Pathology: Benign Bone Tumours Flashcards
how do a lot of bone tumours present
non specifically:
- pain
- soft tissue mass
- compression of adjacent structures
- acutely with fracture
osteochondroma
common bony outgrowth on the external surface of bone that is covered in cartilaginous cap
location of osteochondroma
typically around epiphysis of long bones - most commonly knee
treatment of osteochondroma
if are growing or causing pain excise as they have a small risk of malignancy
CF of osteochondroma
do not usually cause problems but can cause localised pain
what are multiple osteochondromas associated with
genetic disorders
enchondroma
intramedullary cartilaginous tumour - cartilage that lines the inside of the bones
what is the appearance of enchondroma
usually lucent but can undergo mineralisation to become PATCHY SCLEROTIC appearance
what can an enchondroma result in
weakens bone - fracture
where do enchondroma usually occur
classically small tubular bones of hands and feet usually metaphyseal
treatment of enchondroma
benign - simply scrape off bone
simple bone cyst
solitary unicystic fluid filled neoplasm
location of simple bone cysts
metaphyseal long bones (humerus and femur), and also talus and calcaneus
CF of simple bone cyst
asymptomatic and therefore an incidental finding on Xray can cause weakness leading to fracture
treatment of simple bone cyst
curettage and bone grafting
aneurysmal bone cyst
lots of chambers filled with blood or serum
what are aneurysmal bone cyst due to
arteriovenous malformation
location of aneurysmal bone cyst
metaphyses of many different bones
features of aneurysmal bone cyst
expansile lesion usually locally aggressive and causes cortical expansion and destruction - painful risk of fracture
treatment of aneurysmal bone cyst
curettage and grafting or use of bone cement
giant cell tumours
many multi nucleated giant cells
what are the giant cells characterised by
consistent translocation between chromosome 1 and 2
where in the bone are giant cell tumours found
metaphyseal and epiphyseal region can extend to subchondral bone adjacent to joint
GCT common sites
knee and distal radius
characteristics of GCT
benign but locally aggressive
can metastasise to lungs with benign pulmonary GCT. these have an excellent prognosis
CF of GCT
cause pain and can cause fracture
what is seen onX ray wtih GCT
soap bubble appearance
treament of GCT
intralesional excision with use of phenol, bone cement or liquid nitrogen to destroy tumour material and reduce risk of occurrence
there is a small malignant risk
how do you treat very aggressive GCT lesions with cortical destruction
joint replacement
fibrous dysplasia
disease of bone occurring in adolescence where a genetic mutation results in lesions of fibrous tissue develops instead of normal bone and causes immature bone
weakens bone predisposing to fracture
can be monostotic or polystotic
common locations of fibrous dysplasia
head and neck are frequent
aetiology of fibrous dysplasia
usually a mutation causing abnormality in G protein signalling
what do patients with polystotic fibrous dysplasia often have
endocrine disorders (G protein mutations)
which genetic condition is fibrous dysplasia associated with
- McCune Albright
- polystotic fibrous dysplasia
- also see café au lait macules, hormonal abnormalitites etc
features of fibrous dysplasia
defective mineralisation results in angular deformities and the affected bone is wider with thinned cortices
stress fractures can occur
what happens when the proximal femur is involved in fibrous dysplasia
sheperds crook deformity
what is used to reduce pain in fibrous dysplasia
biphosphonate
treatment of fibrous dysplasia caused fractures
stabilised with internal fixation and cortical bone grafts
osteoid osteoma
small nidus of immature bone surrounded by sclerotic halo
when do osteoid osteoma most commonly occur
adolescence
where do osteoid osteoma most commonly occur
long bones
CF of osteoid osteoma
persistent pain that is worse at night and relieved by NSAIDs
diagnosis of osteoid osteoma
may be seen on X ray bone scan and CT scan can confirm diagnosis
treatment of osteoid osteoma
may resolve spontaneously CT guided radiofrequency ablation
what can also present with a lytic lesion of bone
brodies abscess (osteomyelitis) and hyperparathyroidism (Browns tumours)
A mostly lucent lesion, with a patchy sclerosis, found within the metaphyseal region of short tubular bones.
enchondroma
A lucent, multi-loculated cyst found within the medulla of many different bones, often with associated cortical expansion.
aneurysmal bone cyst
A bony spur, originating the in metaphyseal regions of long bones, growing away from the epiphysis.
osteochondroma
