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Flashcards in MSK tumour pathology Deck (75):
1

How common are skeletal tumours?

Uncommon

2

What are the categories of tumour which can affect the skeleton?

Myeloma (plasma cells)
Metastases
Benign
Benign but locally destructive
Malignant

3

What are the benign tumours affecting the skeleton?

Osteochondroma (exostosis)
Chondroma/enchondroma
Osteoid osteoma
Chondroblastoma

4

What is an osteochondroma?

Cartilage capped bony outgrowth on the external surface of the bone

5

How will an osteochondroma appear on imaging?

The bony outgrowth will be continuous with the normal bone

6

Which age group is affected by osteochondromas?

Young

7

Are males or females more affected by osteochondroma?

Equal distribution

8

Where on the bone do osteochondromas tend to develop?

Near epiphysis of long bones

9

When might an osteochondroma cause problems?

Can cause local pain or irritation

10

What is an (en)chondroma?

Hyaline cartilage tumour arising within the medullary cavity of bones

11

Which bones develop (en)chondromas?

Hands
Feet

12

In which two conditions might you see more than one (en)chondroma?

Ollier's disease
Mafucci's syndrome

13

Who gets (en)chondromas?

Young adult men

14

What are the enchondromas associated with in Mafucci's syndrome?

Angiomas

15

What is Ollier's disease?

Rare developmental disorder

16

Is ollier's disease hereditory?

No

17

Where do the (en)chondromas arise in ollier's disease?

Metaphyses
Diaphyses

Unilateral

18

What is the risk with Ollier's disease?

Malignant transformation possible

19

What is the risk with Mafucci's syndrome? How does this compare to ollier's syndome?

Malignant transformation much higher than in ollier's syndrome

20

Small peripheral bone lesions are less likely to be benign than large axial lesions. T/F

False - small peripheral lesions are more likely to be benign

21

Who gets osteoid osteoma?

Children and young adults
More common in males

22

Where are osteoid osteomas typically found?

Femur
Tibia
Hands & feet
Spine

23

Which cells do osteoid osteomas arise from?

Osteoblasts

24

How do osteoid osteomas typically appear on imaging?

Central vascular osteoid core
Peripheral sclerosis
Cortex of bone

25

How does osteoid osteoma present?

Pain worse at night
Dull/achey
Relieved with aspirin/NSAIDs
+/- spinal scoliosis
+/- soft tissue swelling

26

How are osteoid osteomas managed?

Self resolving within 3 years
Pain relief

27

Who gets chondroblastomas?

Teens

28

How common is chondroblastoma?

Rare

29

Chondroblastomas are benign. T/F

True - can be locally aggressive

30

Where in bones and in which bones do chondroblastomas present?

Epiphysis
Long bones

31

How doe chondroblastomas appear on imaging?

Well circumscribed osteolytic sphere
+/- extension from epiphysis

32

What type of calcification is characteristically seen with chondroblastomas?

Chicken wire

33

How are most benign bone tumours treated?

Biopsy and curettage + liquid nitrogen

34

List the three benign but locally aggressive bone tumours

Giant cell tumour
Osteoblastoma
Chordoma

35

Which cells do giant cell tumours arise from?

Osteoclasts

36

Which age groups get giant cell tumours?

25-40 y/o

37

Which sex is more prone to giant cell tumours?

Females

38

Which bones do giant cell tumours typically arise on?

Long bones
Very common around knee (distal femur)

39

How do giant cell tumours typically appear on imaging?

Dense around the periphery
Destroyed medullary cavity
Destroyed cortex
+/- soft tissue expansion

Nb - "soap bubble" appearance buzzword

40

What type of cells can be seen on histology of a giant cell tumour?

Multi-nucleated giant cells

41

Is an osteoblastoma single or multiple?

Single

42

Where and on which bones can an osteoblastoma be found?

Metaphysis
Diaphysis

Long bones

43

How does an osteoblastoma appear on imaging?

Central density
Well circumscribed
+/- peripheral sclerosis

44

How might an osteoblastoma present?

Pain
Swelling
Tenderness

45

How are benign but locally aggressive bone lesions treated?

Surgical excision

46

How common is chordoma?

Rare

47

Which cells do chordomas arise from?

Notochord embyrological remnants

48

Which age group presents with chordomas?

>40 y/o

49

Which sex is more commonly affected by chordomas?

Females

50

On which bones are chordomas found?

Sacrococcygeal
Base of skull
(midline)

51

How do chordomas present on imaging?

Midline lesions
Bony lysis
+/- soft tissue mass
+/- focal calcifications

52

How are chordomas treated?

Difficult to resect
Radiation
Chemotherapy for late stage

53

List the three most common malignant tumours of the bone?

Osteosarcoma
Chondrosarcoma
Ewing's sarcoma

54

What is the commonest primary malignant bone tumour?

Osteosarcoma

55

Which type of cells do osteosarcomas arise from?

Osteoblasts

56

Which age groups are affected by osteosarcomas?

Young adults

57

Which sex is affected by osteosarcoma?

Male more commonly

58

Where and on which bones are osteosarcomas typically found?

Epiphysis

Long bones (distal femur, proximal tibia and humerus)

59

Osteosarcoma is fast growing. T/F

True

60

What are the three subtypes of osteosarcoma?

Osteoblastic
Chondroblastic
Fibroblastic

61

How is osteosarcoma treated?

Biopsy, CT, bone scan
Chemo pre and post op
Surgical resection

62

Which type of cells do chondroblastomas arise from?

Chondrocytes

63

Chondroblastomas are commonly found within the pelvis. T/F

True

64

How are chondroblastomas treated?

Excision

65

What type of tumour is Ewing's sarcoma?

Peripheral primitive neuroectodermal tumour (PPNT)

66

Where and in which bones does Ewing's sarcoma arise?

Metaphysis
Diaphysis

Femur
Tibia
Humerus

67

Which age group is affected by Ewing's sarcoma?

Teens

68

Which sex is more commonly affected by Ewing's sarcoma?

Males

69

How is Ewing's sarcoma treated?

Surgery
Radiotherapy
Chemotherapy

70

Which cancers commonly metastasise to bone?

Renal
Thyroid
Prostate
Breast
Lung (small cell)

71

Bone metastases are osteosclerotic. T/F

Osteolytic EXCEPT from prostate cancer

72

What is multiple myeloma?

Malignant cancer of plasma cells

73

Who gets multiple myeloma?

Old people

74

What is a common complication of multiple myeloma?

Kidney failure
(and death)

75

How does multiple myeloma appear on imaging?

Punched out
"Pepper pots"

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