Pathology

Question 1

Osteochondroma

Answer 1

Bony outgrowth with cartilaginous cap, may result in local pain.

Question 2

Osteochondroma Issues

Answer 2

1% chance of becoming metastatic, any increase in growth may require excision.

Question 3

Enchondroma

Answer 3

Intra medullary cartilaginous tumour due to failure of enchondral ossification.

Question 4

Enchondroma issues

Answer 4

Pathological fractures due to area of weakness- bone grafting is usual response.

Question 5

Simple bone cyst

Answer 5

Single cavity benign fluid filled cyst, often incidental finding , usually on long bones.

Question 6

Simple bone cyst issue

Answer 6

Pathological fractures due to weakening of the bone, bone grafting +/- stabilisation.

Question 7

Aneurysmal Bone cyst

Answer 7

Lots of chambers filled with blood or serum, affects long and flat bones.

Question 8

Aneurysmal Bone cyst issues

Answer 8

Locally aggressive causing cortical destruction and pain, pathological fractures

Question 9

Aneurysmal Bone Cyst treatment

Answer 9

Bone grafts or cement

Question 10

Giant Cell tumour

Answer 10

Tend to occur in epiphysis especially around the knee but can occur in other long bones pelvis and spine.

Question 11

Giant cell tumour appearance

Answer 11

On Xray look for soap bubble apearance

Question 12

Giant Cell Tumour issues

Answer 12

Locally destroying cortex, associated with pain and pathological fractures

Question 13

Giant Cell risk

Answer 13

5% can metastasise to the lung, metastatic tumour is still considered benign.

Question 14

Giant cell tumour treatment

Answer 14

Intralesional excision, phenol bone cement and liquid nitrogen used to remove tumour and prevent recurrence.

Question 15

Fibrous Dysplasia

Answer 15

occurs in adolescence, lesions of fibrous tissue and immature bone.

Question 16

Fibrous dysplasia in one bone

Answer 16

Monostotic

Question 17

Fibrous dysplasia in several bones

Answer 17

Polyostotic

Question 18

Fibrous dysplasia issues

Answer 18

Wider bones with thin cortices, angular deformities are common. All lead to pathological fractures.

Question 19

Fibrous dysplasia treatment

Answer 19

Bisphosphonates to reduce pain

Internal fixation and bone grafts used to stabilise.

Question 20

Fibrous dysplasia excision

Answer 20

Simple intralesional excision has a very high recurrence rate.

Question 21

Osteoid osteoma

Answer 21

Is a small nidus of immature bone surrounded by sclerotic halo, occur in adolescence.

Question 22

Common site for osteoid osteoma?

Answer 22

Proximal femur, diaphysis of long bones and vertebrae.

Question 23

Clinical features of osteoid osteoma?

Answer 23

Intense constant pain worse at night.

Massively reduced by NSAIDs

Question 24

Identification of osteoid osteoma?

Answer 24

Xray may reveal however bone san and CT used to confirm.

Question 25

Osteoid osteoma treatment.

Answer 25

May be self resolving, CT guided radio frequency ablation or en bloc excision.

Question 26

Are primary or secondary bone tumours more common?

Answer 26

Secondary bone tumours are more common.

Question 27

Most common primary bone tumours?

Answer 27

Osteosarcoma

Question 28

Osteosarcoma

Answer 28

Malignant tumour producing bone, affects younger age groups .

Question 29

Common site for Osteosarcoma

Answer 29

Usually bones around the knee, proximal femur humerus and pelvis.

Question 30

Osteosarcoma metastatic spread

Answer 30

Usually haematogenous but can be lymphatic.

Question 31

Osteosarcoma treatment

Answer 31

They are not radiosensitive , chemotherapy can prolong survival, surgery is curative.

Question 32

Chondrosarcoma

Answer 32

Cartilage producing primary bone tumour, less common and less aggressive that osteosarcoma,

Question 33

Chondrosarcoma occurence

Answer 33

Older age group 45years, pelvis or proximal femur.

Question 34

Chondrosarcoma treatment

Answer 34

Very large and slow to metastasise, however radiotherapy and chemotherapy is as of yet ineffective.

Question 35

Fibrosarcoma

Answer 35

Fibrous malignant bone tumours occurring in abnormal bone. Tends to affect young adults.

Question 36

Ewings Sarcoma

Answer 36

Malignant tumour of primary cells within the marrow.

Question 37

Ewings occurence

Answer 37

2nd most prevalent with the poorest prognosis. | Affects ages between 10 and 20.

Question 38

Clinical appearance of Ewings sarcomma

Answer 38

Fever raised inflammatory markers and warm swelling.

Question 39

What is Ewings sarcoma easily mistaken with?

Answer 39

Osteomyelitis

Question 40

Treatment for Ewings sarcomma

Answer 40

it tends to be radio and chemo sensitive.

Question 41

Metastatic bone tumours

Answer 41

Brest, prostate, lung, renal, thyroid

Question 42

Breast metastatic disease

Answer 42

Blastic or sclerotic, mean survival is around 24-26 months

Question 43

Prostate metastatic disease

Answer 43

Sclerotic, pathological fractures likely, 45% one year survival.

Question 44

Lung metastatic disease

Answer 44

Lytic disease, mean survival is 6 months

Question 45

Renal metastatic disease

Answer 45

Large vascular lytic metastases, large risk of bleeding, one isolated tumour surgery is curative.

Question 46

Lipoma

Answer 46

Common benign tumour of the fat

Question 47

Angiosarcoma

Answer 47

Malignant tumour of blood vessels

Question 48

Fibrosarcoma

Answer 48

Fibrous tissue

Question 49

Liposarcoma

Answer 49

From fat

Question 50

Rhabdomyosarcoma

Answer 50

Skeletal muscle

Question 51

Synovial Sarcoma

Answer 51

synovial lining of joints

Question 52

ganglion cyst

Answer 52

herniation of joint capsule well defined and firm excision if causing discomfort or for cosmesis

Question 53

Bursitis

Answer 53

Inflammation of fluid filled sac preventing friction between tendons bones and muscles.