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Musculoskeletal > Pathology of MSK Tumours II > Flashcards

Pathology of MSK Tumours II Flashcards

1
Q

What are some features of soft tissue tumours?

A

May present as lump or swelling, may be associated with pain or discomfort, superficial lesions less likely to be malignant

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2
Q

What are some examples of soft tissue tumours?

A

Ganglion cysts, rheumatoid nodules, gouty tophus, tenosynovitis, proliferative conditions, benign tumours, malignancy

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3
Q

What are some features of nodular fasciitis?

A

Self-limiting, cellular proliferation of fibroblastic and myofibroblastic cells, upper age limit of young adults, rapidly growing tumour

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4
Q

How does nodular fasciitis appear?

A

Superficial or deep, usually less than 5cm, circumscribed, very cellular, plump cells, stellate and spindle, cells mature towards periphery

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5
Q

What are some features of myositis ossificans?

A

Associated with insertions of large muscles of arms and legs, cellular proliferation but with evidence of bone formation and zonation

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6
Q

How does Dupuytren’s contracture appear?

A

Firm grey-white tissue, nodules and fascicles, bland fibroblasts and dense collagen

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7
Q

What are some features of deep fibromatosis?

A

Desmoid tumour, large infiltrative masses, don’t metastasise, commonly teens-age 30, associated with mutation of APC and beta-catenin genes

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8
Q

What are some common sites of deep fibromatosis?

A

Limb girdles, mesenteric tissue, musculo-aponeurotic tissue of abdominal walls

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9
Q

What are some examples of tenosynovitis?

A

Giant cell tumours of tendon sheath = digits and wrist, excise and rarely recur
Pigmented villonodular synovitis = large joints, likely to recur

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10
Q

What are some classes of lipomas?

A

Simple lipoma, intramuscular lipoma, fibrolipoma, angiolipoma (spindle cell, pleomorphic, atypical)

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11
Q

Where do lipomas occur?

A

Usually on neck, must be superficial

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12
Q

What are some features of liposarcomas?

A

One of most common sarcomas, patients aged 50-60, deep soft tissue of extremities or retroperitoneum, subtypes (well differentiated, myxoid, pleomorphic)

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13
Q

What measures are used to grade sarcomas?

A

Degree of differentiation
Degree of proliferation:mitotic count
Presence of coagulative necrosis

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14
Q

What are some examples of leiomyomas?

A

Uterine (fibroid), leiomyoma of erector pilae or rarely in deeper soft tissues/muscularis of GI tract

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15
Q

How do leiomyomas appear?

A

Soft tissue leiomyomas usually 1-2cm, fascicles of spindle cells, cigar shaped nuclei, minimal atypia and few mitoses

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16
Q

What are some features of leiosarcomas?

A

More common in females, deep soft tissue of extremities and retroperitoneum, recur if exclusion not complete, lethal due to local invasion and metastasis

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17
Q

What are some examples of benign cartilaginous tumours?

A

Enchondroma = digits, can be part of syndrome (Ollier’s and Maffuci)
Osteochondroma
Chondromyxoid fibroma

18
Q

What do chondrosarcomas produce?

A

Cartilage

19
Q

What are some types of chondrosarcomas?

A

Conventional (90%) = intramedullary or juxtacortical

Clear cell, mesenchymal, dedifferentiated

20
Q

Who gets chondrosarcomas?

A

More common in adults >40

Clear cell and mesenchymal affect younger patients

21
Q

Where do chondrosarcomas occur?

A

Axial skeleton, head and neck

Clear cell arises in epiphyses of long bones

22
Q

What are some characteristics of chondrosarcomas?

A

Bulky tumours, nodules of grey/white tissue, locally invasive in bone and into muscle and fat

23
Q

How are chondrosarcomas graded?

A

Grade 1-3
Lost conventional tumours are grade 1
Grade 3 tumours often metastasise to lungs

24
Q

How do dedifferentiated chondrosarcomas appear?

A

Low grade with separate high grade components that don’t produce cartilage

25
Q

How do clear cell chondrosarcomas appear?

A

Abundant clear cytoplasm

26
Q

How do mesenchymal chondrosarcomas appear?

A

Sheets of well differentiated hyaline-appearing cartilage with surrounding small round cells

27
Q

What are some benign bone tumours?

A

Simple osteoma = cranial bones, multiple is Gardner’s syndrome
Osteoid osteoma = <2cm, young men, mostly femur and tibia, severe nocturnal pain
Osteoblastoma = involve vertebrae posteriorly, pain not responsive to aspirin

28
Q

What do osteosarcomas produce?

A

Osteoid matrix or mineralised bone

29
Q

What are some features of osteosarcomas?

A

Most cases in <20 year olds, more common in men, cases in adults secondary to Paget’s/infarcts/radiation,
usually long bones around knee, painful mass, sudden fracture

30
Q

What genes are linked to osteosarcoma?

A

Mutations in Rb, TP53, INK4a and MDM2

31
Q

How are osteosarcomas classified?

A

Site, grade, primary/secondary, osteoblastic/chondroblastic/fibroblastic/telangiectatic

32
Q

How do osteosarcomas spread?

A

Haematogenous spread, aggressive disease = treated with chemo and surgery

33
Q

What are some tumours of unknown origin?

A

Ewing’s sarcoma, synovial sarcoma, undifferentiated pleomorphic sarcoma, giant cell tumour (osteoclastoma), aneurysmal bone cyst, pathological fracture

34
Q

What are some features of Ewing’s sarcoma?

A

Malignant, aged <20, diaphysis of long bones and pelvis, painful enlarging mass, destructive lesion, primitive round cells, no obvious line of differentiation

35
Q

What are some features of synovial sarcomas?

A

Malignant, aged 20-40, deep seated mass around knee joint, also chest and head and neck, can combine areas of spindle and epithelial cells (biphasic) or b monophasic

36
Q

How should synovial sarcomas be treated?

A

Can metastasise so treat aggressively with surgery +/- chemo

37
Q

What are some features of undifferentiated pleomorphic sarcomas?

A

Malignant, deep soft tissue of extremities (often thigh), 10-20cm, necrosis and haemorrhage, pleomorphic cells, aggressive

38
Q

What are some features of giant cell tumours (osteoclasts)?

A

Benign but locally aggressive, aged 20-40, usually solitary, arise in epiphysis of femur and tibia, thin shell reactive bone, treat with curettage

39
Q

What may giant bone cells cause?

A

Arthritis-like symptoms or fractures may occur, destroy cortex and expands into soft tissue, can become cystic

40
Q

What are some features of aneurysmal bone cysts?

A

Most common aged <20, metaphysis of long bones and posterior elements of vertebral bodies, pain and swelling, lytic lesion with smooth margin and thin bone shell

41
Q

What are some associations of aneurysmal bone cysts and how are the condition treated

A

Associated with giant cell tumours and chondroblastomas; treated with curettage or resection

42
Q

What are pathological fractures?

A

Fracture through abnormal bone = spontaneous or with minimal trauma
Many causes = osteopenic conditions, tumours

Musculoskeletal (57 decks)

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