Pathology Flashcards
give the 5 types of benign bone tumours
can be: neoplastic developmental traumatic infectious inflammatory in nature
Give the main benign bone tumours (9)
osteochondroma enchondroma simple bone cyst (aka unicameral bone cyst) aneurysmal bone cyst giant cell tumour Fibrous dysplasia osteoid osteoma Brodie’s abscess (subacute osteomyelitis) hyperparathyroidism (Brown tumours)
Osteochondroma
- appearance
- presentation
-a bony outgrowth on the external surface with a cartilaginous cap
-can produce local pain
Multiple osteochondromata can occur as an autosomal dominant hereditary disorder
enchondroma
- location & type
- why it develops
- appearance
- presentation
- management
-intramedullary and usually metaphyseal cartilaginous tumour
can occur in the femur, humerus, tibia and small bones of the hand and feet
- caused by failure of normal enchondral ossification at the growth plate
- The lesion is usually lucent but can undergo mineralization with a patchy sclerotic appearance.
- incidental or pathologic fracture
- may be scraped out (curettage) and filled with bone graft to strengthen the bone
Simple bone cyst
- appearance
- location
- presentation
- management
- single cavity benign fluid filled cyst in a bone
- probably a growth defect from the physis and are therefore metaphyseal in long bones (usually in the proximal humerus and femur) although they can occur in the talus or calcaneus
- incidental/pathologic frature
- may be scraped out (curettage) and filled with bone graft to strengthen the bone
Aneurysmal bone cyst
- appearance
- caused by
- location
- presentation
- management
- contains lots of chambers which are filled with blood or serum, seen on X-ray
- due to a small arteriovenous malformation
- occur in the metaphyses of many different long bones, flat bones (ribs, skull) and vertebral bodies
- The lesion is locally aggressive causing cortical expansion and destruction and is usually painful/ pathological fracture
- curettage and grafting or the use of bone cement.
Giant cell tumour
- xray appearance
- location
- presentation
- treatment
-On Xray they have a characteristic “soap bubble”
- metaphyseal region, tend to involve the epiphysis
can extend to the subchondral bone
GCTs most commonly occur around knee & distal radius but can occur in pelvis & spine
-They occur after the physis has fused and are locally destructive destroying cortex.
Painful and may cause pathological fracture.
metastasize to the lung with benign pulmonary GCT.
-intralesional excision with use of phenol, bone cement or liquid nitrogen to destroy remaining tumour material and reduce the risk of recurrence. Very aggressive lesions with cortical destruction may need joint replacement
Fibrous dysplasia
- what is it
- appearance
- location
- management
-disease of a bone in adolescence where a genetic mutation results in lesions of fibrous tissue and immature bone
-Defective mineralization may result in angular deformities and the affected bone is wider with thinned cortices
femur involvement can produce shepherd crook deformity
-one bone (monostotic) or more (polyostotic)
-Bisphosphonates may reduce pain
pathologic fractures should be stabilized with internal fixation and cortical bone grafts used to improve strength
Osteoid osteoma
- what is it
- location
- presentation
- management
- small nidus of immature bone surrounded by an intense sclerotic halo
- proximal femur, the diaphysis of long bones and the vertebrae
- intense constant pain, worse at night due to the intense inflammatory response
pain is greatly relieved by NSAIDs
-Bone scan and CT to confirm
resolve spontaneously over time OR require CT guided radiofrequency ablation or en bloc excision
Malignant primary bone tumours
- give the types (8)
- hx red flags (5)
- presentation (5)
- x ray findings (4)
- staging
- management
osteosarcoma chondrosarcoma fibrosarcoma & malignant fibrous histiocytoma Ewings sarcoma lymphoma myeloma
-constant bone pain, worse at night
weight loss
anorexia
fatigue
-often misdiagnosed as muscular pain
unexplained persistent pain
ill-defined bony swelling
red flags should warrant Xray
-aggressive and destructive signs: cortical destruction periosteal reaction sclerosis and lysis extension into surrounding soft tissue
-Bone scan and CT
biopsy for diagnosis
-surgical removal of tumour and surrounding tissue
wide margin 3-4cm
joint is then reconstructed with replacements
adjuvant chemo and radio used prior to surgery
osteosarcoma
- composed of
- age group
- location
- spread
- management
- bone
- younger patients
- knee, proximal femur/humerus, pelvis
- usually haemtogenous, patients can have pulmonary mets at diagnosis
- adjuvant chemo to prolong survival
chondrosarcoma
- composed of
- age group
- location
- management
- cartilage
- older patients
- pelvis/proximal femur
- not radio or chemo sensitive but tend to be low grade
Fibrosarcoma and Malignant Fibrous Histiocytoma
- composed of
- location
- age group
- fibrous material
- occur n abnormal bone (fibrous dysplasia, paget’s disease)
- younger population
Ewings sarcoma
- composed of
- age group
- assoc
- management
- primitive cells in the marrow
- 10-20 yrs
- fever, raised inflammatory markers, and warm swelling; misdiagnosed as osteomyelitis
- radio and chemo sensitive
Lymphoma
- composed of
- types
- location
- treatment
-cancer of macrophages
-primary tumour from marrow (non-hodgekins lymphoma)
pelvis/femur
surgical resection
mets to bone (lymphoma)
lymphadenopthy and splenomegaly
chemo and radio
Myeloma
- composed of
- presentation
- age group
- diagnosis
- treatment
-malignant B cell proliferation [antibodies] arising from the marrow
-present as a solitary lesion (known as a plasmacytoma) OR with multiple osteolytic lesions throughout the skeleton (known as multiple myeloma).
Multiple myeloma: weakness, back pain, bone pain, fatigue, and weight loss and may have marrow suppression = anaemia and recurrent infection. Pathologic fracture
- 45‐65
- plasma protein eectrophoresis and Bence Jones protein assay
- solitary: radio
multiple: chemo
Metastatic bone tumours
- common origin sites of bony mets (5)
- features of each
- bones usually involved
- presentation
- management
-Breast carcinoma- sclerotic or lytic
Prostate carcinoma-sclerotic mets
Lung carcinoma- lytic bony mets
Renal cell carcinoma- large vascular, lytic “blow out” bony mets (bleed heavily on biopsy)
Thyroid adenocarcinoma
- vertebra, pelvis, ribs, skull, humerus and long bones of the lower limb
- bone pain and pathologic fracture
-bone scan to exclude primary tumour
CXR
bloods: Ca, LFTs, FBC, U&Es, plasma protein electrophoresis
areas at risk of fracture are stabilised using intramedullary nails or joint replacement if destruction
if not at risk of fracture then bisphosphonates and radiotherapy
+ surgical decompression if in the spine
Name the most common soft tissue swellings
diffuse: synovitis & oedema
inflammatory: bursitis, rheumatoid nodules
infection: abscess
cystic lesions: ganglion, meniscal cyst, Baker’s cyst
neoplasms: benign & malignant
examination of soft tissue swelling (10)
- findings in benign swelling (6)
- findings in malignant swelling (7)
- management
Site & Size Definition: well defined or ill defined Consistency: cystic, solid, soft, hard Surface: smooth or irregular Mobility or Fixity: to skin or deep tissues Temperature: abscess Transilluminable: fluid filled Pulsatility Overlying skin changes Local lymphadenopathy
- smaller, fluctuation in size, cystic lesion, well defined lesions, fluid filled/soft and fatty
- larger, rapid growth, solid, ill defined, irregular surface, assoc lymphadenopathy and systemic upset
-if unknown then
MRI/US if cystic
biopsy for histological diagnosis
Benign soft tissue tumours
- most common
- what is a GCT of the tendon sheath (appearance, management)
- name for a GCT when in a joint?
-lipoma- neoplastic proliferation of fat
giant cell tumour of the tendon sheath
small from swelling found on the flexor tendon sheath of a finger
can erode bone if large enough
-pigmented lesion
histologically contain multinucleated giant cells and haemosiderin
-excision
-Pigmented Villonodular Synovitis (PVNS).
Malignant soft tissue tumours
- general term and how they are named
- age group
- management
-Sarcoma- malignant soft tissue tumour arising from connective tissue
named due to origin
-50-70
-imaging and biopsy
surgical resection + adjuvant chemo/radio
ganglion cyst
- occur where and due to what (3)
- appearance(2)
- management
- give examples (4)
-around a synovial joint/synovial tendon sheath
due to herniation/out-pouching of a weak portion of the joint capsule or sheath
weakness can be developmental or due underlying joint damage
-well defined and firm
transilluminate
-excision to relieve discomfort/cosmesis
-juvenile Baker’s cyst
adult Baker’s cyst
mucous cyst of the DIP joint
wrist ganglion
Bursitis
- what is a bursa
- what is bursitis, common sites (3)
- other causes
- complication
-small fluid filled sac lined with synovium around a joint to prevent friction between the tendons, bones, muscle and skin
-occurs after repeated trauma or pressure
pre pattelar bursitis, olecranon bursitis, bunions
-bacterial infection= abscess
gout
-thickened bursal sac may be left, reoccurance and excision
sebaceous cysts & implantation dermoids
-management
-may need excision/boipsy
