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Flashcards in Tumours Deck (18)
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1

Osteoma (Gardner's Syndrome)

Benign Sclerotic Tumour 

  • Asymotomatic 
  • Female 3:1
  • Frontal or ethmoid sinus distribution 
  • Round/oval radiopaque, mostly <2cm 
  • Small, white, solid, osseous growths off the outer cortex of bone

 

2

Osteoid Osteoma 

Benign Sclerotic Tumour 

  • 10-15 years 
  • Male 2:1 
  • Proxima Femur, Tibia, Lumbar Spine (pedicle) 
  • Lucent nidus <1cm (nidus = vascularised fibrous connective tissue)
  • Relieved by asprin 
  • Reactive sclerosis, cortical thickening, solid periosteal reaction 

3

Brodie's Abscess 

Benign Lucent Tumour 

  • Lesion is close to growth plates 
  • Lucency greater than 1 cm 
  • Drainage tract toward the epiphysis 

4

Bone Island (Enostoma)

Benign Sclerotic Tumour 

  • Ischium, Illium, Sacrum, Proximal femur
  • Not in the skull 
  • Intramedullary location 
  • Adults 
  • Round, Radiopaque lesions 
  • long axis of bone 

5

Osteochondroma 

Benign 

  • Most common skeletal tumour 
  • 75% discovered before age 20 
  • Femur, TIbia, Humerus 
  • Exostosis = grows form the cortex of bone 
  • Peduculated, Sessile, Cauliflower presentation
  • The lesions begin as growth of new bone off the cortex of long bones and then cartliage is calcified within the lesion giving a slcerotic and lucent appearance 
  • These are usually asymptomatic unless obstrucitng internal strucutres 
  • Multiple Osteochondroma's = Heriditory Multiple Exostosis 

6

Enchondroma 

Lucent Benign Tumour 

  • Most common tumour of the hand 
  • 50% have a calcification of the cartilage in the matrix 
  • Can progress in to malignant chondrosarcoma 
  • Lytic, geograpgic lesion occuring in the metaphysis 
  • Mildly expansive with endosteal scalloping 
  • Stippled calcification in the matrix 

7

Haemangioma 

Benigns Lucent Tumour 

  • Female 
  • >40 years 
  • Most common tumour of the spine 
  • Thoracolumbar vertebral body, Skull 
  • Vertical striations in the vertebral body 

DDx.

  • Padget's 
  • Osteoporosis 

8

Fibrous Xanthoma 

Lucent Benign 

  • Fibrocortical defect
    • 4-8 years <2cm
    • Male 2:1 
    • Posterior medial surface of distal femour most common 
  • Nonossifying fibroma
    • 8-20 years 2-7cm 
    • Males 2:1
    • Distal tibia, dital femur, proximal tibia, humerus, fibula 
  • Diametaphyseal
  • Eccentric, oval lytic lesion with well defined rim of scleorsis 
  • Thinned cortex
  • Soap bubble appearance  

9

Simple Bone Cyst 

Benign Lucent 

  • Fluid filled cyst lined with fibrous tissue 
  • 3-14 years of age 
  • Proximal humerus, Proximal femur  
  • Truncated lesion starting in the metaphysis and tapering into the diaphysis. It does not cross into the epiphysis 
  • Soap bubble matrix 
  • mild endosteal scollaping 
  • No periosteal reaction 
  • Fallen fragment sign or hinge fragement sign if fragment isnt completly detached 

10

Aneurysmal Bone Cyst 

Benign Lucent 

  • Non-neoplastic blood folled cavity 
  • Female 3:2
  • 5-20 years 
  • Long bones and thoracolumbar spine 
  • Metaphyseal and diaphyseal 
  • Rapidly expanding reaching 8-10cm in diameter 
  • Egg shell rim of sclerosis 
  • Buttressing of new periosteal bone 
  • Will no extend into epiphysis of gorwht plate is closed 
  • Exapansion into vertebral body is knwn as balloon in finger sign 

11

Giant Cell Tumour 

Lucent Benign 

  • Quasimalignant tumour 
  • Also known as osteoclastomas 
  • 5-20% of malignant 
  • Malignant tumour 
    • Male 2:1
  • Benign 
    • Female 3:2
  • 20-40 years of age after clsure of epiphysis 
  • Distal femur, proximal tibia, proximal humerus, distal radius 
  • Distal radius is 99% malignant 
  • Most common benign tumour of saccrum 
  • Metaphyseal that can extend into epiphysis 
  • Eccentric, lytic, geographic, soap bubble matrix, expansive lesion, thinning of cortex 

12

Osteosarcoma 

Malignant Sclerotic 

  • Abnoormal osteoblastic cells 
  • 5 types 
    • Central (conventional)
    • Multicentric
    • Parosteal (juxtacortical)
    • Extraosseous
    • Secondary 
  • Males 2:1
  • 10-20 years 
  • 50% osseous neoplastic lesion (sclerotic), 25% comprised of connective tissue (lytic), 25% are a mixed lesion 
  • Occur around the knee in the metaphysis 
  • Metastases to lungs, bones kidneys 
  • Dense ivory sclerosis filling meduallry cavity, or permitive lytic lesion, poorly defined zone of transition
  • Cortical disruption, Aggressive periosteal reaction, bone exapnsion
  • Roughened lobulated boarder (cumulus cloud)
  • Large soft tissue mass may also ossify 

13

Multiple Myeloma 

Malignant Lucent 

  • Malignant proliferation of plasma cells that replace bone marrow 
  • Most common malignnant tumour 
  • Male 2:1
  • Thoracolumbar junction most common 
  • Diaphysis of long bones (rarelt bellow the knee and elbow)
  • Hallmark sign: Osteolytic defects
    • sharply circumscribed 
    • punched out lesions 
    • skull, pelvis, long bones, clavicle, ribs
    • raindrop skull 
    • uniform size differentiates from lytic metasteses 
    • endosteal scalloping 
  • Diffuse osteolytic round/ocal lesions without reactive sclerosis in diaphysis with endosteal scalloping
  • Diffuse, unexplained osteoporosis in vertebral bodies 
  • Wrinkles vertebra sign may be single or multiple 

DDx

  • Ewing's sarcoma, Non-hodgkin's lymphoma, 

14

Ewings Sarcoma 

Malignnat Lucent 

  • Males 2:1
  • Proliferationof primitive round cells 
  • Long bones are more affected in younger patients 
    • femur, tibia, humerus 
  • Flat bones more affected in older patients 
    • pelvis, ribs 
  • Most common tumour to metasesise to lungs and and bone 
  • Diaphyseal apressive lucent lesion 
  • Permative with wide xone of transition
  • Periosteal raction = sunburst and codmans triangle 
  • Cortical saucerisation (shallow concave defect on outer cortex)

DDx

  • Osteosarcoma 
  • Osteomyelitis 

15

Non-Hodgkin's Lymphoma 

Malignant Lucent 

  • Reticulum cell sarcoma 
  • Round cell tumour 
  • Adults 50-80 years 
  • Males 2:1
  • Femur, tibia, humerus diaphysis 
  • Pelvis, ribs, scapula, vertebrae 
  • Permative, moth eaten appearence in medullary cavity 
  • Patch destruction of cortex 
  • Minimal periosteal reaction, with soft tissue mass 
  • Vertebral collapse 

16

Chondrosarrcoma 

Malignant Lucent 

  • Malignant chondrogenic producing cartilage and callagen which often calcifies 
  • Males 2:1
  • Pelvis, femur, humerus 
  • Most common tumour of hand, sternum, scapula 
  • large radiolucent lesion wit poorly defined margins 
  • Expansion/enlargement of bone 
  • Metaphysis/Diaphysis 
  • Endosteal scalloping, cortical thinning
  • Circular radiolucent giving bubble appearence in matrix 
  • 2/3 of lesion with a cotton woll appearance (foci of calcification)
  • Cortical destruction 

17

Fibrosarcoma 

Malginant Lucent 

  • 30-50 years 
  • Female = Male 
  • Produces varying amounts of malignant fibrous collagen
  • 50% occur around the knee 
  • Eccentric lytic lesion, cortical thinning and endosteal erosion 
  • permative destruction, wide zone of transition 
  • Often produces hyge soft tissue mass

18

Metasteses 

Osteolytic 

  • Cortical and trabecular destruction 
  • Lack of bone expansion
  • Lack of periosteal response 
  • Moth-eaten, permative destruction 
  • Small or absent soft tissue mass 

Osteoblastic metasteses 

  • Localised or diffuse increased bone density 
  • poorly defined margins 

Mixed metasteses

  • Combination of features