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Pathology > Benign bone-cartilage tumours > Flashcards

Benign bone-cartilage tumours Flashcards

1
Q

Define primary bone tumour?

A

Neoplasm/new growth that originates in bone

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2
Q

Are primary bone tumours common compared to secondary bone tumours?

A

No, primary bone tumours are uncommon

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3
Q

Do primary bone tumours tend to affect all age groups?

A

No, tend to affect certain age groups and locations

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4
Q

What are the 2 ways in which bone tumours are classified?

A

What normal cell type they originate from

What matrix they produce

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5
Q

In which age range are benign tumours most likely to occur?

A

First 3 decades of life (0-30)

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6
Q

Are benign or malignant tumours more common in general?

A

Benign tumours are more common than malignant tumours in general

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7
Q

Are older adults more likely to be affected by benign or malignant tumours?

A

Malignant tumours

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8
Q

What normal cell type does osteoma arise from?

A

Osteoblast

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9
Q

What is the maturity of the bone that is predominantly affected by osteoma?

A

Predominantly affects mature bone

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10
Q

Which body region is typically affected by osteoma, and give 3 specific areas within this region?

A

Cranio-facial region, especially jaw bones, temporal bones and paranasal sinuses

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11
Q

Which syndrome is osteoma a feature of?

A

Gardner syndrome

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12
Q

What are the 2 defining features of Gardner syndrome, and what kind of inheritance causes it?

A

Gardener syndrome is an autosomal dominant disorder that is characterised by multiple colorectal polyps (eg. inside large bowel) and tumours outside the colon

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13
Q

Are tumours outside the colon always benign, in patients with Gardner syndrome?

A

No, they are different kinds of benign and malignant tumours

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14
Q

Define polyp?

A

Projecting growth of tissue from a body surface, usually mucous membrane

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15
Q

Which normal cell type gives rise to enchondroma, and which part of the bone does this arise from?

A

hyaline cartilage

arises within medullary cavity

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16
Q

Do enchondromas commonly become malignant?

A

No, rarely become malignant

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17
Q

What condition increases the risk of enchondromas becoming malignant tumours?

A

Enchondromatosis (multiple enchondromas)

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18
Q

Which 2 conditions is enchondromatosis a characteristic feature of?

A

Ollier disease, Mafucci syndrome

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19
Q

Which normal cell type gives rise to juxtacortical/periosteal chondroma, and which part of the bone does this arise from?

A

Hyaline cartilage

Arises from cortex

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20
Q

Which part of the bone typically has tumour growth on the cortex, which have arisen from hyaline cartilage, and what is the classification of this tumour?

A

Juxtacortical/periosteal chondroma

Tumours arise on cortex on metaphysis of long tubular bones (eg. humerus, femur) or small tubular bones (eg. phalanges in hands and feet)

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21
Q

What are the 3 x-ray features of juxtacortical/periostral chondroma?

A

Circumscribed (confined to one area) lucency with central irregular calcifications

Sclerotic rim

Intact cortex

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22
Q

What is the characteristic shape of osteochondroma?

A

Exostosis (cartilage-capped tumour)

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23
Q

Which region of the bone does osteochondroma typically grow from, and what structure grows to connect to this area?

A

Metaphysis of long tubular bones (near growth plate)

24
Q

Are bones affected by osteochondroma typically formed by endochondral or intramembranous ossification?

A

Endochondral ossification

25
Q

Is osteochondroma more likely in men or women?

A

3x more likely in men

26
Q

Is osteochondroma fast or slow growing?

A

Slow growing

27
Q

Give 2 ways in which osteochondroma becomes painful?

A

Infringes on nerve

Bony stalk is fractured

28
Q

In most patients, are osteochondromas solitary or multiple?

A

Solitary

29
Q

What age range is typically affected by solitary osteochondromas?

A

Late adolescence/early adulthood

30
Q

What condition is multiple osteochondromas a feature of?

A

multiple hereditary exostosis syndrome

31
Q

Why is multiple hereditary exostosis syndrome commonly diagnosed in childhood?

A

Underlying bone bowed and shortened due to disrupted longitudinal growth from growth plate which has resulted in multiple osteochondromas

32
Q

What is the difference between a sessile and pedunculated osteochondroma?

A

Osteochondromas with a visible stalk are called pedunculated.

Flatter ones with a broader base are called sessile

33
Q

What direction does pedunculated osteochondroma typically point in relative to the joint?

A

Points away from the joint

34
Q

Does the parent bone grow continuously with the pedunculated osteochondroma?

A

Yes, medullary cavity and cortex grow continuously

35
Q

How thick is the cartilage cap of an osteochondroma?

A

2-3mm thick

36
Q

What unusual radiological feature could be caused by a secondary pedunculated osteochondroma?

A

cartilage cap of lesion in excessively thick/irregular

37
Q

How does the bony stalk of the pedunculated osteochondroma grow continuously with the parent bone?

A

Lesion undergoes endochondral ossification and trabecular bone fuses with normal trabecular bone below

38
Q

Which bones are commonly affected by osteoid osteoma?

A

Osteoblast tumour that usually arise in cortex of long bones (mostly femur, tibia and lower extremities)

39
Q

What is usually the diameter of osteoid osteoma?

A

Less than 2 cm

40
Q

What is the usual age range of patients with osteoid osteoma, and are they more common in men or women?

A

Occurs in adults under 25 and is more common in men than women

41
Q

What is the characteristic radiological feature of osteoid osteoma?

A

Thick rim of reactive cortical bone with radiolucent core

42
Q

What is the characteristic macroscopic feature of osteoid osteoma?

A

Rounded, oval mass of red-brown tissue located on the cortex

43
Q

What is the characteristic microscopic feature of osteoid osteoma?

A

Radiolucent nidus containing trabecular bone, cancer cells and vascular tissue surrounded by sclerotic bony shell

44
Q

How intense is the pain caused by osteoid osteoma, and is it constant throughout the day?

A

Severe pain at night

45
Q

What substance is released by osteoblasts that causes pain, in a patient with osteoid osteoma, and what drug class is prescribed for pain relief?

A

Pain caused by prostaglandins released by osteoblasts

Relieved by NSAIDs

46
Q

What normal cell type does osteoblastoma originate from, and which body region is most commonly affected?

A

Osteoblast tumour

Predominantly affects posterior components of vertebrae, long bones of lower limbs

47
Q

Do osteoblastomas usually become malignant?

A

Rarely become malignant

48
Q

How can you differentiate between osteoid osteoma and osteoblastoma in terms of size?

A

Osteoid osteoma are less than 2cm in diameter

Osteoblastoma are more than 2cm in diameter

49
Q

What kind of pain does a patient with osteoblastoma usually present with?

A

Vertebral pain with no marked bony reaction

Isn’t relieved by aspirin

50
Q

Which 2 normal cell types give rise to Giant Cell Tumour of bone?

A

Multinucleated giant stromal cells (osteoclast precursors)

Osteoclasts

51
Q

Which part of the bone is typically affected by Giant Cell Tumour of bone, and give 2 specific examples of long bones?

A

Epiphysis of long bones

Distal femur, proximal tibia (any long bones near joint)

52
Q

Why does a patient with Giant Cell Tumour of bone present with arthritic symptoms?

A

Tumour is near joint

53
Q

Does Giant Cell Tumour of bone affect all ages equally?

A

No, almost exclusively in young adults

54
Q

Does Giant Cell Tumour of bone commonly metastasise to lungs, and is this always fatal?

A

4% metastasise to lungs, but these can spontaneously regress so are rarely fatal

55
Q

What is the characteristic radiological feature of Giant Cell Tumour of bone, and why does this occur?

A

Expansive lytic lesion with ‘soap bubble’ appearance

Neoplastic osteoclast precursors express high RANKL levels, so osteoclast proliferation and bone resorption occurs at fast rate, produces lytic lesions

56
Q

Explain how Giant Cell Tumour of bone is treated with cutterage?

A

Curette instrument is used to scrape the tumour out of the bone, then cavity is filled with a bone graft

40-60% treated tumours recur locally

Pathology (17 decks)

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