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MSK > Skeletal Tumours > Flashcards

Skeletal Tumours Flashcards

1
Q

Metastatic lesions in bone are commonly from what primary tumours?

A 
breast 
lung 
prostate 
thyroid
kidney
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2
Q

Describe an osteochondroma.

A

benign cartilage capped bony projection arising on external surface of bone containing a marrow cavity that is continuous with that of underlying bone.

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3
Q

In who do osteochondromas arise and what do they present with?

A

Young <20
Male = female
develop near epiphyses of long bones
pain and irritation

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4
Q

What is the treatment for osteochondromas?

A

surgical removal

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5
Q

A chondroma is another benign skeletal tumour. Describe it.

A

Benign hyaline cartilage tumour arising in the medullary cavity of bones of hands and feet - if breaks through into bone cortex then is malignant

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6
Q

Are chondromas more common in young men or young women?

A

young men

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7
Q

What is Maffucci’s syndrome?

A

Multiple enchondromatosis with soft tissue and visceral haemangiomas of viscera.

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8
Q

What is Ollier’s disease?

A

Enchondromas

Tumours are typically unilateral and involving one extremity

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9
Q

Is the risk of malignant transformation higher in Ollier’s disease or Maffucci’s syndrome?

A

Maffucci’s syndrome

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10
Q

What is an osteoid ostemoa?

A

Benign osteoblastic tumour composed of a central core of vascular osteoid tissue and a peripheral zone of sclerotic bone.

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11
Q

What is the typical presentation of an osteoid ostemoa?

A

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.

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12
Q

How long does an osteoid osteoma take to spontaneously resolve?

A

33 months without treatment

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13
Q

What is a chondroblastoma.

A

Benign cartilage tumour arising in bone. If more aggressive may extend beyond bone.

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14
Q

Where are chondroblastomas found?

A

Epiphysis of long bones

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15
Q

Describe the radiological appearance of a chondroblastoma.

A

Spherical and well defined osteolytic foci, sometimes extending into the subarticular bone, joint, space or metaphysis.

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16
Q

Describe the histological appearance of a chondroblastoma.

A

distinct cytoplasmic borders with foci of “chicken-wire” calcification

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17
Q

What treatment is required for a chondroblastoma.

A

Biopsy and curettage plus adjuvant liquid nitrogen

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18
Q

Name the 3 benign but locally aggressive skeletal tumours.

A

Chordroma
Giant cell tumour
Osteoblastoma

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19
Q

What cell is presumed to be the origin of giant cell tumour?

A

Osteoclast

20
Q

Where are giant cell tumours often found?

A

Long bones - often around the knee

21
Q

Radiologically, what is key to differentiate a giant cell tumour from an osteoblastoma?

A

Giant cell tumour - radiolucent with increasing density towards periphery
Osteoblastoma - radiolucent defect with a central density due to ossification. May have surrounding sclerosis.

22
Q

What are the treatment options for a giant cell tumour?

A

Curettage or resection

23
Q

Why should a giant cell tumour not be radiated?

A

If radiated it may undergo malignant transformation

24
Q

Describe an osteoblastoma.

A

Solitary, benign and self-limited tumour that produces osteoid and bone.

25
Q

What are the common symptoms of osteoblastoma?

A

Pain of long duration, swelling and tenderness.

Tumours of the spine may cause scoliosis and neurological symptoms

26
Q

What are the treatment options for am osteoblastoma?

A

Curettage or intra-lesional excision or en-bloc resection

27
Q

What is a Chordroma?

A

Very rare tumour arising from notochord remnants. It is locally destructive and invasive.

28
Q

Where are chordromas found?

A

Midline tumour often in the sacral region - management is hard

29
Q

Who do chordromas present in?

A

older adults 40+ years

M:F 1:2

30
Q

Where do chordromas often invade into?

A

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.

31
Q

What is used for treatment of a Chordroma?

A

difficult to resect (usually in sacral region)
radiation may be helpful
Chemotherapy for late stage disease

32
Q

Metastatic bone lesions are described as what?

A

Osteolytic lesions

Prostate mets - osteoslerotic giving hardening of bony lesions

33
Q

Less commonly what other tumours can metastasise to bone?

A

gastric
malignant melanoma
neuroblastoma

34
Q

What is multiple myeloma?

A

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.

35
Q

What doe multiple myeloma produce and what does this mean for the patient?

A

Produces monoclonal IgG therefore patient is susceptible to infection

36
Q

What is the characteristic appearance of multiple myeloma?

A

rounded “punched out” lesions

37
Q

What is Ewing’s sarcoma?

A

Highly malignant peripheral primitive neuroectodermal tumour (PNET)

38
Q

Where does ewing’s sarcoma arise?

A

metaphysis and diaphysis of femur, tibia and humerus.

39
Q

In who does Ewing’s sarcoma present?

A

Most common in second decade of life

M:F 3:2

40
Q

What is the most common and second most common primary bone tumour?

A

1 - Osteosarcoma

2 - Chondrosarcoma

41
Q

What causes an osteosarcoma and where does it usually occur?

A

Malignant osteoblasts forming osteoid, mineralizes poorly

Usually occurs in the ends of long bones particularly distal femur, proximal tibia and proximal humerus

42
Q

What is essential for diagnosis of Osteosarcoma?

A

Osteoid production from the tumour

43
Q

What Tx is required for osteosarcoma?

A

Pre op chemo (tumour debulking)
surgical resection
post op chemo (residual tumour or mets)

44
Q

What is specific about a chondrosarcoma?

A

Exhibits pure hyaline cartilage differentiation no bony elements - composed of malignant chondrocytes

45
Q

What happens in a chondrosarcoma?

A

Nodules of tumour erode and extend outward from bone giving areas of bone destruction accompanied by partial calcification. Tumour often extends into soft tissue.

46
Q

What treatment is required for chondrosarcoma?

A

Wide surgical excision

MSK (19 decks)

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