Primary + Secondary bone tumours

Question 1

Do sclerotic or lytic lesions mean benign/malignant?

Answer 1

Sclerotic = healed or benign

Lytic = malignant

Question 2

____ level is a marker of osteoBLAST activity?

Answer 2

ALP

Question 3

How to tell on an X-ray if something is a tumour of bone or cartilage?

Answer 3

Cartilage: popcorn stippling / rings and arcs e.g. chondrosarcoma

Bone: fluffy/trabecular

Question 4

Stages of the periosteal reaction and what they tell you about the tumour?

Answer 4

1. Callus - slow growing
2. Lamellated / onion skinning - slow growing but definitely a tumour - Ewing’s tumour
3. Sunburst spicules, codmans triangle -> an aggressive tumour e.g. osteosarcoma

Question 5

What does the zone of transition tell you?

Answer 5

Wide zone of transition - means there is poor definition of healthy | not healthy - so more likely to be malignant

Narrow zone of transmission does not always mean benign, beware of myeloma esp. in old people

Question 6

Define sarcoma.

Answer 6

A rare tumour of mesenchymal origin: a malignant connective tissue neoplasm.

Question 7

Soft tissue sarcomas make up what percentage of overall sarcomas?

Answer 7

80%. The remaining 20% are boney.

Question 8

Name 3 soft tissue sarcomas.

Answer 8

1. Liposarcoma.
2. Leiomyosarcoma.
3. Rhabdomyosarcoma.

Question 9

What is liposarcoma?

Answer 9

A malignant neoplasm of adipose tissue.

Question 10

What is leiomyosarcoma?

Answer 10

A malignant neoplasm of smooth muscle.

Question 11

What is rhabdomyoscarcoma?

Answer 11

A malignant neoplasm of skeletal muscle.

Question 12

Name 4 primary bone tumours / boney sarcomas.

Answer 12

1. Osteosarcoma.
2. Ewing’s sarcoma.
3. Chondrosarcoma.
4. Fibrosarcoma.

Question 13

Primary bone tumours originate from the _____ tissue.

Answer 13

mesenchymal

Question 14

What is osteosarcoma? Give 3 features of osteosarcoma.

Answer 14

Bone forming (produce osteoid) and is malignant.
1. Fast growing.
2. Aggressive.
3. Typically affects 15 - 17 y/o - in the young.
4. ALP will be raised, as osteoblast hyperactivity.

Question 15

What is osteochondroma? Give 3 features.

Answer 15

• Cancer of the cartilage
• Most common adult none sarcoma
• Associated with dull, deep pain and affected area is swollen & tender
• Common sites affected: pelvis, femur, humerus, scapula and ribs

Question 16

What is an Ewing sarcoma? Give 3 features.

Answer 16

Malignant
Bone marrow
Mesenchymal stem cells/neuroectodermal cells
Very young
Lamellated bone
Can compress nerves
Lytic bone lesions, onion skinning

Question 17

Name a boney sarcoma that responds well to chemotherapy.

Answer 17

Ewing’s sarcoma.

Question 18

Give 2 red flag symptoms for sarcoma.

Answer 18

1. Non mechanical pain.
2. Pain at night.

Question 19

Give 5 symptoms of a bone tumour.

Answer 19

Constant, non mechanical bone pain
Swelling
Fracture
B symptoms - fever, night sweats, malaise
Avascular necrosis
Symptoms of nerve compression - numbness/weakness

Question 20

Give 4 signs that suggest malignancy and can be used to make a diagnosis of soft tissue sarcoma.

Answer 20

1. Lump > 5cm.
2. Lump is increasing in size.
3. Lump is deep to fascia.
4. Pain.

Question 21

What investigations might you do in someone who you suspect to have a sarcoma?

Answer 21

1. MRI.
2. Core needle biopsy.
3. CT scan.

Question 22

What is the treatment for sarcomas?

Answer 22

1. MDT meeting.
2. Surgery for localised soft tissue sarcomas; ensure a wide margin.
3. Amputation.
4. If non resectable, chemotherapy and radiotherapy.

Question 23

If it is not possible to get a wide margin when resecting a sarcoma, what might you do?

Answer 23

Give adjuvant radiotherapy.

Question 24

Which tumours can metastasise into bone tumours? Give 5.
HINT: Mnemonic

Answer 24

Mnemonic - PB-KTL - ‘Lead kettle’:
P: prostate
B: breast
K: kidney
T: thyroid
L: lung

Question 25

What is myeloma?

Answer 25

Abnormal proliferation of a single clone of plasma cells, leading to production of monoclonal immunoglobulins (IgG or IgA).

Question 26

What are the diagnostic criteria for myeloma?

Answer 26

2 out of 3: 1. Paraproteinaemia on serum protein immunofixation or Bence Jones proteins in urine. 2. Radiological (MRI/CT) evidence of lytic bone lesions. 3. Increase in bone marrow plasma cells - bone marrow aspiration/biopsy.

Question 27

Describe the clinical features caused by osteolytic bone lesions in myeloma.

Answer 27

Backache. Pathological fractures (e.g. long bone, ribs). Vertebral collapse. Hypercalcaemia.

Question 28

What other clinical features, apart from those associated with osteolytic bone lesions, may be present in a myeloma patient?

Answer 28

Anaemia, neutropenia or thrombocytopenia (due to marrow infiltration) - anaemia symptoms, infections and bleeding. Renal impairment due to light chain deposition in tubules.

Question 29

What would blood tests show in a myeloma patient?

Answer 29

Normocytic, normochromic anaemia, thrombocytopaenia, leukopaenia. ESR high. U&Es: Raised Calcium Raised Urea + creatinine Hypercalcaemia.

Question 30

What would be found in the urine of someone with myeloma?

Answer 30

Bence Jones proteins - paraproteinaemia leads to excretion of kappa/lambda light chains in urine

Question 31

Serum ____ is high in secondary bone tumours.

Answer 31

calcium

Question 32

How would myeloma be treated?

Answer 32

Analgesia → bone pain Bisphosphonates → e.g. Alendronate -> reduce fractures and bone pain Local radiotherapy → reduce focal disease Transfusion → correct anaemia Fluids/ dialysis → manage renal failure Abx for infections Chemotherapy - melphalan + prednisolone, or VAD (vancristin, adriamycin + dexamethasone), if fit.