bone and soft tissue tumours Flashcards
What is a very common bone tumour
Secondary tumour metastasising from another area
What type of bone tumour is likely to be in an individual over 50
metastatic
What are sarcomas
Malignant tumours arising from connective tissues
Where do sarcomas spread to and how do they spread
They spread along fascial planes
Haematogenous spread to the lungs
rarely spread to regional lymph nodes
What are the benign bone forming tumours and how do they present
osteoid osteoma and osteoblastoma
Present with night pain which is relieved by non steroidal
What are the malignant bone forming tumours
name for malignancy is sarcoma
therefore the name is osteosarcoma
What are the benign cartilage forming tumours
enchondroma - lies within the bone itself
osteochondroma - very close to the growth plates
What is the malignant cartilage forming tumours
chondrosarcoma
What are benign fibrous tissue tumours
fibroma
What are malignant fibrous tissue tumours
fibrosarcoma
malignant fibrous histiocytoma
What are the benign vascular tissue tumours
hemangioma - excessive number of blood vessels
Aneurysmal bone cyst - vascular tumours at the end of long bones which are very agressive
What are the malignant vascular tissue tumours
Angiosarcoma
What are benign adipose tissue tumours
lipoma
What are malignant adipose tissue tumours
liposarcoma
What are Malignant marrow tissue tumours
Ewing’s sarcoma in children
Lymphoma
Myeloma
What are giant cell tumours
Benign Tumours made up of giant cells which occur at the end of long bones - tend to be locally destructive
What are simple bone cysts
Usually in children and just a hole in the bone - weaken the bone leaving it susceptible to fracture
What are fibrous cortical defect
Holes in the cortex of bone where there is fibrous tissue instead of bone cortex - can occasionally fracture
What is the commonest primary malignant bone tumour in a younger patient
osteosarcoma - still very uncommon due to how uncommon primary bone tumours are
What is the commonest primary malignant bone tumour in an old patient
Myeloma - still very uncommon due to how uncommon primary bone tumours are
What is the classical presentation of bone tumours
Pain !!
mass
seen on abdominal xray
What is the pain from bone tumours like
Activity related due to the bone weak
Progressive pain at rest and at NIGHT
When do benign tumours present with activity related pain
if they are large enough to weaken the bone
Describe osteoid osteomas
very small bone forming tumours which can create intense pain at night which can be relieved by NSAIDs
When should swellings raise suspicion
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
What investigations are done for bone and soft tissue tumours
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)
What can be seen in xrays of benign bone tumours
clear margins with surrounding rim of reactive bone
What can be seen on Xrays of malignant tumours
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
What is the study of choice for primary bone and soft tissue tumours
Size, extent, anatomical relationships
What is done to give a confirmed diagnosis
Biopsy which is examined histologically
What is the usual investigations done for bone and soft tissue tumours
bloods
xray of affected limb and chest
MRI of lesion
Bone scan
CT chest, abdo and pelvis
Biopsy of lesion
How are biopsis done of bone tumours
needle core - drill a hole and take the samples out
Open -biopsy - make a cut and then take the samples
Who does osteosarcomas occur in most
Men
10-30 year olds
Where are osteosarcomas most common
distal femur and proximal tibia
What are the clinical features of osteosarcoma
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…
Describe the swelling of osteosarcomas
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
What is the history of a pathological fracture
Minimal trauma
What are the investigations done for osteosarcoma
MRI scan very sensitive
What is the treatment of osteosarcoma
chemotherapy
radiotherapy
Surgery:
Limb salvage if possible - excision of bony tumour and keeping the limb
What is the restrictions of limb salvage in osteosarcoma tumour excision
If neurovascular structures are involved
What are the common primary cancers which metastasise to bone
lung
breast
prostate
kidney
thyroid
GI tract
melanoma
Where are the most common sites of bone when tumours metastasise to bone
vertebra > proximal femur > pelvis > ribs > sternum > skull
How are pathological fractures prevention
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
What are the commonest type of soft tissue tumours
lipomas
If a swelling is large and deep seated what is the suspicion
sarcoma
How do soft tissue tumours present
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
What is the imaging done when a patient comes in with a soft tissue tumour
MRI
