Pathology cortex 1

Question 1

What is a bone cyst and where/who are they usually found in?

Answer 1

• Is a single cavity benign fluid filled cyst in a bone
• Usually found in the prox humerus and femur in kids or young adults

Question 2

If required what is the treatment of osteochondromas ?

Answer 2

If growing in size or causing pain then it may require excisional biopsy

Question 3

What are enchondromas, simple bone cysts and aneurysmal bone cysts all at risk of and therefore what is done to treat them ?

Answer 3

• All as risk of pathological fractures
• Curettage (scrapped out) and bone grafting

Question 4

What is an aneurysmal bone cyst?

Answer 4

• A cavity which contains lots of chambers which are filled with blood or serum
• They can occur in the metaphyses of many different long bones, flat bones (ribs, skull) and vertebral bodies
• Lesion is benign but locally aggressive causing cortical destruction and is usually painful

Question 5

What is fibrous dysplasia ?

Answer 5

• A disease of a bone usually occurring in adolescence where a genetic mutation results in lesions of fibrous tissue and immature bone.
• Can affect one or many bones
• Benign

Question 6

What deformities can fibrous dysplasia result in ?

Answer 6

Can result in angular deformities due to defective mineralisation and stress fractures.

If there is extensive involvement with the proximal femur it can result in sheperds crook deformity

Question 7

What is the treatment for fibrous dysplasia ?

Answer 7

• Bisphosphonates may reduce pain
• pathologic fractures should be stabilized with internal fixation and cortical bone grafts used to improve strength.

Question 8

What are some of the red flags of bone cancer ?

Answer 8

Metastatic cancer affecting bone tends to cause:

• a constant pain
• usually worse at night
• May also be swelling

Systemic symptoms may also be present:

• weight loss
• loss of appetite
• fatigue

Patients over 60 are at risk of cancer and unexplained skeletal pain should be investigated

Patients under 25 should not have unexplained skeletal pain and should also be investigated

with at least an X-ray

Question 9

When assessing soft tissue swellings what do you need to consider ?

Answer 9

1. Site
2. Size
3. Definition – well defined or ill defined
4. Consistency – cystic, solid, soft, hard
5. Surface – smooth or irregular
6. Mobility or Fixity – to skin or deep tissues
7. Temperature – abscess
8. Transilluminable – fluid filled
9. Pulsatility
10. Overlying skin changes
11. Local lymphadenopathy

Question 10

Thinking about the findings you need to consider when assessing soft tissue swellings, what are suggestive of benign soft tissue swellings ?

Answer 10

Include:

• Smaller size
• Fluctuation in size (malignant tumours don’t regress in size)
• Cystic lesions
• Well‐defined lesions
• Fluid filled lesions and soft / fatty lesions

Question 11

Thinking about the findings you need to consider when assessing soft tissue swellings, what are suggestive of malignant tissue swellings ?

Answer 11

Include:

• Larger lesions (>5cm),
• Rapid growth in size,
• A solid lesion,
• An ill‐defined lesion, A
• n irregular surface, A
• Associated lymphadenopathy
• Systemic upset (weight loss, loss of apetite, fatigue).

Question 12

What is the most common benign soft tissue swelling and describe it

Answer 12

Lipoma (neoplastic proliferation of fat) - usually occurs in S/C fat but can occur in muscle (main point for these i think is where they arise)

Question 13

A small firm swelling usually found on the flexor tendon sheath of a finger, what is it ?

Answer 13

Giant cell tumour of tendon sheath

Similar lesions can occur within a synovial joint (commonly the knee) known as Pigmented Villonodular Synovitis (PVNS).

Question 14

In general terms what are malignant soft tissue swellings known as ?

Answer 14

Sarcomas

Question 15

Match the malignant soft tissue swelling to the tissue type fro which they arise:

• Is a malignant tumour from blood vessels
• Arise from fibrous tissue
• Arises from fat.
• Originates in the synovial lining of joints or tendons.
• Is a malignant tumour of skeletal muscle.
• Originates in the synovial lining of joints or tendons.

Angiosarcoma,Liposarcoma, Fibrosarcoma and Malignant Fibrous Histiocytoma, Synovial sarcoma, Rhabdomyosarcoma

Answer 15

• Angiosarcoma is a malignant tumour from blood vessels
• Fibrosarcoma and Malignant Fibrous Histiocytoma arise from fibrous tissue
• Liposarcoma arises from fat.
• Rhabdomyosarcoma is a malignant tumour of skeletal muscle.
• Synovial sarcoma originates in the synovial lining of joints or tendons.

Question 16

Where do ganglionic cysts occur and what are they due to ?

Answer 16

Occur around a synovial joint or a synovial tendon sheath

May form as a result of herniation or out‐pouching of a weak portion of joint capsule or tendon sheath

Question 17

What are the different terms for ganglion cysts ?

Answer 17

Weakness cussing it can be development (juvenile bakers cyst)

Or as a result of underlying joint damage / arthritis (adult bakers cyst)

Question 18

Describe the presentation of ganglions

Answer 18

Well‐defined, may be quite firm and readily transilluminate

Question 19

What is burisitis ?

Answer 19

Bursa are small fluid filled sac lined by synovium around a joint which prevents friction between tendons, bones, muscle and skin

Bursitis = inflammation of the bursa

Due to:

• Repeated pressure or trauma (think housemaids knees)
• Bacterial infection
• Gout

Question 20

What are sebaceous cysts ?

Answer 20

Cysts which affect the sebaceous glands usually appear on the face, neck, or upper body, especially the chest and shoulders

Question 21

What is an abscess ?

Answer 21

• A collection of pus
• Can occur from cellulitis, bursitis, penetrating wound or infected sebaceous cysts
• Won’t resolve with antibiotics alone and require incision and drainage.