Flashcards in Neoplasia & Pathological Fractures Deck (9):
What are the common metastases to bone?
Prostate - produced both sclerotic and lytic lesions
What is meant by zone of transition?
Is there a clear cut off between the normal and abnormal bone
Is the zone of transition narrow or wide?
What is meant by periosteal reaction?
A non-specific change to bone (seen on X-ray) when the periosteum has been irritated. It can be benign where there is chronic irritation forming normal/near normal cortex. When the reaction happens quickly, there isn't enough time for the formation of normal cortex. The bone can look scaly at the edges/lamellated
What are the key features of osteosarcoma?
Most common in the distal femur, proximal tibia, proximal humerus
Painful, mass, pathological fractures
Blastic and destructive lesions, periosteal reaction Codman's triangle
Young adults associated with retinoblastoma tumour suppressor gene
What are the management options in osteosarcoma?
High grade: neoadjuvant chemotherapy for 8-12 weeks, limb salvage, adjuvant chemotherapy 6-12 months
Low grade: wide surgical resection
What are the key features of Ewing's sarcoma?
Young adults with pain and swelling in mid-femur (50% involve diaphysis of long bones)
Genetic mutation t(11:22)
Moth eaten destruction with periosteal reaction (onion skin/sunburst appearance)
Raised ESR and WBC - can mimic infection
Consider bone marrow biopsy too
What are the management options in Ewing's sarcoma?
Chemo and radio in non-resectable
Most patients have 8-12 weeks of neoadjuvant chemotherapy, followed by limb salvage, then 6-12 months of adjuvant chemotherapy
What is Mirel's score?
Classifies lesions and if we need to fix them
Treat if score 9+
Variables: site, pain, the type of lesion, the size