Topic 9

Question 0

What may elevate alkaline phosphatase

Answer 0

Alkaline phosphatase may be elevated in blastic type lesions, with acid phosphotase being elevated in prostate carcinoma following spread
beyond the prostate capsule.
May also be due to liver function disease, need liver test as well as alkaline elevated to confirm blastic lesion

Question 1

Clinical features of Metastatic bone tumours

Answer 1

40yo, weight loss, cacexia, and bone pain, often worse at night
Pain may not be the presenting feature.

Question 2

How does cancer metastasise

Answer 2

Cancers metastasize by three routes:
1) direct extension;
2) lymphatic channels;
3) hematogenous dissemination (most common pathway).
Batson’s venous plexus provides a rapid pathway for cancer cells to seed the bone, bypassing the liver and lungs.

Question 3

Lytic lesions

Answer 3

Occur as a result of pressure erosion from the medullary tumor
deposits and are unrelated to osteoclastic activity.

Question 4

Blastic lesions

Answer 4

Blastic lesions represent a reactive repair response of local osteoid tissue to the presence of tumor.

Question 5

Clinical features of Neuroblastoma

Answer 5

80% are found in children under 2 1/2 years of age, the remainder before age 5, abdominal neoplasm.
Metastasis to skull has classic sunburst spiculation of the skull tables

Question 6

Clinical features of multiple myeloma

Answer 6

50-70yo M 2:1 predominance
Pain is the initial symptom, relieved with bed rest and aggravated by weight bearing.
May not have pain initially but pathological fracture is common

Question 7

Clinical lab findings for multiple myeloma

Answer 7

normochromic normocytic anemia, 
thrombocytopenia,  
hypercalcemia,  
hyperglobulinemia,  
hyperuricemia, and  
40% show Bence Jones proteinuria (pathopneumonic)

Question 8

What is pathopneumonic for multiple myeloma

Answer 8

Bence jones proteinuria

Question 9

What is the pathological features of multiple myeloma

Answer 9

Myelogenous round cell proliferation of plasma cells is noted. Myeloma kidney occurs as a result of permanent tubular damage, leading to renal failure.
The most common site for extramedullary plasmacytoma is the
nasopharynx.

Question 10

Clinical features of Chondrosarcoma

Answer 10

40 to 60 years, with 2:1 male predominance.
Pain usually presents late in the disease process.
Severe pain follows pathologic fracture.

Question 11

Pathological features of Chondrosarcoma

Answer 11

Lobules of grayish-white or bluish cartilaginous tissue.

The closer the lesion is to the axial skeleton, the higher the potential for malignant degeneration.

Question 12

Clinical features of Chordoma

Answer 12

Sacrococcygeal Chordoma: localized pain with pressure symptoms from the bladder and rectum
Spheno-Occipital Chordoma: The most consistent symptom is headache, may have ocular disturbances, increased intracranial pressure, ataxia, deafness, and tinnitus.
Vertebral Chordoma: In the cervical spine dysphagia
Sensory complaints include numbness in an arm or leg, usually followed by pain.
Motor weakness may occur, with vertebral body collapse, creating
paraplegia or quadriplegia as a late complication.

Question 13

Pathological features of Chordoma

Answer 13

A lobulated, well-encapsulated mass is found upon gross inspection.
Most sacral lesions are not midline.
In the spine usually more than one vertebral body is involved. Chordoma is the only primary malignant bone tumor that is known to cross the intervertebral disc, involving adjacent spinal segments.

Question 14

Clinical features of Lymphoma

Answer 14

20-40yo, male predominance 2:1
Localised pain of an intermittent nature
Contrast between apparent well-being of the patient and the size of the lesion
Well defined soft tissue mass develop

Question 15

Clinical features Osteosarcoma osteoma

Answer 15

10-25yo, M 2:1 predominance
Severe pain, worse at night, dramatically alleviated by aspirin
Muscle atrophy and limp occur in long-standing lesions of lower limb
Painful and rigid scoliosis, lesion on the concave side of the curve

Question 16

Pathological features of Osteoid osteoma

Answer 16

Tumor consists of a nidus usually 1cm or less, with target calcification in the center
Common location within the bone is the cortex, intramedullary and subperiosteal lesions.

Question 17

Clinical features of Osteoblastoma

Answer 17

Rare, 10-20 yo, M 2:1 predominance
Localised pain not nocturnal and less severe than Osteoid osteoma
Painful scoliosis, may have neurological deficits (spinal stenosis)
Neural arch most common site (SP, TP and laminae)

Question 18

Clinical features of Neurofibromatosis

Answer 18

Inherited as and autosomal dominant gene
Triad of findings occur:
1) Cafe au lait spots- >6 1.5cm is diagnostic
2) Fibroma molluscum- multiple cutaneous nodule
3) Osseous deformities and lesions
Also may have pulsating exophthalmos as a result of temporal lobe herniation

Question 19

Clinical features of Paget’s disease

Answer 19

M 2:1, rare before 40 mc after 55
When present, pain is low intensity and may associated with bowing deformities or fractures
Common to have enlarged calvarium, increasing hat size noted

Question 20

Pathological features of Paget’s disease

Answer 20

May have bone deformity, pathological fracture, pseudofracture or spinal stenosis
May have anaemia from fibrous tissue replacing bone marrow
Ureteric colic occurs secondary to hypercalcaemia and hypercalcuria
Hot on bone scans