Histopathology 2: Neoplastic Bone Disorders

Question 1

X-ray: Codman’s Triangle at end of long bones
Histology: Malignant mesenchymal cells

Diagnosis?

Answer 1

Osteosarcoma

Question 2

X-ray: Lytic lesions with fluffy calcification
Histology: Malignant chondrocytes

Diagnosis?

Answer 2

Chondrosarcoma

Question 3

X-ray: Onion skinning of periosteum
Histology: Sheets of small round cells
Karyotype: shows t(11;22)

Diagnosis ?

Answer 3

Ewing’s sarcoma

Question 4

X-ray: Lytic appearance in the epiphysis of knee
Histology: Giant cells look like osteoclasts, spindle/ovoid cells

Diagnosis?

Answer 4

Giant cell tumour

Question 5

X-ray: Soap bubble osteolysis, Shepherd’s crook deformity
Histology: Chinese letters

Diagnosis ?
Associated syndrome ?

Answer 5

Fibrocystic dysplasia
Albright syndrome

Question 6

List the triad of features Albright syndrome?

Answer 6

• Polyostotic dysplasia
• cafe au lait spots
• Precocious puberty

Question 7

X-ray: Mushroom protuberance from Bone
Histology: Cartilage capped bony outgrowth

Diagnosis?

Answer 7

Osteochondroma

Question 8

X-ray: popcorn calcification
Histology: Proliferation of cartilage

Diagnosis ?

Answer 8

Enchondroma

Question 9

X-ray: Bulls eye appearance of radioleucent nidus with sclerotic rim
Histology: normal bone arising from osteoblasts

Diagnosis ?

Answer 9

Osteoid Osteoma

Question 10

Which benign bone tumour causes pain at night which is relieved by Aspirin ?

Answer 10

Osteoid osteoma

Question 11

In which syndrome do you get Osteomas, GI polyps and epidermoid cysts ?

Answer 11

Gardner syndrome

Question 12

Parts of the bone

Answer 12

long part = diaphysis (dying is long man)
end part = epiphysis

outside - inside = periosteum - cortex - medulla

Question 13

list 5 tumour- like condition

Answer 13

• fibrous dysplasia
• metaphysial fibrous cortical defect/ non-ossifying fibroma
• reparative giant cell granuloma
• ossifying fibroma
• simple bone cyst

Question 14

Age group that Primary malignant bone tumours are more common

Answer 14

children and young adults

Question 15

Where are bone tumours most common?

Answer 15

around the knee (distal femur or proximal tibia)

Question 16

What part of the bone are metaphysis, diaphysis, and epiphysis?

Answer 16

• diaphysis: long part (dying is long man)
• epiphysis: EEEnds
• metaphysis: middle/in between diaphysis and epiphysis

Question 17

How to biopsy bone tumour

Answer 17

Needle core biopsy - using Jamshidi needle

done with USS or CT guidance

Question 18

Soap bubble X-ray appearance, which bone tumour?

Answer 18

Fibrous Dysplasia

Question 19

What bone tumour do you get in McCune Albright Syndrome, and which other Sx do you get?

Answer 19

polyostotic fibrous dysplasia (soap bubble lesion)

Other Sx: endocrine problems + café au lait spots

Question 20

Name if you see Fibrous Dysplasia in the Femoral Head

Answer 20

Shepherd’s Crook

Question 21

Benign bone tumours (6)

Answer 21

Cartilaginous differentiation

• Osteochondroma
• Enchondroma
• Chondroblastoma

Bone Forming

• Osteoid osteoma
• Osteoblastoma
• Osteoma

Question 22

Benign bone tumour with overgrowth of cartilage AND bone

Answer 22

Osteochondroma - mainly occur at the ends of long bones

Osteochondromas mimic the normal tubular bones- they have a cartilaginous surface overlying the normal cortical and trabecular bone

Question 23

Benign bone tumour - cartilaginous proliferation WITHIN the bone

Which bone do they mainly affect?

X-ray sign

Answer 23

Enchondromas

hands with some in the feet

X-ray: popcorn calcification’

Question 25

Benign Bone Tumours May erode through the cortex of the bone but do NOT invade through what?

Answer 25

NOT burst through the articular (cartilaginous) surface

Question 26

Where on the bone does Ewing Sarcoma form?

Answer 26

diaphysis/ metaphysis of long bones, pelvis

Question 27

X-ray feature of onion skinning for which tumour? Histology for this

Answer 27

Ewing sarcoma Histology: small round cells

Question 28

5-year survival for Ewing sarcoma

Answer 28

75%

Question 29

Chromosomal translocation of Ewing sarcoma

Answer 29

translocation 11;22 (EWSR1/ Fli1) (q24;q12)

Question 30

X-ray lesion of fluffy calicification which bone tumour? Which are the main bones affected? What does the tumour produce?

Answer 30

Chondrosarcoma axial skeleton, _pelvis_, proximal femur, proximal tibia Produces cartilage

Question 31

X-ray of Giant Cell Tumour (Borderline Malignancy of bone) Histology

Answer 31

lytic appearance osteoclasts on a background of spindle/ ovoid cells

Question 32

Tumour of bone characterised by the presence of osteoclasts

Answer 32

Giant Cell Tumour (giant cells = osteoclasts - these are not neoplastic) Can be locally aggressive, may recur and can metastasise through the blood vessels (to the lungs)

Question 33

What is the most common malignant bone tumour? Which bones are they rarely found?

Answer 33

Tumours that metastasise to the bone Below elbow and knee

Question 34

Adult cancers that spread to the bone (+ how to remember)

Answer 34

REMEMBER: 1-2-2-2-1 * Thyroid * Breast * Lung * Kidney * Prostate

Question 35

Carcinoma is which type of tumour?

Answer 35

Epithelial cell tumour

Question 36

3 Malignant Bone Tumours (and what each produces)

Answer 36

* Osteosarcoma (bone forming) * Chondrosarcoma (cartilage forming) * Ewing’s sarcoma/ PNET (primitive peripheral neuroectodermal tumour)

Question 37

What is a Malignant bone-forming tumour? Which bone do you mainly find it?

Answer 37

Osteosarcoma (most common bone sarcoma) * at the ends of long bones (e.g.60% occur around the knee) - lower femur or upper tibia * Older people get in in their jaw

Question 38

Key sign of osteosarcoma on X-ray

Answer 38

Elevated periosteum (_Codman’s triangle_)

Question 39

Examples of soft tissue tumours (3)

Answer 39

Soft tissue tumour: mesenchymal proliferations which occur in the extra-skeletal, non-epithelial tissues of the body- excluding the meninges and lymphoreticular system. Can be found anywhere, but mostly in large muscles of the extremities * Myxoid Tumours- Liposarcoma (have myxoid appearance) * Spindle Cell Sarcoma (tissue can originate from nerve, muscle, fibrous tissue) * Pleomorphic Sarcoma

Question 40

Staging of soft tissue tumours

Answer 40

\*\*INSERT THE PICS OF STAGING, FOLLOWED BY PROGNOSTIC FACTORS OF SOFT TISSUE TUMOURS\*\*