Skeletal Tumours Flashcards
Metastatic lesions in bone are commonly from what primary tumours?
breast lung prostate thyroid kidney
Describe an osteochondroma.
benign cartilage capped bony projection arising on external surface of bone containing a marrow cavity that is continuous with that of underlying bone.
In who do osteochondromas arise and what do they present with?
Young <20
Male = female
develop near epiphyses of long bones
pain and irritation
What is the treatment for osteochondromas?
surgical removal
A chondroma is another benign skeletal tumour. Describe it.
Benign hyaline cartilage tumour arising in the medullary cavity of bones of hands and feet - if breaks through into bone cortex then is malignant
Are chondromas more common in young men or young women?
young men
What is Maffucci’s syndrome?
Multiple enchondromatosis with soft tissue and visceral haemangiomas of viscera.
What is Ollier’s disease?
Enchondromas
Tumours are typically unilateral and involving one extremity
Is the risk of malignant transformation higher in Ollier’s disease or Maffucci’s syndrome?
Maffucci’s syndrome
What is an osteoid ostemoa?
Benign osteoblastic tumour composed of a central core of vascular osteoid tissue and a peripheral zone of sclerotic bone.
What is the typical presentation of an osteoid ostemoa?
Dull pain that is worse at night and disappears within 20-30 mins of treatment with aspirin or NSAID.
may be accompanied by soft tissue swelling and tenderness, synovitis and limitation of movement.
How long does an osteoid osteoma take to spontaneously resolve?
33 months without treatment
What is a chondroblastoma.
Benign cartilage tumour arising in bone. If more aggressive may extend beyond bone.
Where are chondroblastomas found?
Epiphysis of long bones
Describe the radiological appearance of a chondroblastoma.
Spherical and well defined osteolytic foci, sometimes extending into the subarticular bone, joint, space or metaphysis.
Describe the histological appearance of a chondroblastoma.
distinct cytoplasmic borders with foci of “chicken-wire” calcification
What treatment is required for a chondroblastoma.
Biopsy and curettage plus adjuvant liquid nitrogen
Name the 3 benign but locally aggressive skeletal tumours.
Chordroma
Giant cell tumour
Osteoblastoma
What cell is presumed to be the origin of giant cell tumour?
Osteoclast
Where are giant cell tumours often found?
Long bones - often around the knee
Radiologically, what is key to differentiate a giant cell tumour from an osteoblastoma?
Giant cell tumour - radiolucent with increasing density towards periphery
Osteoblastoma - radiolucent defect with a central density due to ossification. May have surrounding sclerosis.
What are the treatment options for a giant cell tumour?
Curettage or resection
Why should a giant cell tumour not be radiated?
If radiated it may undergo malignant transformation
Describe an osteoblastoma.
Solitary, benign and self-limited tumour that produces osteoid and bone.
What are the common symptoms of osteoblastoma?
Pain of long duration, swelling and tenderness.
Tumours of the spine may cause scoliosis and neurological symptoms
What are the treatment options for am osteoblastoma?
Curettage or intra-lesional excision or en-bloc resection
What is a Chordroma?
Very rare tumour arising from notochord remnants. It is locally destructive and invasive.
Where are chordromas found?
Midline tumour often in the sacral region - management is hard
Who do chordromas present in?
older adults 40+ years
M:F 1:2
Where do chordromas often invade into?
lesion often tracks along nerve roots in the sacral plexus or out the sciatic notch in planes of least resistance. Also soft tissue planes between muscles.
What is used for treatment of a Chordroma?
difficult to resect (usually in sacral region)
radiation may be helpful
Chemotherapy for late stage disease
Metastatic bone lesions are described as what?
Osteolytic lesions
Prostate mets - osteoslerotic giving hardening of bony lesions
Less commonly what other tumours can metastasise to bone?
gastric
malignant melanoma
neuroblastoma
What is multiple myeloma?
Malignant primary bone tumour that occurs in old age. Malignant proliferation of plasma cells in bone marrow giving bone destruction of axial skeleton and often causes renal failure.
What doe multiple myeloma produce and what does this mean for the patient?
Produces monoclonal IgG therefore patient is susceptible to infection
What is the characteristic appearance of multiple myeloma?
rounded “punched out” lesions
What is Ewing’s sarcoma?
Highly malignant peripheral primitive neuroectodermal tumour (PNET)
Where does ewing’s sarcoma arise?
metaphysis and diaphysis of femur, tibia and humerus.
In who does Ewing’s sarcoma present?
Most common in second decade of life
M:F 3:2
What is the most common and second most common primary bone tumour?
1 - Osteosarcoma
2 - Chondrosarcoma
What causes an osteosarcoma and where does it usually occur?
Malignant osteoblasts forming osteoid, mineralizes poorly
Usually occurs in the ends of long bones particularly distal femur, proximal tibia and proximal humerus
What is essential for diagnosis of Osteosarcoma?
Osteoid production from the tumour
What Tx is required for osteosarcoma?
Pre op chemo (tumour debulking)
surgical resection
post op chemo (residual tumour or mets)
What is specific about a chondrosarcoma?
Exhibits pure hyaline cartilage differentiation no bony elements - composed of malignant chondrocytes
What happens in a chondrosarcoma?
Nodules of tumour erode and extend outward from bone giving areas of bone destruction accompanied by partial calcification. Tumour often extends into soft tissue.
What treatment is required for chondrosarcoma?
Wide surgical excision
