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Musclo Patho > Tumours Of Bone > Flashcards

Tumours Of Bone Flashcards

1
Q

Def of osteoma

A

Benign rare tumour , regarded by some as hamartoma rathen than true neoplasm

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2
Q

Types of osteoma

A

1- compact ( ivory)
2- osteoid osteoma

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3
Q

Talk about compact osteoma

A

Origin and site : skull bones
Gross picture: hemispherical , non capsulated and ivory like mass
Microscopic picture: cocentric arranged bone lamalle
Complications; disfigurement, pressure eg : proptosis

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4
Q

Talk about osteoid osteoma

A

Related to osteoblasmtoma as there is some similarities between them and differences

Similarities
• benign
• most common in childern and young adults
• microscopic picture: trabcule of osteoid rimmed by osteoblasts separated by highly vascularized connective tissue stroma

Differences
Osteoma is small , located in the cortex of long bone , painful due to excessive production of PG E2 ( it can be treated by aspirin) and the pain is mainly nocturnal , demarcated by surrounding zone of bone formation ( reactive sclerotic bone )

Osteoblastoma is larger and painless and located in the medulla of long bone , vertebrae or hips or ribs and there is no reactive surrounding sclerotic bone

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5
Q

Talk about chondroma

A

Benign tumour of cartilage , capsulated , bluish grey and translucent

Microscopic picture : the mature cartilage

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6
Q

Def of Osteochondroma

A

The commonest tumour of benign cartilage forming lesion

It can solitary or multiple ( heredity)

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7
Q

Sites of osteochondroma

A

Arise from metaphysis of long bone and the commonest site is around the knee ( lower part of femur and upper part of tibia )

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8
Q

Gross picture of osteochondroma

A

Has narrow or broad base ( sessile or pedunculated ) continuous with the cortical bone and has mushroom shape

Cartilage capped covering well formed cortical bone with marrow

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9
Q

Microscopic picture of osteochondroma

A

Outer cartilage cap resembling epiphyseal cartilage covering lamller bone with marrow

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10
Q

Def of giant cell tumour ( osteoclastoma)

A

Locally malignant tumour of bone

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11
Q

Sites of osteoclastoma

A

In the epiphyseal of long bone around the knee

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12
Q

Common age of osteoclastoma

A

20 years but may occur also in younger

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13
Q

Gross picture of osteoclastoma

A

1-The tumour is located in the epiphyseal part of the long bone
2-It is well circumscribed, dark tan
3-The cut surface is characteristically haemorrhagic and necrotic and honey comed due to focal areas of cystic degeneration
4-The covering cortical bone is markedly thinned ( egg shell )

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14
Q

Microscopic picture of osteoclastoma

A

1- the characteristic features are the presence of large number of multinucleated osteoclast like giant cells scattered throughout stromal mononuclear cells
2- giant cells often contain as many as 100 benign nuclei
3- stromal cells are the real tumour cells ( malignant component) and their histologic appearance determines the biologic behavior of tumour
4- they are uniform spindle or oval or round that has numerous mitiotic figures
5- there is scanty collagen , areas of heamorrhages , rich vessels and presence of macrophages

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15
Q

Spread of osteoclastoma

A

80 -90% locally malignant and the rest is malignant and metastesize by blood

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16
Q

Def of osteosarcoma

A

The most common primary malignant tumour of bone

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17
Q

Origin and sites of osteosarcoma

A

Osteogenic cells and it secretes bone matrix ( osseus tissue or osteoid)
Metaphysis at medullary portion around the knee

18
Q

Types of osteosarcoma

A

1- primary: more common , it occurs in abscence of underlying diseases
2- secondary: as a complication of preexisting diseases eg paget disease- fibrous displagia

19
Q

Age of osteosarcoma

A

Primary occurs in below 20 years
Secondary occurs in elderly especially on top of Paget’s disease

20
Q

Gross picture of osteosarcoma

A

1-large mass in the medulla destroying cortical bone
2- areas of haemorrhage and necrosis
3- periosteul elevation and then penetration
4- extension with adjacent soft tissue occurs

21
Q

Microscopic picture of osteosarcoma

A

1- the tumour cells are pleomorphic
2- areas of heamorrhage and necrosis
3- thin walled vessels and very numerous in a special type of osteosarcoma named telangiectatic osteosarcoma
4- the matrix contains osteoid that is prominent in well differentiation and minimal in ill differentiation
5- there is also collagen and cartilage

22
Q

Radiological picture of osteosarcoma

A

1- tumour shows sun rays appearance in X ray due to deposition of new bone around the blood vessels
2- there is also deposition between the cortex and the periosteul elevation in triangle arrangement called codman traiangle

23
Q

Spread of osteosarcoma

A

Highly malignant that spreads locally or by blood

24
Q

Def of multiple myeloma

A

It is one of plasma cell neoplasms ( malignant)

25
Q

Common age of multiple myeloma

A

Over 40 years

26
Q

Origin and sites of multiple myeloma

A

1- plasma cells in bone marrow
2- axial skeleton

27
Q

Gross picture of multiple myeloma

A

1- soft red nodule and its multiple ( myelomatosis ) but rarely starts as solitary and later or sooner become multiple

28
Q

Microscopic picture of multiple myeloma

A

Malignant plasma cells with different ranges of maturation, binucleated form is common

29
Q

Radiological picture of multiple myeloma

A

Multiple osteolytic defects

30
Q

Effects of multiple myeloma

A

1- pathological fracture
2- pancytopenia
3- hypercalcemia and metastatic calcification
4- production of abnormal immunoglobulin ( bence jones )
Bence jonas proteinuria : these proteins form casts blocking the tubules and can be detected easily by heating urine , coagulation happens at 55 c and dissolve at 85 c
5- low immunity
6- blood spread
7- amyloidosis
8-renal changes ( myeloma nephrosis) can lead to CRF associated with blocking of tubules. Neprocalcenosis and pyelonephritis are common

31
Q

What is the other type of plasma cell neoplasm

A

Solitary plasmacytoma

32
Q

What is solitary plasmacytoma and common sites and complications

A

Solitary plasma cell tumour formed of sheets of plasma cells with different ranges of differentiation and highly vascularized stroma
Common sites : any bone especially long bone and soft tissues
Complications: can turn to multiple myeloma

33
Q

Def of ewing sarcoma

A

Highly malignant small round cell tumour

34
Q

Common age and sex and types of Ewing sarcoma

A

5-20 😟
Females
Types are :-
1- classic ( skeletal)
2- soft tissue
3- primitive neuroectodermal

35
Q

Common sites of ewing sarcoma

A

Metaphysis and diaphysis of long bones especially femur and hemur and tibia and fibula

36
Q

Clinical and radiological picture of Ewing sarcoma

A

Signs of inflammation
1- pain
2- tenderness
3- swelling
4- fever
5- lymphocytocytosis

These can lead to diagnoses of osteomyelitis however Xray picture shows osteolytic lesions with patchy subperiosteal new bone formation producing onionskin appearance

37
Q

Gross picture of Ewing sarcoma

A

It invades the medulla and expands in it and extends into the adjacent soft tissues

38
Q

Microscopic picture of Ewing sarcoma

A

1- member of small round cell tumour
2- its separated by fibrous septa into irregular lobules of closely pached tumour cells
3- these tumour cells are characteristicly arranged around capillaries forming pseudorosettes
4- tumour cell is small uniform similar to lymphocytes with nuclei of “ salt and paper “ chromatin
5- cytoplasm is full of glycogen
6- + for PAS stain and CD99 tumour cell marker
7- there is necrosis and inflammatory infltiration

39
Q

Spread of Ewing sarcoma

A

Highly malignant and metastisize

40
Q

Talk about metastatic bone tumours

A

6 ( 4 frequent)
1- more frequent than primary malignant tumour
2- more frequent by blood spread
3- more frequently in spine, ribs , hemur , femur
4- more frequent with carcinoma than sarcoma
carcinomas like prostate and breast and kidney and lung
sarcomas like Ewing sarcoma and osteosarcoma
5-usual radiographic picture is of osteolytc lesions .osteoblastic lesions may be in some tumour like prostate and small cell carcinoma of lung
6- the same microscopic picture of primary tumour

41
Q

Origin of Ewing sarcoma

A

Neuroectodermal cells

Musclo Patho (6 decks)

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