What are the most common bone tumours?
Bone mets
Which cancers commonly metastasise to bone?
Bronchus Thyroid Breast Kidney Prostate
How do bony mets appear on x-rays?
They are usually radiolucent, apart from prostate which is sclerotic
Where do bony mets usually occur?
Axial skeleton
Why do bony mets usually occur in the axial skeleton?
Because it contains red marrow
How do bony mets present?
Pain or pathological fractures
How are pathological fractures caused by bony mets managed?
Internal fixation
How is pain caused by bony mets managed?
Radiotherapy
Give 4 tumour-like non-neoplastic conditions of bone
Fibrous dysplasia
Simple bone cyst
Aneurysmal bone cyst
Fibrous cortical defect and non-ossifying fibroma
When does fibrous dysplasia present?
0-30
Which gender is fibrous dysplasia more common in?
Females
What increases the risk of fibrous dysplasia?
Fractures
What does McCune Albright’s syndrome consist of?
Polyostotic fibrous dysplasia
Precocious puberty in females
Cafe-au-lait spots
What bones does fibrous dysplasia affect?
Long bones
Ribs
Skulls
What is meant by fibrous dysplasia being mono-ostotic?
Usually only one bone is involved
How might fibrous dysplasia appear on x-ray?
‘Ground glass’ lytic lesions
Shepherds crook deformity of proximal femur
When do simple bone cysts present?
<20
What happens to the site of a simple bone cyst?
The lump migrates down the shaft from original growth plate site
Where do simple bone cysts affect?
Proximal metaphysis of humerus or femur
How do simple bone cysts appear on x-ray?
Well-defined lytic lesion
Cortex can fall into the cyst, causing a ‘fallen fragment’
When do aneurysmal bone cysts present?
<30 years
How do aneurysmal bone cysts present?
Pain
What is seen on MRI in aneurysmal bone cysts?
Multiple fluid cysts
Who do fibrous cortical defects and non-ossifying fibromas present in?
Children
What is the prognosis of fibrous cortical defects and non-ossifying fibromas?
Non-painful, benign, and spontaneously regress
Where do fibrous cortical defects and non-ossifying fibromas affect?
Distal femur
Proximal tibia
Are fibrous cortical defects and non-ossifying fibromas single or multiple?
Often multiple
Give 3 benign cartilaginous neoplasms of bone
Osteochondroma
Enchodroma/chondromas
Chondroblastoma
When does osteochondroma present?
10-20 years old
What is the male to female ratio of osteochondroma?
M:F = 3:1
What might osteochondroma be related to?
Previous trauma
Where does osteochondroma affect?
Knee
What may be seen on x-ray in osteochondroma?
Cartilage-capped bony outgrowth
When do endochondroma/chondromas present?
10-40 years
What is Ollier disease?
Multiple endochondromas
What is Maffucci Syn?
Condition with endochondromatosis and multiple soft-tissue haemangiomas
What is the risk with multiple enchondromas?
Risk of malignant transformation
Where do enchondromas/chondromas affect?
Hands and feet
What will be found on x-ray in enchondromas/chondromas?
O sign
Endosteal scalloping
What is O sign?
Oval lucencies with radiodense rim
When do chondroblastomas present?
10-20
What is the male to female ratio of chondroblastoma?
M:F = 2:1
Where do chondroblastomas affect?
Epiphysis
Knee
How do chondroblastomas appear on x-ray?
Radiolucent with sclerotic border
Give a malignant cartilaginous neoplasm
Chondrosarcoma
When do chondrosarcoma present?
> 40
How do chondrosarcomas present?
Pain and lump
What do chondrosarcomas arise from?
De novo or from chondromas
What is the prognosis of chondrosarcomas?
70% at 5 years
Where are chondrosarcomas located?
Pelvis
Axial skeleton
How do chondrosarcomas appear on x-ray?
Lytic lesion
Fluffy ‘popcorn calcification’
Give 4 benign bone-forming neoplasms
Osteoma
Osteoid osteoma
Osteoblastoma
Giant cell tumour/osteoclastoma
How does osteoma present?
Lump
Are osteomas solitary or multiple?
Usually solitary, but may be multiple
Where are osteomas found?
Skull
Facial bones
What is the male to female ratio of osteoid osteoma?
M:F = 2:1
When do osteoid osteomas present?
Teens and 20s
How does osteoid osteoma present?
Severe noctural pain relieved by aspirin
How do osteoid osteomas appear on bone scan?
Hot
Where are osteoid osteomas found?
Lower limb
Diaphyseal cortex
How do osteoid osteomas appear on x-ray?
Lytic lesions with central nidus and sclerotic rim
How do osteoblastomas present?
Pain unresponsive to aspirin
Where are osteoblastomas found?
Spine
When do giant cell tumours/osteoclastomas present?
20-40, after fusion of growth plate
Where are giant cell tumours/osteoclastomas found?
Knee
On a boundary with joint surface
How do giant cell tumours/osteoclastomas present?
Soap bubble appearance - solitary, expansile, lytic lesion
Give two malignant bone-forming neoplasms
Osteosarcomas
Ewing’s sarcoma
Who do osteosarcomas present in?
Adolescents
What is the male to female ratio of osteosarcoma?
M:F = 2:1
How do osteosarcomas present?
Pain
Warmth
Briut
What might osteosarcomas arise secondary to?
Paget’s or irritation
Where are osteosarcomas found?
Knee
Metaphysis
What will be found on x-ray with osteosarcoma?
Periosteal elevation, with sunburst appearance and Codman’s triangle
?? dunno lol
When does Erwing’s sarcoma present?
<20
How does Erwing’s sarcoma present?
Painful, warm, enlarging mass
Systemic features, including fever, increased ESR, anaemia, increased WCC
Where is Erwing’s sarcoma found?
Long bone diaphysis
How does Erwing’s sarcoma present on x-ray?
Lytic tumour
Onion-skin periosteal reaction