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Musculoskeletal + Rheumatology > Bone and Soft Tissue Malignancy > Flashcards

Bone and Soft Tissue Malignancy Flashcards

1
Q

Give examples of benign bone-forming tumours

A

Osteoid Osteoma

Osteoblastoma

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2
Q

Give examples of malignant bone-forming tumours

A

Osteosarcoma

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3
Q

Give examples of cartilage-forming benign tumours

A

Enchondroma

Osteochondroma

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4
Q

Give examples of cartilage-forming malignant tumours

A

Chondrosarcoma

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5
Q

Give examples of benign fibrous tissue tumours

A

Fibroma

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6
Q

Give examples of malignant fibrous tissue tumours

A

Fibrosarcoma

Malignant Fibrous Histiocytoma (MFH

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7
Q

Give examples of benign vascular tumours

A

Haemangioma

Aneurysmal Bone Cys

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8
Q

Give examples of malignant vascular tumours

A

Angiosarcoma

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9
Q

Give examples of benign adipose tissue tumours

A

Lipoma

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10
Q

Give examples of malignant adopose tissue tumours

A

Liposarcoma

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11
Q

Give examples of malignant marrow tissue tumours?

A

Ewing’s Sarcoma

Lymphoma

Myeloma

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12
Q

What is the most common primary malignant bone tumour in younger patients?

A

Osteosarcoma

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13
Q

What is the most common primary malignant ‘bone’ tumour in older patients?

A

Myeloma

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14
Q

What is the most common soft tissue tumour?

A

Lipoma

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15
Q

What is the most common benign bone/soft tissue tumour?

A

Osteochondroma

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16
Q

How can soft tissue tumours present?

A

Rapidly growing

Hard, fixed, craggy surface, indistinct margins

Non tender to palpitation but associated with deep ache, particularly worse at night

May be painless

Recurred after previous excision

17
Q

How can bone tumours present?

A

Unlike soft tissue tumours, bone tumours are likely to be painful

  • Progressive pain
  • Unexplained pain
  • Deep-seated boring nature
  • Activity related
  • Night pain

Mass

Difficulty weight-bearing

Deep swelling

18
Q

How common is bone malignancy?

A

Primary bone tumours are rare

Seconday bone tumours are common, and is the 3rd most common secondary site after lung and liver

19
Q

List the order of frequency of secondary bone malignancy sites

A

Vertebrae

Proximal femur

Pelvis

Ribs

Sternum

Skull

20
Q

What are the most common primary cancers that spread to bone?

A

Lung

Breast

Prostate

Kidney

Thyroid (Medullary cancer)

GI

Melanoma

21
Q

What is the most common primary cancer thats spreads to bone?

A

Breast

22
Q

Where does osteosarcoma arise from?

A

Osteoblasts

23
Q

What site of the bone does osteosarcoma occur?

A

Often takes place in metaphysis where cell proliferation is occurring

24
Q

How does osteosarcoma present?

A

Pain

  • Cardinal feature
  • Increasing pain, especially in lower limb
  • Analgesics eventually ineffective
  • Not related to exercise
  • Deep boring ache, worse at night

Loss of function

  • Limp
  • Reduced joint movement
  • Stiff back especially in a child

Swelling

  • Generally diffuse in malignancy
  • Generally near the end of long bone
  • Once reaching noticeable size, enlargement may be rapid
  • Warmth over swelling + venous congestion = active
  • Pressure effects

Pathological fracture

Joint effusion

Deformity

Neurovascular effects

Systemic effects of neoplasia

25
Q

What investigations are used in bone tumour diagnosis?

A

X-Ray: Most useful for bone lesions

CT: Assesses ossification and calcification

Isotope Bone Scans: Staging for skeletal metastasis

MRI: Identify resection margins, determines size, extent and anatomical relationships

PET: Investigating response to chemo

Biopsy

26
Q

What X-ray sign is seen in osteosarcoma?

A

unburst pattern and Codman’s triangle (periosteum is lifted)

27
Q

What X-ray sign is seen in Ewing’s sarcoma?

A

Onion skin appearance

28
Q

What X-ray sign is seen in chondrosarcoma?

A

Moth eaten cloth appearance

29
Q

What X-ray sign is seen in osteochondroma?

A

Lytic bone lesions

30
Q

What scoring system assess risk of pathological fracture in malignancy?

A

Mirel’s scoring system

31
Q

Describe Mirel’s score 1

A

Upper limb

Mild pain

Blastic lesion

<1/3

32
Q

Describe Mirel’s score 2

A

Lower limb

Moderate pain

Mixed lesion

1/3-2/3

33
Q

Describe Mirel’s score 3

A

Peritrochanter

Functional pain

Lytic lesion

>2/3

34
Q

How is metastatic bone pain managed?

A

Analgesia

Biphosphonates

Radiotherapy

Musculoskeletal + Rheumatology (16 decks)

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