Week 1

Question 1

X-ray terminology includes

Answer 1

-Radiopaque (white), sclerotic bone
-Radiolucent (black), lytic bone

Question 2

CT scan terminology includes

Answer 2

-hyperdense (white)
-hypodense (dark)

Question 3

MRI terminology includes

Answer 3

hyperintense (white)
hypointense (dark)

Question 4

Bone neoplasms

Answer 4

primary tumours are classified as benign or malignant, though some exhibit borderline/intermediate characteristics

secondary metastatic bone tumours are far more common than primary bone cancers

Question 5

5 basic parameters to determine tumour type and behaviour are

Answer 5

1. patient age
2. which bone
3. what part of the bone
4. radiography
5. macro/microscopy

Question 6

important features of the bone include

Answer 6

1. Epiphysis which includes:
   -Articular cartilage
   - spongy bone
   - epiphyseal plate
2. metaphysics
3. diaphysis which includes
   
   • medullar cavity (inner)
   • endosteum (inner layer)
   • periosteum (outer layer)

Question 7

Look up x rays of

Answer 7

1. Fibrous dysplasia
2. ewing sarcoma
3. osteochondroma
   -penduculated
   -sessile
   -cauliflower
4. enostosis bone island
5. osteomyelitis or other aggressive lesion
6. simple/unicameral boen cyst
7. aneurysmal bone cyst
8. osteoid osteoma
9. non-ossifying fibroma
10. osteosarcoma
11. chondroblastoma
12. enchondroma

Question 8

revise table sheet for

Answer 8

types of tumours, common locations, age, morphology

Question 8

benign tumours and tumour like lesions include

Answer 8

1. osteochondroma
2. chondroma
3. osteoma
4. osteoid osteoma
5. non-ossifying fibroma

Question 8

tumours fall into 3 categories based on what they make

Answer 8

1. Cartilage forming
2. Bone forming
3. unknown origin

Question 8

non-malignant lesions are more common

Answer 8

in bone than malignant primary neoplasms

Question 9

osteochondroma

Answer 9

location: cortex of metaphysis of long bones, pelvis

usual age: 10-30

features: bony excrescence with cartilage cap

osteochondroma is the most frequent benign bone tumour.

Question 9

chondroma

Answer 9

location: small bones of hand and feets (enchondroma) and long bones

usual age: 30-50

features: circumscribed hylaine cartilage nodule in medulla

chondroma is common benign cartilaginous tumour. it can lead to pathological fracture

Question 10

osteoma

Answer 10

location: skull and facial bones

usual age: 40-50

features: may protrude intro paranasal sinus

Question 11

osteoid osteoma

Answer 11

location: metaphysis of femur or tibia

usual age: <20

features: cortical, severe pain relieved by aspirin; akin to osteoblastoma of spine

intense sharply localised pain.

Question 12

non-ossifying fibroma

Answer 12

location: metaphysis of femur and tibia

usual age: childhood

features: developmental abnormality, usually asymptomatic

Question 13

Giant cell tumour of bone

Answer 13

2 components found in GCT
-giant cell = osteoclast-like cell
-stromal cell = true neoplastic element

the stromal cell in GCT s an osteoblast precursor expressing high levels of RANKL, a promoter of osteoclast proliferation and differentiation. this leads to excessive resorption of bone. denosumab by binding to RANKL, inhibits excessive osteoclast-mediated bone resorption an docmponents surgical treatment of GCT

Question 14

malignant primary bone neoplasms include

Answer 14

1. osteosarcoma
2. chondrosarcoma
3. ewing’s tumour

Question 15

osteosarcoma

Answer 15

location: metaphysis of long bones espicially distal femur and proximal tibia

usual age: teenagers and young adults

features: rapid growth, lung metastases. 5-year survival = 60-80% if localised

Question 16

chondrosarcoma

Answer 16

location: pelvis, rib, spine, long bones

usual age: 40-60

features: relatively slow growth, 5 year survival greater than 80% for low grade, less than 30 % if high grade

Question 17

ewing’s tumour

Answer 17

location: diaphysis or metaphysis of long bones, pelvis, ribs

usual age: children and teenagers

features: survival 5 years is greater than 70% if localised but 20-30% if metastatic

Question 18

metastases to bone

Answer 18

-most originate in breast, lung, prostate, thyroid, or kidney (>80%) and the vast majority are carcinoma.
-metastases most commonly 70% involve the axial skeleton; vertebrae, sacrum, skull, ribs
-metastases to the appendicular skeleton are usually proximal to the elbows and knees and metaphyseal.

-any tumour metastatic to bone, if extensive enough may lead to hypercalcemia and elevation of serum acid phosphatase.

-most metastatic bone lesions cause pain

-most metastases are osteolytic

-prostate carcinoma metastases, and some breast carcinoma metastases are osteoblastic

Question 19

bone metastasis of a breast carcinoma

Answer 19

a 50 year old woman had a right radical mastectomy, widespread painful metastases developed in right shoulder leg pelvis. post mortem exam revealed multiple fleshy nodules in cranium bone, varying in size from 3mm to 3cm = bone metastases of mammary carcinoma.

metastases from breast carcinoma to vertebrae with crush fracture; woman aged 29 who has noticed a lump in her breast 3 years before death

Question 20

mechanism of metastases in bone

Answer 20

• tumour cells must detach from primary host tissue (acquisition of invasive properties)
  -penetrate and migrate through bloodstream
  -escape surveillance of immune system
• attain bone marrow sinusoids, stop and grow there
• numerous factors including proteinases, adhesion molecules,a nd growth factors are involved in this multi-step process

Question 21

metastases to bone

Answer 21

haematogenous spread can be via the systemic circulation or the vertebral venous plexus

Question 22

dormant micrometastases - a time bomb

Answer 22

- patients with localised breast cancer, even treated with adjuvant therapy, remain at risk for late metastatic relapse, most commonly in bone -clinically silent bone marrow micrometastases can be detected in 30% of breast cancer patients with stage I to III disease ---> relapse -bone marrow is a particularly attractive location for micrometastases and its microenvironment can maintain tumor dormancy for extended periods

Question 23

Haematological malignancies

Answer 23

- haematological malignancies cna involve the skeletal system primarily or as manifestation of systemic disease -these tumours can be of a variety of types (lymphoma, leukaemia, myeloma)

Question 24

clinical features of hematological malignancies involving bone

Answer 24

1. bone paina nd tenderness sweeling; pain typically worsens at night 2. pathological fractures: most commonly involving weight-bearing bones such as the femur 3. abnormalities in hematopoiesis : eg leukoerythroblastic anaemia if metastatic deposits are extensive 4. features of hypercalcemia: CNS (confusion); renal (stones), GI (constipation), CV (arrhythmia)

Question 25

Primary lymphomas of bone

Answer 25

-most lymphomas start in the lymphatic system (lymph nodes, mucosa associated and other lymphoid tissue), but primarily lymphoma of bone (PLB) starts in the skeleton -the peak age of people diagnosed with PLB is 50-60 year of age group -in most cases, PLB is diagnosed as a single, localised tumour

Question 26

Burkittt lymphoma

Answer 26

-aggressive B-cell lymphoma with a chromosomal tarnslocation causing c-myc overexpression. -massive involvement of craniofacial ( jaw) bones typical of endemic type

Question 27

acute leukaemia

Answer 27

in the childhood patient population, acute leaukaemia is associated with radiographic abnormalities of the skeletal systemin 70-90% of cases

Question 28

plasma cell neoplasms

Answer 28

1. B-lymphocytic proliferation formed by malignant plasma cells (immunosecretory cells) 2. secrete a monoclonal immunoglobulin (Ig) 3. Can present as a solitary mass (plasmacytoma) or as part of a systemic disease (multiple myeloma) 4. bone marrow involvement --> lytic skeletal lesions 5. peak incidence = 7th decade/ most common lymphoid neoplasm in order adults

Question 29

multiple myeloma

Answer 29

most common and deadly of the plasma cell neoplasms generally accompanied by perturbation of serum immunoglobulins and can lead to immunoglobulins deposition disease (amyloidosis, light and heavy chain deposition disease)--> morbidity incurable but treatment can alleviate symptoms, reverse cytopenia, decrease end-organ damage, improve quality of life and prolong overall survival chromosomal translocation that fuse that IgH locus on chromosome 14 to oncogenes such as cyclin D1 and cyclin D3 genes proliferation of myeloma cells supported by the cytokine interleukin 6 (IL-6) produced by fibroblasts and macrophages in the bone marrow

Question 30

multiple myeloma complications

Answer 30

1. renal dysfucntion 2. amyloidosis 3. hypercalcaemia, pathological fractures, spinla cord compression 4. anaemia, hyperviscosity syndrome 5. infections