Bone pain and swelling

The aim of this topic is to review the pathophysiology and investigation of common neoplasms occurring in bone.

Learning objectives:

At the completion of this topic you should be able to:

1. List the common neoplasms occurring in bone in approximate order of frequency.
2. Name the primary neoplasms that are most likely to metastasise to bone and describe the common locations, clinical effects and investigative abnormalities associated with bony metastases.
3. Describe the clinical and radiographic features of benign neoplasms and developmental disorders of bone including osteochondroma, osteoid osteoma, enchondroma, fibrous dysplasia and aneurysmal bone cyst.
4. Outline the genetic and acquired risk factors for the development of osteosarcoma.
5. Construct a table that compares the epidemiology, cell of origin, clinical behaviour and radiographic appearances of osteosarcoma, chondrosarcoma, Ewing sarcoma and giant cell tumour of bone.
6. Define the term "multiple myeloma" and discuss the pathophysiology of this disorder in terms of infiltration of bone and the presence of secreted paraprotein in serum and/or urine.
7. Explain the development of renal impairment and immunodeficiency in patients with multiple myeloma.
8. Distinguish between benign and malignant causes of paraproteinaemia, and list the features of "monoclonal gammopathy of undetermined significance" (MGUS).

1. List the clinical effects of multiple myeloma that result from: (a) infiltration of bone; and (b) monoclonal gammopathy.
2. Write brief notes on the pathogenesis and complications of osteogenic sarcoma.

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