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MSK > bone and soft tissue tumours > Flashcards

bone and soft tissue tumours Flashcards

1
Q

What is a very common bone tumour

A

Secondary tumour metastasising from another area

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2
Q

What type of bone tumour is likely to be in an individual over 50

A

metastatic

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3
Q

What are sarcomas

A

Malignant tumours arising from connective tissues

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4
Q

Where do sarcomas spread to and how do they spread

A

They spread along fascial planes

Haematogenous spread to the lungs

rarely spread to regional lymph nodes

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5
Q

What are the benign bone forming tumours and how do they present

A

osteoid osteoma and osteoblastoma

Present with night pain which is relieved by non steroidal

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6
Q

What are the malignant bone forming tumours

A

name for malignancy is sarcoma

therefore the name is osteosarcoma

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7
Q

What are the benign cartilage forming tumours

A

enchondroma - lies within the bone itself
osteochondroma - very close to the growth plates

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8
Q

What is the malignant cartilage forming tumours

A

chondrosarcoma

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9
Q

What are benign fibrous tissue tumours

A

fibroma

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10
Q

What are malignant fibrous tissue tumours

A

fibrosarcoma
malignant fibrous histiocytoma

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11
Q

What are the benign vascular tissue tumours

A

hemangioma - excessive number of blood vessels

Aneurysmal bone cyst - vascular tumours at the end of long bones which are very agressive

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12
Q

What are the malignant vascular tissue tumours

A

Angiosarcoma

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13
Q

What are benign adipose tissue tumours

A

lipoma

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14
Q

What are malignant adipose tissue tumours

A

liposarcoma

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15
Q

What are Malignant marrow tissue tumours

A

Ewing’s sarcoma in children

Lymphoma

Myeloma

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16
Q

What are giant cell tumours

A

Benign Tumours made up of giant cells which occur at the end of long bones - tend to be locally destructive

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17
Q

What are simple bone cysts

A

Usually in children and just a hole in the bone - weaken the bone leaving it susceptible to fracture

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18
Q

What are fibrous cortical defect

A

Holes in the cortex of bone where there is fibrous tissue instead of bone cortex - can occasionally fracture

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19
Q

What is the commonest primary malignant bone tumour in a younger patient

A

osteosarcoma - still very uncommon due to how uncommon primary bone tumours are

20
Q

What is the commonest primary malignant bone tumour in an old patient

A

Myeloma - still very uncommon due to how uncommon primary bone tumours are

21
Q

What is the classical presentation of bone tumours

A

Pain !!
mass
seen on abdominal xray

22
Q

What is the pain from bone tumours like

A

Activity related due to the bone weak

Progressive pain at rest and at NIGHT

23
Q

When do benign tumours present with activity related pain

A

if they are large enough to weaken the bone

24
Q

Describe osteoid osteomas

A

very small bone forming tumours which can create intense pain at night which can be relieved by NSAIDs

25
Q

When should swellings raise suspicion

A

If they are rapidly growing

Hard, fixed, craggy surface with indistinct margins

Non-tender on palpation but Associated with deep ache and pain which is worse at night

(They can be painless)

If they have recurred after being excised

26
Q

What investigations are done for bone and soft tissue tumours

A

Plain X rays- best for bone lesions and soft tissue lesions

soft tissue lesions can be seen on X ray due to:

calcification of synovial sarcoma

myositis ossificans

Calcification in hemangioma (phleboliths)

27
Q

What can be seen in xrays of benign bone tumours

A

clear margins with surrounding rim of reactive bone

28
Q

What can be seen on Xrays of malignant tumours

A

Cortical destruction

Less well defined transition between lesion and normal growth (permeative growth - invading into the normal bone)

When the cortex is destroyed by the lesion, periosteal reactive new bone growth occurs:
Codmans triangle, onion-skinning or sunburst pattern

29
Q

What is the study of choice for primary bone and soft tissue tumours

A

Size, extent, anatomical relationships

30
Q

What is done to give a confirmed diagnosis

A

Biopsy which is examined histologically

31
Q

What is the usual investigations done for bone and soft tissue tumours

A

bloods
xray of affected limb and chest
MRI of lesion
Bone scan
CT chest, abdo and pelvis
Biopsy of lesion

32
Q

How are biopsis done of bone tumours

A

needle core - drill a hole and take the samples out

Open -biopsy - make a cut and then take the samples

33
Q

Who does osteosarcomas occur in most

A

Men
10-30 year olds

34
Q

Where are osteosarcomas most common

A

distal femur and proximal tibia

35
Q

What are the clinical features of osteosarcoma

A

pain
loss of function - limp, reduced joint movement, stiff back (especially in children)
swelling - late presentation as the tumour grows
fracture - pathological
joint effusion - if the tumour is next to a joint
deformity
neurovascular effects
systemic effects of neoplasia - weight loss, loss of appetite, low grade temperature…

36
Q

Describe the swelling of osteosarcomas

A

widespread
generally near the end of long bone
enlargement of the swelling may be rapid
warmth over the swelling and venous congestion means that it is biologically active - high bloodflow through it

37
Q

What is the history of a pathological fracture

A

Minimal trauma

38
Q

What are the investigations done for osteosarcoma

A

MRI scan very sensitive

39
Q

What is the treatment of osteosarcoma

A

chemotherapy
radiotherapy

Surgery:
Limb salvage if possible - excision of bony tumour and keeping the limb

40
Q

What is the restrictions of limb salvage in osteosarcoma tumour excision

A

If neurovascular structures are involved

41
Q

What are the common primary cancers which metastasise to bone

A

lung
breast
prostate
kidney
thyroid
GI tract
melanoma

42
Q

Where are the most common sites of bone when tumours metastasise to bone

A

vertebra > proximal femur > pelvis > ribs > sternum > skull

43
Q

How are pathological fractures prevention

A

Early chemotherapy to reduce risk of developing secondary bone metastases

Prophylatic internal fixation - if they have a lytic lesion and increasing pain - more than 2.5cm diameter or if there is more than 50% cortical destruction

Use of bone cement

44
Q

What are the commonest type of soft tissue tumours

A

lipomas

45
Q

If a swelling is large and deep seated what is the suspicion

A

sarcoma

46
Q

How do soft tissue tumours present

A

Painless

If it is deep to deep fascia and bigger than 5 cm be suspicious of sarcoma

Any fixed, harm or indurated mass - suspicion of sarcoma

47
Q

What is the imaging done when a patient comes in with a soft tissue tumour

A

MRI

MSK (36 decks)

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