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Flashcards in Pathology Deck (92):
1

How common are malignant primary bone tumours?

Very rare

2

How common is skeletal metastatic cancers?

Common

3

What is the most common benign bone tumour?

Osteochondroma

4

What is an enchondroma?

Metaphyseal cartilaginous tumour caused by failure of normal enchondral ossification at the growth plate

5

Where do simple bone cysts commonly occur?

Long bones.

6

What are the symptoms of simple bone cysts?

Usually asymptomatic but can cause bone weakness

7

What causes an aneurysmal bone cyst?

Arteriovenous malformations

8

Giant cell tumours are locally aggressive. Where do they commonly affect?

Around the knee and distal radius and other long bones.

9

What do giant cell tumours look like on x-ray?

Soap bubble appearance

10

What are the red flag symptoms of metastatic bone cancer?

Severe constant pain
Worse at night

11

What do malignant primary bone tumours show on x-ray?

Cortical destruction and a periosteal reaction

12

What is the most common primary malignant bone tumour?

Osteosarcoma

13

What age group is an osteosarcoma most likely to affect?

Adolescents and young adults

14

Where is an osteosarcoma most common?

Around the knee.

15

What is a chondrosarcoma?

A malignant hyaline cartilage producing primary bone tumour.
Mean age: 45

16

Where are chondrosarcomas found?

Pelvis
Proximal femur

17

What is Ewing's sarcoma?

Malignant tumour of primative cells.
2nd most prevalent primary bone tumour.
Poorest prognosis.
Occurs in people 10-20 .

18

Which primary malignant tumour metastasises to bone most commonly?

Breast Ca

19

If breast Ca has spread to bone, how long is the prognosis?

24 months

20

What features are suggestive of a malignant soft tissue neoplasm?

>5cm
Rapid growth
Solid, ill defined
Associated lymphadenopathy

21

What is the most common soft tissue tumour?

Lipoma

22

What is a ganglion cyst?

Occurs around a synovial joint.
Forms as a result of a herniation of the joint capsule.

23

What does a Ganglion cyst look like?

well defined, firm, transilluminate.

24

What can cause bursitis?

Repeated pressure or trauma

25

What is a possible consequence of osteochrondritis?

Localised necrosis due to ischaemia

26

What is avascular necrosis (AVN) ?

Ischaemic necrosis which commonly occurs in adults.

27

True or False
AVN is always idiopathic

False
Can be secondary to fractures or due to alcoholism or steroids

28

On xray what disease can present as bone enlargement, thickened corticles and trabeculae?

Paget's disease where bone repairal is chaotic.

29

Where does Paget's disease commonly affect?

Pelvis
Femur
Skull
Tibia

30

In what kind of tumour would a Shepherd's crook deformity be found in the proximal femur?

Fiberous dysplasia

31

What is a fascicle?

Group of muscle fibres

32

What surrounds a fascicle?

Perimysium

33

What sounds the individual muscle fibres?

Endomysium

34

In skeletal muscle, where are the nuclei positioned?

At the cell periphery

35

Why is glycolysis high in white fibres?

Not much mitochondria
Not much myoglobin.
operates mainly on anaerobic-generated ATP.

36

What would a high creatinine kinase level indicate?

Dystrophy

37

What would dystrophic changes look like on staining?

Variable muscle fibre sizes
Fatty infiltration
Myocyte hypertrophy
Central nuclei
Ring fibres

38

Which 2 muscular dystrophies are X linked?

Duchenne (DMD)
Becker (BMD)
Which are essentially the same thing but BMD affects later in life

39

When does DMD usually present?

Preschool.
2-4.
Will not live past 20

40

What gene is responsible for DMD?

Mutations on dystrophin gene on chromosome X

41

What does the mutation in DMD mean happens intracellularly?

Actin cytoskeleton is altered so it does not anchor to the basement membrane so muscle contractions do not occur properly.

42

What is seen on histology of DMD?

Muscle fibre necrosis
Chronic inflammation

43

What is myotonic dystrophy?

DM1 and DM2
Autosomal dominant.
Muscle weakness and myotonia

44

What are the symptoms of myotonic dystrophy?

weakness in face and distal limbs
Cardiomyopathy
Low intelligence
Cataracts

45

What is seen on histology of myotonic dystrophy?

Atrophy of type 1 red fibres
Central nuclei
Fibrofatty replacement

46

What are the primary inflammatories of muscle?

Infective agents e.g. coxsackie
Polymyositis
Dermatomyositis

47

What is polymyositis?

Chronic inflammatory disease of unknown cause

48

What T cells are involved in polymyositis?

CD8+

49

What is dermatomyositis?

Polymyositis plus skin changes e.g. erythema

50

True or False
There is a 70% risk of malignancy with dermatomyositis

False.
10% risk of malignancy

51

What T cells are involved in dermatomyositis?

CD4 cells.

52

What do the muscle fibres look like in neurogenic muscular disorders in adults?

Small, angulated muscle fibres.

53

Fibre grouping occurs in neurogenic muscular disorders. What does this mean?

Type I fibres all clump together instead of being spread out.

54

Where does the fault lie in motor neuron disease?

The anterior horn of spinal cord cells.

55

What is fasciculation?

Uncontrolled muscle twitching

56

What is spinal muscular atrophy?

Degeneration of anterior horn of spinal cord cells but INHERITED, unlike MND.

57

What is myasthenia gravis?

Autoantibodies to the ACh receptor in the post synaptic cleft.

58

Who does Myasthenia gravis affect most commonly?

Women aged 20-40

59

What is rhabdomyolysis?

Breakdown of skeletal muscle

60

What are the antibodies involved in SLE?

Antinuclear antibodies (ANA)

61

In what way can SLE be classified as a type II and type III hypersensitivity?

type III due to IgG and C3 immune complexes in kidney
type II due to direct haemolysis leading to anaemia

62

What is polyarteritis nodosa?

Inflammation and necrosis of small/medium arteries, especially kidneys, heart, liver.

63

What autoantibody is found in serum for PAN?

pANCA

64

What is scleroderma?

Excessive collagen production, leading to excessive fibrosis of organs and tissues

65

Describe an osteochondroma

Cartilage capped bony projection on the external surface of a bone

66

Who is an osteochondroma more common in?

Young people

67

Where do osteochondromas tend to develop?

Epiphyses of long bones

68

What is a chondroma?

Benign hyaline cartilage tumour which rises in the medulla of the bone in hands and feet

69

What is the syndrome called when there are many chondromas?

Mafucci's syndrome

70

Which age group does chondromas affect?

Young adults

71

What is Ollier's disease?

Single chondroma which has a 10% malignancy transformation.

72

What is an osteoid osteoma?

Benign tumour of a central core of vascular osteoid tissue

73

Are osteoid osteoma tumours painful?

Yes and worse at night. May be accompanied by swelling and tenderness

74

Where are osteoid osteomas found?

Axial skeleton

75

What is the treatment for osteoid tumours?

They are self resolvable and can be managed with NSAIDs

76

What is a chondroblastoma?

Benign cartilage tumour in bone

77

Where are chondroblastomas found?

Epiphysis of long bones

78

What do chondroblastomas look like on histology?

Closely packed polygonal cells. "Chicken wire" calcification.

79

What is the treatment for chondroblastomas?

Biopsy and curettage plus liquid nitrogen

80

Who do giant cell tumours most commonly affect?

25-40 yrs old women

81

Why are giant cell tumours locally aggressive?

They destroy the medulla and cortex and may expand into soft tissue

82

What do giant cell tumours look like on histology?

Multinucleated giant cells in a seal of round mononuclear cells.

83

What is an osteoblastoma?

Benign and self-limited tumour that produces osteoid and bone.

84

What do osteoblastomas look like, grossly?

Red in colour with haemorrhagic areas.

85

What do osteoblastomas look like on histology?

Irregular, mineralised bone. Woven bone.

86

What is the treatment for an osteoblastoma?

Intralesional excision

87

What is a chordoma?

Benign but locally destructive.
Very rare

88

Who is a chordoma more common in?

Older females

89

Where are chordomas most common?

In the midline- often sacral region

90

Why is an osteosarcoma painful?

the periosteum is being eroded

91

Who does Ewing's sarcoma most commonly affect?

20 year old males

92

What is a multiple myeloma?

Malignant proliferation of plasma cells in marrow.