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Systems 2nd Year: MSK > Bone and soft tissue tumours > Flashcards

Bone and soft tissue tumours Flashcards

1
Q

Sarcoma Features

A

Malignant
Arise from Connective Tissue
Spread along Fascial Planes
Haematogenous Spread to Lungs

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2
Q

Bone Tumours what is common

A

Benign

Secondary Bone Common

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3
Q

Bone Tumour in Patient >50

A

Likely Metastatic

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4
Q

Benign Bone Tumours (2)

A

Osteoid Osteoma

Osteoblastoma

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5
Q

Malignant Bone Tumour

A

Osteosarcoma

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6
Q

Cartilage Forming Benign Tumour

A

Enchondroma, Osteochondroma

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7
Q

Cartilage Forming Malignant Tumour

A

Chondrosarcoma

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8
Q

Fibrous Tissue Benign Tumour

A

Fibroma

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9
Q

Fibrous Tissue Malignant Tumour

A

Fibrosarcoma, Malignant Fibrous Histocytoma

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10
Q

Vascular Tissue Benign Tumour

A

Haemangioma, Aneurysmal Bone Cyst

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11
Q

Vascular Tissue Malignant Tumour

A

Angiosarcoma

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12
Q

Adipose Tissue Benign Tumour

A

Lipoma

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13
Q

Adipose Tissue Malignant Tumour

A

Liposarocma

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14
Q

Marrow Tissue Malignant Tumour

A

Ewing sarcoma
Lymphoma
Myeloma

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15
Q

What are Giant Cell Tumours

A

Benign
Local Destructive
Rarely Move

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16
Q

Most common Primary Bone tumours

A

Osteosarcoma (3 per million) most common in younger patient

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17
Q

commonest primary malignant “bone” tumour in older patient

A

myeloma

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18
Q

commonest primary malignant bone tumour in younger patient

A

osteosarcoma

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19
Q

A tumour is inactive if on x-ray

A

clear margins
surrounding rim of reactive bone
cortical expansion can occur with aggressive benign lesions

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20
Q

a tumour is aggressive is on x-ray

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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21
Q

CT in tumours is best for assessing

A

Assessing ossification and calcification
integrity of cortex
best for assessing nidus in osteoid osteoma
Staging - primarily of lungs

22
Q

isotope bone scans in bone tumours

A

Staging for skeletal metastasis
Multiple lesions - osteochondroma, enchondroma, fibrous dysplasia & histiocytosis
Frequently negative in Myeloma
Benign also demonstrate increased uptake

23
Q

MRI in bone tumours

A

Study of choice
size, extent, anatomical relationships
Accurate for limits of disease both within and outside bone
Specific for Lipoma, haemangioma, haematoma or PVNS.
Non-specific for benign vs. malignant

24
Q

prior to biopsy do

A 
Bloods
X-rays of affected Limb 
& Chest
MRI of lesion
Bone Scan
CT Chest, abdo & pelvis
25
Q

Malignant Primary Bone Tumour Features

A 
Cardinal features
Increasing pain
unexplained pain
Deep-seated boring nature
Night pain
Difficulty weight-bearing
Deep swelling
26
Q

Malignant primary bone tumour examples

A

Osteosarcoma

Ewings sarcoma

Chondrosarcoma

27
Q

Osteosarcoma Features

A

pain

loss of function

swelling

pathological fracture

joint effusion

deformity

neurovascular effects

systemic effects of neoplasia

impending fracture esp lower limb

analgesics eventually
ineffective

deep boring ache at night

limp

reduced joint movement

stiff back (esp. child)

28
Q

If there is warmth over swelling and venous congestion what does this mean

A

active

29
Q

Investigations for Bone Tumours

A 
investigation of choice - very sensitive
VG for showing 
intraosseous (intramedullary) extent of tumour
extraosseous soft tissue extent of tumour
joint involvement
skip metastases
epiphyseal extension
determines resection margins
30
Q

Ewing sarcoma Treatment

A

Chemo
Surgery
Radio

31
Q

Suspicious signs of Malignant soft tissue tumours

A

deep (i.e. deep to deep fascia) tumours of any size
subcutaneous tumours > 5 cm
rapid growth, hard, craggy, non-tender

rapidly growing
hard, fixed, craggy surface, indistinct margins
non-tender to palpation, but assoc. with deep ache, esp. worse at night
BEWARE – may be painless
Recurred after previous excision

32
Q

What is the most common site for secondary tumours after lung and liver

A

bone

33
Q

breast cancer most commonly goes to

A

bone

34
Q

melanoma commonly goes to

A

lung

35
Q

which bone does metatstates usually go to

A

vertebrae

36
Q

7 commonest primary cancers which metastases to bone

A 
Lung
Breast
Prostate
Kidney
Thyroid
GI
Melanoma
37
Q

Breast Cancer soft tissue metastases

A

decreases survival compared to bone tumours

38
Q

pathological fracture prevention

A

prophylactic internal fixation if lytic lesion, pain and or >2.5cm diameter or >50% cortical destruction

39
Q

What is fracture risk assessment called

A

Mirel’s Scoring

40
Q

Risk is highest in Mirel’s Scoring System for what type of fracture

A

Site: Peritrochanter
Functional Pain
Lytic Lesion
>2/3 Size

41
Q

Fixation of pathological fractures or lytic lesions around where has high fail rate

A

Hip/Proximal femur

42
Q

what has low failure rate for hip/proximal femur pathological fractures/lytic lesion

A

cemented hip prosthesis

43
Q

when surgery is indicated for spinal mets what else should be done

A

decompression

stabilisation

44
Q

If Solitary Lipoma is >10cm what does this mean

A

Bad

45
Q

Commonest soft tissue tumour

A

Lipoma

46
Q

Soft tissue presentation

A 
painless
mass deep to deep fascia
any mass >5cm
any fixed, hard or indurated mass
any recurrent mass

Imaging studies - MRI

47
Q

Peak age incidence of osteosarcoma

A

10-25

48
Q

peak age of Ewing sarcoma

A

10-18

49
Q

peak age of chondrosarcoma

A

45-60

50
Q

If soft tissue sarcoma is deep seated or >5cm

A

refer to specialist

Systems 2nd Year: MSK (75 decks)

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