Pathology Flashcards
What is the difference between sarcoma and carcinoma?
A sarcoma is any malignant neoplasm arising from mesenchymal cells (which give rise to connective tissue and non-epithelial tissue). There are three broad categories:
1. Soft tissue cancers
2. Primary bone cancers
3. GI stromatal tumours
Carcinomas affect epithelial cells and frequently cause breast, bowel and lung cancers.
What is a ganglion cyst (ganglia)? Where are they common? What causes them? Treatment? Complications? Is it really a true cyst?
These are smooth, multilocular swellings containing fluid in communication with joint capsules or tendon sheaths.
Common around the wrist.
Degenerative change within connective tissues.
Treatment is not needed unless they cause pain or pressure (e.g. median nerve compression at the wrist).
Aspiration may work, but surgical dissection gives less recurrence. Problems include painful scars, neurovascular damage and recurrence.
Not a true cyst - no epithelial lining
Superficial fibromatoses Features? Arises from what? Aggressive? Example? What is it called on the penis?
Common slow growing tumour arising from fascia or aponeurosis
Less aggressive than deep fibromatosis
Dupuytren’s – common, M>F, idiopathic, lots of associations e.g. alcohol but diabetes and anticonvulsants are more likely cause
Knuckle pads
Plantar
Penile – Peyronie’s
Deep fibromatoses Features? Where does it tend to occur? Other name? Associated with what syndrome?
THIS IS A DIFFERENT DISEASE TO SUPERFICIAL FIBROMATOSES
This is a different disease
Rapidly growing tumour which usually reaches a large size
Tends to occur in mesenteric or pelvic regions
Referred to as Desmoid tumours Associated with Gardner’s syndrome (FAP)
Giant cell tumours
Name and describe the two main types
Benign or malignant
Similarity?
- Giant cell tumour of tendon sheath (GCTS) - small nodules in the digits that are easier to remove with occasional recurrence
- Pigmented villonoduar synovitis (PVNS) - more destructive and diffuse in a joint space; get pain and difficulty locking joint; difficult to excise and commonly recur
Both are benign
These two lesions are very similar
Angiolipoma
Where in the body do they occur?
Why angio?
Painful or not?
Multiple and peripheral
Vascular with fibrin thrombi
One of the painful subcutaneous lesions (other than infection/trauma)
What are benign tumours of smooth muscle called?
Where do they often arise from?
Leiomyomas are one of the most common tumours in the body
Rarely encountered in orthopaedic practice
Often arise from large vessel walls -> muscular veins etc
What are benign tumours of skeletal muscle called?
What is the most common type and who gets it?
Rhabdomyomas - very rare:
Cardiac – limited to paediatric age group
What are the three types of rhabdomyosarcoma?
Describe them
Embryonal rhabdomyosarcoma – kids (looks like grapes coming out of the vagina); genital tract (botyroides), GU tract, H&N (periorbital) and common bile duct
Alveolar – older (young adults); lots of sites; H&N
Pleomorphic – rarest form; still older age groups
What are benign tumours of cartilage called?
Enchrondroma (chondroma)
What is the most common primary malignant bone tumour?
What % of malignant bone tumours does it account for?
Describe the manifestation
Multiple myeloma
45% of all malignant bone tumours
Multiple punched out osteolyic lesions
What is the second most common primary malignant bone tumour?
Who does the primary kind usually affect and where does it arise in these people?
When might the secondary type of this tumour arise?
Osteosarcoma
Primary osteosarcoma typically affects adolescents and arises in the metaphyses of long bones, especially around the knee
Secondary type may arise in bone affected by Pagets or after irradiation
Who does primary osteosarcoma typically present in?
Classically between ages 10-20 with a peak in adolescent growth spurt
What does imaging for osteosarcoma show?
Bone destruction and new bone formation (sunray spiculation), often with marked periosteal elevation (Codman’s triangle)
50% of lesions are around the knee joint
How does osteosarcoma typically present?
What does staging assess?
What other imaging should you do?
Usually pain before a mass develops
Staging assesses intramedullary spread
Do a HRCT chest to screen for pulmonary metastases, especially if ALP is raised
Treatment of osteosarcoma?
Used to be amputation but >80% of patients devloped metastatic disease which highlights that most patients have micrometastases at diagnosis
Neoadjuvant (prior to surgery) chemotherapy is advised
What is Ewing’s sarcoma?
Who typically gets it?
What genetic abnormality is it associated with?
Malignant round-cell tumour of long bones (typically diaphysis) and limb girdles
Usually presents in adolescents
T11:22 chromosomal translocation
Radiological features of Ewing’s sarcoma?
Bone destruction
New bone formation in concentric layers ‘onion ring’ sign
Soft tissue swelling
Periosteal elevation
Treatment of Ewing’s sarcoma?
Chemotherapy, radiotherapy and surgery
Chondrosarcoma What are the two possible causes? How and where on the body does it typically present? What sign is seen on x-ray? Treatment?
May arise de novo of from malignant transformation of chondromas
Usually associated with pain, or a lump, and presents in the axial skeleton of the middle aged
‘Popcorn calcification’ is typical on x-ray
No response so chemo or radio, so treatment is by excision
Inadequate surgery is associated with local recurrence, often with a high malignancy
What is the commonest benign bone tumour?
Where are the typical sites?
How does it present?
How does it show on x-ray?
Osteochondroma
Typical sites - around the knee; proximal femur; proximal humerus
Painful mass associated with trauma
A bony spur arising from the cortex and usually pointing away from the joint
Treatment of osteochonroma?
Remove if causing symptoms, e.g. pressure on adjacent structures
Any osteochondroma continuing to grow after skeletal maturity must be removed because of risk of malignancy
Osteoid osteoma What is it? Where does it occur? Who gets it? How does it appear on x-ray? - How does this relate to the symptoms?
A painful benign bone lesion that occurs most commonly in long bones of males 10-25 years old (and also often in the spine)
Appears on x-ray as local cortical sclerosis with a central radiolucent nidus
The nidus produces prostaglandins leading to pain unrelated to activity, and relieved with ibuprofen
Treatment of osteoid osteoma?
CT guided biopsy and radiofrequency ablation
Plain x-rays may miss these tumours; CT is the best imaging modality
