Bone Tumours

Question 1

What is the commonest primary bone tumour in children and adolescents

Answer 1

Osteosarcoma

Question 2

Peak age incidence of osteosarcoma

Answer 2

10-20yrs

Question 3

Pathology of osteosarcoma

Answer 3

primary osseous malignant neoplasm composed of mesenchymal cells producing malignant osteoid and immature bone

Question 4

Secondary causes of osteosarcoma

Answer 4

Rare complication of Pagets disease

Irradation

Question 5

Clinical features of osteosarcoma

Answer 5

Pain worse at night (dull boring ache)
Mass/swelling
Joint effusion

Children/Adolescents

Question 6

Is pain related to exercise in osteosarcoma

Answer 6

No

Question 7

Which gender is osteosarcoma more common in

Answer 7

Males

Question 8

Where majority of osteosarcoma appear

Answer 8

Knee (proximal tibia, distal femur)

Question 9

Ix for osteosarcoma

Answer 9

X-ray
HRCT 
MRI 
CT 
Bone scan 
Surgical biopsy

Question 10

Which characteristic sign can be seen on x-ray in Osteosarcoma

Answer 10

Codmans Triangle

Question 11

Rx for Osteosarcoma

Answer 11

Complete radial surgical resection:
Amputation

Neoadjuvant chemotherapy
Radiotherapy

Question 12

Which gender is Ewing Sarcoma more common in

Answer 12

Males

Question 13

Which age is Ewing Sarcoma most prevalent in

Answer 13

Teenagers

Young adults

Question 14

Pathology of Ewing Sarcoma

Answer 14

Malignant round, blue cell tumour

Question 15

Pathological features of Ewing Sarcoma

Answer 15

Small 
Round 
Blue cell tumour 
Monomorphic tumour cells 
Granular chromatin 
Necrosis

Question 16

What type of reaction can be seen at the periosteum in Ewing Sarcoma

Answer 16

Periosteal onion skin reaction

Question 17

Which chromosomal translocation is associated with Ewing Sarcoma

Answer 17

T11:T22

Question 18

Which bones does Ewing Sarcoma typically affect

Answer 18

Pelvis 
Femur 
Tibia 
Ribs 
Spine

Question 19

Clinical features of Ewing Sarcoma

Answer 19

Night bone pain

Swelling tenderness over area

Question 20

Ix for Ewing Sarcoma

Answer 20

X-ray 
Bone scan 
PET 
MRI 
Biopsy: histological Dx 
CT chest/abdo/pelvis

Question 21

Typical x-ray feature of Ewing Sarcoma

Answer 21

Periosteal onion skin reaction

Bone destruction

Question 22

Does Ewing Sarcoma spread rapidly or slowly

Answer 22

Rapidly

Question 23

Rx for Ewing Sarcoma

Answer 23

Chemotherapy 
Radiotherapy 
Surgery: 
Resection 
amputation

Question 24

What is the key adverse prognostic factor at Dx for Ewing Sarcoma

Answer 24

Metastatic disease

Question 25

Is the bone a common metastatic sight

Answer 25

Yes | 3rd most common

Question 26

Common primary sites for bone metastases

Answer 26

``` Prostate Thyroid Lung Kidney Breast GIT Melanoma ```

Question 27

Clinical features of metastatic bone tumours

Answer 27

Bone pain worse at night Progressive bone pain Fracture Swelling

Question 28

Staging IX for metastatic bone disease

Answer 28

``` Bone scan X-ray CT MRI PET Biopsy ```

Question 29

Is secondary or primary bone neoplasms more common

Answer 29

Secondary far more common | Primary bone neoplasms are actually quite rare

Question 30

What is the commonest benign bone tumour

Answer 30

Osteochondroma

Question 31

What are the two types of osteochondroma

Answer 31

1. Solitary Osteocartilaginous Exotosis | 2. Hereditary Multiple Exotoses/Osteochondroma

Question 32

Describe solitary osteocartilaginous exotosis

Answer 32

When there is 1 tumour

Question 33

Describe Hereditary Multiple Exotoses/Osteochondroma

Answer 33

Development of multiple osteochondromas | Variability in size, number and location

Question 34

Which genes are associated with Hereditary Multiple Exotoses/Osteochondroma

Answer 34

EXT1 and EXT2

Question 35

What type of inheritance is Hereditary Multiple Exotoses/Osteochondroma

Answer 35

Autosomal Dominant

Question 36

Clinical features of osteochondroma

Answer 36

Hard painless mass

Question 37

Do osteochondromas affect life expectancy

Answer 37

no as benign lesions

Question 38

Rx for osteochondromas

Answer 38

Often do nothing | Surgery: excision if symptomatic

Question 39

Do osteochondromas have the capability of malignant transformation

Answer 39

Yes but this is very rare

Question 40

Which has a higher malignant transformation rate? 1. Solitary Osteocartilaginous Exotosis OR 2. Hereditary Multiple Exotoses/Osteochondroma

Answer 40

Hereditary/multiple | Much higher ratw

Question 41

What is an osteoid osteoma

Answer 41

Benign bone lesion

Question 42

Clinical features of osteoid osteoma

Answer 42

Dull pain that worsens at night Limping Swelling

Question 43

Common sites for osteoid osteoma

Answer 43

Long bones | E.g femur or tibia

Question 44

Which gender is more affected with osteoid osteoma

Answer 44

Male

Question 45

Common age for osteoid osteoma

Answer 45

10-25yrs

Question 46

Why do osteoid osteomas cause pain

Answer 46

Because the nidus produces prostaglandins causing pain

Question 47

X-ray features of osteoid osteoma

Answer 47

Long cortical scleoris Central radiolucent nidus Within nidus small nucleus calcification

Question 48

Ix for Osteoid Osteoma

Answer 48

X-ray | CT: better for detection

Question 49

Rx for osteoid osteoma

Answer 49

Analgesia (NSAIDs) | CT Guided radiofrequency ablation

Question 50

What is the treatment problem with chondrosarcomas

Answer 50

They are relatively insensitive to radiotherapy and chemotherapy

Question 51

What is a chondrosarcoma

Answer 51

Malignant tumour of cartilage

Question 52

Which age is chondrosarcoma common in

Answer 52

Middle aged

Question 53

Rx for chondrosarcoma

Answer 53

Surgery (with margin)

Question 54

Definitive Dx for bone tumours

Answer 54

Biopsy