Flashcards in Bone tumours Deck (28):
What should all bone tumours be assumed to be?
What periosteal reaction on XR suggests malignancy?
Rapid growth, warmth, tenderness and ill defined edges suggest malignancy- hazy and diffuse borders on XR.
What investigations should be used in those with a tumour in the bone?
○ FBC - myeloid and infection
○ LFTs- ALP indicator of bone damage and may also have metastasized to the liver
○ Thyroid function test - could be thyroid ca
○ U&Es- looking for increased Ca and Phosphate as well as kidney damage
○ Myeloma screening -Bence Jones proteins
○ PSA in men
What is an osteosarcoma? What condition is it associated with?
- Malignancy of osteoblasts
- More common in adolescents with paget's disease due to rapid bone recycling
How do osteosarcoma present?
- Presents with pain and swelling over affected bone and may be loss of weight bearing in LL.
- Pain is constant and gets worse with progression
- Usually metaphyseal tumours of long bones
What are found on XR in osteosarcoma?
- Wide or absent margins
- Periosteal reaction - sunburst and Codman’s triangle.
- Cortex breached and often into surrounding tissue
What is the treatment of osteosarcoma?
- Bone resection
What is ewing sarcoma?
- Cancer caused by malignancy of neural tube cells - primitive neuroectodermal cells
- More common in 10-20y/o
What are the symptoms of Ewing Sarcoma?
- Symptoms - more common presenting with back problems and may mimic osteomyelitis – warm painful enlarging lump
What are the XR finding of Ewing sarcoma?
- Osteolytic lesions and some sclerotic - mixed
- Periosteal reaction with lamellated bone growth – onion skin periosteal reaction
What is the treatment of Ewing sarcoma?
- Surgical removal - best outcome
- chemo/radio therapy
What is a chondrosarcoma?
- Malignancy of the cartilage
- More likely to occur in middle to old age
- More common in proximal bones - pelvis, femur, humerus and ribs
- Present with a dull ache
What is a chondrosarcoma Xr finding?
- Invasion and soft tissue extension
- Lytic lesion with fluffy popcorn calcification
What is multiple myeloma?
B cell lymphoproliferative disorder of the marrow with plasma cells predominating- effects bone due to marrow cell proliferation and increased osteoclastic activity leading to lytic lesions.
- Plasmacytoma - solitary tumour in one bone.
What is a non ossifying fibroma?
Commonest benign lesion of bone - developmental defect
Asymptomatic and almost always encountered in children as an accidental finding
What are the XR findings of non ossifying fibroma?
XR - oval radiolucent area in or adjacent to the cortex- appears cystic but is a solid lesion of fibrous tissue.
What is the management of non ossifying fibroma?
Heal spontaneously and don't need treatment unless cause of pathological #.
What is fibrous dysplasia?
Developmental disorder in which areas of trabecular bone are replaced by fibrous tissue, osteoid and woven bone
May affect one bone, one limb or lots of bones
Those with many lesions can experience a change to fibrosarcoma
What are the XR findings of fibrous dysplasia?
cystic areas in metaphysis or shaft have hazy appearance. Weight bearing bones may be bent.
What is an osteoid osteoma?
Benign tumour of osteoid and newly formed bone.
Small and usually encased in dense bone
Seen in pts over 30y/o- femur or tibia
What are the osteoid osteoma XR findings?
tiny radiolucent area which in the diaphysis are surrounded by dense bone and thickened cortex but in metaphysis show less cortical thickening
What is a chondroma?
Islands of cartilage may persist in metaphysis of bone- sometimes they grow and take on characteristics of benign tumour.
CF- often asymptomatic - seen in all ages.
What are the indications of surgery or treatment in a chondroma?
only if painful,enlarging or caused pathological #- removed by curettage and then filled by bone graft
What are osteochrondromas?
Developmental lesion which starts as a small overgrowth of cartilage at the end of physeal plate and develops by endochondral ossification into bony tuberance covered by cartilage
What is a bony cyst?
True solitary or unicameral bone cyst - occurs in children in metaphysis of the long bones and tends to heal spontaneously
What is the management of bony cysts?
avoid activities that might lead to fracture and active cysts should be aspirated and injected with steriod
What is an aneurysmal bone cyst?
Cystic tumour which occurs in the spine and metaphysis of long bones in young adults.
May expand and cause thinning of the cortex