Bone Tumors - Lecture 1
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Questions and Answers

What is a common symptom of bone tumours in older patients?

  • Swelling without pain
  • Pain from tiny lesions (correct)
  • Neurological symptoms (correct)
  • Asymptomatic presentation
  • Which imaging technique is NOT typically used for diagnosing bone tumours?

  • X-Rays
  • Ultra-sensitive blood tests (correct)
  • Magnetic Resonance Imaging
  • Computed Tomography
  • Which primary malignant tumour is most commonly found in childhood and adolescence?

  • Ewing's tumour (correct)
  • Fibrosarcoma
  • Metastatic bone lesions
  • Chondrosarcoma
  • What does the presence of flecks of calcification in a bone lesion indicate?

    <p>Possibly a malignant process</p> Signup and view all the answers

    Which factor is significant when assessing whether a bone lesion is solitary or multiple?

    <p>Age of the patient</p> Signup and view all the answers

    What is the staging classification of benign bone tumors as described by Enneking?

    <p>Latent, Active, Aggressive</p> Signup and view all the answers

    What would be an expected laboratory finding in patients with certain bone conditions?

    <p>Increased ESR and elevated serum alkaline phosphatase</p> Signup and view all the answers

    Which of the following is NOT a method of tumor excision?

    <p>Conservative incision</p> Signup and view all the answers

    What is the primary indication for multi-agent chemotherapy in treating bone tumors?

    <p>To reduce the size of the primary lesion</p> Signup and view all the answers

    What is crucial to complete before performing a biopsy on a suspected bone tumour?

    <p>Imaging studies</p> Signup and view all the answers

    Which of the following conditions could be included in the differential diagnosis of bone tumours?

    <p>Myositis ossificans</p> Signup and view all the answers

    Which of the following is characteristic of non-ossifying fibroma?

    <p>Asymptomatic and typically found in children</p> Signup and view all the answers

    What is a significant complication associated with radiotherapy for bone tumors?

    <p>Post-irradiation spindle-cell sarcoma</p> Signup and view all the answers

    What distinguishes osteoid osteoma from other bone tumors?

    <p>Pain is relieved by salicylates</p> Signup and view all the answers

    Which statement about fibrous dysplasia is accurate?

    <p>Large lesions can weaken the bone and lead to fractures</p> Signup and view all the answers

    At what age is osteoid osteoma primarily diagnosed?

    <p>Under 30 years</p> Signup and view all the answers

    What is the only effective treatment for a chondroma that shows signs of enlargement?

    <p>Complete removal or destruction of the nidus</p> Signup and view all the answers

    At what stage of bone growth does an osteochondroma stop enlarging?

    <p>At the end of the normal growth period for that bone</p> Signup and view all the answers

    Which of the following symptoms might indicate malignant transformation of an osteochondroma?

    <p>Further enlargement after the growth period</p> Signup and view all the answers

    In which demographic is a giant-cell tumour most commonly found?

    <p>Young adults</p> Signup and view all the answers

    What imaging techniques are likely used to identify a giant-cell tumour?

    <p>X-ray, CT scan, and MRI</p> Signup and view all the answers

    What is a common characteristic of a simple bone cyst?

    <p>It typically heals spontaneously</p> Signup and view all the answers

    What constitutes a pathological fracture often leading to the discovery of a chondroma?

    <p>Fracture resulting from minimal trauma</p> Signup and view all the answers

    What is the potential risk associated with giant-cell tumours?

    <p>Transformation into an osteosarcoma</p> Signup and view all the answers

    Study Notes

    Bone Tumors - Lecture 1

    • Tumours, tumour-like lesions, and cysts are grouped due to similar clinical presentation and management. Definitive classification is ongoing.

    Clinical Presentation - History

    • Tumours are often asymptomatic (discovered incidentally).
    • Childhood and adolescent primary malignant tumors (Ewing's tumour, osteosarcoma) are common.
    • Chondrosarcoma and fibrosarcoma are more common in older people.
    • In patients over 70, metastatic bone lesions are more frequent than primary tumors.

    Clinical Presentation - Symptoms

    • Pain: Even tiny lesions can be very painful if encapsulated in dense bone (e.g., osteoid osteoma).
    • Swelling: A visible lump can be alarming.
    • Neurological symptoms: Paraesthesia or numbness can occur.

    Clinical Presentation - Examination

    • Examination focuses on the symptomatic area.
    • Lymphatic drainage, pelvis, abdomen, chest, and spine should be assessed.

    Imaging - X-Rays

    • Questions to ask when studying an X-ray:
      • Is the lesion solitary or multiple?
      • What bone type is involved?
      • Location of the lesion in bone?
      • Are lesion margins well- or ill-defined?
      • Are there calcification flecks present?
      • Is the cortex eroded or destroyed?
      • Is there periosteal new bone formation?
      • Does the tumor extend into soft tissues?

    Imaging - Other modalities

    • Radioisotope scanning
    • Computed tomography (CT)
    • Magnetic resonance imaging (MRI)

    Laboratory Investigations

    • Blood tests rule out other conditions like infection, metabolic bone disorders, or hyperparathyroidism ('brown tumour').
    • Increased erythrocyte sedimentation rate (ESR) and serum alkaline phosphatase are potential markers.
    • Serum protein electrophoresis, urine for Bence Jones protein.

    Biopsy

    • Needle biopsy is common.
    • Open biopsy is another option.
    • Delay biopsy until all imaging is complete.

    Differential Diagnosis

    • Soft tissue haematoma
    • Myositis ossificans
    • Stress fracture
    • Bone infection
    • Gout

    Staging of Bone Tumors

    • Benign bone tumors are staged (latent, active, aggressive) as described by Enneking.
    • Bone sarcomas are staged:
      • Stage I: All low-grade sarcomas.
      • Stage II: Histologically high-grade lesions.
      • Stage III: Metastasized sarcomas.

    Treatment Methods

    • Tumor excision
    • Multi-agent chemotherapy
    • Radiotherapy

    Benign Bone Lesions

    • Non-ossifying fibroma (fibrous cortical defect): A common benign developmental lesion in children, often found incidentally.
    • Fibrous dysplasia: A developmental disorder where trabecular bone is replaced by fibrous tissue. Significant lesions may lead to fractures or deformities. Treatment depends on the lesion's size and symptoms.
    • Osteoid osteoma: A tiny benign bone tumor (usually under 1 cm) commonly found in young adults. Pain is a key symptom, typically relieved by salicylates. Characterized by a small radiolucent nidus on X-ray. Treatment is complete removal of the nidus.
    • Chondroma (enchondroma): Usually asymptomatic, discovered incidentally. They can occur at any age in almost any bone (especially hands and feet). Removal usually only necessary if the tumor grows or if it causes a pathological fracture.

    Additional Types

    • Osteochondroma (cartilage-capped exostosis): A common benign tumor that typically grows during the growth period of a bone
    • Giant cell tumour of bone: Pain and swelling are common symptoms. The tumor can develop into a more aggressive type of cancer. It's frequently treated by curettage and bone grafting.
    • Simple bone cyst: Benign lesion, often seen in children and teens. The cysts can heal on their own.
    • Aneurysmal bone cyst: Usually in long bones. Radiolucent lesion found on X-rays (often trabeculated). MRI can confirm and it is curetted then filled with bone grafts.

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    Description

    This quiz covers the essential aspects of bone tumors, including their clinical presentation, common types, symptoms, and diagnostic imaging approaches. It focuses on the differences between primary malignant tumors and metastatic lesions, as well as the examination techniques used. Test your knowledge on the critical features associated with bone tumors.

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