Tumours of Bone Flashcards
Osteochondroma B/M? (exotosis)
Benign
Chondroma B/M?
Benign
Osteoid osteoma B/M?
Benign
Chondroblastoma B/M?
Benign
Osteochondroma (exotosis)
Cartilage capped bony projection arising on external surface of bone containing a marrow cavity that is continuous with that of the underlying bone.
Chondroma
Low power - lobules of varying sizes
Chondrocytes with small, round, pyknotic nuclei inside hyaline cartilage – no atypia.
Variable cellularity
Osteoid production is essential for diagnosis of what?
Osteosarcoma?
What is essential for diagnosis of osetosarcoma?
Osteoid production
Are small peripheral lesions more likely to be benign or malignant that large axial regions?
(endochondroma)
Small peripheral lesions are more likely to be benign than large axial lesions.
(endochondroma)
Dull pain
Worse at night
Characteristically relieved by aspirin or non-steroidal anti-inflammatory drugs
Osteoid osteoma
Radiolucent nidus surrounded by reactive sclerosis in cortex of bone
Osteoid osteoma
Prognosis of osteoid osteoma
Will resolve without treatment in an average of 33 months.
Osteoid osteoma
benign osteoblastic tumour
central core of vascular osteoid
peripheral zone of sclerotic bone
Cartilage capped bony projection arising on external surface of bone containing a marrow cavity that is continuous with that of the underlying bone
Osteochondroma
Which age group are affected by ostochondromas?
Young <20
Benign hyaline cartilage tumour arising in medullary cavity of bones of hands and feet?
Chondroma
Multiple enchondromas are associated with multiple angiomas?
Maffucis syndrome
Chondrocytes with small, round, pyknotic nuclei inside hyaline cartilage
Chondroma
Must differentiate chondroma from what?
Chondrosarcoma
-small peripheral lesions are more likely to be benign that large axial lesions
Distinct clinical picture of dull pain that is worse at night and disappears within 20-30 minutes o treatment with NSAIDS
Osteoid osteoma
Radiolucent nidus surrounded by reactive sclerosis in cortex of bone?
Osteoid osteoma
benign osteoblastic tumour
central core of vascular osteoid
peripheral zone of sclerotic bone
Osteoid osteoma
How long does it take for an osteoid osteoma to resolve?
Average of 33 months
Benign cartilage tumour arising in bone - rare
Can occasionally exhibit more aggressive course
Found at epiphysis of long bones
Age group – second decade of life
Chondroblastoma
Spherical and well-defined osteolytic foci, sometimes extending into the subarticular bone, joint space or metaphysis
Chondroblastoma
Distinct cytoplasmic borders with foci of “chicken-wire” calcification.
Closely packed polygonal cells plus areas of immature chondroid.
Mitotic activity is low
Chondroblastoma
Treatment for chondroblastoma
Biopsy and curettage plus adjuvant liquid nitrogen
Where are giant cell tumours often found?
Site - long bones, often around the knee
Multinucleated giant cells in a sea of round to oval mononuclear cells
Giant cells
Irregular spicules of mineralised bone and osteoid surrounded by osteoblasts
Vascular stroma with pleomorphic spindle cells
Osteoid and woven bone are seen
Osteoid osteoma
Very rare tumour arising from notocord remnants (midline tumour, often in sacral region)
Chordoma
Soft, blue-gray, lobulated tumours
Gelatinous translucent areas and often a capsule is present
Lesion often tracks along nerve roots in the sacral plexus or out the sciatic notch in planes of least resistance.
Chordoma
On plain x-ray - appear as a solitary mid-line lesion with bony destruction
Often an accompanying soft tissue mass
Approximately half of the time focal calcifications are present
CT and MRI scans help demonstrate the soft tissue component
Chordoma
Lobules and fibrous septa. The malignant cell has eosinophilic cytoplasm & prominent vacuoles of mucus push the nuclei to the side
Chordoma
Commonest primary malignant tumour
Osteosarcoma
Malignant osteoblasts forming osteoid
Osteosarcoma
Age group affected by osteosarcoma?
Young adults, 60% <25 years old
Condition which can predispose to osteosarcoma in older patients?
Pagets
The second commonest primary malignant tumour of bone
Exhibits pure hyaline cartilage differentiation
Composed of malignant chondrocytes
Chondrosarcoma
Malignant nodules of chondrosarcoma infiltrate between the lamellar bone obliterating the marrow
Separation of the nodules by fibrous bands would be another feature highly suggestive of malignancy.
Chondrosarcoma
Peripheral primitive neuroectodermal tumour (PNET)
Ewing’s sarcoma
-Most common in second decade of life
Small round blue cells
Ewing’s sarcoma
Surgery
Radiation therapy
Chemotherapy with vincristine, dactomycin and cyclophosphamide
Post-operative adjuvant chemotherapy
Ewing’s sarcoma
Malignant proliferation of plasma cells in bone marrow
Occurs in old age
Often causes renal failure
Results in bone destruction of axial skeleton
Multiple myeloma
Cancers which can metastasise to bone?
Thyroid, breast, lung (particularly small cell), kidney prostate
Other cancers: gastric cancer, malignant melanoma and neuroblastoma
Which type of lung cell cancer may metastasise to bone?
Small cell
