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MSKJaz > Pathology - MSK tumours > Flashcards

Pathology - MSK tumours Flashcards

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1
Q 
osteochondroma aka \_\_\_
is benign/malignant?
presumed cell origin =
age =
M:F =
A 
exostosis
benign
chondrocyte
<20yo
1
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2
Q

describe the appearance of a osteochondroma

A

cartilage capped bony outgrowth from external surface of bone containing a marrow cavity that is continuous with that of the underlying bone

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3
Q

cartilage capped bony outgrowth from external surface of bone containing a marrow cavity that is continuous with that of the underlying bone =

A

osteochondroma/exostosis

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4
Q

usual location in bones of a osteochondroma

A

nea

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5
Q

possible s+s of osteochondroma -

A

pain and irritation

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6
Q

enchondroma/chondroma = benign/malig?
age=
M:F

A

benign
young adults
M>F

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7
Q

benign hyaline cartilage tumour arising in medullary cavity of hand and feet bones =

A

enchondroma

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8
Q

multiple chondroma = __/___

A

Ollier’s disease

Maffucci’s syndrome

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9
Q

Ollier’s disease: rare developmental disorder of ____ in __+__physes
usually ___ and involve 1 extremity
malignancy risk = ___ roughly
not hereditary/familial

A

enchondromas
meta+diaphyses
unilateral
10-25%

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10
Q

Maffuccci’s syndrome = multiple ___ with soft tissue and visceral ___
far greater ___ risk that Ollier’s

A

enchondromatosis
haemangiomas
malignancy

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11
Q

possible x ray appearance of enchondromas

A

powderlike/dense aggregates

lytic lesions with scalloped edges +/- a #

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12
Q

histology of enchondromas

A

chondrocytes with small, round, pyknotic nuclei in hyaline cartilage - no atypia
variable cellularity

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13
Q

for enchondromas: ___ lesions are more likely to be benign than ___ lesions

A

small peripheral

large axial

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14
Q 
osteoid osteoma is benign/malig?
M:F
age groups:
bones affected (5)
usually resolve without treatment in \_\_
A 
benign
M>F
children and young adults
hands feet femur tibia and spine
33 months
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15
Q

osteoblastic tumour composed of a central core of vascular osteoid and a peripheral zone of sclerotic bone =

A

osteoid osteoma

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16
Q

s+s of osteoid osteoma

A

dull pain worse at night - relieved by NSAIDs/aspirin
possibly lcoal temp increase, increased sweating and tenderness
if in joint = synovitis
in epiphyses = abnorm growth
spine = torticollis, spinal stiffness, scoliosis

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17
Q

xray appearance of osteoid osteoma

A

radiolucent nidus surrounded by reactive sclerosis in cortex of bone

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18
Q

histology of osteoid osteoma

A

nidus = osteoid and woven bone surrounded by osteoblasts

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19
Q

Chondroblastoma is benign/malig
age =
treatment =

A

benign
teenagers
biopsy and curettage and adjuvant liquid N2

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20
Q

rare benign cartilage tumour arising in bone found at epiphysis of long bones=

A

chondroblastoma

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21
Q

xray appearance of chondroblastoma

A

spherical and well-defined osteolytic foci

sometimes extends into subarticular bone, joint space or metaphysis

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22
Q

histology of chondroblastoma =

A

closely packed polygonal cells + areas of immature chondroid
Distinct cytoplasmic borders with foci of “chicken-wire” calcification.
Low mitotic activity

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23
Q

on histology chicken wire calcification =

A

chondroblastoma

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24
Q

3 benign but locally aggressive primary bone tumours

A

GC tumour
osteoblastoma
chordoma

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25
``` GC tumour is benign/malig? M:F age: thought to be derived from ___ sites = Rx = ```
``` benign M>F 25-40yo osteoclasts long bones and often around knee curettage/resect ```
26
gross appearance of GC bone tumour
irregular haemorrhagic mass in epiphyseal region
27
xray appearance of GC tumour of bone
radiolucent with increasing density towards periphery destruction of medullary cavity and adjacent cortex may expand into surrounding soft tissue
28
histology of GC tumour of bone
multinucleated giant cells in sea of round and oval mononuclear cells
29
osteoblastoma = malig/benign site = __+___ tumour that produces __+__
benign metaphysis/diaphysis of long bones solitary and self limiting osteoid and bone
30
solitary and self limiting tumour that produces osteoid and bone =
osteoblastoma
31
symptoms of osteoblastoma
chronic pain swelling tender may lead to scoliosis and neuro problems if affects spine
32
x ray appearance of osteoblastoma
radiolucent with central density due ossification | well-circumscribed +/- surrounding scoliosis
33
on a bone scan of an osteoblastoma there increased/decreased
increased
34
gross appearance of osteoblastoma =
red-tan with haemorrhagic areas | compact tissue is granular, friable and gritty
35
histology of osteoblastoma =
irregular spicules of mineralised bone and osteoid surrounded by osteoblasts vascular stroma with pleomorphic spindle cells, osteoid and woven bone seen
36
Rx of osteoblastoma
biopsy to confirm resect by curettage/en bloc/ intralesion excision if aggressive and unresectable lesion of spine may = cryoSx, radio or chemo
37
v rare benign bone tumour that arises from notochord remnants
chordoma
38
``` chordoma M:F age: site: Rx = ```
M1:2F >40yo midline - 1/2 in sacrococcygeal region and 1/3 in vase of skull radio. chemo for late stage
39
chordoma possible s+s depending on site
``` back pain bowel and bladder dysfunction palpated on PR dysphagia headaches ```
40
gross appearance of chordoma
soft, blue-grey, lobulated gelatinous translucent areas and often a capsule pften tracks along nerve roots in sacral plexus or out sciatic notch and often soft tissue mass 1/2 have focal calcification
41
histology = lobules and fibrous septa. Malig cell has eosinophilic cytoplasm and prominent vacuoles of mucus push nuclei to peripheries =
chordoma
42
chrodoma metastasises to (4)
bone, lungs, lymph nodes, liver
43
5 malignant primary bone tumours
``` osteosarcoma Ewing's sarcoma Chondrosarcoma fibrosarcoma malignant fibrous histiocytoma ```
44
commonest primary malignancy of bone
osteosarcoma
45
malignant osteoblasts form osteoid =
osteosarcoma
46
``` osteosarcoma age M:F sites rapid ___ and ___ active Rx = ```
60% <25yo - if older tend to have predisposition eg Pagets M3:2 F ends of long bones esp distal femur, prox tibia and prox humerus growth + mitotically biopsy>CT and bone scan > preop chemo> resect > post op chemo
47
management of osteosarcoma
biopsy>CT and bone scan > preop chemo> resect > post op chemo
48
xray appearance of osteosarcoma
erodes cortex extends into soft tissue irregular bone growth with calcification periosteum lifted off
49
histology of osteosarcoma
nuclear atypia hyperchromasia high mitotic rate osteoid production needed for diagnosis
50
3 histological variants of osteosarcoma
osteoblastic chondroblastic fibroblastic
51
2nd commonest primary bone malignancy
chondrosarcoma
52
malignant chondrocytes and exhibits pure hyaline differentiation
chondrosarcoma
53
gross appearance of chondrosarcoma
nodules of tumour erode and extend out from bone - extend to soft tissue
54
hsitology of chondrosarcoma
nodules infiltrate between lamellar bone and obliterate marrow separation of nodules by fibrous bands is highly suggestive of malignancy
55
Rx of chondrosarcoma
wide excision | limit chemo and radio use
56
``` Ewings sarcoma are ___ (PNET) very ___ M:F age site ```
``` primitive neuroectodermal tumours malignant M3:2F teenagers mainly meta+diaphysis of femur, tibia and humerus ```
57
small round blue cells on histology of this bone tumour =
Ewing's sarcoma
58
gross appearance of Ewing's sarcoma =
irregular tan-brown mass that can break through cortex
59
Rx of Ewing's sarcoma
Sx, radio and chemo (with vincristine, dactomycin and cyclophosphamide) post op chemo
60
multiple myeloma =
malignant proliferation of plasma cells in marrow
61
``` multiple myeloma age: bone destruction of ___ skeleton often => __ failure characteristic ___ lesions ```
elderly axial renal rounded "punched out"
62
rounded "punched out" lesions of axial skeleton =
multiple myeloma
63
in multiple myeloma see ___ on protein electrophoresis or ____ in urine
Ig "spike" | Bence-Jones proteins (light chains)
64
bone cancer ass with Gardner's syndrome
osteoma
65
xray = double/soap bubble appearance
Giant cell tumour
66
Codman triangle and sunburst pattern on xray =
osteosarcoma
67
__ mutation slightly increases risk of osteosarcoma so is associated with ___
Rb | retinoblastoma
68
onion-skinning on xray is indicative of which tumour
Ewing's sarcoma
69
Ganglion cyst has no ___ space contains ___
epithelial lining | myxoid material
70
Angiolipoma = usually __+__ __ with ___ a painful SC lesion
multiple + peripheral | vascular with fibrin thrombi
71
superficial tumours (ANGEL)
``` angiolipoma neuroma glomus tumour eccrine spiradenoma cutaneous leiomyoma ```
72
IHC of leiomyoma
actin, desmin, caldesmon
73
leiomyoma often arise from ___
large vessel walls
74
3 reactive lesions (usually Hx of trauma )
nodular fasciitis myositis ossificans rheumatoid
75
enchondroma are ___ and usually ___ (location) due to failure of normal enchondral ossification at the __
intramedullary metaphyseal growth plate
76
enchondroma appearance: | usually ___ but can undergo __ with a patchy __ appearance
lucent mineralisation sclerotic
77
sites of enchondromas
femur, humerus, tibia and small bones of hands and feet
78
simple bone cyst can be due to ____ | and so are ___ in __ bones (site) esp ___+__ can occur in __+__
``` growth defect from physis metaphyseal long prox humerus and femur talus/calcaneus ```
79
aneurysmal bone cyst = lots of chambers with __+__ maybe due to ____ sites =
blood serum small arteriovenous malformation metaphyses of long bones, skull and ribs, vertebral bodies
80
aneurysmal bone cysts are locally aggressive => __+__ | usually __+___
cortical expansion and destruction | painful +pathological #
81
Rx of aneurysmal bone cyst
curettage + graft/use of bone cement
82
Rx of GCT =
intralesional excision with phenol, bone cement or liquid N2 to destroy remains and decrease recurrence
83
genetic mutation that causes lesions of fibrous tissue and immature bone. Mono/polyostotic => stress fractures =
fibrous dysplasia
84
fibrous dysplasia age: defective mineralisation => ___ deformities with affected bone ___ with thinned ___
adolescence angular wider cortices
85
shepherd's hook deformity is a feature of ___ is proximal femur is extensively involved
fibrous dysplasia
86
Rx for fibrous dysplasia
biphosphonates | stabilise fractures with internal fixation and cortical bone grafts
87
small nidus of immature bone with surrounding intense sclerotic halo =
osteoid osteoma
88
Brodies abscess =
subacute osteomyelitis | may present with lytic lesion of bone
89
hyperparathyroidism can cause this which may present as a lytic lesion of bone
Browns tumour
90
chondrosarcoma is/ isnt radio and chemo sensitive
not
91
Ewings sarcoma is / isnt radio and chemo sensitive
usually is
92
non-hodgkins lymphoma tends to affect which bones
pelvis/femur
93
singular myeloma =
plasmacytoma
94
treatment for plasmacytoma (singular myeloma) =
radiotherapy
95
treatment for multiple myeloma =
chemotherapy
96
top 5 cancers that metastisise to bone in order commonest to least
``` breast prostate lung renal cell carcinoma thyroid adenocarcinoma ```
97
large and very lytic blow out lesion in bone that bleed on biopsy/Sx = ___ metastasis
renal cell carcinoma
98
on histology = multinucleated giant cells and haemosiderin | firm and small soft tissue tumour =
GCT
99
osteochondritis: age usually due to ___
kids and youths | lots of physical activity with repetitive stress
100
osteochondritis of 2nd metatarsal head
Freiburg's disease
101
osteochondritis of navicular
Kohler's
102
osteochondritis of lunate
Kienbock's
103
osteochondritis of capitellum of elbow
Panner's
104
osteochondritis due to vertebral compression
Scheuermann's
105
traction osteochondritis of the calcaneus
Sever's
106
``` lateral part of medial femoral condyle in knee anteromedial talar dome superomedial femoral head humeral capitellum are all sites predisposed to ___ ```
osteochondritis dissecans
107
sites prone to AVN
``` femoral head and condyles humerus head capitellum prox pole of scaphoid prox talus ```
108
alcohol and steroid use alter ___ > circulate in capillaries and promote ___ in bone + increase ___ in bone marrow => compress ___ => AVN
fat metabolism coagulation fat content venous outflow
109
thrombophilia, sickle cell and antiphospholipid deficiency in SLE can cause AVN because
they increase coagulability of blood

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