bone tumours Flashcards
(28 cards)
Classify bone tumours
Benign
Malignant
-Primary
-Secondary
What are the most common bone tumours in children, young adults and adults?
Most common bone tumours in children and young adults are primary benign bone tumours
Most common bone tumour in older adults are multiple myeloma and metastasis from other sites
Describe mets to bone
Carcinomas much more common than sarcomas –Carcinoma of the breast –Prostatic carcinoma –Bronchogenic carcinoma –Renal cell carcinoma Osteolytic –Direct erosion of bone –Stimulation of osteoclasts by cytokines (osteoclasts are macrophages) Osteosclerotic
Complications of met tumours of bone
Pain Pathologic fracture Replacement of the bone marrow Hypercalcaemia Nerve and spinal compression
Define myeloma
Primary malignant proliferation of plasma cells in the marrow
Solitary plasmacytoma or multiple myeloma
Outline general features of primary bone tumour
Primary benign tumours are more common in children and young adult
Primary malignant tumours are more common in older individuals
Accurate diagnosis depend on clinical, radiologic and pathologic examination of the lesion
Many tumours characteristically involve certain part of bone
What are the 3 types of primary bone tumours
Bone-producing tumours
Cartilage-producing tumours
Other types
Outline bone forming tumours
Benign –Osteoma –Osteoid-osteoma Locally aggressive –Osteoblastoma Malignant –Osteosarcoma
Define osteoma
site?
morphology?
Benign bone forming tumour
Often craniofacial in location
Probably hamartomatous or reactive growth and not true neoplasm
Gardner syndrome - multiple osteomas
Define osteoid osteoma
age of occurrence?
site?
morphology?
Benign bone forming tumour Young age (second decade) Male: female = 3:1 Painful due to presence of high intra-lesional prostaglandin levels Pain relived by aspirin
nidus producing blood vessels surrounded by bone which produces prostaglandin
Features and tx of osteoid osteoma
Small size (<2cm)
Cortex of femur or tibia
Nidus consists of vascular spaces surrounded by sclerotic bone
Therapy - complete resection of nidus
Define osteoblastoma age of occurrence? site? morphology? tx?
Benign bone forming tumour –Can be locally aggressive (local recurrence) Young age Most common location- vertebral column > 2 cm Minimal or no sclerotic reaction Pain not relived by aspirin Therapy- curettage/resection
Define osteosarcoma
age of occurrence?
site?
morphology?
Malignant bone forming tumour
Bimodal age distribution
–Young - <20 years
–Second peak in elderly
End of long bones (classically around the knee)
Most arise in the metaphysis of a long bone
these tumors are composed of malignant mesenchymal cells that produce osteoid, often in an irregular, lace-like pattern
Pathogenesis of osteosarcoma
Pathogenesis: Sporadic Genetic (deletions and mutations in cell cycle regulators including Rb, p16 and p53) Secondary osteosarcoma –Radiation –Paget’s disease
Clinical features of osteosarcoma
Tenderness and/or pain of the affected region with or without a palpable mass
Fracture
Distant metastasis (lung
Spread of osteosarcoma
Within the medullary cavity
Through the periosteum
Across epiphyseal plate
Haematogenous
What are morphological features of osteosarcoma?
Codman’s triangle-lesion lifts periosteum
Sunray speculation-osteoid perpendicular to bone
Tx, prognosis of osteosarcoma
Patients are usually treated with pre-operative chemotherapy and surgical resection
Poor prognosis- metastasis occur early in the course
The current disease-free-five-year survival rate is about 60%
List cartilage producing tumours
Benign –Osteochondroma –Enchondroma –Chondroblastoma –Chondromyxoid fibroma Malignant –Chondrosarcoma
Define osteochondroma
age of occurrence?
site?
morphology?
Age < 20 years
Multiple (osteochondromatosis-hereditary) or single (sporadic)
Mushroom-shaped bony projections from the lateral aspects of long bones
Arise from metaphysis
Chondrosarcomas can occasionally arise in osteochondromas; incidence is higher in osteochondromatosis
Define enchondroma
age of occurrence?
site?
morphology?
Benign tumours of cartilage
-Any age (20 - 50 years)
Small bones of hands and feet
Arise from metaphysis
Single or multiple sites
-Ollier’s disease (usually one side of the body)
-Maffucci’s syndrome – (haemangiomas of soft tissue)
-Increased risk for chondrosarcoma
Well-circumscribed mature hyaline cartilage
Define chondrosarcoma
age of occurrence?
site?
morphology?
Malignant tumour of cartilage
Second most common malignant tumour of bone
–Half as frequent as osteosarcoma
De novo or from a previous benign tumour
Middle age > 40
Axial skeleton (bones of pelvis and shoulder girdles, ribs and spine)
Morphologically, these tumours are composed of lobules of cartilage with chondrocytes in the lacunae and with focal ossification and calcification
Spread, tx, prognosis of chondrosarcoma
These tumors can be quite aggressive and can erode through cortical bone to involve the soft tissues
Can metastasise to lungs, liver, kidney and brain
Chondrosarcomas are not sensitive to chemotherapeutic agents, and treatment is usually restricted to surgical resection
Poor prognosis (5 year survival rate 40%)
Name a tumor that derives from EPIPHYSEAL of bone
osteoclastoma- giant cell tumor
