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Y2 MSK > Benign bone lesions > Flashcards

Benign bone lesions Flashcards

1
Q

What is osteochondroma

A

Benign bony lesion that arises from perichondral ring

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2
Q

What is the perichondral ring

A

Circumferential fibrous layer that secures the epiphysis and metaphysis together

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3
Q

Where is osteochondroma found

A

At the end of the bone near growth plate

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4
Q

Osteochondroma is commonly seen in which age group

A

Adolescents and young adults 10-20 years old

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5
Q

Osteochondroma can be solitary or multiple. Multiple osteochondroma can be due to

A

autosomal dominant disorder: Multiple hereditary Exostosis

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6
Q

Describe the structure of osteochondroma

A

Bony outgrowth near the end of the bone with a cartilaginous cap

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7
Q

Clinical presentation of osteochondroma

A

Painless
Hard lump
May have pain / numbness during activities

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8
Q

Osteochondroma commonly occur at

A

Distal femur
Proximal tibia

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9
Q

Investigations for osteochondroma

A

Xray or MRI

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10
Q

Management for osteochondroma

A

Close observation
may require removal if it grows or causes pain

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11
Q

Risk of osteochondroma developing into malignancy is

A

Small <1%
but higher in multiple hereditary exostosis due to more lesions

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12
Q

What is enchondroma

A

Intramedullary and metaphyseal cartilaginous tumour

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13
Q

Cause of enchondroma

A

Failure of endochondral ossification

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14
Q

What is endochondral ossification

A

Process of bone formation where cartilage is gradually replaced by bone

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15
Q

Which bones are not formed by endochondral ossification

A

Skull
Mandible
Clavicles

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16
Q

Enchondroma usually presents in which age group

A

20-50

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17
Q

Where does enchondroma occur

A

Intramedullary, at metaphysis

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18
Q

Which bones are commonly affected by enchondroma

A

Femur
Humerus
Tibia
Small bones of hands and feet

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19
Q

Enchondroma can lead to

A

Pathological fractures because they can weaken the bone
but usually asymptomatic

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20
Q

Investigations for enchondroma

A

Xray

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21
Q

Presentation of enchondroma on Xray

A

Lucent
Patchy sclerotic appearance

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22
Q

Management of enchondroma

A

curettage then fill with bone graft if there is risk of pathological fracture / fracture already occurred

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23
Q

What is a bone cyst

A

Benign fluid filled cyst in bone

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24
Q

Where is bone cyst usually located at

A

Metaphysis

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25
Q

Which bones are usually affected by bone cysts

A

Proximal humerus
Femur
Talus
calcaneus

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26
Q

What can bone cysts lead to

A

Pathological fracture due to weakening of the bone
But usually asymptomatic

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27
Q

Investigations for bone cysts

A

Xray

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28
Q

Management of bone cysts

A

Curettage then fill with bone graft

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29
Q

What is aneurysmal bone cyst

A

Lesion made of many chambers filled with blood or serum in bone

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30
Q

Cause of aneurysmal bone cyst

A

Small arteriovenous malformation

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31
Q

Where does aneurysmal bone cyst usually occur

A

metaphyses

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32
Q

What type of bones do aneurysmal bone cyst affect

A

Long bones
Flat bones - skull / clavicle/ scapula / mandible ..etc
Vertebral bodies

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33
Q

Symptoms of aneurysmal bone cyst

A

Painful mass
Swelling
pathological fracture

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34
Q

Investigations for aneurysmal bone cyst

A

Xray

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35
Q

Management of aneurysmal bone cyst

A

Curettage then bone graft

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36
Q

What is giant cell tumour of bone

A

Benign lesion arising from the giant cells of the bone marrow

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37
Q

Where does giant cell tumour of bone usually occur

A

Metaphyseal region
Involves epiphysis
Can extend to adjacent subchondral bone in joint

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38
Q

What is subchondral bone

A

The bone tissue lying beneath cartilage in a joint

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39
Q

Clinical presentation of giant cell tumour of the bone

A

Painful mass
Swelling
Pathological fracture

40
Q

Which bones are commonly affected by giant cell tumour of the bone

A

Knee
Distal radius
Pelvis
Spine
other long bones

41
Q

Xray presentation of giant cell tumour of the bone

A

Soap bubble appearance

42
Q

Histology of giant cell tumour of the bone will show

A

Multi-nucleated giant cells

43
Q

Management of giant cell tumour of the bone

A

Phenol / Bone cement / Liquid nitrogen
Joint replacement if damage to cortical layer of bone

44
Q

Giant cell tumour of the bone can metastasise to

A

Lungs as benign pulmonary giant cell tumour

45
Q

What is fibrous dysplasia

A

Benign, developmental disorder of bone that causes normal skeletal tissue to be replaced by fibrous tissue

46
Q

Cause of fibrous dysplasia

A

Genetic mutation

47
Q

Fibrous dysplasia usually occurs in which age group

A

Adolescents

48
Q

Clinical presentation of fibrous dysplasia

A

Deformities
Bone pain
Pathological fractures

49
Q

What happens to the bone structure in fibrous dysplasia

A

Affected bone is wider with thinner cortical layer

50
Q

Investigations for fibrous dysplasia

A

Bone scan
Xray

51
Q

Bone scan result for fibrous dysplasia

A

Increase in uptake of radioactive substances during development of the lesion
then becomes inactive

52
Q

Xray presentation of fibrous dysplasia

A

Shepherd’s crook

53
Q

Management of fibrous dysplasia

A

Bisphosphonates
Internal fixation
Cortical bone grafts

54
Q

What is osteoid osteoma

A

Benign bone-forming tumors that typically occur in children

55
Q

Osteoid osteoma usually affects which bones

A

Proximal femur
Diaphysis of long bones
Diaphysis of vertebrae

56
Q

Clinical presentation of osteoid osteoma

A

Constant severe pain
Pain worse at night
Pain relieved by NSAID

57
Q

Investigations for osteoid osteoma

A

Bone scan - increased uptake
CT

58
Q

Presentation of osteoid osteoma on CT

A

Lucent nidus surrounded by sclerotic bone

59
Q

What is nidus

A

Center of an osteoid osteoma, consists of growing tumour cells, blood vessels and cells that form bone

60
Q

Management of osteoid osteoma

A

May resolve spontaneously
If not -> CT guided radio frequency ablation

61
Q

What are lipomas

A

Benign soft tissue lesion due to neoplastic proliferation of fat

62
Q

Characteristics of soft tissue neoplasm like lipomas

A

Smaller
Fluctuates in size
Well defined lesions
Fluid filled lesions
No overlying skin changes
Fatty lesions

63
Q

Risk factors of bone cancer

A

Young
Previous radiotherapy
Paget’s / Multiple enchondromas / Fibrous dysplasia
Li Fraumeni syndrome
Familial retinoblastoma

64
Q

Malignant bone tumours are often found at early / late stages

A

Late

65
Q

What is Li Fraumeni syndrome

A

Inherited disorder predisposing people to malignancies due to mutation in p53

66
Q

Li Fraumeni syndrome is inherited in which pattern

A

Autosomal dominant

67
Q

Types of malignant bone tumours

A

Multiple myeloma
Osteosarcoma
Chondrosarcoma
Ewing’s sarcoma
Fibrosarcoma

68
Q

What is multiple myeloma

A

Malignancy from plasma cells in the bone marrow

69
Q

4 characteristics of Multiple myeloma

A

Hypercalcaemia
Anaemia
Renal impairment
Bone pain

70
Q

Multiple myeloma usually affects which age group

A

Elderly

71
Q

Most common type of sarcoma

A

Osteosarcoma

72
Q

What is osteosarcoma

A

Malignant tumour that produces bone

73
Q

How does osteosarcoma usually spread

A

Haematogenous

74
Q

Osteosarcoma that occurs in elderly is associated with

A

Paget’s disease

75
Q

Which bones are commonly affected by osteosarcoma

A

Distal femur
Proximal tibia
Proximal humerus
Pelvis

76
Q

What is chondrosarcoma

A

Malignany of chondrocytes causing production of cartilage

77
Q

How often does chondrosarcoma arise from benign lesions such as enchondroma and osteochondroma

A

Rare, most arise de novo

78
Q

Which bones are often affected by chondrosarcoma

A

Pelvis
Proximal femur

79
Q

How aggressive is chondrosarcoma

A

Less aggressive than osteosarcoma
Slow to metastasise

80
Q

Chondrosarcoma tends ot affect which age group

A

45 years old; older age group

81
Q

What is fibrosarcoma

A

Fibrous malignant tumours

82
Q

Fibrosarcoma tend to affect which bones

A

Abnormal bones such as bone infarcts / post radiation bones

83
Q

Which age group is usually affected by fibrosarcoma

A

Young adults / adolescents

84
Q

What is Ewing’s sarcoma

A

Tumour of the endothelial cells of the bone marrow

85
Q

2nd most common bone tumour in children is

A

Ewing’s sarcoma

86
Q

Ewing’s sarcoma tend to affect which age group

A

10-20

87
Q

Presentation of Ewing’s sarcoma

A

Hot, swollen, tender joint

88
Q

which bones are often affected by Ewing’s sarcoma

A

Distal femur
Proximal tibia

89
Q

Investigations for bony tumours

A

Xray
Biopsy
Staging using bone scan, CT, MRI

90
Q

What would the xray results be for malignant bone tumours

A

Aggressive
Cortical layer damaged
Sclerosis
Loss of bone - lysis

91
Q

Management of malignant bone tumours

A

Surgery
Adjuvant chemotherapy /radiotherapy
Neo-adjuvant chemotherapy

92
Q

Which type of malignant bone lesion does not respond to chemotherapy

A

Chondrosarcoma

93
Q

What are the cancers that commonly metastasise to the bone

A

Breast
Prostate
Lungs
Renal cell carcinoma
Thyroid cancer

94
Q

Prostate cancer often gives which type of metastases

A

Sclerotic metastases

95
Q

Lung cancer often gives which type of metastases

A

Lytic metastases

96
Q

Renal cell carcinoma often gives which type of metastases

A

Large, very vascular lytic metastases
These can bleed a lot during biopsy or surgery

Y2 MSK (19 decks)

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