36: Bone and Soft Tissue Tumours Flashcards
describe sarcoma and their spread
- 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)
a bone tumour in a patient > 50 is likely to be?
metastatic
give examples of benign and malignant bone-forming tumours
- benign: osteoid osteoma, osteoblastoma
- malignant: osteosarcoma
give examples of benign and malignant cartilage-forming tumours
- benign: endochondroma, osteochondroma
- malignant: chondrosarcoma
give examples of benign and malignant fibrous tissue tumours
- benign: fibroma
- malignant: fibrosarcoma, malignant fibrous histiocytoma (MFH)
give examples of benign and malignant vascular tissue tumours
- benign: hemangioma, aneurysmal bone cyst
- malignant: angiosarcoma
give examples of benign and malignant adipose tissue tumours
- benign: lipoma
- malignant: liposarcoma
give examples of malignant marrow tissue tumours
- Ewing’s sarcoma
- lymphoma
- myeloma
what is the most common primary malignant bone tumour in a younger patient?
osteosarcoma
what is the most common primary malignant ‘bone’ tumour in an older patient?
myeloma
what is the most useful imaging modality for suspected bone lesions?
plain x-rays
inactive bone lesion x-ray features
- clear margins
- surrounding rim of reactive bone
- cortical expansion can occur with aggressive benign lesions
aggressive bone lesion x-ray features
- 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
what is the complete work up of investigations prior to bone biopsy?
bone lesion investigations
- Bloods
- x-ray of affected limb and chest, most useful for bone lesions
- MRI of lesion
- bone scan
- CT CAP
what are the cardinal clinical features of malignant primary bone tumours?
- increasing pain
- unexplained pain
- deep-seated aching
- night pain
- difficult weight-bearing
- deep swelling