Bone Tumours

Question 0

What disease are osteomas associated with?

Answer 0

Gardner syndrome =

Familial adenomatous polyposis

Fibromatosis @ peritoneum = non-neoplastic proliferation of fibroblasts that destroys tissue

Osteoma of facial bones

Question 1

Is in osteoma benign?

Where do you find osteomas?

Answer 1

Benign bone tumour

@Surface of facial bones

Question 2

What is in osteoid osteoma

Answer 2

Benign tumour of osteoblasts

The tumour produces osteoid – >
get rim of sclerotic reactive bone around it

Question 3

Epidemiology of osteoid osteoma?

Answer 3

Young adults <25 years

Question 4

What type of bone does osteoid osteoma effect?

Where specifically on the bone does osteoid osteoma occur?

Answer 4

Long bone cortex

Diaphyses

Question 5

What does osteoid osteoma bone pain resolved with?

Answer 5

Aspirin

Question 6

How does osteoid osteoma present on imaging?

Answer 6

Radiolucent core = osteoid
+
Bony mass = osteoma

Question 7

Give three differences between osteoblastoma and osteoid osteoma

Answer 7

Osteoblastoma:
>2 cm
@Vertebrae
Bone pain = not respond to aspirin

Osteoid osteoma:
<2 cm
@Cortex of deficits of long bones
Bone pain respond to aspirin

Question 8

What is the most common benign bone tumour?

Answer 8

Osteochondroma

Question 9

What is an osteochondroma

Answer 9

Benign bone tumour with overlying cartilage

Question 10

Where does the osteochondroma arise from?

Answer 10

Arises from lateral projection of growth plate

Question 11

What is the bone continuous with in osteochondroma?

Answer 11

Marrow space

Question 12

What is an osteosarcoma

Answer 12

Malignant tumour of bone

specifically malignant proliferation of osteoblasts

Question 13

Incidence of osteosarcoma

Answer 13

@Teens >elderly

Question 14

What are the four risk factors for osteosarcoma

Answer 14

Familia retinoblastoma = hence @ teenagers

Radiation +
Pagett disease of bone

Li-Fraumeni syndrome – P 53 germline mutations

Question 15

Explain how a patient with osteosarcoma would present

Answer 15

Pathologic fracture: tumour weaken bone – >fracture
+
Bone pain + swelling

Question 16

Explain where on the body does osteosarcoma usually occur?

Answer 16

Distal femur + proximal tibia = KNEE

Question 17

What does x-ray reveal for osteosarcoma

Answer 17

Osteoma grows+expands bone= codman triangle –>

drag periosteoma of bone into adjacent software – >

sunburst appearance

Question 18

What comprises a giant cell tumour?

Answer 18

Multinucleated giant cells
+
Stromal cells

Question 19

Where does it giant cell tumour occur on the bone?

Answer 19

Epiphysis of long bones – the only epiphyseal tumour

Knee = distal femur/proximal tibia

Question 20

What does x-ray reveal for giant cell tumour

Answer 20

Soap bubble

Tumour – > reactive bone in response to tumour – > soap bubbles @ epiphysis

Question 21

What does biopsy of osteosarcoma reveal?

Answer 21

Pleomorphic cells that make osteoid

Question 22

Where exactly on the bone does Ewings sarcoma okay?

What type of bone? Who does it affect?

Answer 22

At diathesis inside medullary cavity

Long bones

Male kids < 15 years

Question 23

What is Ewing sarcoma

Answer 23

Malignant proliferation of poorly differentiated cells derived from neuroectoderm

Question 24

Explain how Ewing sarcoma grows?

Answer 24

Grow inside medullary cavity – > Push on bone surface – > layering of new bone by periosteum= Onionskin appearance @ x-ray

Question 25

What would biopsy and histology reveals for Ewing sarcoma

Answer 25

Small round blue ANAplastic cells

Question 26

At histology what can Ewing sarcoma be confused with

Answer 26

Lymphoma + chronic osteomyelitis Osteomyelitis also presents with fever and bone swelling so can be confused with Ewing sarcoma too

Question 27

How do you distinguish lymphoma +osteomyelitis from Ewing sarcoma

Answer 27

11:22 translocation causing fusion protein EWS – FLI 1

Question 28

How aggressive it is Ewing sarcoma? | How do you treat it?

Answer 28

Chemo

Question 29

Two types of cartilage tumours? | Where do they arise in the bone?

Answer 29

Chondroma – benign = @small bones of hands + feet Chondrosarcoma – malignant = @Centrally occurring – pelvis + central skeleton in the medulla

Question 30

Which bone tumours are more common metastatic or primary?

Answer 30

Metastatic > primary

Question 31

How do metastatic bone tumours present?

Answer 31

Osteolytic/punched out lesions of the bone

Question 32

Give an exception for a metastatic tumour related to bone that isn't punched out?

Answer 32

Prostate cancer – osteoblastic lesion No punched out circular space Activation of osteoblast – > lays down bone next to -> get sclerosis

Question 33

What is a Lipoma?

Answer 33

Benign tumour of adipose tissue

Question 34

What is the most common benign soft tumour tissue in adults

Answer 34

Lipoma

Question 35

At histology we see LIPOblasts. what is the diagnosis?

Answer 35

Liposarcomas – malignant tumour of adipose tissue

Question 36

What is the most common malignant soft tissue tumour in adults

Answer 36

Liposarcomas

Question 37

What is the rhabdomyoma? | What is the cardiac rhabdomyoma associated with?

Answer 37

Benign tumour of skeletal muscle Associated with tuberous sclerosis and St heart and tongue

Question 38

What is the most common malignant soft tumour @kids

Answer 38

Rhabdomyosarcoma - malignant tumour of skeletal muscle

Question 39

What is the characteristic cell for rhabdomyosarcoma

Answer 39

The rhabdomyoblast = desmin positive

Question 40

Where does rhabdomyosarcoma okay?

Answer 40

@Head + neck @ a young girl – five years = vagina

Question 41

A young girl presents with a grape-like mass protruding from the vagina. Biopsy = rhabdomyoblast is Desmin positive with striation within the cells.

Answer 41

sarcoma praeities – Embryonal rhabdomyosarcoma

Question 42

What is the fibrosarcoma and where is it

Answer 42

Arise after irradiation Thigh upper limb

Question 43

What is a dermatofibromas

Answer 43

But 99 in capsulated proliferation of spindle cells confined to dermis Read nodule that umbilicate (i.e. has a central dimple) when squeezed

Question 44

What is a malignant fibrous histiocytoma and where is it

Answer 44

Radiation therapy + scarring Retroperitoneum thigh

Question 45

What is a leiomyoma and leiomyosarcoma where does it occur

Answer 45

Uterus + GI tract for both

Question 46

What is a synovial sarcoma and where does it occur

Answer 46

Doesn't arise from Synovial cells in joints Arise from mesenchymal cells around joints Has biphasic pattern: epithelial cells forming glands + intervening spindle cells