Bone Tumours and Metastases

Question 1

What are the features of myeloma?

Answer 1

• Commonest primary bone tumour and can be a monoclonal proliferation of plasma cells or a multiple myeloma
• Bone lesions, marrow replacement and immunoglobulin excess
• Renal impairment from myeloma kidney precipitates light chains in renal tubule leading to renal failure, hypercalcaemia and amyloidosis
• Marrow replacement for pancytopenia, anaemia, leukopenia and thrombocytopenia

Question 2

What are the features of osteoid osteoma?

Answer 2

• Small, benign osteoblastic proliferation
• Any bone, especially long bones and spine
• Pain, worse at night, relieved by aspiring, scoliosis
• Juxta-articular tumours - sympathetic synovitis

Question 3

What are the features of osteosarcoma?

Answer 3

• Malignant tumour from osteoid or bone
• Common in metaphysis of long bones
• Codman’s triangle is a triangle of reactive bone on the surface and cortex underneath (indicates aggressive process)
• Early lung metastases
• Worse with Paget’s as well (disorder of excessive bone turnover)

Question 4

What are the features of chrondrosarcoma?

Answer 4

• De novo (primary) from pre-existing endochondroma or exostosis (secondary)
• Central within medullary canal or peripheral on bone surface
• Hands and feet rare

Question 5

What are the features of Ewing’s tumour?

Answer 5

• Peak 5-15yrs
• Long bones
• Flat bones of limb girdles
• Early metastases to lung, bone marrow and bone
• CD99 stain to diagnose
• RTPCR and FISH to look for 11-22 translocation

Question 6

What are the features of enchondroma?

Answer 6

• Lobulated mas of cartilage within medulla
• >50% on hands and feet, long bones
• Often asymptomatic in long bones
• Low cellularity, often surrounded by plates of lamellar bone

Question 7

What are the features of osteocartilagenous exostosis?

Answer 7

• Benign outgrowth or cartilage with endochondral ossification
• Common in adolescence

Question 8

Where do secondary tumours commonly come from and what are their features?

Answer 8

• Bronchis, breast, prostate, kidney and thyroud (follicular)
• Bone destruction, pain and fractures

Question 9

Benign vs Malignant Leg Pain

Answer 9

Question 10

Red flag symptoms associated with MSK malignancy

Answer 10

• Fever
• Systemic features (weight loss, pallor, fever, petechiae, lymphadenopathy, lethargy, malaise, hepatosplenomegaly)
• Bone pain
• Back pain
• Nocturnal pain
• Pain out of keeping with physical findings

Question 11

Top 5 cancers that spread to bone

Answer 11

• Breast
• Prostate
• Lung
• Kidney
• Thyroid