36: Bone and Soft Tissue Tumours Flashcards

1
Q

describe sarcoma and their spread

A
  • malignant tumours arising from connective tissues
  • spread along fascial planes
  • haematogenous spread to lungs
  • rarely spread to regional lymph nodes (rhabdomyosarcomas, epitheloid sarcomas & synovial sarcomas)
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2
Q

a bone tumour in a patient > 50 is likely to be?

A

metastatic

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3
Q

give examples of benign and malignant bone-forming tumours

A
  • benign: osteoid osteoma, osteoblastoma
  • malignant: osteosarcoma
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4
Q

give examples of benign and malignant cartilage-forming tumours

A
  • benign: endochondroma, osteochondroma
  • malignant: chondrosarcoma
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5
Q

give examples of benign and malignant fibrous tissue tumours

A
  • benign: fibroma
  • malignant: fibrosarcoma, malignant fibrous histiocytoma (MFH)
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6
Q

give examples of benign and malignant vascular tissue tumours

A
  • benign: hemangioma, aneurysmal bone cyst
  • malignant: angiosarcoma
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7
Q

give examples of benign and malignant adipose tissue tumours

A
  • benign: lipoma
  • malignant: liposarcoma
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8
Q

give examples of malignant marrow tissue tumours

A
  • Ewing’s sarcoma
  • lymphoma
  • myeloma
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9
Q

what is the most common primary malignant bone tumour in a younger patient?

A

osteosarcoma

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10
Q

what is the most common primary malignant ‘bone’ tumour in an older patient?

A

myeloma

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11
Q

what is the most useful imaging modality for suspected bone lesions?

A

plain x-rays

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12
Q

inactive bone lesion x-ray features

A
  • clear margins
  • surrounding rim of reactive bone
  • cortical expansion can occur with aggressive benign lesions
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13
Q

aggressive bone lesion x-ray features

A
  • less well-defined zone of transition between lesion and normal bone (permeative growth)
  • cortical destruction = malignancy
  • periosteal reactive new bone growth occurs when the lesion destroys the cortex
  • Codman’s triangle, onion-skinning or sunburst pattern
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14
Q

what is the complete work up of investigations prior to bone biopsy?
bone lesion investigations

A
  • Bloods
  • x-ray of affected limb and chest, most useful for bone lesions
  • MRI of lesion
  • bone scan
  • CT CAP
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15
Q

what are the cardinal clinical features of malignant primary bone tumours?

A
  • increasing pain
  • unexplained pain
  • deep-seated aching
  • night pain
  • difficult weight-bearing
  • deep swelling
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16
Q

osteosarcoma clinical features

A
  • pain: increasing, worse at night, deep borin ache
  • loss of function: limp, reduced ROM, stiff back esp. child
  • swelling: generally diffuse, warmth over swelling + venous congestion = active!
  • pathological fracture
  • joint effusion
  • deformity
  • neurovascular effects
  • systemic effects of neoplasia
17
Q

osteosarcoma investigation of choice

A

MRI scan
- very sensitive
- very good for showing extent of tumour, joint involvement, skip metastases, epiphyseal extension
- determines resection margins

18
Q

what are suspicious signs that a soft tissue tumour could be malignant?

A
  • deep (i.e. deep to deep fascia) tumours of any size
  • subcutaenous tumours > 5cm
  • rapid growth, hard, craggy, non-tender
19
Q

BEWARE swelling which is..

A
  • rapidly growing
  • hard, fixed, craggy surface, indistinct margins
  • non-tender to palpation, but assoc. with deep ache, esp. worse at night
  • may be painless
  • recurred after previous excision
20
Q

what is more common, a primary or a secondary bone tumour?

A
  • secondary is 25x more common
21
Q

list the 7 most common primary cancers which metastasise to bone

A
  1. breast, most common
  2. lung
  3. prostate
  4. kidney
  5. thyroid
  6. GI tract
  7. melanoma
22
Q

how can a pathological bone fracture be prevented?

A
  • early chemotherapy/DXT
  • prophylactic internal fixation
  • +/- use of bone cement
23
Q

what is the most common soft-tissue tumour

A

lipoma