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MSKJaz > Pathology - MSK tumours > Flashcards

Pathology - MSK tumours Flashcards

1
Q 
osteochondroma aka \_\_\_
is benign/malignant?
presumed cell origin =
age =
M:F =
A 
exostosis
benign
chondrocyte
<20yo
1
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2
Q

describe the appearance of a osteochondroma

A

cartilage capped bony outgrowth from external surface of bone containing a marrow cavity that is continuous with that of the underlying bone

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3
Q

cartilage capped bony outgrowth from external surface of bone containing a marrow cavity that is continuous with that of the underlying bone =

A

osteochondroma/exostosis

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4
Q

usual location in bones of a osteochondroma

A

nea

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5
Q

possible s+s of osteochondroma -

A

pain and irritation

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6
Q

enchondroma/chondroma = benign/malig?
age=
M:F

A

benign
young adults
M>F

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7
Q

benign hyaline cartilage tumour arising in medullary cavity of hand and feet bones =

A

enchondroma

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8
Q

multiple chondroma = __/___

A

Ollier’s disease

Maffucci’s syndrome

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9
Q

Ollier’s disease: rare developmental disorder of ____ in __+__physes
usually ___ and involve 1 extremity
malignancy risk = ___ roughly
not hereditary/familial

A

enchondromas
meta+diaphyses
unilateral
10-25%

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10
Q

Maffuccci’s syndrome = multiple ___ with soft tissue and visceral ___
far greater ___ risk that Ollier’s

A

enchondromatosis
haemangiomas
malignancy

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11
Q

possible x ray appearance of enchondromas

A

powderlike/dense aggregates

lytic lesions with scalloped edges +/- a #

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12
Q

histology of enchondromas

A

chondrocytes with small, round, pyknotic nuclei in hyaline cartilage - no atypia
variable cellularity

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13
Q

for enchondromas: ___ lesions are more likely to be benign than ___ lesions

A

small peripheral

large axial

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14
Q 
osteoid osteoma is benign/malig?
M:F
age groups:
bones affected (5)
usually resolve without treatment in \_\_
A 
benign
M>F
children and young adults
hands feet femur tibia and spine
33 months
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15
Q

osteoblastic tumour composed of a central core of vascular osteoid and a peripheral zone of sclerotic bone =

A

osteoid osteoma

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16
Q

s+s of osteoid osteoma

A

dull pain worse at night - relieved by NSAIDs/aspirin
possibly lcoal temp increase, increased sweating and tenderness
if in joint = synovitis
in epiphyses = abnorm growth
spine = torticollis, spinal stiffness, scoliosis

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17
Q

xray appearance of osteoid osteoma

A

radiolucent nidus surrounded by reactive sclerosis in cortex of bone

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18
Q

histology of osteoid osteoma

A

nidus = osteoid and woven bone surrounded by osteoblasts

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19
Q

Chondroblastoma is benign/malig
age =
treatment =

A

benign
teenagers
biopsy and curettage and adjuvant liquid N2

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20
Q

rare benign cartilage tumour arising in bone found at epiphysis of long bones=

A

chondroblastoma

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21
Q

xray appearance of chondroblastoma

A

spherical and well-defined osteolytic foci

sometimes extends into subarticular bone, joint space or metaphysis

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22
Q

histology of chondroblastoma =

A

closely packed polygonal cells + areas of immature chondroid
Distinct cytoplasmic borders with foci of “chicken-wire” calcification.
Low mitotic activity

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23
Q

on histology chicken wire calcification =

A

chondroblastoma

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24
Q

3 benign but locally aggressive primary bone tumours

A

GC tumour
osteoblastoma
chordoma

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25
Q 
GC tumour is benign/malig?
M:F
age:
thought to be derived from \_\_\_
sites =
Rx =
A 
benign
M>F
25-40yo
osteoclasts
long bones and often around knee
curettage/resect
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26
Q

gross appearance of GC bone tumour

A

irregular haemorrhagic mass in epiphyseal region

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27
Q

xray appearance of GC tumour of bone

A

radiolucent with increasing density towards periphery
destruction of medullary cavity and adjacent cortex
may expand into surrounding soft tissue

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28
Q

histology of GC tumour of bone

A

multinucleated giant cells in sea of round and oval mononuclear cells

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29
Q

osteoblastoma = malig/benign
site =
__+___ tumour that produces __+__

A

benign
metaphysis/diaphysis of long bones
solitary and self limiting
osteoid and bone

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30
Q

solitary and self limiting tumour that produces osteoid and bone =

A

osteoblastoma

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31
Q

symptoms of osteoblastoma

A

chronic pain
swelling
tender
may lead to scoliosis and neuro problems if affects spine

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32
Q

x ray appearance of osteoblastoma

A

radiolucent with central density due ossification

well-circumscribed +/- surrounding scoliosis

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33
Q

on a bone scan of an osteoblastoma there increased/decreased

A

increased

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34
Q

gross appearance of osteoblastoma =

A

red-tan with haemorrhagic areas

compact tissue is granular, friable and gritty

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35
Q

histology of osteoblastoma =

A

irregular spicules of mineralised bone and osteoid surrounded by osteoblasts
vascular stroma with pleomorphic spindle cells, osteoid and woven bone seen

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36
Q

Rx of osteoblastoma

A

biopsy to confirm
resect by curettage/en bloc/ intralesion excision
if aggressive and unresectable lesion of spine may = cryoSx, radio or chemo

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37
Q

v rare benign bone tumour that arises from notochord remnants

A

chordoma

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38
Q 
chordoma
M:F
age:
site:
Rx =
A

M1:2F
>40yo
midline - 1/2 in sacrococcygeal region and 1/3 in vase of skull
radio. chemo for late stage

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39
Q

chordoma possible s+s depending on site

A 
back pain
bowel and bladder dysfunction
palpated on PR
dysphagia
headaches
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40
Q

gross appearance of chordoma

A

soft, blue-grey, lobulated
gelatinous translucent areas and often a capsule
pften tracks along nerve roots in sacral plexus or out sciatic notch and often soft tissue mass
1/2 have focal calcification

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41
Q

histology = lobules and fibrous septa. Malig cell has eosinophilic cytoplasm and prominent vacuoles of mucus push nuclei to peripheries =

A

chordoma

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42
Q

chrodoma metastasises to (4)

A

bone, lungs, lymph nodes, liver

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43
Q

5 malignant primary bone tumours

A 
osteosarcoma
Ewing's sarcoma
Chondrosarcoma
fibrosarcoma
malignant fibrous histiocytoma
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44
Q

commonest primary malignancy of bone

A

osteosarcoma

45
Q

malignant osteoblasts form osteoid =

A

osteosarcoma

46
Q 
osteosarcoma
age
M:F
sites
rapid \_\_\_ and \_\_\_ active
Rx =
A

60% <25yo - if older tend to have predisposition eg Pagets
M3:2 F
ends of long bones esp distal femur, prox tibia and prox humerus
growth + mitotically
biopsy>CT and bone scan > preop chemo> resect > post op chemo

47
Q

management of osteosarcoma

A

biopsy>CT and bone scan > preop chemo> resect > post op chemo

48
Q

xray appearance of osteosarcoma

A

erodes cortex
extends into soft tissue
irregular bone growth with calcification
periosteum lifted off

49
Q

histology of osteosarcoma

A

nuclear atypia
hyperchromasia
high mitotic rate
osteoid production needed for diagnosis

50
Q

3 histological variants of osteosarcoma

A

osteoblastic
chondroblastic
fibroblastic

51
Q

2nd commonest primary bone malignancy

A

chondrosarcoma

52
Q

malignant chondrocytes and exhibits pure hyaline differentiation

A

chondrosarcoma

53
Q

gross appearance of chondrosarcoma

A

nodules of tumour erode and extend out from bone - extend to soft tissue

54
Q

hsitology of chondrosarcoma

A

nodules infiltrate between lamellar bone and obliterate marrow
separation of nodules by fibrous bands is highly suggestive of malignancy

55
Q

Rx of chondrosarcoma

A

wide excision

limit chemo and radio use

56
Q 
Ewings sarcoma are \_\_\_ (PNET)
very \_\_\_
M:F
age
site
A 
primitive neuroectodermal tumours
malignant
M3:2F
teenagers
mainly meta+diaphysis of femur, tibia and humerus
57
Q

small round blue cells on histology of this bone tumour =

A

Ewing’s sarcoma

58
Q

gross appearance of Ewing’s sarcoma =

A

irregular tan-brown mass that can break through cortex

59
Q

Rx of Ewing’s sarcoma

A

Sx, radio and chemo (with vincristine, dactomycin and cyclophosphamide)
post op chemo

60
Q

multiple myeloma =

A

malignant proliferation of plasma cells in marrow

61
Q 
multiple myeloma 
age:
bone destruction of \_\_\_ skeleton
often => \_\_ failure
characteristic \_\_\_ lesions
A

elderly
axial
renal
rounded “punched out”

62
Q

rounded “punched out” lesions of axial skeleton =

A

multiple myeloma

63
Q

in multiple myeloma see ___ on protein electrophoresis or ____ in urine

A

Ig “spike”

Bence-Jones proteins (light chains)

64
Q

bone cancer ass with Gardner’s syndrome

A

osteoma

65
Q

xray = double/soap bubble appearance

A

Giant cell tumour

66
Q

Codman triangle and sunburst pattern on xray =

A

osteosarcoma

67
Q

__ mutation slightly increases risk of osteosarcoma so is associated with ___

A

Rb

retinoblastoma

68
Q

onion-skinning on xray is indicative of which tumour

A

Ewing’s sarcoma

69
Q

Ganglion cyst has no ___ space contains ___

A

epithelial lining

myxoid material

70
Q

Angiolipoma = usually __+__
__ with ___
a painful SC lesion

A

multiple + peripheral

vascular with fibrin thrombi

71
Q

superficial tumours (ANGEL)

A 
angiolipoma
neuroma
glomus tumour
eccrine spiradenoma
cutaneous leiomyoma
72
Q

IHC of leiomyoma

A

actin, desmin, caldesmon

73
Q

leiomyoma often arise from ___

A

large vessel walls

74
Q

3 reactive lesions (usually Hx of trauma )

A

nodular fasciitis
myositis ossificans
rheumatoid

75
Q

enchondroma are ___ and usually ___ (location) due to failure of normal enchondral ossification at the __

A

intramedullary
metaphyseal
growth plate

76
Q

enchondroma appearance:

usually ___ but can undergo __ with a patchy __ appearance

A

lucent
mineralisation
sclerotic

77
Q

sites of enchondromas

A

femur, humerus, tibia and small bones of hands and feet

78
Q

simple bone cyst can be due to ____

and so are ___ in __ bones (site) esp ___+__ can occur in __+__

A 
growth defect from physis
metaphyseal 
long
prox humerus and femur
talus/calcaneus
79
Q

aneurysmal bone cyst = lots of chambers with __+__
maybe due to ____
sites =

A

blood
serum
small arteriovenous malformation
metaphyses of long bones, skull and ribs, vertebral bodies

80
Q

aneurysmal bone cysts are locally aggressive => __+__

usually __+___

A

cortical expansion and destruction

painful +pathological #

81
Q

Rx of aneurysmal bone cyst

A

curettage + graft/use of bone cement

82
Q

Rx of GCT =

A

intralesional excision with phenol, bone cement or liquid N2 to destroy remains and decrease recurrence

83
Q

genetic mutation that causes lesions of fibrous tissue and immature bone. Mono/polyostotic => stress fractures =

A

fibrous dysplasia

84
Q

fibrous dysplasia
age:
defective mineralisation => ___ deformities with affected bone ___ with thinned ___

A

adolescence
angular
wider
cortices

85
Q

shepherd’s hook deformity is a feature of ___ is proximal femur is extensively involved

A

fibrous dysplasia

86
Q

Rx for fibrous dysplasia

A

biphosphonates

stabilise fractures with internal fixation and cortical bone grafts

87
Q

small nidus of immature bone with surrounding intense sclerotic halo =

A

osteoid osteoma

88
Q

Brodies abscess =

A

subacute osteomyelitis

may present with lytic lesion of bone

89
Q

hyperparathyroidism can cause this which may present as a lytic lesion of bone

A

Browns tumour

90
Q

chondrosarcoma is/ isnt radio and chemo sensitive

A

not

91
Q

Ewings sarcoma is / isnt radio and chemo sensitive

A

usually is

92
Q

non-hodgkins lymphoma tends to affect which bones

A

pelvis/femur

93
Q

singular myeloma =

A

plasmacytoma

94
Q

treatment for plasmacytoma (singular myeloma) =

A

radiotherapy

95
Q

treatment for multiple myeloma =

A

chemotherapy

96
Q

top 5 cancers that metastisise to bone in order commonest to least

A 
breast 
prostate
lung
renal cell carcinoma
thyroid adenocarcinoma
97
Q

large and very lytic blow out lesion in bone that bleed on biopsy/Sx = ___ metastasis

A

renal cell carcinoma

98
Q

on histology = multinucleated giant cells and haemosiderin

firm and small soft tissue tumour =

A

GCT

99
Q

osteochondritis:
age
usually due to ___

A

kids and youths

lots of physical activity with repetitive stress

100
Q

osteochondritis of 2nd metatarsal head

A

Freiburg’s disease

101
Q

osteochondritis of navicular

A

Kohler’s

102
Q

osteochondritis of lunate

A

Kienbock’s

103
Q

osteochondritis of capitellum of elbow

A

Panner’s

104
Q

osteochondritis due to vertebral compression

A

Scheuermann’s

105
Q

traction osteochondritis of the calcaneus

A

Sever’s

106
Q 
lateral part of medial femoral condyle in knee
anteromedial talar dome
superomedial femoral head
humeral capitellum
are all sites predisposed to \_\_\_
A

osteochondritis dissecans

107
Q

sites prone to AVN

A 
femoral head and condyles
humerus head
capitellum
prox pole of scaphoid
prox talus
108
Q

alcohol and steroid use alter ___ > circulate in capillaries and promote ___ in bone + increase ___ in bone marrow => compress ___ => AVN

A

fat metabolism
coagulation
fat content
venous outflow

109
Q

thrombophilia, sickle cell and antiphospholipid deficiency in SLE can cause AVN because

A

they increase coagulability of blood

MSKJaz (28 decks)

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