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Flashcards in Tumours and tumour-like lesions Deck (29)
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Name 2 differential diagnoses of bone tumours

  1. Chronic osteomyelitis: pain, swelling, and x-ray destruction of metaphysis with periosteal bone
  2. Stress fracture
  3. Gout tophus


What is the commonest benign lesion of bone?

Non-ossifying fibroma

Asymptomatic, and almost always occurs in children


Describe the radiographic appearance of a non-ossifying fibroma

Oval radiolucent area of cortex, that may appear cystic



Name 4 types of primary malignant bone tumours

  1. Osteosarcoma: children and adolescents
  2. Chondrosarcoma: 40-50s
  3. Ewing's sarcoma: 10-20s
  4. Multiple myeloma: 45-65


Define osteosarcoma

A highly malignant tumour arising within the bone. Rapidly spreads outwards to the periosteum and surrounding soft tissues.


Describe the clinical features of osteosarcoma

  • Most commonly around knee and proximal humerus
  • Pain: constant, worse at night, progressive
  • May present with a lump and local tenderness
  • Later palpable mass with overlying inflammation
  • ESR raised +/- ALP raised


How does osteosarcoma appear on imaging?

  • Entirely osteolytic, or
  • Alternating lysis and increased bone density.
  • Poor defined tumour margins
  • Cortex often breached: 'sunburst' effect
  • Periosteal reaction: 'codman' triangle

N.B. Sunburt and Codman indicate invasive tumours, not specific to osteosarcoma


How is osteosarcoma diagnosed?

  • X-ray appearance
  • Biopsy


Outline the treatment of osteosarcoma

  1. Neoadjuvent chemotherapy
  2. Wide resection
  3. Tumour-replacement implants


Define multiple myeloma

A malignant B-cell lymphoproliferative disorder of the marrow, with plasma cells predominating


Describe the appearance of multiple myeloma

  • Osteoporosis
  • Myelomatosis: discrete lytic lesions through the skeleton


Outline the clinical features of multiple myeloma

  • Typically aged 45-65
  • Weakness
  • Backache
  • Bone pain
  • Pathological fractures
  • Hypercalcaemia: thrist, polyuria, abdominal pain


What investigation of suggestive of multiple myeloma?

Bence-Jones protein in urine (occurs in 50%)


Describe the incidence of metastatic bone disease

In patients over 50 years, bone metastases are seen more frequently than all primary malignant bone tumours togther


Name the common primary sources of metastatic bone disease

  • Breast
  • Lung
  • Thyroid
  • Kidney
  • Prostate


Describe the clinical features of metastatic bone disease

  • Pain: often the only feature
    • Sudden back or thigh pain is suspicious
  • Pathological fracture
  • Sudden vertebral collapse
  • Hypercalacaemia: anorexia, nausea, polydipsia, polyuria, abdominal pain, weakness, depression


What imaging should be ordered in suspected metastatic bone disease?

  • X-ray of affect bone
  • CXR: primary lung cancer
  • Staging CT CAP: primary cancers
  • Radioscintigraphy 99mTc-HDP: silent metastases


Describe the characteristic x-ray features of multiple myeloma

Bone rarefication and punched-out areas in the ling bones, ribs, and skull.


X-ray may just show generalised osteoporosis. Multiple myeloma is one of the commonest causes of osteoporosis and vertebral compression fracture men over the age of 45 years.


What are the signs and symptoms of hypercalcaemia?

  • Bone pain
  • Renal stones, polydipsia, polyuria
  • Abdominal pain, nausea, ileus, constipation
    • acute pancreatitis
  • Depression, lethargy, psychosis


State the commonest sites of bone metastases

  • Vertebrae
  • Pelvis
  • Proximal half of femur
  • Humerus


Explain the initial investigations for bone metastases

  • FBC: anaemia, WCC
  • U&Es and glucose: kidney function and DM
  • Bone profile:ALP often raised
    • Acid phosphatase raised in prostate cancer
  • LFTs and clotting: liver function


What additional investigations should be requested for bone metastases?

  • Prostate specific antigen
  • Carcinoembryonic antigen: breast and colorectal
  • Serum electrophoresis: multiple myeloma
    • High IgG Gamma
  • Urinary Bence-Jones protein
  • Biopsy (done last): grading


What treatment principles exist for bone metastases?

  • Palliative care
  • Opioid analgesia
  • Radiotherapy: analgesia and reduce growth
  • Hormone therapy: prostate or breast primary
  • Solitary lesions: surgery + radiotherapy
  • Hypercalcaemia: hydration, reduce calcium, bisphosphonates
  • Internal fixation of fractures
  • Prophylactic fixation
  • Spinal stabilisation: posterior spinal fusion
  • Counselling
  • Practical assisstance with material affairs


Outline the clinical features of chondrosarcomas

  • Slow-growing tumour, with late metastateses
  • Usually presents for many months prior to discovery
  • Dull ache or gradually enlarging lump
  • Pathological fracture


How are chondrosarcomas treated?

Due to slow-growth and late metastates, these are ideal for wide excision and prostetic replacement.

Tumour does not respond to radiotherapy or chemotherapy.


Describe the clinical features of Ewing's sarcoma?

Most commonly occurs tibia, fibula, clavicle

  • Pain: often throbbing
  • Swelling


How does Ewing's sarcoma appear on x-ray?

Bone destruction predominantly in mid diaphysis

'Onion-peel' effect: periosteal reaction produces multiple concentric parallel layers.


Name an important differential diagnoses of Ewing's sarcoma. How is this exluded?


Excluded on biopsy, different appearance to osteosarcoma.


How is Ewing's sarcoma treated?

Combination of

  • Radiotherapy
  • Surgery
  • Chemotherapy