CORTEX pathology Flashcards
1
Q
List the possible causes of a benign bone tumour
A
Neoplastic Developmental Traumatic Infectious Inflammatory
2
Q
Which is more common primary bone cancer or metastatic disease?
A
Metastatic disease by far
3
Q
What is the most common benign bone tumour? Describe this tumour
A
Osteochondroma
Bone outgrowth with cartilaginous cap
4
Q
How do osteochrondromas present?
A
Asymptomatic
Local pain
5
Q
Osteochondromas, while benign, carry a high malignant transformation risk. T/F
A
False - risk of malignant transformation low
6
Q
When might multiple osteochondromas occur?
A
Autosomal dominant hereditary disorder
7
Q
Describe an enchondroma. Why do they occur?
A
Intramedullary, metaphyseal cartilaginous tumour
Failure of normal endochondral ossification
8
Q
How do enchondromas appear radiologically?
A
Lucent radiologically +/- sclerotic areas
9
Q
How do enchondromas present?
A
Asymptomatic
Pathological fractures
10
Q
Which bones do enchondromas occur within?
A
Femur
Humerus
Tibia
Hand & feet (phalynx)
11
Q
How can enchondromas be treated?
A
Curattege of lesion
Filling with bone graft
12
Q
What are simple bone cysts sometimes called?
A
Unicameral bone cysts
13
Q
Describe a simple bone cyst. What causes them?
A
Single cavity fluid filled cyst in bone (metaphysis in long bones)
Defect in the physis
14
Q
Which bones do simple bone cysts occur within?
A
Long bones (femur, humerus)
Talus
Calcanus
15
Q
How do simple bone cysts present?
A
Asymptomatic
Pathological fracture
16
Q
How can simple bone cysts be treated?
A
Curattege of lesion
Filling with bone graft
+/- stabilisation
17
Q
Which age group is usually diagnosed with simple bone cysts? How are they diagnosed?
A
Young adults/children
Incidentally on x-ray
18
Q
Describe an aneurysmal bone cyst
A
Multichambered cyst filled with blood or serum occuring in metaphyses
19
Q
What causes aneurysmal bone cysts?
A
Arteriovenous malformation
20
Q
Which bones do aneurysmal bone cysts usually occur within?
A
Long bones
Flat bones (skull, ribs)
Vertebral bodies
21
Q
How do aneurysmal bone cysts present?
A
Locally aggressive –> pain
Pathological fracture
22
Q
How are aneurysmal bone cysts treated?
A
Curettege
Filling with bone graft
23
Q
Describe a giant cell tumour of the bone
A
Radiolucent lesion affecting metaphyseal, epiphyseal or even subchondral bone near joints
24
Q
Which bones do giant cell tumours usually occur within?
A
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
