Week 1 Pathology - Bone Tumours

Question 1

Describe an osteochondroma.

Is it ever painful?

Answer 1

Bone outgrowth with cartilaginous cap

My have local pain

Question 2

2 benign tumours which have the potential to metastatise?

Answer 2

osteochondroma = #1 common and 1% mets risk

giant cells tumours also - 5% mets to the lungs

Question 3

which benign tumour forms in incomplete ossification?

Answer 3

Enchondroma - an intermedullary tumour.

Question 4

what benign tumours causes cortical expansion with pain?

Answer 4

aneurysmal cyst

Question 5

what benign tumour looks like a soap bubble on xray ?

Answer 5

giant cell tumour

Question 6

name 2 benign tumours that teens get

Answer 6

1. fibrous dysplasia

2. osteid osteoma

Question 7

name 3 malignant tumours that teens get

in order of most common

Answer 7

1. osteosarcoma
   2 ewings sarcoma
2. fibrosarcome

Question 8

name the malignant tumour that is slow to metastatsise and occurs in people aged 45 on average

Answer 8

chondrosarcoma

Question 9

describe the metastatic spread of osteosarcoma - where does it commonly go quickly, and how?

Answer 9

haematogenous spread to the lungs - sadly, 10% of patients already have this on Dx

Question 10

15 year old Shannon has constant pain in her proximal femur which gets worse at night. Taking ibuprofen can help the pain. she has a benign tumour - which one?

Answer 10

a type of benign bone tumour - osteoid osteoma

may resolve, or need ablated / excised.

Question 11

16 year old Paige has Pagets. what malignant tumour is she at risk of getting?

Answer 11

Fibrosarcoma

Question 12

14 year old Flora is getting stress fractures in her proximal femur. she has fibrous dysplasia - what is seen on x ray?

Answer 12

Flora has fibrous dysplasia
on xray the bone would look wide, with thin cortices
If the involvement of the proximal femur is hella extensive - Flora may have a shephards crook deformity.

Question 13

how will you treat Flora? (FD)
1 drug
2 surgical strategies

Answer 13

biphosphates
internal fixation
bone grafts

Question 14

what malignant bone tumour may mimic osteomyelitis? what features??

Answer 14

Ewings sarcoma

fever, raised markers, heat and swelling

Question 15

what malignant bone tumour mostly affects the hip areas = the proximal femur and the pelvis?
what age are they on average?

Answer 15

Chondrosarcoma

45

Question 16

Macrophage cancer can be a primary bone tumour of marrow, or may be due to metastasis to the bone. what is the primary version called?
where does it normally occur?
what is the Tx?

Answer 16

Non hodgkins lymphoma
Hip area - pelvis or femur
Surgery

Question 17

Systemic involvement of metastatic lymphoma (2)
Treatment?
prognosis? expected survival time?

Answer 17

Splenomegaly / lymphadenopathy
Chemo / radio
serious - less than 2 year survival

Question 18

what is multiple myeloma?

Answer 18

multiple osteolytic lesions of myeloma - a B cell cancer

Question 19

what is the effect of bone marrow suppression in myeloma?

Answer 19

anaemia and recurrent infection

Question 20

B cell cancers…..
Tx of a plasmacytoma?
Tx of multiple myeloma?

Answer 20

1. radiotherapy - only 1 lesion so you can direct radiotherapy specifically to it.
2. chemotherapy

Question 21

name the malignant bone tumour…
1- produces bone
-2 produces cartilage
- 3 occurs in abnormal bone

Answer 21

1. osteosarcoma
2. chondrosarcoma
3. fibrosarcoma

Question 22

name the malignant bone tumour….

• macrophage cancer
• B cell cancer (antibodies)
• primitive cells of bone marrow

Answer 22

lymphoma
myeloma
Ewings sarcoma

Question 23

what is fibrous dysplasia?

what is a fibrosarcoma?

Answer 23

FD is a benign bone tumour. Genetic. Lesions of fibrous tissue and immature bone. 1 or more bones Defective mineralization = angular deformities. Bone is wider with thinned cortices.
Fibrosarcoma is a malignant tumour that occurs in abnormal bone eg Pagets

Question 24

describe an osteoid osteoma

include who gets them and 3 common sites

Answer 24

small nidus of immature bone surrounded by an intense sclerotic halo. Teens. Common sites include the proximal femur, the diaphysis of long bones and the vertebrae

Question 25

Giant cell tumours are locally aggressive. where do they normally start – spread?

Answer 25

normally start in the epiphysis and invade into the subchondral bone around the joint.
they destroy the cortex

Question 26

giant cell tumours normally occur in the knee, but where else (3) ??
what is the normal treatment?
severe cases ?

Answer 26

other long bones, the pelvis and the spine

intralesional excision with use of phenol / bone cement / liquid nitrogen to destroy remaining tumour material and reduce the risk of recurrence

severe = cortical destruction = joint replacement