1 - Pathology Flashcards
(55 cards)
What is the most common benign bone tumour?
Osteochondroma
List 7 benign tumours of the bone
- Osteochondroma
- Enchondroma
- Simple bone cyst
- Aneurysmal bone cyst
- Giant cell tumour
- Fibrous dysplasia
- Osteoid osteoma
Describe osteochondroma - appearance, symptoms and possible treatment (benign bone tumour)
- Produces a bony outgrowth with a cartilaginous cap
- Usually causes local pain but no other symptoms
- Small (1%) risk of malignant transformation so excisional biopsy of growing lesions may be necessary
Describe enchondroma - appearance, cause, symptoms, possible treatment (benign bone tumour)
- Cartilaginous tumour, usually found in the medullary cavity of the metaphyses of the femur, humerus, tibia and small bones of hands and feet
- Usually translucent or patchy, sclerotic appearance
- Caused by a failure of normal cartilage ossification at the growth plate
- Usually asymptomatic but can weaken the bones and cause fracture
- Bone may be scraped out (curettage) and filled with bone graft to strengthen bone
Describe simple bone cysts - appearance, cause, most common location, symptoms, possible treatments (benign bone tumour)
- A single, benign, fluid-filled cyst in a bone
- Most likely caused by a growth defect of the metaphyses
- Usually present in proximal humerus or femur
- May be asymptomatic or lead to pathological fracture
- Treatment with bone curettage and bone grafting may be required
Describe aneurysmal bone cysts - appearance, cause, location, symptoms, treatment (benign bone tumour)
- Appears as multiple chambers filled with blood or serum on x-ray
- Cause thought to be a small arteriovenous malformation
- Can occur in metaphyses of long bones, flat bones (ribs, skull) and vertebrae
- Symptoms include pain due to local cortical expansion and pathological fracture
- Treatment is with curettage and bone grafting
Describe giant cell tumours - appearance, most common locations, cause, symptoms, treatment options (benign bone tumour)
- Appear as multi-nucleate giant cells on histology and characteristically ‘soap-bubble’ in appearance on xray
- Most common in metaphysis, epiphysis and subchondral bone of knee and distal radius
- Unknown cause
- Symptoms include pain, pathological fracture or metastasis to the lungs
- Treatment is intra-lesional excision and destruction of tumour material
- Joint replacement may be required as disease can be locally destructive
Describe fibrous dysplasia of bone - description, cause, symptoms, treatment options (benign tumour)
- A disease of adolescence resulting in lesions of fibrous tissue and immature bone
- Caused by genetic mutation
- Symptoms include angular deformities, wider bones with thinned cortices, proximal femur can have ‘shepherd’s crook’, pathological fractures
- Biophosphonates may reduce pain
- Pathological fractures can be stabilised with bone grafting
Describe osteoid osteoma - appearance, most common age and site affected, symptoms, investigations, treatments (benign bone tumour)
- A small nidus of immature bone surrounded by an intense sclerotic halo
- Most common in adolescence, affecting the proximal femur, diaphysis of long bones and the vertebrae
- Most prominent symptom is intense constant pain worse at night
- Xray may show the lesion but bone scan and CT can confirm the diagnosis
- Pain is greatly relieved by NSAIDs and lesion may resolve spontaneously overtime
- Some cases may require CT-guided RF ablation
Malignant primary bone tumours are common/rare
Metastatic bone tumours are common/rare
Rare
Common
What are the typical ‘red flag’ symptoms of bone cancer?
- Constant bone pain which is worse at night
- Weight loss
- Fatigue
- Loss of appetite
- Aged 60+ years
- Aged <25 years with unexplained skeletal pain
How can a malignant bone tumour appear on xray?
- Ill-defined bony swelling
- Cortical destruction
- Periosteal reaction (inflamed periosteum)
- Sclerosis and lysis of bone
- Extension into surrounding soft tissue
What is the most common malignant primary bone tumour?
Osteosarcoma
Describe osteosarcoma - description, common people and locations affected, metastatic spread, treatment (malignant primary bone tumour)
- Malignant tumour producing bone
- Most common in adolescence and early adulthood affecting the knee (60%), femur, humerus or pelvis
- Haematogenous or lymphatic metastases - often to the lungs
- Adjuvant chemotherapy can prolong survival (they are not radiosensitive)
What is the second most common primary malignant bone tumour?
Ewing’s sarcoma
Describe Ewing’s sarcoma - description, who is affected, symptoms, treatment (malignant primary bone tumour)
- Malignant tumour of the primative cells in the marrow
- Usually occurs in 10-20 y/o’s
- Symptoms include fever, warmth, swelling and raised inflammatory markers
- It is radio and chemo-sensitive but has the worst prognosis out of all the primary bone tumours
Describe chondrosarcoma - description, most common location and people affected, metastases, treatment (malignant primary bone tumour)
- Cartilage producing primary bone tumour which is less common and less aggressive than osteosarcoma
- Often occurs in ~45 y/o’s in the pelvis or proximal femur
- They are large and slow to metastasise
- Tumours are not radiosensitive and are unresponsive to adjuvant chemotherapy
List 2 fibrous malignant primary bone tumours and who they most commonly affect
Fibrosarcoma and malignant fibrous histiocytoma
Tend to affect adolescents and young adults with abnormal bone e.g., Paget’s disease, fibrous dysplasia, bone infarct
What are the investigations for primary malignant bone tumours? (3)
Bone scan (checks for metastases)
MRI/CT (local involvement)
Biopsy (for histological diagnosis and grading prior to surgery)
How can primary malignant bone tumours be treated?
- Surgical removal of tumour and biopsy tract
- Joint replacement
- Adjuvant chemo and radiotherapy
What is the 5 year survival rate of primary bone tumours with adjuvant therapy?
80%
What is a lymphoma and how do they occur?
A cancer of round cells of the lymphocytic system/macrophages
They can occur as…
- A primary bone tumour of the marrow (Non-Hodgkins Lymphoma)
- Lymphoma metastases to bone
Which bones are most commonly affected by primary lymphoma?
Pelvis or femur
How is primary lymphoma treated?
Surgical resection
