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Flashcards in Tumours of Bone Deck (46):
1

Osteochondroma B/M? (exotosis)

Benign

2

Chondroma B/M?

Benign

3

Osteoid osteoma B/M?

Benign

4

Chondroblastoma B/M?

Benign

5

Osteochondroma (exotosis)

Cartilage capped bony projection arising on external surface of bone containing a marrow cavity that is continuous with that of the underlying bone.

6

Chondroma

Low power - lobules of varying sizes

Chondrocytes with small, round, pyknotic nuclei inside hyaline cartilage – no atypia.

Variable cellularity

7

Osteoid production is essential for diagnosis of what?

Osteosarcoma?

8

What is essential for diagnosis of osetosarcoma?

Osteoid production

9

Are small peripheral lesions more likely to be benign or malignant that large axial regions?
(endochondroma)

Small peripheral lesions are more likely to be benign than large axial lesions.
(endochondroma)

10

Dull pain
Worse at night
Characteristically relieved by aspirin or non-steroidal anti-inflammatory drugs

Osteoid osteoma

11

Radiolucent nidus surrounded by reactive sclerosis in cortex of bone

Osteoid osteoma

12

Prognosis of osteoid osteoma

Will resolve without treatment in an average of 33 months.

13

Osteoid osteoma

benign osteoblastic tumour

central core of vascular osteoid

peripheral zone of sclerotic bone

14

Cartilage capped bony projection arising on external surface of bone containing a marrow cavity that is continuous with that of the underlying bone

Osteochondroma

15

Which age group are affected by ostochondromas?

Young <20

16

Benign hyaline cartilage tumour arising in medullary cavity of bones of hands and feet?

Chondroma

17

Multiple enchondromas are associated with multiple angiomas?

Maffucis syndrome

18

Chondrocytes with small, round, pyknotic nuclei inside hyaline cartilage

Chondroma

19

Must differentiate chondroma from what?

Chondrosarcoma
-small peripheral lesions are more likely to be benign that large axial lesions

20

Distinct clinical picture of dull pain that is worse at night and disappears within 20-30 minutes o treatment with NSAIDS

Osteoid osteoma

21

Radiolucent nidus surrounded by reactive sclerosis in cortex of bone?

Osteoid osteoma

22

benign osteoblastic tumour
central core of vascular osteoid
peripheral zone of sclerotic bone

Osteoid osteoma

23

How long does it take for an osteoid osteoma to resolve?

Average of 33 months

24

Benign cartilage tumour arising in bone - rare

Can occasionally exhibit more aggressive course

Found at epiphysis of long bones

Age group – second decade of life

Chondroblastoma

25

Spherical and well-defined osteolytic foci, sometimes extending into the subarticular bone, joint space or metaphysis

Chondroblastoma

26

Distinct cytoplasmic borders with foci of “chicken-wire” calcification.

Closely packed polygonal cells plus areas of immature chondroid.

Mitotic activity is low

Chondroblastoma

27

Treatment for chondroblastoma

Biopsy and curettage plus adjuvant liquid nitrogen

28

Where are giant cell tumours often found?

Site - long bones, often around the knee

29

Multinucleated giant cells in a sea of round to oval mononuclear cells

Giant cells

30

Irregular spicules of mineralised bone and osteoid surrounded by osteoblasts

Vascular stroma with pleomorphic spindle cells

Osteoid and woven bone are seen

Osteoid osteoma

31

Very rare tumour arising from notocord remnants (midline tumour, often in sacral region)

Chordoma

32

Soft, blue-gray, lobulated tumours

Gelatinous translucent areas and often a capsule is present

Lesion often tracks along nerve roots in the sacral plexus or out the sciatic notch in planes of least resistance.

Chordoma

33

On plain x-ray - appear as a solitary mid-line lesion with bony destruction

Often an accompanying soft tissue mass

Approximately half of the time focal calcifications are present

CT and MRI scans help demonstrate the soft tissue component

Chordoma

34

Lobules and fibrous septa. The malignant cell has eosinophilic cytoplasm & prominent vacuoles of mucus push the nuclei to the side

Chordoma

35

Commonest primary malignant tumour

Osteosarcoma

36

Malignant osteoblasts forming osteoid

Osteosarcoma

37

Age group affected by osteosarcoma?

Young adults, 60% <25 years old

38

Condition which can predispose to osteosarcoma in older patients?

Pagets

39

The second commonest primary malignant tumour of bone

Exhibits pure hyaline cartilage differentiation

Composed of malignant chondrocytes

Chondrosarcoma

40

Malignant nodules of chondrosarcoma infiltrate between the lamellar bone obliterating the marrow

Separation of the nodules by fibrous bands would be another feature highly suggestive of malignancy.

Chondrosarcoma

41

Peripheral primitive neuroectodermal tumour (PNET)

Ewing's sarcoma
-Most common in second decade of life

42

Small round blue cells

Ewing's sarcoma

43

Surgery
Radiation therapy
Chemotherapy with vincristine, dactomycin and cyclophosphamide
Post-operative adjuvant chemotherapy

Ewing's sarcoma

44

Malignant proliferation of plasma cells in bone marrow

Occurs in old age

Often causes renal failure

Results in bone destruction of axial skeleton

Multiple myeloma

45

Cancers which can metastasise to bone?

Thyroid, breast, lung (particularly small cell), kidney prostate

Other cancers: gastric cancer, malignant melanoma and neuroblastoma

46

Which type of lung cell cancer may metastasise to bone?

Small cell