Pathology Tumours

Question 1

three methods to detect genetic abnormalities causing cancer

Answer 1

• karotyping= overview of chromosomal number and structure
• FISH= detect specific abnormalities and known translocations
• immunohistochemistry= pigment on antibody to target protein to detect whether it is being produced

Question 2

examples detected by karotyping

Answer 2

synovial sarcoma t(X;18)
alveolar rhabdomyosarcoma t(2;13)
Ewing’s sarcoma t(11;22)

Question 3

8 examples of benign bone tumours

Answer 3

1. osteochondroma
2. enchondroma
3. simple bone cyst
4. aneurysmal bone cyst
5. giant cell tumour
6. fibrous dysplasia
7. osteoid osteoma
8. Brodie’s abscess

Question 4

describe osteochondroma

Answer 4

bony outgrowth with cartilaginous cap
can produce local pain
small risk of malignant transformation

benign lesion derived from cartilage, common around the knee (distal femur/proximal tibia), usually adolescence

Question 5

describe enchondroma

Answer 5

intramedullary and metaphysical cartilaginous tumour caused by failure of normal enchondral ossification of the growth plate

Question 6

what do the lesions in enchondroma look like?

Answer 6

Lucent lesions but can undergo mineralisation

Question 7

what do enchondromas do?

Answer 7

can weaken bones causing fracture

Question 8

where do enchondromas occur

Answer 8

femur
humerus
tibia
small bones of hands and feet

Question 9

management of enchondromas

Answer 9

curettage and bone graft

Question 10

describe a simple bone cyst

Answer 10

single cavity fluid-filled cyst in bone

can lead to fractures

Question 11

where are simple bone cysts usually located?

Answer 11

metaphysics of long bones (humerus and femur) but can occur in talus and calcaneus

Question 12

describe aneurysmal bone cyst

Answer 12

contains lots of chambers filled with blood or serum, due to small arteriovenous malformations

Question 13

where do aneurysmal bone cysts occur?

Answer 13

metaphysis of long bones, flat bones (ribs and skull) and vertebral bodies

Question 14

what can aneurysmal bone cysts lead to?

Answer 14

locally aggressive can cause pain and fractures

Question 15

where do giant cell tumours occur?

Answer 15

locally aggressive in metaphyseal and epiphysis of bones

commonly around the knee and distal radius but can occur in spine and pelvis

Question 16

XR appearance of giant cell tumours (BUZZWORD)

Answer 16

soap bubble appearance

Question 17

does giant cell tumours have potential to metastasise?

Answer 17

can metastasise to benign pulmonary GCT

Question 18

management of giant cell tumour

Answer 18

intralesional excision with use of phenol, bone cement or liquid nitrogen to destroy tumour material

Question 19

management of aggressive giant cell tumour with cortical destruction

Answer 19

joint replacement

Question 20

two types of GCT

Answer 20

PVNS (pigmented villonodular synovitis)

GCTS (tendon sheath)

Question 21

describe fibrous dysplasia

Answer 21

genetic mutation resulting in lesions of fibrous tissue and immature bone

Question 22

what does defective mineralisation in fibrous dysplasia lead to?

Answer 22

angular deformities
thinned cortices
shepherd’s crook deformity (BUZZWORD)

Question 23

management of fibrous dysplasia

Answer 23

bisphosphonates may reduce pain

internal fixation and cortical bone grafts are used to improve strength

Question 24

describe osteoid osteoma

Answer 24

small nidus of immature bone surrounded by sclerotic halo
commonly in adolescence in long bones
inflammatory response leads to pain at night

Question 25

describe Brodie's abscess

Answer 25

hyperparathyroidism, brown tumours, lytic lesion of bone

Question 26

four examples of malignant bone tumours

Answer 26

osteosarcoma chondrosarcoma fibrosarcoma Ewing's sarcoma

Question 27

describe osteosarcoma

Answer 27

younger age groups involving bones around the knee and long bones

Question 28

XR of osteosarcoma

Answer 28

``` Codman's triangle Sunray speculation (BUZZWORD) ```

Question 29

describe chondrosarcoma

Answer 29

cartilaginous tumour

Question 30

XR appearance of chondrosarcoma

Answer 30

popcorn calcification on Xr

Question 31

who presents with fibrosarcoma?

Answer 31

young adults

Question 32

define Ewing's sarcoma

Answer 32

malignant tumour of primitive cells in the marrow | small, round, blue cell tumours

Question 33

what is the genetic abnormality in Ewing's sarcoma

Answer 33

t(11;22)

Question 34

who is Ewing's sarcoma seen in?

Answer 34

10-20 associated with fever, raised CRP and swelling

Question 35

management of Ewing's sarcoma

Answer 35

radio and chemo sensitive

Question 36

buzzword for Ewing's sarcoma

Answer 36

onion-peel sign

Question 37

diagnosis of malignant bone tumours

Answer 37

bone scan, CT, MRI | biopsy

Question 38

management of malignant bone tumours

Answer 38

surgery (wide margins 3-4cm) amputations Neo-adjuvant and adjuvant chemo and radiotherapy

Question 39

describe nodular fasciitis

Answer 39

benign soft tissue lesion, often of the superficial fascia | presents in any age group, rapid growth, small, occasionally history of preceding trauma

Question 40

describe myositis ossificans

Answer 40

evidence of cellular proliferation and bone formation in muscles commonly in big muscles e.g. quadriceps, gluteus and brachialis zonation evidence of preceding trauma

Question 41

where are rheumatoid nodules often found?

Answer 41

elbows

Question 42

six examples of soft tissue tumours

Answer 42

``` ganglion cyst bursitis sebaceous cyst abscess superficial fibromatoses deep fibromatosis ```

Question 43

define ganglion cyst

Answer 43

peripheral lump near a joint capsule or tendon sheath- wrist usually form as part of herniation through capsule or sheath

Question 44

histology of ganglion cyst

Answer 44

not a true cyst as no epithelial lining; space with myxoid material

Question 45

ganglion cyst origin?

Answer 45

can be development or asa result of underlying damage (Baker's cyst)

Question 46

appearance of ganglion cyst

Answer 46

well-defined, firm and excision may be required

Question 47

define bursitis

Answer 47

inflamed bursa usually occurs due to repeated pressure or trauma which results in swelling

Question 48

what do abscesses result from?

Answer 48

cellulitis, bursitis, penetrating wound or infection

Question 49

management of abscess

Answer 49

antibiotics | incision and drainage

Question 50

example of superficial fibromatoses

Answer 50

Dupuytrens (common in 60 year old males, associated with alcohol)

Question 51

what is deep fibromatosis associated with?

Answer 51

Gardner's syndrome (FAP)

Question 52

five tumour of unknown origin

Answer 52

1. Ewing's sarcoma 2. synovial sarcoma 3. pleomorphic undifferentiated sarcoma 4. GCT (osteoclastoma) 5. aneurysmal bone cyst

Question 53

describe synovial sarcoma

Answer 53

malignant tumour affects patients 20-40 deep seated mass around knee, chest wall and H&N area