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Musculoskeletal > Tumours and tumour-like lesions > Flashcards

Tumours and tumour-like lesions Flashcards

1
Q

Name 2 differential diagnoses of bone tumours

A
  1. Chronic osteomyelitis: pain, swelling, and x-ray destruction of metaphysis with periosteal bone
  2. Stress fracture
  3. Gout tophus
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2
Q

What is the commonest benign lesion of bone?

A

Non-ossifying fibroma

Asymptomatic, and almost always occurs in children

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3
Q

Describe the radiographic appearance of a non-ossifying fibroma

A

Oval radiolucent area of cortex, that may appear cystic

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4
Q

Name 4 types of primary malignant bone tumours

A
  1. Osteosarcoma: children and adolescents
  2. Chondrosarcoma: 40-50s
  3. Ewing’s sarcoma: 10-20s
  4. Multiple myeloma: 45-65
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5
Q

Define osteosarcoma

A

A highly malignant tumour arising within the bone. Rapidly spreads outwards to the periosteum and surrounding soft tissues.

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6
Q

Describe the clinical features of osteosarcoma

A
  • Most commonly around knee and proximal humerus
  • Pain: constant, worse at night, progressive
  • May present with a lump and local tenderness
  • Later palpable mass with overlying inflammation
  • ESR raised +/- ALP raised
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7
Q

How does osteosarcoma appear on imaging?

A
  • Entirely osteolytic, or
  • Alternating lysis and increased bone density.
  • Poor defined tumour margins
  • Cortex often breached: ‘sunburst’ effect
  • Periosteal reaction: ‘codman’ triangle

N.B. Sunburt and Codman indicate invasive tumours, not specific to osteosarcoma

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8
Q

How is osteosarcoma diagnosed?

A
  • X-ray appearance
  • Biopsy
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9
Q

Outline the treatment of osteosarcoma

A
  1. Neoadjuvent chemotherapy
  2. Wide resection
  3. Tumour-replacement implants
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10
Q

Define multiple myeloma

A

A malignant B-cell lymphoproliferative disorder of the marrow, with plasma cells predominating

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11
Q

Describe the appearance of multiple myeloma

A
  • Osteoporosis
  • Myelomatosis: discrete lytic lesions through the skeleton
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12
Q

Outline the clinical features of multiple myeloma

A
  • Typically aged 45-65
  • Weakness
  • Backache
  • Bone pain
  • Pathological fractures
  • Hypercalcaemia: thrist, polyuria, abdominal pain
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13
Q

What investigation of suggestive of multiple myeloma?

A

Bence-Jones protein in urine (occurs in 50%)

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14
Q

Describe the incidence of metastatic bone disease

A

In patients over 50 years, bone metastases are seen more frequently than all primary malignant bone tumours togther

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15
Q

Name the common primary sources of metastatic bone disease

A
  • Breast
  • Lung
  • Thyroid
  • Kidney
  • Prostate
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16
Q

Describe the clinical features of metastatic bone disease

A
  • Pain: often the only feature
    • Sudden back or thigh pain is suspicious
  • Pathological fracture
  • Sudden vertebral collapse
  • Hypercalacaemia: anorexia, nausea, polydipsia, polyuria, abdominal pain, weakness, depression
17
Q

What imaging should be ordered in suspected metastatic bone disease?

A
  • X-ray of affect bone
  • CXR: primary lung cancer
  • Staging CT CAP: primary cancers
  • Radioscintigraphy 99mTc-HDP: silent metastases
18
Q

Describe the characteristic x-ray features of multiple myeloma

A

Bone rarefication and punched-out areas in the ling bones, ribs, and skull.

X-ray may just show generalised osteoporosis. Multiple myeloma is one of the commonest causes of osteoporosis and vertebral compression fracture men over the age of 45 years.

19
Q

What are the signs and symptoms of hypercalcaemia?

A
  • Bone pain
  • Renal stones, polydipsia, polyuria
  • Abdominal pain, nausea, ileus, constipation
    • acute pancreatitis
  • Depression, lethargy, psychosis
20
Q

State the commonest sites of bone metastases

A
  • Vertebrae
  • Pelvis
  • Proximal half of femur
  • Humerus
21
Q

Explain the initial investigations for bone metastases

A
  • FBC: anaemia, WCC
  • U&Es and glucose: kidney function and DM
  • Bone profile:ALP often raised
    • Acid phosphatase raised in prostate cancer
  • LFTs and clotting: liver function
22
Q

What additional investigations should be requested for bone metastases?

A
  • Prostate specific antigen
  • Carcinoembryonic antigen: breast and colorectal
  • Serum electrophoresis: multiple myeloma
    • High IgG Gamma
  • Urinary Bence-Jones protein
  • Biopsy (done last): grading
23
Q

What treatment principles exist for bone metastases?

A
  • Palliative care
  • Opioid analgesia
  • Radiotherapy: analgesia and reduce growth
  • Hormone therapy: prostate or breast primary
  • Solitary lesions: surgery + radiotherapy
  • Hypercalcaemia: hydration, reduce calcium, bisphosphonates
  • Internal fixation of fractures
  • Prophylactic fixation
  • Spinal stabilisation: posterior spinal fusion
  • Counselling
  • Practical assisstance with material affairs
24
Q

Outline the clinical features of chondrosarcomas

A
  • Slow-growing tumour, with late metastateses
  • Usually presents for many months prior to discovery
  • Dull ache or gradually enlarging lump
  • Pathological fracture
25
Q

How are chondrosarcomas treated?

A

Due to slow-growth and late metastates, these are ideal for wide excision and prostetic replacement.

Tumour does not respond to radiotherapy or chemotherapy.

26
Q

Describe the clinical features of Ewing’s sarcoma?

A

Most commonly occurs tibia, fibula, clavicle

  • Pain: often throbbing
  • Swelling
27
Q

How does Ewing’s sarcoma appear on x-ray?

A

Bone destruction predominantly in mid diaphysis

‘Onion-peel’ effect: periosteal reaction produces multiple concentric parallel layers.

28
Q

Name an important differential diagnoses of Ewing’s sarcoma. How is this exluded?

A

Osteomyelitis

Excluded on biopsy, different appearance to osteosarcoma.

29
Q

How is Ewing’s sarcoma treated?

A

Combination of

  • Radiotherapy
  • Surgery
  • Chemotherapy

Musculoskeletal (17 decks)

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