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MSK > Pathology > Flashcards

Pathology Flashcards

1
Q

Malignant tumours of MSK are common and most often occur in older age groups

A

F

UNCOMMON AND OCCUR MORE IN YOUNGER

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2
Q

What is the most common type of benign bone tumor?

A

Osteochondroma

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3
Q

What is osteochondroma?

A

BENIGN

  • Bony outgrowth on external surface of bone
  • Cartilagenous cap
  • Doesn’t usually cause problems except for localised pain
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4
Q

Where does osteochondroma typically occur?

A

Around the epiphysis of long bones and most common in the kneww

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5
Q

What are the different types of benign bone tumors

A 
GOOB HEAFs
Giant cell tumour
Osteochondroma
Osteoid osteoma
Brodie's abcess
Hyperparathyroidism
Enchondroma
Aneurysmal Bone cyst
Fibrous Dysplasia
Simple bone cyst
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6
Q

For osteochondroma, there is a very large risk of malignant transformation and any lesion growing in size or producing pain may require excisional biopsy

A

SMALL RISK OF MALIGNANCY

but ANY lesion growing in size or producing pain MAY require excisional biopsy

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7
Q

Multiple osteochondromata can be associated with underlying genetic disorders.

A

T

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8
Q

What is enchondroma?

A
  • Intramedullary tumor
  • Usually metaphyseal
  • Usually asymptomatic but can weaken bone (leading to fracture)
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9
Q

How does an enchondroma look on X ray?

A
  • Usually shows as white

- can undergo mineralization resulting in a patchy sclerotic appearance

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10
Q

Where do enchondromas classically occur?

A

small tubular bones of the hands and feet

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11
Q

What is a simple bone cyst?

A
  • Solitary unicystic fluid filled neoplasm located in a bone
  • Can be asymptomaic but can cause weakness in bone
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12
Q

Simple bone cyst is likely to be a defect as a result of what? Where are they commonly found?

A

Growth from physis - usually found in metphysis in long bones (can be in talus or calc too)

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13
Q

What is an aneurysmal bone cyst?

A
  • Growth with lots of chambers that are filled with blood or serum
  • LOcally aggressive and causes CORTICA EXPANSION and DESTRUCTION
  • Usually painful
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14
Q

An aneurysmal bone cyst can occur in the metaphyses of many different long bones, flat bones (ribs, skull) and vertebral bodies

A

T

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15
Q

Where do giant cell tumours most commonly occur?

A

Tend to involve the epiphyses

Most commonly occur in the knee

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16
Q

What do giant cell tumours look like on X ray?

A

characteristic “soap bubble” appearance

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17
Q

How to treat giant cell tumour?

A

intralesional excision

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18
Q

What is fibrous dysplasia?

A

a genetic mutation results in lesions of fibrous tissue and immature bone
- problems with g protein signalling

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19
Q

Fibrous dysplasia is a disease of a bone usually occurring in adolescence

A

T

20
Q

bones of the head and neck are most frequently affected in fibrous dysplasia

A

T

21
Q

How can fibrous dysplasia be managed?

A
  • Biphosphonates can reduce pain
  • Pathologic fractures stabilised with internal fixation
  • Cortical bone graft to inc. strengths
22
Q

What is an osteoid osteoma?

A

small nidus of immature bone surrounded by an intense sclerotic halo

23
Q

What are the clinical fetures of osteoid osteoma?

A

Intense constant pain, worse at night

24
Q

Brodie’s abscess (subacute osteomyelitis) and hyperparathyroidism (Brown tumours) can also present with?

A

lytic lesion of bone

25
Q

What is the most common type of malignant primary bone tumor?

A

Osteosarcoma

26
Q

What are the different types of primary malignant bone tumors?

A

Osteosarcoma
Chondrosarcoma
FIbrosarcoma
Ewing’s Sarcoma

27
Q

What is osteosarcoma?

A
  • malignant tumour producing bone

- mutations in the tumour suppressor Retinoblastoma gene

28
Q

What is chondrosarcoma?

A
  • cartilage producing primary bone tumour
  • tends to occur in an older age group (mean age 45)
  • Large and are slow to metastasize
29
Q

Ewing’s sarcoma on X ray?

A

“onion-skin” pattern

30
Q

Ewing’s sarcoma may be associated with which clinical features?

A

fever, raised inflammatory markers and a warm swelling

31
Q

What does treatment of primary bone tumors usually involve?

A

surgery to remove the tumour and surrounding tissue to reduce the risk of recurrence

32
Q

Which is the most common primary malignant tumor to mets to bone?

A

breast

33
Q

What to look for examining soft tissue tumour? (11)

A 
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
34
Q

Features suggestive of a benign soft tissue neoplasm?

A

smaller size, fluctuation in size (malignant tumours don’t regress in size), cystic lesions, well‐defined lesions, fluid filled lesions and soft / fatty lesions

35
Q

Features suggestive of a potential malignant soft tissue neoplasm

A
  • larger lesions (>5cm)
  • rapid growth in size
  • a solid lesion
  • an ill‐defined lesion
  • an irregular surface
  • associated lymphadenopathy
  • systemic upset
36
Q

extremely rapid growth (one week etc.) is associated with high malignancy

A

F

tends to be more associated with reactive pseudotumours and this history can be reassuring.

37
Q

What is the most common type of benign soft tissue neoplasm?

A

lipoma

38
Q

What is a ganglion cyst?

A

Swelling around synovial joint/tendon sheath

Result of herniation or outpouching of weak portion of joint or tendon or joint damage

39
Q

Bursitis can be caused by

A

gout or bacterial infection

40
Q

What are sebaceous cysts?

A
  • Epidermal inclusion cysts
  • line by squamous cell epithelium
  • painless but can be irritating when caught on clothing
41
Q

What happens when a sebacous cyst bursts?

A

cheesy substance is released that consists of this degenerate keratin

42
Q

What is an abcess?

A

collection of neutrophils, infective and cellular debris +/- infective organsism. Abscesses on a limb can occur from cellulitis, bursitis, penetrating wound or infected sebaceous cysts.

43
Q

Treating an abscess?

A

will not resolve with antibiotics alone and require incision and drainage.

44
Q

What are pseudotumors?

A

Mimic neoplasms but are reactive/inflammatory lesions
Unusual reaction to injury - MYOSITIS OSSIFICANS
or
NODULAR FASCITIS rapid growth lesion after trauma

45
Q

What is the consequence of rised NADH?

A

Fatty liver disease

avascular necrosis in femoral head

46
Q

Microscopically, dead bone is seen as..?

A
  • trabeculae without osteocytes in the lacunae

- “creeping substitution” where the dead bone is slowly encircled by new viable bone and eventually replaced

47
Q

AVN can be secondary to fractures, where the fracture disrupts the blood supply to an entire portion of bone

A

T

MSK (8 decks)

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