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MSK > Pathology > Flashcards

Pathology Flashcards

1
Q

How common are malignant primary bone tumours?

A

Very rare

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2
Q

How common is skeletal metastatic cancers?

A

Common

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3
Q

What is the most common benign bone tumour?

A

Osteochondroma

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4
Q

What is an enchondroma?

A

Metaphyseal cartilaginous tumour caused by failure of normal enchondral ossification at the growth plate

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5
Q

Where do simple bone cysts commonly occur?

A

Long bones.

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6
Q

What are the symptoms of simple bone cysts?

A

Usually asymptomatic but can cause bone weakness

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7
Q

What causes an aneurysmal bone cyst?

A

Arteriovenous malformations

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8
Q

Giant cell tumours are locally aggressive. Where do they commonly affect?

A

Around the knee and distal radius and other long bones.

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9
Q

What do giant cell tumours look like on x-ray?

A

Soap bubble appearance

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10
Q

What are the red flag symptoms of metastatic bone cancer?

A

Severe constant pain

Worse at night

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11
Q

What do malignant primary bone tumours show on x-ray?

A

Cortical destruction and a periosteal reaction

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12
Q

What is the most common primary malignant bone tumour?

A

Osteosarcoma

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13
Q

What age group is an osteosarcoma most likely to affect?

A

Adolescents and young adults

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14
Q

Where is an osteosarcoma most common?

A

Around the knee.

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15
Q

What is a chondrosarcoma?

A

A malignant hyaline cartilage producing primary bone tumour.
Mean age: 45

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16
Q

Where are chondrosarcomas found?

A

Pelvis

Proximal femur

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17
Q

What is Ewing’s sarcoma?

A

Malignant tumour of primative cells.
2nd most prevalent primary bone tumour.
Poorest prognosis.
Occurs in people 10-20 .

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18
Q

Which primary malignant tumour metastasises to bone most commonly?

A

Breast Ca

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19
Q

If breast Ca has spread to bone, how long is the prognosis?

A

24 months

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20
Q

What features are suggestive of a malignant soft tissue neoplasm?

A

> 5cm
Rapid growth
Solid, ill defined
Associated lymphadenopathy

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21
Q

What is the most common soft tissue tumour?

A

Lipoma

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22
Q

What is a ganglion cyst?

A

Occurs around a synovial joint.

Forms as a result of a herniation of the joint capsule.

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23
Q

What does a Ganglion cyst look like?

A

well defined, firm, transilluminate.

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24
Q

What can cause bursitis?

A

Repeated pressure or trauma

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25
Q

What is a possible consequence of osteochrondritis?

A

Localised necrosis due to ischaemia

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26
Q

What is avascular necrosis (AVN) ?

A

Ischaemic necrosis which commonly occurs in adults.

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27
Q

True or False

AVN is always idiopathic

A

False

Can be secondary to fractures or due to alcoholism or steroids

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28
Q

On xray what disease can present as bone enlargement, thickened corticles and trabeculae?

A

Paget’s disease where bone repairal is chaotic.

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29
Q

Where does Paget’s disease commonly affect?

A

Pelvis
Femur
Skull
Tibia

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30
Q

In what kind of tumour would a Shepherd’s crook deformity be found in the proximal femur?

A

Fiberous dysplasia

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31
Q

What is a fascicle?

A

Group of muscle fibres

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32
Q

What surrounds a fascicle?

A

Perimysium

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33
Q

What sounds the individual muscle fibres?

A

Endomysium

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34
Q

In skeletal muscle, where are the nuclei positioned?

A

At the cell periphery

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35
Q

Why is glycolysis high in white fibres?

A

Not much mitochondria
Not much myoglobin.
operates mainly on anaerobic-generated ATP.

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36
Q

What would a high creatinine kinase level indicate?

A

Dystrophy

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37
Q

What would dystrophic changes look like on staining?

A 
Variable muscle fibre sizes
Fatty infiltration
Myocyte hypertrophy
Central nuclei
Ring fibres
38
Q

Which 2 muscular dystrophies are X linked?

A

Duchenne (DMD)
Becker (BMD)
Which are essentially the same thing but BMD affects later in life

39
Q

When does DMD usually present?

A

Preschool.
2-4.
Will not live past 20

40
Q

What gene is responsible for DMD?

A

Mutations on dystrophin gene on chromosome X

41
Q

What does the mutation in DMD mean happens intracellularly?

A

Actin cytoskeleton is altered so it does not anchor to the basement membrane so muscle contractions do not occur properly.

42
Q

What is seen on histology of DMD?

A

Muscle fibre necrosis

Chronic inflammation

43
Q

What is myotonic dystrophy?

A

DM1 and DM2
Autosomal dominant.
Muscle weakness and myotonia

44
Q

What are the symptoms of myotonic dystrophy?

A

weakness in face and distal limbs
Cardiomyopathy
Low intelligence
Cataracts

45
Q

What is seen on histology of myotonic dystrophy?

A

Atrophy of type 1 red fibres
Central nuclei
Fibrofatty replacement

46
Q

What are the primary inflammatories of muscle?

A

Infective agents e.g. coxsackie
Polymyositis
Dermatomyositis

47
Q

What is polymyositis?

A

Chronic inflammatory disease of unknown cause

48
Q

What T cells are involved in polymyositis?

A

CD8+

49
Q

What is dermatomyositis?

A

Polymyositis plus skin changes e.g. erythema

50
Q

True or False

There is a 70% risk of malignancy with dermatomyositis

A

False.

10% risk of malignancy

51
Q

What T cells are involved in dermatomyositis?

A

CD4 cells.

52
Q

What do the muscle fibres look like in neurogenic muscular disorders in adults?

A

Small, angulated muscle fibres.

53
Q

Fibre grouping occurs in neurogenic muscular disorders. What does this mean?

A

Type I fibres all clump together instead of being spread out.

54
Q

Where does the fault lie in motor neuron disease?

A

The anterior horn of spinal cord cells.

55
Q

What is fasciculation?

A

Uncontrolled muscle twitching

56
Q

What is spinal muscular atrophy?

A

Degeneration of anterior horn of spinal cord cells but INHERITED, unlike MND.

57
Q

What is myasthenia gravis?

A

Autoantibodies to the ACh receptor in the post synaptic cleft.

58
Q

Who does Myasthenia gravis affect most commonly?

A

Women aged 20-40

59
Q

What is rhabdomyolysis?

A

Breakdown of skeletal muscle

60
Q

What are the antibodies involved in SLE?

A

Antinuclear antibodies (ANA)

61
Q

In what way can SLE be classified as a type II and type III hypersensitivity?

A

type III due to IgG and C3 immune complexes in kidney

type II due to direct haemolysis leading to anaemia

62
Q

What is polyarteritis nodosa?

A

Inflammation and necrosis of small/medium arteries, especially kidneys, heart, liver.

63
Q

What autoantibody is found in serum for PAN?

A

pANCA

64
Q

What is scleroderma?

A

Excessive collagen production, leading to excessive fibrosis of organs and tissues

65
Q

Describe an osteochondroma

A

Cartilage capped bony projection on the external surface of a bone

66
Q

Who is an osteochondroma more common in?

A

Young people

67
Q

Where do osteochondromas tend to develop?

A

Epiphyses of long bones

68
Q

What is a chondroma?

A

Benign hyaline cartilage tumour which rises in the medulla of the bone in hands and feet

69
Q

What is the syndrome called when there are many chondromas?

A

Mafucci’s syndrome

70
Q

Which age group does chondromas affect?

A

Young adults

71
Q

What is Ollier’s disease?

A

Single chondroma which has a 10% malignancy transformation.

72
Q

What is an osteoid osteoma?

A

Benign tumour of a central core of vascular osteoid tissue

73
Q

Are osteoid osteoma tumours painful?

A

Yes and worse at night. May be accompanied by swelling and tenderness

74
Q

Where are osteoid osteomas found?

A

Axial skeleton

75
Q

What is the treatment for osteoid tumours?

A

They are self resolvable and can be managed with NSAIDs

76
Q

What is a chondroblastoma?

A

Benign cartilage tumour in bone

77
Q

Where are chondroblastomas found?

A

Epiphysis of long bones

78
Q

What do chondroblastomas look like on histology?

A

Closely packed polygonal cells. “Chicken wire” calcification.

79
Q

What is the treatment for chondroblastomas?

A

Biopsy and curettage plus liquid nitrogen

80
Q

Who do giant cell tumours most commonly affect?

A

25-40 yrs old women

81
Q

Why are giant cell tumours locally aggressive?

A

They destroy the medulla and cortex and may expand into soft tissue

82
Q

What do giant cell tumours look like on histology?

A

Multinucleated giant cells in a seal of round mononuclear cells.

83
Q

What is an osteoblastoma?

A

Benign and self-limited tumour that produces osteoid and bone.

84
Q

What do osteoblastomas look like, grossly?

A

Red in colour with haemorrhagic areas.

85
Q

What do osteoblastomas look like on histology?

A

Irregular, mineralised bone. Woven bone.

86
Q

What is the treatment for an osteoblastoma?

A

Intralesional excision

87
Q

What is a chordoma?

A

Benign but locally destructive.

Very rare

88
Q

Who is a chordoma more common in?

A

Older females

89
Q

Where are chordomas most common?

A

In the midline- often sacral region

90
Q

Why is an osteosarcoma painful?

A

the periosteum is being eroded

91
Q

Who does Ewing’s sarcoma most commonly affect?

A

20 year old males

92
Q

What is a multiple myeloma?

A

Malignant proliferation of plasma cells in marrow.

MSK (30 decks)

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