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Flashcards in CORTEX pathology Deck (123):
1

List the possible causes of a benign bone tumour

Neoplastic
Developmental
Traumatic
Infectious
Inflammatory

2

Which is more common primary bone cancer or metastatic disease?

Metastatic disease by far

3

What is the most common benign bone tumour? Describe this tumour

Osteochondroma
Bone outgrowth with cartilaginous cap

4

How do osteochrondromas present?

Asymptomatic
Local pain

5

Osteochondromas, while benign, carry a high malignant transformation risk. T/F

False - risk of malignant transformation low

6

When might multiple osteochondromas occur?

Autosomal dominant hereditary disorder

7

Describe an enchondroma. Why do they occur?

Intramedullary, metaphyseal cartilaginous tumour
Failure of normal endochondral ossification

8

How do enchondromas appear radiologically?

Lucent radiologically +/- sclerotic areas

9

How do enchondromas present?

Asymptomatic
Pathological fractures

10

Which bones do enchondromas occur within?

Femur
Humerus
Tibia
Hand & feet (phalynx)

11

How can enchondromas be treated?

Curattege of lesion
Filling with bone graft

12

What are simple bone cysts sometimes called?

Unicameral bone cysts

13

Describe a simple bone cyst. What causes them?

Single cavity fluid filled cyst in bone (metaphysis in long bones)
Defect in the physis

14

Which bones do simple bone cysts occur within?

Long bones (femur, humerus)
Talus
Calcanus

15

How do simple bone cysts present?

Asymptomatic
Pathological fracture

16

How can simple bone cysts be treated?

Curattege of lesion
Filling with bone graft
+/- stabilisation

17

Which age group is usually diagnosed with simple bone cysts? How are they diagnosed?

Young adults/children
Incidentally on x-ray

18

Describe an aneurysmal bone cyst

Multichambered cyst filled with blood or serum occuring in metaphyses

19

What causes aneurysmal bone cysts?

Arteriovenous malformation

20

Which bones do aneurysmal bone cysts usually occur within?

Long bones
Flat bones (skull, ribs)
Vertebral bodies

21

How do aneurysmal bone cysts present?

Locally aggressive --> pain
Pathological fracture

22

How are aneurysmal bone cysts treated?

Curettege
Filling with bone graft

23

Describe a giant cell tumour of the bone

Radiolucent lesion affecting metaphyseal, epiphyseal or even subchondral bone near joints

24

Which bones do giant cell tumours usually occur within?

Knee
Distal radius

Long bones
Pelvis
Spine

25

How do giant cell tumours characteristically appear on x-ray?

Soap bubble appearance

26

How do giant cell tumours present?

Locally destructive --> pain
Pathological fracture
Metastases to lung (benign GCT)

27

How are giant cell tumours treated?

Intralesional excision + phenol/bone cement/liquid nitrogen to destroy residual tumour (& prevent reoccurrence)
Joint replacement in aggressive lesions

28

In which age group does fibrous dysplasia occur?

Adolescents

29

Why does fibrous dysplasia occur?

Genetic mutation causing lesions of fibrous tissue & immature bone

30

Does fibrous dysplasia affect one bone or many?

Either - monostotic or polystotic

31

How do bones affected by fibrous dysplasia appear?

Angular deformities
Wide bone with thin cortices

32

How does fibrous dysplasia present?

Pain
Stress fractures

33

What type of deformity can occur in fibrous dysplasia and what bone does this involved?

Proximal femur - shepherd's crook

34

Describe the typical bone scan result in fibrous dysplasia

Increased uptake during development followed by inactivity

35

How can fibrous dysplasia be managed?

Biphosphonates (pain reduction)
Fixation of stress fractures
Cortical bone grafts (improves strength)

36

Why is intralesional excision NOT used in fibrous dysplasia?

Reoccurrence rate high

37

How does an osteoid osteoma present?

Small nidus of immature bone surrounded by sclerotic halo

38

Which age group gets osteoid osteomas?

Adolescents

39

Which bones do osteoid osteomas commonly occur within?

Proximal femur
Diaphysis of long bones
Vertebrae

40

How do osteoid osteomas present?

Intense constant pain
Night pain (inflammatory response)
Pain relieved by NSAIDs

41

How are osteoid osteomas investigated?

X-ray (not diagnostic)
Bone scan
CT

42

How are osteoid osteomas managed?

Self resolving
CT guided radiofrequency ablation
En bloc excision

43

What is a brodie's abscess?

Subacute osteomyelitis which shows up as lytic bone lesion

44

What is a brown tumour?

Lytic bone lesion associated with hyperparathyroidism

45

How do bony metastases present?

Intense constant pain
Worse at night
Systemic symptoms (weight loss, anaemia, loss of apetite)

46

In which age groups would unexplained bone pain be most concerning?

>60

47

Are bony swellings a cause for concern?

When paired with red flags or constant bony pain

48

How do cancer affecting the bone appear on x-ray?

Cortical destruction
Periosteal retraction (raised & producing new bone)
Sclerosis
Lysis
Extension into soft tissues

49

What is the most common form of primary bone cancer?

Osteosarcoma

50

Who gets osteosarcoma?

Young adults

51

Which bones does osteosarcoma most commonly affect

Knee

Proximal humerus
Proximal femus
Pelvis

52

How does osteosarcoma typically spread?

Haematogenous (can spread lymphatically but less common)

53

Where does osteosarcoma commonly metastasis to?

Lungs

54

Osteosarcomas are sensitive to which treatment?

Excision
Chemotherapy (as adjuvant - not curative)

NOT radiotherapy

55

What is chondrosarcoma?

Cartilage producing primary bone tumour

56

Which age group commonly gets chondrosarcoma?

Adults (median age 45)

57

Chondrosarcomas are typically small and fast spreading. T/F

False - large and slow spreading

58

Where are chondrosarcomas most commonly found?

Pelvis
Proximal femur

59

How are chondrosarcomas treated?

NOT radio OR chemotherapy
Excision

60

Which two fibrous primary bone tumours tend to occur in pathological bone? List conditions associated with pathological bones

Fibrosarcoma
Malignant fibrous histiocytoma

Paget's
Fibrous dysplasia
Post irradiation
Bone infarct

61

Which age group is affected by fibrosarcoma?

Adolescents and young adults

62

What is Ewing's sarcoma? How common is it? What is it's prognosis?

Malignant tumour of primitive cells in bone marrow
Second most common
Really shitty

63

Which age group tends to get Ewing's sarcoma?

10-20 y/o

64

How does ewing's sarcoma present? What is it commonly misdiagnosed as?

Bone pain
Fever
Raised inflammatory markers
Warm swelling

Osteomyelitis

65

How is ewing's sarcoma treated?

Excision
Radio and chemotherapy

66

How are primary bone tumours staged?

Bone scan
CT chest
MRI/CT (local spread)
Biopsy

67

What is lymphoma?

Cancer of round cells/macrophages

68

How does lymphoma affect the bone? Which bones does it tend to affect?

Primary bone tumour (non-hodkins)
Metastatic

Pelvis
Femur

69

How is lymphoma of the bone treated?

Excision
Chemo/radiotherapy for metastatic

70

What is myeloma?

Malignant B cell proliferation & antibody production

71

What are the two forms of myeloma? How do they differ?

Plasmacytoma - solitary lesion
Multiple myeloma - multiple osteolytic lesions

72

Which age group is typically affected by myeloma?

45-65

73

How does multiple myeloma present?

Weakness
Back pain
Bone pain
Fatigue
Weight loss
Marrow suppression (anaemia & recurrent infection)
Pathological fracture

74

How is multiple myeloma diagnosed?

Plasma protein electrophoresis (high paraprotein)
Early morning urine collection (Bence Jones proteins - overflow proteinuria)

75

Metastases are not always detected on bone scan of multiple myeloma. Why? How is this overcome?

Normal osteoblastic response to bone lysis is not present
Skeletal survey

76

How is myeloma treated?

Plasmacytoma - radiotherapy
Multiple myeloma - chemotherapy

77

Which cancers commonly metastases to bone? State whether they are lytic or sclerotis

Breast - either
Prostate - sclerotic
Lung - lytic
Renal cell - lytic
Thyroid adenocarcinoma

78

How are renal cell bony mets different from other mets?

Large and vascular - can bleed profusely on biopsy/surgery

79

Which bones are frequently metastasised?

Vertebrae
Pelvis
Ribs
Skull
Humerus
Long bones of lower limb

80

Bone pain with any red flag symptom should be investigated how?

X-ray

81

How should bony lesions be investigated?

Bone scan (occasionally MRI)
Blood tests (serum calcium - raised ; LFTs - mets ; plasma protein electrophoresis - myeloma ; FBC ; U&E)

82

Skeletal stabilisation and/or joint replacement is often indicated for pre-emptive treatment of pathological fractures. T/F

True - if high risk

83

When might soft tissue swellings be diffuse?

Synovitis (around joint)
Oedema

84

When might soft tissue swellings be local?

Bursitis
Rheumatoid nodules
Abscess
Cystic lesions (ganglion, meniscal, baker's)
Benign or malignant neoplasm

85

What should be looked for on examination of soft tissue swellings?

Site(s)
Size
Border
Consistency
Surface
Mobility
Temperature (infection)
Transilluminable
Pulsatility
Skin changes
Lymphadenopathy

86

Which features suggest benign soft tissue swelling?

Small
Fluctuation in size
Cystic lesions
Well defined
Fluid filled
Soft/fatty

87

Which features suggest malignant soft tissue swelling?

Large (>5cm)
Rapid growth
Solid
Ill defined
Irregular
Lymphadenopathy
Systemic symptoms

88

How may soft tissue swellings be investigated?

MRI
USS (if suspected cystic)
Biopsy

ONLY if cause unknown with unclear clinical picture

89

What is the commonest benign soft tissue swelling? What is this?

Lipoma
Neoplasm of fat tissue

90

Where do lipomas occur?

Subcutaneous fat
Rarely within muscle

91

What is a giant cell tumour of the tendon sheath? How does it present?

Exactly what it says on the tin
Swelling found on flexor tendon sheath of finger
Painful
+/- bone erosion

92

How are giant cell tumours of the tendon sheath treated?

Excision has high reoccurrence rate
Not malignant so leave them alone

93

What are giant cell tumours of the tendon sheath known as when they involve a synovial joint? How do they present?

Pigmented Villonodular Synovitis
Pain +/- effusion in knee

94

Malignant tumours arising from the connective tissues are called what?

Sarcomas

95

Which age group most commonly gets sarcomas?

50-70 but can occur at any age

96

What is a ganglion cyst? Where are they most commonly found?

Herniation of weak portion of joint capsule/tendon sheath occuring around synovial joints
Wrist

97

What causes ganglions?

Congenital weakness (juvenile Baker's cyst)
Underlying joint damage (arthritis --> adult Baker's cyst, mucous cyst of DIP, wrist ganglion)

98

Describe a ganglion

Well circumscribed
Transilluminate
Firm

99

Are ganglions excised?

It can be done but will reoccur so try to avoid this

100

What is buristis?

Inflammation of bursa

101

What is a bursa?

Small fluid filled sac lined with synovium preventing friction at a joint

102

What are the common areas for bursitis? Why does it occur?

Pre-patellar
Olecranon
Bunion (medial 1st metatarsal head)

Repeated pressure/trauma
Bacterial infection (abscess)
Gout

103

How are sebaceous cysts managed?

Excision +/- biopsy

104

What are the causes of abscesses on a limb? How are the managed?

Cellulitis
Bursitis
Penetrating wound
Infected sebaceous cyst

Must incise and drain pus

105

What is the end result of osteochondritis and AVN? Why does this occur?

Necrosis
Disrupted blood supply to the area --> ischaemia

106

Who gets osteochondritis? Why?

Young adults & children
Physical activity with repeated stress
Familial
Coagulopathy

107

How might repeated impaction or traction injuries cause osteochondritis?

Bleeding and oedema within bone -->
Capillary compression -->
Reduced blood supply -->
Necrosis

108

What is the result of necrosis in osteochondritis?

Compression/fragmentation/separation of bone +/- overlying cartilage -->
Irregular joint surface -->
Osteoarthritis at a young age

109

What are the common sites of compression osteochondritis?

Second metatarsal head (Freiburg's)
Navicular bone (Kohler's)
Lunate (Kienbock's)
Capitellum (Panners)
Vertebral (Scheuermann's disease)

110

What is traction osteochondritis and at which sites does it commonly occur?

Osteochondritis occuring at apophysis

Tibial tubercule (Osgood Schlatters)
Calcaneus (Sever's disease)

111

Define osteochondritis dissecans. Where does it commonly occur?

Fragmentation with separation of bone and cartilage within a joint

Lateral part of medial femoral condyle of knee
Anteriomedial talar done
Superomedial femoral head
Humeral capitulum

112

How does osteochondritis dissecans present?

Pain
Locking
Effusions
Giving way of joints

113

How is traction osteochondritis treated?

Settles with test

114

How can osteochondritis and osteochondritis dissecans be treated respectively?

Osteotomy (joint damage)
Pinning of fragments +/- excision of detached parts

115

What is avascular necrosis (AVN) and in which age group does it occur?

Ischaemic necrosis of bone
Adults

116

Which sites are prone to AVN?

Femoral head
Femoral condyles
Head of humerus
Capitulum
Proximal pole of scaphoid
Proximal part of talus

117

Which pathologies can AVN be secondary to?

Femoral neck fracture
Proximal humerus fracture
Waist of scaphoid fracture
Talar neck fracture

118

Is AVN ever idiopathic?

Yep

119

How can alcoholism, primary hyperlipidaemia and steroids cause AVN?

Mobilise fats into circulations where they get lodged in small vessels & increased fat content of bone can compress venous outflow

120

Which causes of increased coagulation are linked to AVN?

Thrombophilia
Sickle cell disease
Antiphospholipid deficiency in SLE

121

What is a rare cause of AVN?

Decompression sickness after deep sea diving (due to nitrogen bubbles)

122

How does AVN progress?

Necrosis -->
Patchy sclerosis -->
Subchondral collapse -->
Irregularity of articular surface -->
Secondary OA

123

How is AVN managed?

If not yet collapsed and in amenable site (e.g femoral head) drilling under fluroscopy can relieve pressure
Joint replacement or fusion if collapse

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