Benign and Malignant Bone Tumours Flashcards Preview

The Musculoskeletal System > Benign and Malignant Bone Tumours > Flashcards

Flashcards in Benign and Malignant Bone Tumours Deck (98):
1

What is the most common benign bone tumour?

Osteochondroma

2

What does an osteochondroma produce?

Bony outgrowth on the external surface of bone which is covered with a cartilaginous cap

3

Where do osteochondromas typically affect?

Epiphysis of long bones - most common around the knee

4

What are the negative effects of an osteochondroma?

They are usually asymptomatic and incidental findings

They may produce local pain

There is a small risk of malignant transformation

5

Any osteochondroma growing in size or producing local pain will be treated in what way?

Excisional biopsy

6

Multiple osteochondromas may be associated with what?

Underlying genetic disorder

7

What is an enchondroma?

An intramedullary metaphyseal (usually) cartilaginous tumour

8

What is the usual appearance of an enchondroma?

Usually lucent

May undergo mineralisation and have a sclerotic appearance

9

What are the usualy symptoms of an enchondroma?

Usually asymptomatic, but can weaken bones resulting in pathological fracture

10

Where do enchondromas typically affect?

Small tubular bones of the hands and feet

11

Given the benign nature of enchondromas, what is the treatment?

Currettage - they can be scraped out of bone

12

What is a simple bone cyst?

A solitary unicystic fluid filled neoplasm

13

What is the most probable cause for a simple bone cyst?

Growth defect in the physis

14

Where are simple bone cysts most commonly found?

Metaphyseal in long bones

They can also occur in the talus or calcaneus

15

What are the most common symptoms of a simple bone cyst?

Usually asymptomatic

May lead to weakness and pathological fracture

16

What is the treatment for a simple bone cyst?

Curettage and bone grafting

Stabilisation may be required

17

What is an aneurysmal bone cyst?

A lesion of bone containing many blood/serum filled chambers

18

The formation of aneurysmal bone cysts is thought to be down to what?

Small arteriovenous malformations

19

Where are aneurysmal bone cysts most commonly found?

  • Metaphyses of long bones
  • Flat bones (ribs, skull)
  • Vertebral bodies

20

What are the normal symptoms of an aneurysmal bone cyst?

  1. Pain (due to cortical expansion and bone destruction)
  2. Pathological fracture (due to bone weakness)

21

What is the treatment for an aneurysmal bone cyst?

  • Curettage and grafting
  • Bone cement

22

Giant cell tumours of bones have a predilection for which long bone regions?

  1. Methaphysis
  2. Epiphysis
  3. Can extend as far as subchondral region beside the joint

23

Where do giant cell tumours most commonly occur in bones?

Around the knee and in the distal radius

(can also occur in other long bones, pelvis and spine)

24

Why are giant cell tumours of bone often painful?

They are locally destructive to the cortex

They weaken bone and may cause pathological fracture

25

In terms of causation of the condition, how are giant cell tumours of bone characterised?

A translocation between chromosomes 1 and 2

26

What is the characteristic appearance of giant cell tumours on x-ray?

Soap-bubble appearance

27

Despite being benign, where can giant cell tumours of bone metastasize?

Lungs

Causes benign pulmonary giant cell tumour

(this occurs in 5% of cases)

28

What is the treatment for giant cell tumour of bone?

Intralesional excision

The use of phenol, bone cement or liquid nitrogen to destroy an remaining tumour

Aggressive lesions may need joint replacement

29

What is fibrous dysplasia?

A disease of bone resulting from a genetic mutation that causes lesions of fibrous tissue and immature bone

30

Which age group of patients is fibrous dysplasia most likely to affect?

Adolescents

31

Where are the most frequent sites for fibrous dysplasia?

Head and neck

32

What is the the underlying cause of fibrous dysplasia?

A genetic mutation causes an abnormality in protein in G protein signalling

33

Patients with polyostotic fibrous dysplasia have other symptoms involving which type of disorders?

Endocrine

34

Angular derformities with affected bone being wider with thinner cortices are as a result of what?

Defective bone mineralisation

35

Why may stress fractures occur in patients with fibrous dysplasia?

The bone is weakened due to defective mineralisation

36

Extensive involvement of the proximal femur in a patient with fibrous dysplasia causes which chracteristic deformity?

Shepherd's crook deformity

37

Which medication may help to reduce pain in patients with fibrous dysplasia?

Bisphosphonates

38

How are pathological fractures stabilised in patients with fibrous dysplasia?

  1. Internal fixation
  2. Cortical bone grafts

39

Why is intralesional excision not generally used for fibrous dysplasia?

It has a high recurrence arte

40

What is an osteoid osteoma?

A small nidus of immature bone surrounded by an intense sclerotic halo which secretes prostaglandins causing great pain

41

In which age group do osteoid osteomas most commonly affect and where in the body do the usually affect?

Adolescents

Proximal femur, diaphysis of long bones, vertebrae

42

What is the predominant clinical feature of osteoid osteoma?

Constant pain, worse at night

43

Classically, the pain from an osteoid osteoma is greatly relieved by what?

NSAIDs

44

Which two non-invasive tests can confirm the diagnosis of an osteoid osteoma?

  1. Bone scan
  2. CT

45

What is the treatment for osteoid osteoma?

46

What is a Brodie's abscess?

An intraossoeus abscess as a result of subacute osteomyelitis

This is usually as a result of S. aureus infection

This can present as a lytic lesion of bone

47

Brown tumours are a result of what, and how do they appear on X-ray?

Hyperparathyroidism

Lytic lesions of bone

48

Malignant primary bone tumours are most common which age?

Younger age groups

49

Bony lesions usually relate to ___________

Bony lesions usually relate to metastasis

50

Metastatic cancer of bone tends to produce _________ pain which is usually worse ____ _________

Metastatic cancer of bone tends to produce constant pain which is usually worse at night

51

Which generalised systemic symptoms may be present with metastatic bone cancer?

  1. Loss of appetitie
  2. Weight loss
  3. Fatigue

52

What is the most common form of primary bone tumour?

Osteosarcoma

53

What is an osteosarcoma?

A malignant bone tumour producing bone

54

The majority of osteosarcoma cases are asscociated with a mutation in which gene?

Retinoblastoma gene (a tumour suppressor)

55

In which age of patient and location of the body are osteosarcomas most common?

Younger patients

Most commonly the knee

(can also be the proximal femur, proximal humerus and pelvis)

56

Metastasis of an osteosarcoma via the blood is relatively ___________ and spread via the lymph nodes is __________

Metastasis of an osteosarcoma via the blood is relatively common and spread via the lymph nodes is rare

57

10% of patients with osteosarcoma have which type of mestastasis upon diagnosis?

Pulmonary

58

In a patient with osteosarcoma, how may lifespan be prolonged?

Chemotherapy

59

What is a chondrosarcoma?

A cartilage producing primary bone tumour

60

In which age group is a chondrosarcoma more common?

Older (mean age 45)

61

Chondrosarcomas tend to be very ________ and _______ to metastasise

Chondrosarcomas tend to be very large and slow to metastasise

62

Where are chondrosarcomas most commonly found?

Pelvis or proximal femur

63

What is the treatment for chondrosarcoma?

Surgical resection

Radiotherapy and chemotherapy are not suitable

64

What is Ewing's sarcoma?

A primary bone tumour with an uncertain cell origin that is most common in teenagers

65

Where do Ewing's sarcomas most commonly manifest?

Long bones - especially the femur

66

How are Ewing's sarcomas characteristically described radiologically?

As having an "onion skin" pattern

67

Tumours such as Ewing's sarcoma are part of a group of tumours described as what?

Small round blue cell tumours

68

Ewing's sarcoma is associated with the ______ ___________ involving the _______ __________ gene on chromosome ____

Ewing's sarcoma is associated with the t11;22 translocation involving the Ewing's sarcoma gene on chromosome 22

69

Why may Ewing's sarcoma be misdiagnosed as what and what are the reasons for this?

Osteomyelitis

It presents with:

  1. Fever
  2. Raised inflammatory markers
  3. Warm swelling in affected area

70

Ewing's sarcoma tends to be sensitive to which treatments?

  1. Radiotherapy
  2. Chemotherapy

71

The treatment of primary bone tumours usually involves what as well as radiotherapy and chemotherapy (if these are suitable)?

Surgical resection (of tumour and surrounding tissue)

72

What is required for histological diagnosis and grading of a tumour prior to surgery?

Biopsy

73

What is lymphoma?

A cancer of round cells of the lymphocytic system and macrophages which can occur as a primary bone tumour from bone marrow or lymphoma may mestastasise to bone

74

A primary lymphoma of bone is referred to as which type of lymphoma?

Non-Hodgkins lymphoma

75

Primary lymphoma tends to affect which bones?

Pelvis or femur

76

What is the treatment of primary lymphoma in bones?

Surgical resection

77

What may be present with metastatic lymphoma?

  1. Lymphadenopathy
  2. Splenomegaly

78

What is the treatment for metastatic lymphoma?

  1. Chemotherapy
  2. Radiotherapy

79

What is myeloma?

A malignant clonal proliferation of abnormal plasma cells which arises from bone marrow

80

What is the name of myeloma that presents

a) As a solitary lesion

b) With multiple osteolytic lesions

a) Plasmacytoma

b) Multiple myeloma

81

Abnormal cells in myeloma cause deposition of what type of protein and what is this process called?

Abnormal plasma cells deposit defective imunnoglobulin, this is known as amyloidosis, and more specifically AL amyloid as the deposited protein is the immunoglobulin light chain

82

What is the typical age group of patients with myeloma?

45-65

83

How may patients with multiple myeolma present?

  1. Weakness
  2. Back pain
  3. Bone pain
  4. Weight loss
  5. Fatigue
  6. Anaemia and recurrent infection (due to bone marrow supression)

84

Diagnosis of myeloma often requires what?

Plasma protein electrophoresis

(shows paraprotein - monoclonal immunoglobulin or light chain)

Early morning urine collection for Bence Jones protein assay

85

Why may metastases of myeloma not be picked up on a bone scan?

There is not usually an osteoblastic response to the osteoclastic response

86

What is the treatment for:

a) Plasmacytoma

b) Multiple myeloma

a) Radiotherapy

b) Chemotherapy

87

Name the top 5 primary malignant tumours which most commonly mestastasise to bone

  1. Breast cancer
  2. Prostate cancer
  3. Lung cancer
  4. Renal cell cancer
  5. Thyroid cancer

(adenopcarcinoma of the colon, bladder cancer and melanoma can rarely metastasise to bone)

88

Describe how breast cancer metastases appear in bone

Blastic (sclerotic) or lytic

89

How do prostate cancer metastases appear in bone?

Sclerotic masses

90

Why are pathological fractures more likely to heal in prostate cancer metastases to bone?

There is high osteoblastic activity so sclerotic masses are quickly produced

91

Which two therapies can reduce likelyhood of bony metastases in prostate cancer?

  1. Hormonal therapy
  2. Radiotherapy

92

Lung cancer gives rise to what type og bony metastases in bone?

Lytic bone tumours

(mean survival is just 6 months when these are present)

93

Renal cell carcinoma ausually gives rise to which type of bone metastases?

Large and very vascular lytic "blow out" bony metastases

94

Why may surgery of biopsy be an issue with renan cell carcinoma metastasis to bone?

It can cause severe bleeding

95

What is the treatment for renal cell carcinoma with one bony metastasis?

Resection (nephrectomy) - can be curative

96

Which bones are most frequently implicated in bony metastases?

  1. Vertebrae
  2. Pelvis
  3. Ribs
  4. Skull
  5. Humerus
  6. Long bones of the lower limb

97

Fractures or impending fractures as a result of bony metastases are treated in what way?

Stabilisation using long rods and intramedullary nails

98

Painful lesions thought to be at risk of causing fractures can be treated in which ways?

  1. Bisphosphonates
  2. Radiotherapy (if radiosensitive)

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