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MSK CORTEXT > 1- Pathology > Flashcards

1- Pathology Flashcards

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1
Q

What are the symptoms of osteochondroma

A

Usually don’t cause any problems

May produce localised pain

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2
Q

Can osteochondromas malignantly transform

A

Very small risk

Signs include lesion that grows in size or produces significant pain

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3
Q

Benign bone tumours are more common than primary malignant ones - true or false

A

True

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4
Q

What are some potential causes of benign bone tumours

A 
Neoplasm 
Developmental 
Trauma 
Infection 
Inflammation
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5
Q

Enchondromas are usually asymptomatic - true or false

A

True

Often an incidental finding

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6
Q

What is a common complication of enchondroma

A

Weakening of the bone leading to pathological fracture

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7
Q

Which bones do simple bone cysts usually occur in

A

Long bones - proximal humerus and femur

Talus or calcaneus

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8
Q

What are the symptoms of a simple bone cyst

A

Usually asymptomatic

Can weaken the bone and cause pathological fracture

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9
Q

How do you treat enchondroma

A

If risk of fracture or one has already occurred you can scrape it out and fill with a bone graft to strengthen

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10
Q

How can you treat a simple bone cyst

A

If risk of fracture or one has already occurred you can scrape it out and fill with a bone graft to strengthen

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11
Q

What is thought to be the cause of aneurysmal bone cysts

A

Small arteriovenous malformations

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12
Q

Where do aneurysmal bone cysts occur

A

The metaphyses of many different long bones, flat bones (ribs, skull) and vertebral bodies

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13
Q

Describe the presentation of an aneurysmal bone cyst

A

Usually painful
Locally aggressive and causes cortical expansion and destruction
May cause pathological fracture

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14
Q

How do you treat an aneurysmal bone cyst

A

Curettage (scraping out) and grafting

Or use bone cement

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15
Q

Which region of a bone does a giant cell tumour tend to affect

A

Predilection for the metaphyseal region

Also tend to involve the epiphysis and can extend to the subchondral bone adjacent to the joint.

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16
Q

How does a giant cell tumour appear histologically

A

Consists of multi-nucleate giant cells

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17
Q

Can giant cell tumours metastasise

A

5% will metastasise to lung and cause benign pulmonary GCT

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18
Q

How do you treat giant cell tumours

A

Intralesional excision with use of phenol, bone cement or liquid nitrogen to destroy remaining tumour material & reduce the risk of recurrence.
Very aggressive lesions with cortical destruction may need joint replacement.

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19
Q

What is the cause of fibrous dysplasia

A

A genetic mutation which results in lesions of fibrous tissue and immature bone

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20
Q

What are the results of fibrous dysplasia

A

Defective mineralisation can lead to angular deformities, with the bone being wider with thinned cortices
Stress fractures can occur
Shepard’s crook deformity in the proximal femur

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21
Q

How do you treat fibrous dysplasia

A

Bisphosphonates may reduce pain
Pathological fractures should be stabilised with internal fixation
Bone grafts can improve strength

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22
Q

Which age group commonly gets osteoid osteomas

A

Adolescents

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23
Q

Which bones do osteoid osteomas usually affect

A

Proximal femur
The diaphysis of long bones
The vertebrae

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24
Q

How do you treat osteoid osteomas

A

NSAIDs for pain
May resolve spontaneously
May need CT guided radiofrequency ablation

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25
Name 2 other conditions that can present with a lytic lesion of bone
Brodie's abscess - subacute osteomyelitis | Hyperparathyroidism - Brown tumours
26
What are some red flag symptoms of malignant bone cancer
Constant pain - severe and often worse at night Weight loss Loss of appetite Fatigue
27
Which groups should you be aware of malignant bone tumours
Over 60s - more likely to develop cancer so must investigate unexplained skeletal pain Under 25s - unusual to have unexplained skeletal; pain so must investigate
28
What are some common signs of malignant primary bone tumours on x ray
Cortical destruction Periosteal reaction - raised periosteum producing bone New bone formation Extension into the surrounding soft tissue envelope.
29
Which bones are more commonly affected by osteosarcoma
Knee - 60% of cases Proximal femur Proximal humerus Pelvis
30
How does osteosarcoma spread
Usually haematogenous spread but can be lymphatic | 10% of patients will have lung mets on diagnosis
31
How do you treat osteosarcoma
Adjuvant chemotherapy can prolong survival | Not radiosensitive
32
Chondrosarcoma's are small and slow to metastasize - true or false
False | Often very large but are slow to metastasise
33
Which bones are commonly affected by chondrosarcoma
Pelvis | Proximal femur
34
Can you treat chondrosarcomas with radiation or chemo
Nope | not radiosensitive and unresponsive to current chemo
35
What does a chondrosarcoma produce
Cartilage
36
Describe fibrosarcoma and malignant fibrous histiocytoma
Fibrous malignant primary bone tumours Tend to occur in abnormal bone - e.g. bone infarct, Paget's Often affects adolescents or young adults
37
Which symptoms might Ewing's sarcoma be associated with
Fever Raised inflammatory markers A warm swelling
38
Is Ewing's sarcoma sensitive to common cancer treatments?
Yes | It tends to be radio‐ and chemo‐sensitive
39
Why might amputations be used in treatment of bone tumours
Usually to prevent recurrence | Limb salvage attempted with adjuvant therapy first
40
How do you stage a primary bone tumour
Bone scan - usually CT or MRI | CT of chest - look for mets
41
Why is biopsy required
For histological diagnosis | Grading prior to surgery
42
Lymphoma can occur as a primary bone tumour - true or false
True Can originate from the marrow - Non Hodgkin's Lymphoma of any type can metastasize to the bone
43
Where does primary lymphoma of bone tend to affect
Pelvis | Femur
44
How do you treat primary lymphoma of bone
Surgical resection
45
How do you treat metastatic lymphoma
Chemo | Radiotherapy
46
Where does myeloma arise from
The bone marrow
47
What is multiple myeloma
Multiple osteolytic lesions throughout the skeleton
48
Which age group is most affected by multiple myeloma
Age 45-65
49
What is the common presentation of multiple myeloma
``` Weakness Back pain Bone pain Fatigue Weight loss May have marrow suppression resulting in anaemia and recurrent infection May present with pathologic fracture ```
50
How do you treat multiple myeloma
Chemotherapy
51
How do you treat a single lesion caused by myeloma
Radiotherapy
52
How do you diagnose myeloma
Plasma protein electrophoresis Bence Jones protein assay - early morning urine sample Bone scans
53
Which bones are most frequently involved in metastases
``` Vertebra Pelvis Ribs Skull Humerus Long bones of the lower limb ```
54
Which investigations should you do if you suspect metastases in the bone
``` Breast exam PR exam - if appropriate CXR - if lung suspected Bloods - serum calcium, LFTs, plasma protein, FBC Bone scans ```
55
How do you treat pathological fractures
Fractures or impending fractures are treated with stabilization using long rods If there is joint destruction then joint replacement may be better
56
How can you improve symptoms of spinal cord compression due to spinal mets
Radiotherapy | Surgical decompression
57
Which soft tissue swelling are diffuse
Synovitis | Oedema
58
Which soft tissue swelling are local
``` Inflammatory ones - bursitis, rheumatoid Infection - abscess Cystic lesions Benign neoplasms Malignant neoplasms ```
59
What is a lipoma
Neoplastic proliferation of fat Usually occurs in the subcutaneous fat Can occur in muscle
60
Describe a giant cell tumour of the tendon
Small firm swelling Usually found on the flexor tendon sheath of a finger May not be painful Can erode bone if large enough
61
What name is given to a giant cell tumour in the joint
Pigmented Villonodular Synovitis | Can cause pain and effusions
62
What is the general name for tumours of connective tissues
Sarcomas | gain more specific names from the type of tissue they arise from
63
Are sarcomas common
No - account for less than 1% of malignant tumours
64
What is an angiosarcoma
A malignant tumour from blood vessels
65
Which tissues do fibrosarcoma and malignant fibrous histiocytoma
Fibrous tissue
66
What is a liposarcoma
malignant tumour arising from fat
67
What is a rhabdomyosarcoma
malignant tumour arising from skeletal muscle
68
What is a synovial sarcoma
malignant tumour originating in the synovial lining of joint and tendons
69
Which age do sarcomas usually present
Between the ages of 50 and 70
70
How do you treat sarcoma
Usually surgically with adjunctive chemotherapy and/or radiotherapy
71
Describe the appearance of a ganglion cyst
Well-defined Quite firm Readily translucent
72
What treatment would you give for a ganglion cyst
May require excision if there is local discomfort or comesis
73
What can cause a ganglion cyst
Herniation or out-pouching of a weak portion of joint capsule or tendon sheath Can be developmental Or as a result of underlying joint damage leading to build up of pressure
74
What types of ganglion cysts are caused by developmental issues
Juvenile Baker's cyst
75
What types of ganglion cysts are caused by joint damage and pressure
Adult Baker's cyst Mucous cyst of the DIP joint Wrist ganglion
76
What is a bursa
Small fluid filled sac lined by synovium around a joint | It prevents friction between tendons, bones, muscle and skin
77
What is bursitis
Inflammation of a bursa | Usually occurs after repeated trauma or pressure
78
What can cause a bursal abscess
Bacterial infection
79
What can cause an abscess on a limb
Cellulitis Bursitis Penetrating wound Infected sebaceous cysts
80
How do you treat abscesses
Incision and drainage | Antibiotics will not get into it
81
What is the general end result of osteochondritis and AVN
Bone undergoes localised necrosis | Due to ischaemia from a reduction in blood supply
82
Which age group tends to be affected by osteochondritis
Children | Young adults
83
What are some potential 'causes' of osteochondritis
Increased physical activity with repetitive stress Familial predisposition Recurrent impact or traction injury - causes bleeding
84
What are the consequences of osteochondritis
Bone necrosis Results in compression or separation of bone Causes flattening of joints Pain and progression to arthritis
85
What are some common sites affected by compression in osteochondritis
``` 2nd metatarsal head Navicular bone Elbow Vertebrae Hip - Perthes ```
86
What is osteochondritis dissecans
Fragmentation with separation of bone and cartilage | Can lead to pain, effusions and locking
87
How can you treat osteochondritis dissecans
Pinning of the unstable fragments | Remove detached fragments
88
How do you treat osteochondritis
If joint is damaged then osteotomy - surgical realignment of the bone Can shift load from damaged area to undamaged
89
What sites are prone to AVN
``` Femoral head Femoral condyles Head of the humerus Capitellum Proximal pole of the scaphoid Proximal part of the talus. ```
90
What can cause AVN
``` Fractures that disrupt the blood supply Many cases are idiopathic Alcoholism Steroid use Hyperlipidaemia Thrombophilia Sickle cell Anti-phospholipid ```
91
How do you treat AVN
Dependent on stage If articular surface is intact - drill to decompress bone If surface is collapsed - joint replacement

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