familial and maybe viral
  • 4 phases
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6
Q

What are the 4 phases of Page’ts disease pathology?

A

1) Resorptive -osteoclastic activity predominates
2) Mixed -osteoblsatic réponse to osteoclasts
3) Sclerotic -osteoblastic predominates
4) Malignant degeneration (<2% of cases)

• during active phase: rate f transfer of calcium in and out of the skeleton x7 but balance is close to zero

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7
Q

What is the epidemiology of Paget’s disease?

A
  • > 50yrs
  • 3% of >40s have it
  • men x2
  • familial and environmental factors
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8
Q

What are the clinical features of Paget’s disease?

A
  • lesions seldom painful
  • weakened, deformed thickened skeleton (path. fractures)
  • skull enlarges (basilar invagination)
  • shunting of blood (hypertension, arteriosclerosis)
  • <2% malignant changes at 70-80 yrs
  • 80-95% remain undiagnosed due to small symptoms
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9
Q

What area is most commonly affected by Paget’s disease?

A

pelvis
lumbar spine
femur

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10
Q

What is fibrous dysplasia?

A
  • bone marrow replaced with fibro-osseous tissue
  • also effects skin and endocrine (precocious sex development)
  • 8-14yrs
  • asymptomatic unless fracture
  • bowing
  • café au lait
  • from: mutation in gene for G-alpha protein
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11
Q

What is solitary osteochondromas?

A
  • benign, male x2
  • exostoses from cortical surface with a hyaline-lined cartilage cap
  • femur, humerus, tibia
  • asymptomatic
  • discovered by 20yrs incidentally
  • common -50% of all bone tumours
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12
Q

What is hereditary multiple exostoses? (HME) (tissue, symptoms, sites)

A
  • metaphysical overgrowth with multiple osteochondromas
  • average 10 lesions
  • asymptomatic
  • pain if malignant degeneration (rare)
  • autosomal dominant
  • less severe in females
  • femur, tibia, humerus, radius
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13
Q

What is solitary enchondroma?

A
  • bening, < 30s
  • islands of cartilage in metaphysics of a bone
  • hands & feet
  • asymptomatic unless path. fracture
  • long bones more symptomatic
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14
Q

What is the most common benign bone tumour of the hand?

A

solitary enchondroma

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15
Q

What is multiple enchondromatosis?

A
  • < 30s
  • hands, feet, femur, tibia, iliac crest (bilateral)
  • asymptomatic unless path. fracture
  • if large: deformity, loss of function
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16
Q

What is an osteoma?

A
  • slow-growing, silent
  • from cortical bone
  • skull sinuses, tubular bones
  • chronic sinusitis, headaches, ocular disturbances, exophthalmos
  • female x3
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17
Q

What is an osteoid osteoma?

A
  • benign, < 30’s, males x2
  • fibrous CT surrounded by sclerotic bone, < 1cm
  • femur, tibia, spine
  • insidious severe, aching pain, worse at night, relieved by aspirin
  • sweating, hot
18
Q

What is a bone island?

A
  • focal lamellar bone in normal spongiosa
  • incidental finding (asymptomatic)
  • adults
  • 30% show growth active growth
  • some shrink
19
Q

What is Gardner’s syndrome?

A

trio of growths involving:

  • numerous osteomas
  • polyps in colon
  • soft tissue fibromas
20
Q

What is an enostoma?

A

other name for bone island

21
Q

What is multiple myeloma?

A
  • monoclonal malignant, of plasma cells from bone marrow
  • non-Hodgkin’s lymphoma, B cell
Destroys osseous tissue: 
• pain, fractures, deformities
• anaemia, leucopenia, thrombocytopenia
• osteoporosis
• Bence Jones proteins in urine, renal tubular damage, hypercalcaemia
• amyloidosis
22
Q

What is osteosarcoma?

A
  • malignant, < 30’s, male x2
  • undifferentiated osteoid CT
  • long bones (KNEE, close to metaphysis)
  • pain, swelling, increasing
  • poor prognosis
  • mets to lung, bone, kidney
  • Lab: high alkaline phosphatase
23
Q

What are the most common primary malignant bone tumours in order of most to least?

A

1) Multiple myeloma
2) Osteosarcoma
3) Chondrosarcoma
4) Ewing’s sarcoma

24
Q

List the types of osteosarcoma?

A
  • central (medullary)
  • multi centric (multiple lesions)
  • parosteal (juxtacortical)
  • secondary (transformation of benign lesion, Paget’s, osteochondroma)
  • extraosseous
25
Q

What is chondrosarcoma?

A
  • malignant, <30s, male x2
  • cartilaginous tissue
  • pelvis, proximal femur, ribs, humeurs, scapula, femur, tibia
  • highly aggressive
  • mets to lung
26
Q

List the types of chondrosarcomas

A
  • central (medullary)
  • peripheral (juxtacortical)
  • extraosseous (rare)
  • secondary (osteochondroma or enchondroma)
27
Q

What carcinomas DO NOT metastasize to bone?

A

CNS tumours and basal cel carcinomas

28
Q

What are the pathways of metastatic spread of metastatic bone tumours?

A

1) Direct extension -tumours from peritoneal cavity
2) Lymphatic dissemination -rare cus no lymphatic channels in bone marrow

3) Hematogenous dissemination
- most common
- veins vulnerable to tumour penetration
- lung, liver, axial skeleton

29
Q

What are the clinical features of bone metastasis?

A
  • unexplained weight loss, cachexia
  • anaemia, fever (later)
  • skeletal pain insidious and at night
  • pathological fracture
30
Q

What investigations do we do for bone metastasis?

A

• high ESR
• maybe high serum calcium
• elevated alkaline phosphatase with elastic lesions
high acid phosphatase and Prostate specific antigen (PSA) with prostatic carcinoma when spread to bone

31
Q

How can Paget’s disease be fatal?

A
  • complications of pathological fracture -> fat embolism, haemorrhage
  • cardiovascular issues (bones require lots of blood supply -> huge strain on heart)
  • malignancies -lung, brain
32
Q

How can osteoporosis be fatal?

A
  • hip fracture -fat embolus from bone marrow -> pulmonary embolus
  • rib fracture
  • tearing arteries
  • sever kyphosis (interrupt internal organs -lungs, digestion)
33
Q

Explain why hyperparathyroidism has a major effect on the skeleton

A
  • extreme activity of the PTH in its job to increase serum calcium
  • will increase resorption of calcium from the bones to increase serum calcium
  • increase intestinal absorption of calcium
34
Q

Describe the most likely mechanism by which a child may develop acute osteomyelitis.

A
  • most often haematogenous spread
  • staphylococcus aureus is most likely, localised collection under skin (boil)
  • *same as for adult
35
Q

When would you suspect a child to have acute osteomylteitis. How could this be confirmed?

A
  • redness, swelling, heat, tenderness, pain (rest) -any inflamed tissue
  • rapid onset of local tenderness, soft tissue swelling and pyrexia
  • examined by radiograph examination or laboratory blood culture
  • order whole blood check: maybe leucocytes
  • x-ray, CT scan, MRI
  • ESR increased
36
Q

Describe metastatic bone tumours?

A
  • > 40yrs
  • marrow rich bones
  • poor prognosis
  • Hodgkin’s lymphoma, Ewing’s, osteosarcoma, neuroblastoma
37
Q

What are 70% of all bone tumours? metastatic or primary?

A

metastatic

38
Q

What is Ewing’s sarcoma?

A
  • undifferentiated, aggressive (5% survival)
  • <30’s, male x2
  • from bone marrow, round cell
  • diaphysral; femur, pelvis
  • looks like infection (pain, swelling, hot, tender)
  • slight fever
  • mets to lungs
39
Q

What are the clinical features of chondrosarcomas?

A
  • swelling, pain (late)
  • peripheral lesions asymptomatic
  • if early detection and treatment -> 90% 5-year survival rate
40
Q

Where are metastatic bone tumours from?

A
  • breast,
  • prostate
  • lung
  • kidney (most from epithelial tissue)
41
Q

Where are located most metastatic bone tumours?

A
  • spine
  • ribs
  • sternum
  • pelvis
  • sacrum
  • skull
  • long tubular bones
42
Q

What is the difference between lytic and blastic metastases?

A

Lytic:
• destruction from expanding tumour on trabeculae & cortices
• Trabeculae may be absorbed
• begin in the medullary cavity

Blastic:
• increase bone density
• deposition of non-neoplastic bone (reactive sclerosis) -futile attempt at bone repair

Medical Sciences B (23 decks)

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