Tumours

Question 1

6 features to consider for plain radiograph bony lesions?

Answer 1

1. Lytic vs sclerotic
2. Zone of transition
3. Periosteal reaction
4. Cortical destruction / ST invasion
5. Location
6. Patient age

Question 2

Indications for biopsy of ST/ bone lesions?

Answer 2

1. ST lesions >5cm deep to fascia overlying bone/ neuromuscular structures
2. Solitary bone lesions in patients with a hx of cancer
3. Aggressive lesions
4. Unclear dx in asymptomatic patient

Question 3

Open incisional biopsy principles?

Answer 3

1. Incision - longitudinal in extremities - placed in region where future surgery will possibly take place
2. Approach - Do not expose NV structures.
   Meticulous haemostasis
3. Biopsy through involved compartment - do not open other compartments
4. If using drain - take out through incision

Question 4

What are the 2 staging systems in orthopaedic tumours?

Answer 4

1. Enneking (MSTS)

2. AJCC (TNM Staging)

Question 5

What is the Enneking staging system based on? 3

Answer 5

Histo grade
Site (intra/extracompartmental)
Mets

Question 6

In the TNM staging for BONE what is the size cut off between T1 and T2

Answer 6

<8cm and >8cm

Question 7

In the TNM staging for ST TUMOURS what is the size cut off between T1 and T2?

Answer 7

5cm

Question 8

With which 2 conditions does chemo improve Px/ outcomes?

Answer 8

1. Osteosarcoma

2. Ewings (Neo-adjuvant- tu shrinkage)

Question 9

For what lesions is radiotherapy considered? (4)

Answer 9

Myxoid liposarcoma
Multiple Myeloma
Lymphoma
Mets

Question 10

For what 2 lesions is radiotherapy not used?

Answer 10

Osteosarcoma

Chondrosarcoma

Question 11

Name the 4 benign cartilaginous tumours?

Answer 11

1. Chondroblastoma
2. Osteochondroma
3. Enchondroma
4. Chondromyxoid fibroma

Question 12

Name the 2 benign osteoid tumours?

Answer 12

Osteoid Osteoma

Osteoblastoma - spine

Question 13

Name the 2 ‘tumour like’ lesions?

Answer 13

Fibrous dysplasia

Eosinophilic granuloma

Question 14

What are the 2 reactive lesions?

Answer 14

1. UBC

2. ABC

Question 15

What lesion is associated with a USP6 up regulation?

Answer 15

ABC

Question 16

What is the benign/locally aggressive meta-epiphyseal tumour of unknown origin called?

Answer 16

Giant cell tumour

Question 17

What are the 2 malignant tumours of unknown origin?

Answer 17

Ewings

Adamantinoma

Question 18

Where are enchondromas commonly found?

Answer 18

Feet and hands

Question 19

What are the 2 subtypes of chondrosarcoma?

Answer 19

Clear cell

Mesenchymal

Question 20

Which of the malignant tumours has a popcorn type appearance?

Answer 20

Chondrosarcoma

Question 21

Which tumours is characterised by nocturnal pain relieved by Aspirin/NSAIDs

Answer 21

OO

Question 22

What are the 4 types of osteosarcoma?

Answer 22

1. Parosteal
2. Periosteal
3. Telangiectatic
4. Intramedullary

Question 23

Which lytic lesion commonly extends from the metaphysis into the epiphysis (junta-articular)

Answer 23

GCT

Question 24

Which lesion is associated with a t11:22 translocation and is found in young patients? 5-25yo

Answer 24

Ewings sarcoma

Question 25

Which lesion is always located in the mid tibia?

Answer 25

Adamantinoma

Question 26

Which lesion develops from a failure of production of lamellar bone and a GNAS mutation?

Answer 26

Fibrous Dysplasia

Question 27

What is Eosinophilic granuloma otherwise known as?

Answer 27

Histiocytosis X | Langerhans cell histocytosis

Question 28

Which lesion is known as the "great mimicker"?

Answer 28

EG | Self limiting benign histolytic lesions

Question 29

Which lesion is associated with Hand-Schuller-Christian Dx and Letterer-Side disease?

Answer 29

EG

Question 30

2 Indications for surgery for benign bony tumours?

Answer 30

Thinning of >50% of cortex | Mass effect

Question 31

What is marginal excision?

Answer 31

Resection through the reactive zone - outside the tumour pseudocapsule

Question 32

What is wide excision?

Answer 32

Resection outside of the reactive zone

Question 33

What does radical excision involve?

Answer 33

En bloc excision of entire compartment

Question 34

What does a mutation in the EXT1 2 &3 genes cause?

Answer 34

Multiple Hereditary Exostosis | Loss of regulation of Ihh protein

Question 35

What lesion is commonly found in the epiphysis of bones with OPEN growth plates/

Answer 35

Chrondoblastoma

Question 36

Patients carrying the retinoblastoma tumour suppressor gene are predisposed to which tumour?

Answer 36

Intramedullary Osteosarcoma

Question 37

What ST tumour is due to an over expression of CSF1 gene?

Answer 37

PVNS

Question 38

Where is PVNS most commonly found?

Answer 38

Knee

Question 39

Where does a leiomyosarcoma originate from?

Answer 39

?Blood vessels

Question 40

What is the most common ST sarcoma in children

Answer 40

Rhabdomyosarcoma

Question 41

Which lesion is histiologically the same as a GCT of the tendon sheath?

Answer 41

PVNS

Question 42

What 4 factors are in Mirels criteria?

Answer 42

``` Site Pain Lesion Size >8 = prophylactic fixation ```

Question 43

What are the synovial tumours? 3

Answer 43

1. PVNS 2. Synovial chondromatosis 3. Synovial Sarcoma

Question 44

Most common ST sarcoma in YOUNG ADULTS?

Answer 44

Synovial Sarcoma

Question 45

Cold bone scan = which mets?

Answer 45

Renal MM Thyroid