Pathology cortex 1 Flashcards
What is a bone cyst and where/who are they usually found in?
- Is a single cavity benign fluid filled cyst in a bone
- Usually found in the prox humerus and femur in kids or young adults
If required what is the treatment of osteochondromas ?
If growing in size or causing pain then it may require excisional biopsy
What are enchondromas, simple bone cysts and aneurysmal bone cysts all at risk of and therefore what is done to treat them ?
- All as risk of pathological fractures
- Curettage (scrapped out) and bone grafting
What is an aneurysmal bone cyst?
- A cavity which contains lots of chambers which are filled with blood or serum
- They can occur in the metaphyses of many different long bones, flat bones (ribs, skull) and vertebral bodies
- Lesion is benign but locally aggressive causing cortical destruction and is usually painful
What is fibrous dysplasia ?
- A disease of a bone usually occurring in adolescence where a genetic mutation results in lesions of fibrous tissue and immature bone.
- Can affect one or many bones
- Benign
What deformities can fibrous dysplasia result in ?
Can result in angular deformities due to defective mineralisation and stress fractures.
If there is extensive involvement with the proximal femur it can result in sheperds crook deformity
What is the treatment for fibrous dysplasia ?
- Bisphosphonates may reduce pain
- pathologic fractures should be stabilized with internal fixation and cortical bone grafts used to improve strength.
What are some of the red flags of bone cancer ?
Metastatic cancer affecting bone tends to cause:
- a constant pain
- usually worse at night
- May also be swelling
Systemic symptoms may also be present:
- weight loss
- loss of appetite
- fatigue
Patients over 60 are at risk of cancer and unexplained skeletal pain should be investigated
Patients under 25 should not have unexplained skeletal pain and should also be investigated
with at least an X-ray
When assessing soft tissue swellings what do you need to consider ?
- 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
Thinking about the findings you need to consider when assessing soft tissue swellings, what are suggestive of benign soft tissue swellings ?
Include:
- Smaller size
- Fluctuation in size (malignant tumours don’t regress in size)
- Cystic lesions
- Well‐defined lesions
- Fluid filled lesions and soft / fatty lesions
Thinking about the findings you need to consider when assessing soft tissue swellings, what are suggestive of malignant tissue swellings ?
Include:
- Larger lesions (>5cm),
- Rapid growth in size,
- A solid lesion,
- An ill‐defined lesion, A
- n irregular surface, A
- Associated lymphadenopathy
- Systemic upset (weight loss, loss of apetite, fatigue).
What is the most common benign soft tissue swelling and describe it
Lipoma (neoplastic proliferation of fat) - usually occurs in S/C fat but can occur in muscle (main point for these i think is where they arise)
A small firm swelling usually found on the flexor tendon sheath of a finger, what is it ?
Giant cell tumour of tendon sheath
Similar lesions can occur within a synovial joint (commonly the knee) known as Pigmented Villonodular Synovitis (PVNS).
In general terms what are malignant soft tissue swellings known as ?
Sarcomas
Match the malignant soft tissue swelling to the tissue type fro which they arise:
- Is a malignant tumour from blood vessels
- Arise from fibrous tissue
- Arises from fat.
- Originates in the synovial lining of joints or tendons.
- Is a malignant tumour of skeletal muscle.
- Originates in the synovial lining of joints or tendons.
Angiosarcoma,Liposarcoma, Fibrosarcoma and Malignant Fibrous Histiocytoma, Synovial sarcoma, Rhabdomyosarcoma
- Angiosarcoma is a malignant tumour from blood vessels
- Fibrosarcoma and Malignant Fibrous Histiocytoma arise from fibrous tissue
- Liposarcoma arises from fat.
- Rhabdomyosarcoma is a malignant tumour of skeletal muscle.
- Synovial sarcoma originates in the synovial lining of joints or tendons.