Oncology Orthopaedic Topics
Bone & soft tissue tumours. 93 evidence-informed references covering conditions, classifications, management and high-yield exam notes for FRCS (Tr&Orth), FRACS, EBOT and ABOS preparation.
All Oncology topics (93)
- AdamantinomaComprehensive guide to adamantinoma - rare low-grade malignant bone tumour with tibial predilection, imaging features, surgical management, and prognosis for orthopaedic exam
- Allograft-Prosthetic Composite (APC) ReconstructionPrinciples, technique and evidence for combining massive structural allograft with a stemmed prosthesis to restore bone stock and soft-tissue attachment after tumour resection or failed arthroplasty.
- Alveolar Soft Part SarcomaFellowship-level guide to alveolar soft part sarcoma (ASPS) - a rare soft-tissue sarcoma of young adults, defined by the ASPSCR1-TFE3 gene fusion (nuclear TFE3), that grows slowly but has a striking propensity for early haematogenous metastasis (lung, bone, brain) - covering its painless deep limb mass, the alveolar/organoid histology with PAS-positive crystals, the staging/biopsy work-up, and management with wide surgical resection (chemo-resistant) plus anti-angiogenic/immunotherapy and long-term surveillance for late metastases.
- Aneurysmal Bone CystComprehensive guide to aneurysmal bone cyst (ABC) - benign expansile bone lesion with fluid-fluid levels, imaging features, treatment options including curettage and denosumab for orthopaedic exam
- AngiosarcomaRare aggressive vascular malignancy with poor prognosis, occurring in soft tissue and associated with radiation, lymphedema, and chronic inflammation
- Benign Fibrous Histiocytoma of BoneFellowship-level guide to benign fibrous histiocytoma of bone (BFHB) - a rare benign fibrous bone tumour, histologically identical to non-ossifying fibroma (storiform fibroblasts with osteoclast-type giant cells and foamy macrophages) but distinguished by its presentation in atypical sites and older/symptomatic patients - covering the diagnosis, the contested relationship with non-ossifying fibroma, the meaningful local recurrence rate after curettage, and the rare possibility of malignant transformation.
- Benign Notochordal Cell TumourFellowship-level guide to the benign notochordal cell tumour (BNCT) - a benign intraosseous lesion arising from notochordal remnants in the axial skeleton (clivus, vertebrae, sacrum) - covering its typically incidental, sclerotic, non-destructive imaging appearance, the crucial distinction from chordoma (the malignant notochordal tumour it can mimic and may be a precursor to), and the management principle of observation for the benign lesion versus oncological resection for chordoma.
- Biopsy Principles and Techniques in Orthopaedic OncologyComprehensive guide to biopsy principles including Mankin errors, needle vs open biopsy, approach planning, specimen handling, and collaboration with tumor centers for orthopaedic exam preparation
- Bizarre Parosteal Osteochondromatous Proliferation (Nora Lesion)Comprehensive guide to Nora lesion (BPOP), a rare surface-based bone tumour of the hands and feet, including histopathology, differentiation from osteochondroma and parosteal osteosarcoma, and management by marginal excision.
- Bone Island (Enostosis)Comprehensive guide to bone islands: imaging characteristics, differential diagnosis, clinical significance, and distinguishing from malignant lesions
- Brown Tumour of HyperparathyroidismComprehensive guide to brown tumour (osteitis fibrosa cystica) of hyperparathyroidism - pathophysiology, lytic imaging, the critical giant cell tumour mimic, biochemistry and parathyroidectomy-first management for orthopaedic fellowship exams
- Calcifying Aponeurotic FibromaRare benign fibroblastic tumour of the hands and feet in children and adolescents, with stippled calcification, chondroid nodules on histology, and a high local recurrence rate after marginal excision but no metastatic potential.
- ChondroblastomaRare benign cartilage tumor of epiphysis in skeletally immature patients
- ChondrosarcomaMalignant cartilage-forming tumor - second most common primary bone malignancy with varied biological behavior
- ChordomaComprehensive guide to chordoma diagnosis, management, and surgical treatment
- Clear Cell ChondrosarcomaRare low-grade epiphyseal cartilage malignancy of the femoral head and proximal humerus in young adults: diagnosis, differentiation from chondroblastoma, wide resection and lifelong surveillance.
- Clear Cell SarcomaRare aggressive soft tissue sarcoma of tendons and aponeuroses with EWSR1-ATF1 fusion and melanocytic differentiation - the melanoma of soft parts in young adults
- Dedifferentiated ChondrosarcomaFellowship-level reference on dedifferentiated chondrosarcoma: bimorphic imaging, biopsy of the lytic component, wide resection, chemotherapy controversy and dismal survival.
- Dermatofibrosarcoma Protuberans (DFSP)Fellowship-level guide to dermatofibrosarcoma protuberans: a low-grade cutaneous soft-tissue sarcoma with a storiform CD34-positive histology and the COL1A1-PDGFB fusion from t(17;22), its very high local recurrence from infiltrative margins, the fibrosarcomatous variant's metastatic potential, and treatment by wide excision/Mohs micrographic surgery with imatinib for unresectable or recurrent disease.
- Desmoid Tumor (Aggressive Fibromatosis)Locally aggressive benign fibroblastic tumor with CTNNB1 mutations, unpredictable behavior requiring surveillance-first approach
- Desmoplastic Fibroma of BoneComprehensive guide to desmoplastic fibroma of bone, a rare benign but locally aggressive intraosseous fibromatosis affecting the mandible and long bones, with high recurrence risk and indications for wide excision.
- Elastofibroma DorsiBenign fibroelastic pseudotumour beneath the scapular tip with pathognomonic imaging - the soft-tissue mass examiners love to test as a sarcoma mimic
- EnchondromaBenign intramedullary cartilage tumor, most common tumor of hand bones
- Enchondromatosis (Ollier Disease and Maffucci Syndrome)Comprehensive guide to multiple enchondromatosis - Ollier disease, Maffucci syndrome, IDH mutations, malignant transformation, and surveillance protocols
- Epithelioid Haemangioma & Haemangioendothelioma of BoneFellowship-level guide to the epithelioid vascular tumours of bone - the benign/locally aggressive epithelioid haemangioma and the intermediate-grade, low-to-moderate malignancy epithelioid haemangioendothelioma (EHE) - covering their lytic, often multifocal bone presentation, the vascular endothelial immunophenotype (CD31/ERG, with the WWTR1-CAMTA1 fusion characterising EHE), the differential from the highly malignant angiosarcoma, and management that ranges from curettage to wide resection and systemic therapy by grade and extent.
- Epithelioid SarcomaRare INI1/SMARCB1-deficient soft tissue sarcoma of young adults - the great mimic that favours the distal upper limb, recurs locally, and spreads to nodes, skin and lung
- Erdheim-Chester DiseaseFellowship-level guide to Erdheim-Chester disease (ECD) - a rare non-Langerhans cell histiocytosis driven by MAPK-pathway (notably BRAF V600E) mutations - covering its hallmark bilateral symmetric osteosclerosis of the long-bone metadiaphyses (CD68-positive, CD1a-negative foamy histiocytes), the wide multisystem involvement (cardiovascular, retroperitoneal/'hairy kidney', CNS, orbit), the diagnostic role of bone scan/PET and biopsy with BRAF testing, and the transformation of management by targeted BRAF/MEK inhibition.
- Expandable Prostheses in Pediatric OncologyComprehensive guide to expandable endoprostheses for limb salvage in skeletally immature patients with bone tumours - mechanisms, indications, complications, and conversion to adult prosthesis
- Extraskeletal Myxoid ChondrosarcomaFellowship-level guide to extraskeletal myxoid chondrosarcoma (EMC) - a rare soft-tissue sarcoma of (despite its name) uncertain/non-cartilaginous differentiation, defined by NR4A3 gene rearrangement (most often EWSR1-NR4A3) - covering its deep proximal-limb mass presentation, the myxoid, multilobular histology with cords of eosinophilic cells, the indolent but relapsing long-term course with late metastases, and management by wide resection with prolonged surveillance (it is relatively chemo/radio-resistant).
- Extraskeletal OsteosarcomaFellowship-level guide to extraskeletal osteosarcoma - a rare, high-grade soft-tissue sarcoma that produces osteoid/bone but arises in soft tissue with no attachment to bone or periosteum, typically in older adults - covering its deep soft-tissue (often thigh) mass, the distinction from myositis ossificans and from the surface osteosarcomas, the poor prognosis with high metastatic risk, and management by wide resection, with pooled evidence advising against routine adjuvant chemotherapy.
- Fibrosarcoma of BonePrimary malignant spindle cell tumor of bone producing collagen without osteoid or chondroid matrix, representing less than 5% of primary bone sarcomas
- Fibrous DysplasiaBenign fibro-osseous lesion caused by GNAS mutation, monostotic vs polyostotic forms, McCune-Albright and Mazabraud syndromes
- Free Vascularised Fibula TransferFellowship-level guide to free vascularised fibula grafting: peroneal pedicle anatomy, harvest technique, Capanna reconstruction, monitoring, hypertrophy and donor morbidity.
- Giant Cell Reparative GranulomaFellowship-level guide to giant cell reparative granuloma (GCRG) - a benign, reactive giant-cell-rich lesion most often of the small bones of the hands and feet (and the jaws) - covering its lytic, expansile presentation, the histology of a fibrous stroma with unevenly distributed giant cells and haemorrhage/reactive bone (now regarded within the 'solid aneurysmal bone cyst'/giant-cell-lesion-of-small-bones spectrum), the crucial distinction from giant cell tumour of bone (which is rare in the hand and locally aggressive), and management by curettage with a recurrence rate.
- Giant Cell Tumor of BoneBenign but locally aggressive bone tumor characterized by multinucleated giant cells, typically occurring in the epiphysis of skeletally mature patients
- Giant Cell Tumor of Tendon Sheath (GCTTS)Comprehensive guide to giant cell tumor of tendon sheath (GCTTS), a benign proliferative lesion of the tendon sheath - the extra-articular manifestation of tenosynovial giant cell tumor (TGCT).
- Granular Cell TumourFellowship-level guide to the granular cell tumour - an uncommon, usually benign soft-tissue tumour of Schwann-cell (neural) origin (S100-positive), presenting as a small firm dermal/subcutaneous nodule (classically tongue, but also skin and soft tissue of the limbs) - covering the characteristic granular eosinophilic cytology, the rare malignant variant (size over ~4-5 cm, rapid growth, the dangerous one), the differential, and management by complete excision with clear margins.
- Hemangioma (Soft Tissue)Comprehensive coverage of soft tissue hemangiomas including classification, clinical presentation, imaging characteristics, management strategies, and complications for orthopaedic surgery examination preparation
- Hemangioma of BoneBenign vascular tumor of bone, most commonly affecting vertebral bodies and skull, typically asymptomatic and incidental, with characteristic corduroy or polka-dot radiographic appearance
- Hemipelvectomy and Hindquarter AmputationComprehensive surgical technique guide to hemipelvectomy - internal (limb-sparing) and external (hindquarter amputation) for pelvic sarcoma resection, Enneking-Dunham classification, vascular control, reconstruction options, flap coverage for orthopaedic fellowship exam preparation
- High-Grade Surface OsteosarcomaFellowship-level guide to high-grade surface osteosarcoma - the rarest of the three surface (juxtacortical) osteosarcomas (with parosteal and periosteal), a high-grade malignancy arising on the bone surface that behaves like conventional intramedullary osteosarcoma - covering how it differs from the low-grade parosteal and intermediate-grade periosteal variants, the central role of histological grade in determining treatment, and management with neoadjuvant/adjuvant chemotherapy plus wide resection.
- Hip Disarticulation & Forequarter AmputationProximal-level ablative surgery for tumour, infection and trauma: indications, operative technique, oncologic principles, complications and prosthetic reality.
- Internal Hemipelvectomy and Pelvic ReconstructionLimb-sparing pelvic resection by Enneking-Dunham zone with reconstruction selection, complications and functional outcomes for periacetabular and iliac tumours.
- Intramuscular MyxomaBenign myxoid soft-tissue tumour of skeletal muscle driven by GNAS mutation; a classic sarcoma mimic and the soft-tissue component of Mazabraud syndrome
- Intraosseous GanglionFellowship-level guide to the intraosseous ganglion - a benign, mucin-filled subchondral bone cyst (a 'bone ganglion') most often found in the carpus (lunate/scaphoid), the medial malleolus, the femoral head/acetabulum and around the knee - covering its well-defined lytic subchondral appearance with a sclerotic rim, the distinction from a degenerative subchondral (geode) cyst and other lytic lesions, and management by observation when asymptomatic and curettage with bone grafting when symptomatic.
- Intraosseous LipomaRare benign intramedullary fat-containing tumor with classic central calcification
- Langerhans Cell Histiocytosis (Eosinophilic Granuloma)Rare disorder of clonal proliferation of Langerhans cells affecting bone and systemic organs, with spectrum from solitary eosinophilic granuloma to multisystem disease, requiring multidisciplinary management
- Leiomyosarcoma of Soft TissueMalignant smooth-muscle sarcoma of soft tissue - aggressive spindle-cell tumour of older adults driven by grade and size, treated with wide excision and chemotherapy reserved for advanced disease
- Leukaemic Involvement of BoneFellowship-level guide to the skeletal manifestations of leukaemia: how childhood acute lymphoblastic leukaemia frequently presents with musculoskeletal pain (mimicking JIA, septic arthritis, osteomyelitis or CRMO) before haematological signs, the red flags that should prompt a blood film and marrow examination, the radiographic features (leukaemic lines, osteopenia, permeative lesions), and the orthopaedic role of recognition and referral.
- Limb Salvage Surgery PrinciplesComprehensive guide to limb salvage surgery principles for musculoskeletal tumours - Enneking staging, surgical margins, reconstruction options, endoprostheses, allografts, growing prostheses, rotationplasty, and functional outcomes for orthopaedic fellowship exam preparation
- LipomaBenign adipocytic tumor - most common soft tissue tumor with excellent prognosis and rare malignant transformation
- Lipoma ArborescensFellowship-level guide to lipoma arborescens - a rare benign intra-articular lesion of frond-like (tree-like) villous proliferation of mature fat replacing the synovium, most often in the suprapatellar pouch of the knee - covering its presentation as chronic painless joint swelling with effusion, the pathognomonic MRI appearance (fatty frond-like synovial projections, fat signal on all sequences, suppressing with fat saturation), its association with chronic synovial irritation/arthritis, and management by synovectomy with a good outcome.
- LiposarcomaMalignant adipocytic tumor - most common soft tissue sarcoma in adults with variable prognosis based on histological subtype
- Malignant Musculoskeletal Tumours - PrinciplesFellowship-level principles page for malignant musculoskeletal tumours - how a sarcoma announces itself, the published soft-tissue lump and bone-pain referral thresholds, the staging sequence (local MRI, chest CT) and the Enneking and AJCC systems, the hazards of biopsy quantified by the Musculoskeletal Tumor Society studies, the residual-disease problem after unplanned excision, margin definitions and the modern margin debate, limb salvage versus amputation evidence, which sarcomas are chemosensitive and radiosensitive and which are not, and the specialist-centre and surveillance principles that hold the whole pathway together.
- Malignant Peripheral Nerve Sheath Tumor (MPNST)Comprehensive guide to malignant peripheral nerve sheath tumor, including NF1 association, imaging, surgical management, and prognosis
- Marjolin's UlcerComprehensive guide to Marjolin's ulcer - aggressive squamous cell carcinoma arising in chronic wounds, scars, sinuses and burns, including latency, biopsy, wide excision, amputation, nodal staging, and prognosis.
- Massive Osteolysis (Gorham-Stout / Vanishing Bone Disease)Fellowship-level guide to Gorham-Stout disease: a rare disorder of progressive spontaneous massive osteolysis from intraosseous lymphatic/vascular proliferation ('vanishing bone'), its axial predilection, the feared chylothorax complication, the diagnosis of exclusion (progressive osteolysis + characteristic histology) and the treatment options (bisphosphonates, sirolimus, radiotherapy, surgery).
- Mesenchymal ChondrosarcomaRare biphasic small round cell and cartilaginous sarcoma of adolescents and young adults, defined by HEY1-NCOA2 fusion, treated with wide resection plus multi-agent chemotherapy and lifelong surveillance.
- Metastatic Bone DiseaseComprehensive guide to metastatic bone disease including common primaries, fracture risk assessment with Mirels score, surgical stabilization options, and palliative management.
- Multiple MyelomaPlasma cell neoplasm with skeletal manifestations - punched-out lytic lesions without blastic response
- MyxofibrosarcomaFellowship-level guide to myxofibrosarcoma: one of the commonest soft-tissue sarcomas of the elderly, its characteristic infiltrative growth along fascial planes (the MRI 'tail sign'), the resulting very high local recurrence, the spectrum from low to high grade, and management by wide excision with generous margins (guided by pre-operative MRI) plus radiotherapy.
- NeurofibromaBenign peripheral nerve sheath tumor arising from Schwann cells, fibroblasts, and perineural cells - associated with neurofibromatosis type 1
- Nodular FasciitisFellowship-level guide to nodular fasciitis: a benign, self-limiting myofibroblastic proliferation - the classic 'pseudosarcoma' - that grows rapidly and is frequently mistaken for a sarcoma, its USP6 (MYH9-USP6) signature marking it as a transient clonal neoplasm rather than a reactive lesion, the tissue-culture histology, and the importance of accurate diagnosis to allow conservative management and avoid overtreatment.
- Non-Ossifying Fibroma (Fibrous Cortical Defect)Comprehensive guide to non-ossifying fibroma and fibrous cortical defect, including diagnosis, fracture-risk assessment, differential diagnosis, and management.
- OsteoblastomaBenign bone-forming tumor representing 1% of primary bone tumors, characterized by osteoid and bone production with active osteoblasts
- Osteofibrous DysplasiaRare benign fibro-osseous lesion of long bones, primarily affecting the anterior tibia in children, with characteristic cortical involvement and well-defined radiographic features
- Osteoid OsteomaComprehensive guide to osteoid osteoma - diagnosis, imaging characteristics, night pain pattern, surgical excision, and radiofrequency ablation for orthopaedic exam
- OsteopoikilosisComprehensive coverage of osteopoikilosis (spotted bone disease) including LEMD3 genetics, Buschke-Ollendorff syndrome, the spotted-bone radiographic pattern, distinguishing it from sclerotic metastases, and management for orthopaedic surgery examination preparation
- OsteosarcomaComprehensive guide to osteosarcoma including diagnosis, staging, neoadjuvant chemotherapy, limb salvage surgery, and prognostic factors for Orthopaedic examination.
- Paget's Sarcoma (Sarcomatous Transformation of Paget Disease)Comprehensive guide to malignant transformation of Paget disease of bone - epidemiology, presentation, imaging, biopsy, multimodal management and prognosis of this aggressive secondary bone sarcoma.
- Parosteal OsteosarcomaFellowship-level chapter on parosteal osteosarcoma: surface anatomy and imaging signs, reverse zonation, MDM2/CDK4 amplification, medullary invasion, dedifferentiation and wide en-bloc resection.
- Pathologic Fracture ManagementComprehensive guide to diagnosis, surgical decision-making, and reconstruction techniques for pathologic fractures through benign and malignant bone lesions
- Periosteal ChondrosarcomaFellowship-level guide to periosteal (juxtacortical) chondrosarcoma - a rare, usually low-grade malignant cartilage tumour arising on the bone surface, typically at the metaphysis of a long bone - covering its distinction from the benign periosteal chondroma and from surface osteosarcoma, the generally indolent behaviour, the IDH1 mutation, and management by marginal/wide excision with a good prognosis.
- Periosteal OsteosarcomaIntermediate-grade, chondroblastic surface osteosarcoma of the femoral and tibial diaphysis: imaging signature, biopsy pitfalls, intercalary resection and reconstruction, and the unresolved chemotherapy question.
- Phosphaturic Mesenchymal Tumour and Tumour-Induced OsteomalaciaFellowship-level guide to phosphaturic mesenchymal tumour: the FGF23-driven biochemical signature, localisation cascade, histology, curative excision and burosumab-era medical management.
- Pigmented Villonodular Synovitis (PVNS)Comprehensive guide to pigmented villonodular synovitis (PVNS), a benign proliferative synovial disorder causing joint destruction through local invasion.
- Primary Bone LymphomaNon-Hodgkin lymphoma arising in bone with no nodal or visceral disease - a permeative round cell tumour treated by chemotherapy, not wide resection
- Radiotherapy in Musculoskeletal TumoursFellowship-level guide to radiotherapy in orthopaedic oncology: radiosensitive (Ewing sarcoma, lymphoma, myeloma, metastases) versus radioresistant (osteosarcoma, chondrosarcoma) tumours, the role of neoadjuvant versus adjuvant radiotherapy in limb-sparing soft-tissue sarcoma surgery, palliative radiotherapy for bone metastases, the modalities (EBRT/IMRT, brachytherapy, proton beam), and complications including wound problems, fibrosis and radiation-induced sarcoma.
- RhabdomyosarcomaMost common soft tissue sarcoma of childhood - skeletal-muscle differentiation, embryonal vs alveolar histology, PAX-FOXO1 fusion status drives risk, treated by multimodal chemotherapy, surgery and radiotherapy
- RotationplastyComprehensive guide to rotationplasty (Van Nes/Borggreve procedure) - limb-salvage technique converting ankle to knee joint for distal femur and proximal tibia tumours in paediatric patients
- Sacrectomy for Primary Sacral TumoursOncologic principles, level-based classification, root-sacrifice neurology, staged approaches, spinopelvic reconstruction and complications of sacrectomy for chordoma and other sacral tumours.
- Schwannoma (Neurilemmoma)Benign peripheral nerve sheath tumor arising from Schwann cells - eccentric growth allows enucleation without nerve sacrifice
- Soft Tissue Masses and Sarcoma Referral PathwayAdvanced orthopaedic guide to soft tissue masses and sarcoma referral: red flags, clinical assessment, MRI interpretation, staging, biopsy principles, unplanned excision, MDT management and counselling.
- Soft-Tissue & Bone Tumours of the Foot & Ankle (Overview)Fellowship-level overview of tumours of the foot and ankle - benign lesions (ganglion, plantar fibroma, giant-cell tumour of tendon sheath, synovial chondromatosis, simple/aneurysmal bone cysts, osteochondroma, enchondroma) and the rare but dangerous malignancies (synovial sarcoma the commonest soft-tissue sarcoma here, with osteosarcoma the commonest bone malignancy) - and the cardinal principle that a foot mass is malignant until proven otherwise: image and biopsy properly before excision, because an unplanned 'whoops' excision worsens recurrence and survival.
- Solitary Plasmacytoma of BoneFellowship-level guide to solitary plasmacytoma of bone: a single localized plasma-cell tumour with no systemic myeloma, its diagnostic criteria, the mandatory workup to exclude occult multiple myeloma, radiotherapy as the treatment of choice, the role of surgery for structural lesions, and the high rate of progression to multiple myeloma.
- Subungual MelanomaComprehensive guide to subungual (acral lentiginous) melanoma of the nail unit, including Hutchinson sign, ABCDEF nail rules, nail-bed biopsy techniques, wide excision and amputation, and prognosis.
- Synovial ChondromatosisComprehensive exam guide to synovial (osteo)chondromatosis - a benign cartilaginous metaplasia of the synovium producing multiple loose bodies, its Milgram staging, imaging, surgical management, and the small but important risk of malignant transformation to secondary synovial chondrosarcoma.
- Synovial Cyst (Ganglion and Joint-Based Cysts)Comprehensive guide to synovial cysts including ganglion cysts, popliteal (Baker's) cysts, and spinal synovial cysts - benign fluid-filled lesions arising from joint capsule or tendon sheath.
- Synovial SarcomaMalignant soft tissue sarcoma defined by the t(X;18) SS18-SSX translocation - about 5-10% of soft tissue sarcomas, arising near joints in young adults despite a name that does not reflect its origin
- Tumoral CalcinosisComprehensive guide to tumoral calcinosis - periarticular lobulated calcific masses, hyperphosphataemic (familial GALNT3/FGF23) vs secondary (renal) disease, differential from myositis ossificans, and surgical management.
- Undifferentiated Pleomorphic Sarcoma (MFH)High-grade pleomorphic sarcoma of soft tissue and bone, formerly malignant fibrous histiocytoma, now a diagnosis of exclusion defined by the absence of any specific line of differentiation
- Unicameral (Simple) Bone CystComprehensive guide to unicameral (simple) bone cysts in children, including the fallen-fragment sign, pathological fracture management, aspiration and steroid injection, and surgical treatment options.
- Vertebral HaemangiomaBenign vascular lesion of the vertebra, usually incidental, occasionally aggressive with epidural extension and spinal cord compression - imaging signs, classification, staging and management