Tumours of Bone

Question 1

Osteochondroma B/M? (exotosis)

Answer 1

Benign

Question 2

Chondroma B/M?

Answer 2

Benign

Question 3

Osteoid osteoma B/M?

Answer 3

Benign

Question 4

Chondroblastoma B/M?

Answer 4

Benign

Question 5

Osteochondroma (exotosis)

Answer 5

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

Question 6

Chondroma

Answer 6

Low power - lobules of varying sizes

Chondrocytes with small, round, pyknotic nuclei inside hyaline cartilage – no atypia.

Variable cellularity

Question 7

Osteoid production is essential for diagnosis of what?

Answer 7

Osteosarcoma?

Question 8

What is essential for diagnosis of osetosarcoma?

Answer 8

Osteoid production

Question 9

Are small peripheral lesions more likely to be benign or malignant that large axial regions?
(endochondroma)

Answer 9

Small peripheral lesions are more likely to be benign than large axial lesions.
(endochondroma)

Question 10

Dull pain
Worse at night
Characteristically relieved by aspirin or non-steroidal anti-inflammatory drugs

Answer 10

Osteoid osteoma

Question 11

Radiolucent nidus surrounded by reactive sclerosis in cortex of bone

Answer 11

Osteoid osteoma

Question 12

Prognosis of osteoid osteoma

Answer 12

Will resolve without treatment in an average of 33 months.

Question 13

Osteoid osteoma

Answer 13

benign osteoblastic tumour

central core of vascular osteoid

peripheral zone of sclerotic bone

Question 14

Cartilage capped bony projection arising on external surface of bone containing a marrow cavity that is continuous with that of the underlying bone

Answer 14

Osteochondroma

Question 15

Which age group are affected by ostochondromas?

Answer 15

Young <20

Question 16

Benign hyaline cartilage tumour arising in medullary cavity of bones of hands and feet?

Answer 16

Chondroma

Question 17

Multiple enchondromas are associated with multiple angiomas?

Answer 17

Maffucis syndrome

Question 18

Chondrocytes with small, round, pyknotic nuclei inside hyaline cartilage

Answer 18

Chondroma

Question 19

Must differentiate chondroma from what?

Answer 19

Chondrosarcoma

-small peripheral lesions are more likely to be benign that large axial lesions

Question 20

Distinct clinical picture of dull pain that is worse at night and disappears within 20-30 minutes o treatment with NSAIDS

Answer 20

Osteoid osteoma

Question 21

Radiolucent nidus surrounded by reactive sclerosis in cortex of bone?

Answer 21

Osteoid osteoma

Question 22

benign osteoblastic tumour
central core of vascular osteoid
peripheral zone of sclerotic bone

Answer 22

Osteoid osteoma

Question 23

How long does it take for an osteoid osteoma to resolve?

Answer 23

Average of 33 months

Question 24

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

Answer 24

Chondroblastoma

Question 25

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

Answer 25

Chondroblastoma

Question 26

Distinct cytoplasmic borders with foci of “chicken-wire” calcification. Closely packed polygonal cells plus areas of immature chondroid. Mitotic activity is low

Answer 26

Chondroblastoma

Question 27

Treatment for chondroblastoma

Answer 27

Biopsy and curettage plus adjuvant liquid nitrogen

Question 28

Where are giant cell tumours often found?

Answer 28

Site - long bones, often around the knee

Question 29

Multinucleated giant cells in a sea of round to oval mononuclear cells

Answer 29

Giant cells

Question 30

Irregular spicules of mineralised bone and osteoid surrounded by osteoblasts Vascular stroma with pleomorphic spindle cells Osteoid and woven bone are seen

Answer 30

Osteoid osteoma

Question 31

Very rare tumour arising from notocord remnants (midline tumour, often in sacral region)

Answer 31

Chordoma

Question 32

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.

Answer 32

Chordoma

Question 33

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

Answer 33

Chordoma

Question 34

Lobules and fibrous septa. The malignant cell has eosinophilic cytoplasm & prominent vacuoles of mucus push the nuclei to the side

Answer 34

Chordoma

Question 35

Commonest primary malignant tumour

Answer 35

Osteosarcoma

Question 36

Malignant osteoblasts forming osteoid

Answer 36

Osteosarcoma

Question 37

Age group affected by osteosarcoma?

Answer 37

Young adults, 60% <25 years old

Question 38

Condition which can predispose to osteosarcoma in older patients?

Answer 38

Pagets

Question 39

The second commonest primary malignant tumour of bone Exhibits pure hyaline cartilage differentiation Composed of malignant chondrocytes

Answer 39

Chondrosarcoma

Question 40

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.

Answer 40

Chondrosarcoma

Question 41

Peripheral primitive neuroectodermal tumour (PNET)

Answer 41

Ewing's sarcoma | -Most common in second decade of life

Question 42

Small round blue cells

Answer 42

Ewing's sarcoma

Question 43

Surgery Radiation therapy Chemotherapy with vincristine, dactomycin and cyclophosphamide Post-operative adjuvant chemotherapy

Answer 43

Ewing's sarcoma

Question 44

Malignant proliferation of plasma cells in bone marrow Occurs in old age Often causes renal failure Results in bone destruction of axial skeleton

Answer 44

Multiple myeloma

Question 45

Cancers which can metastasise to bone?

Answer 45

Thyroid, breast, lung (particularly small cell), kidney prostate Other cancers: gastric cancer, malignant melanoma and neuroblastoma

Question 46

Which type of lung cell cancer may metastasise to bone?

Answer 46

Small cell