3. Tumours of Bone and Soft Tissue Flashcards
(52 cards)
Which is the more common source of bone tumours, primary or metastatic?
Metastatic
Malignant tumours in bone tend to metastasise from which areas?
Lung, Prostate, Breast, (2/3’s collectively, and most common cancers overall)
Also Kidney, Thyroid
Name the 3 main types of benign Primary Bone Tumours
- Osteoma
- Osteoid Osteoma
- Osteoblastoma
Other o Non-ossifying fibroma o Cysts simple o Aneurysmal Bone Cyst (has a lining) o Fibrous dysplasia (proliferation of benign bone)
What are the clinical signs of and osteoid osteoma?
- Pain is relived by Aspirin
- ~ 1cm
- Radiolucency with Central Nidus of bone,
- Histology = benign bone + plump osteocytes
What distinguishes a osteoid osteoma from an osteoblastoma?
Size
If > 2cm = Osteoblastoma
What are the 4 types of (benign) cartilage-forming bone tumours?
- Osteochondroma (surface)
- Enchodroma (syndromes)(inside)
- Chondroblastoma
- Chondromyxoid fibroma
What is an osteochondroma also known as?
• AKA Cartilaginous Exostosis (any bone)
What are the clinical features of osteochondroma?
Very common primary bone lesion.
At 2-3cm presents as a lump.
Technically the term applies only exostosis is just bone but these are cartilaginous.
Cartilage Cap (if >2cm in depth the risk of malignancy increases)
Rarely Becomes Malignant (<1% become malignant)
What cartilaginous tumour is common in the fingers?
Enchondroma
What are the clinical features of Enchondroma?
- Fingers commonly (and also feet?)
- Islands of Cartilage
- Rarely Becomes Malig.
What presentation of cartilaginous tumours most often becomes malignant? In which conditions is this most often seen?
Multiple Chondromas (Ollier's Disease, Maffucci's Syndrome [autosomal dominant])
What is the rate of malignant transformation in multiple chondromas?
Malignant 20%-40%.
By 50yo=50% (to do with the genetics of the syndromes)
Name the 3 main types of Malignant Primary Bone Tumours. Name the other, less common type.
- Osteosarcoma
- Chondrosarcoma
- Ewing sarcoma
(Also Giant Cell Tumours ‘GCT’s’)
Which is the most common malignant primary bone tumour?
Osteosarcoma
What are some risk factors for osteosarcoma?
Pagets Dis Bone
Post Radiation Therapy
Retinoblastoma (5-10% of paediatric patients develop osteosarcoma*)
(Very High incidence)
Where does osteosarcoma present in younger patients?
90% occur in the metaphysis (active growing area) of long bones
How does osteosarcoma present in elderly patients?
Usually as a result of Pagets Disease
Presents in the Flat Bones
Extraskeletal Osteogenic Sarcoma - V.Rare
Where does osteogenic sarcoma (ogs) typically present?
Near the joints such as the distal femur or proximal tibia
What signs of osteosarcoma are can be present on x-ray?
Medulla
o Combination of Lytic and Sclerotic appearance. Depending on ratio of deposit/dest
o Mixed (10-20% require 2nd biopsy to diagnosis, especially if Rx/Path don’t match)
o “Codman’s Triangle” (not specific) (Codman triangle (previously referred to as Codman’s triangle) is the triangular area of new subperiosteal bone that is created when a lesion, often a tumour, raises the periosteum away from the bone.)
o Destroys Adjacent Bone
What are the main causes of chondrosarcomas?
- De Novo 80%
* Multiple Chondromas 20%
Where do chondrosarcomas typically appear?
- Central Skeleton
- Flat Bones (Metaphysis)
- Rare in hands or feet
What are the signs of chondrosarcoma on X-ray?
o “Ring” Calcification
o Large
o Destroys Adjacent Bone
What is the histological appearence of chondrosarcoma?
o Atypical Cartilage Cells
o Grade I-III (v. v. important) Again Rx/Path must correlate as typical signs N/P
In whom is Ewings Sarcoma Common?
Young <25
Typically 8-10yo
