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Muscluloskeletal Systems > Bone and Soft Tissue Tumours > Flashcards

Bone and Soft Tissue Tumours Flashcards

1
Q

What is Sarcoma?

A

Malignant tumours arising from connective tissues

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2
Q

How can sarcoma spread?

A

Spread along fascial planes

Haematogenous spread to lungs

Rarely to regional lymph nodes

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3
Q

What forms of sarcoma will rarely spread to lymph nodes?

A

Rhabdomyosarcomas
Epithelioid sarcomas
Synovial sarcomas

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4
Q

A bone tumour in a patient >50y is likely to be what?

A

Metastatic

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5
Q

How common are:

  • Benign tumours of skeleton
  • Malignant tumours of skeleton
  • Bony secondaries?
A 
Benign = common
Malignant = RARE
Secondaries = Very common
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6
Q

Name 2 benign bone forming tumours?

A

Osteoid osteoma

Osteoblastoma

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7
Q

Name a malignant bone forming tumour?

A

Osteosarcoma

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8
Q

Name 2 benign cartilage-forming tumours

Name 1 malignant cartilage-forming tumour

A

Benign:

  • Enchondroma
  • Osteochondroma

Malignant:
-Chondrosarcoma

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9
Q

Name 1 benign and 2 malignant fibrous tissue tumours

A

Benign: fibroma

Malignant:

  • Fibrosarcoma
  • Malignant fibrous histiocytoma (MFH)
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10
Q

Name 2 benign and 1 malignant vascular tissue tumours

A

Benign:

  • haemangioma,
  • aneurysmal bone cyst

Malignant:
-angiosarcoma

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11
Q

Name 1 benign and 1 malignant adipose tissue tumours

A

benign: lipoma

Malignant: liposarcoma

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12
Q

Name 2 malignant marrow tissue tumours

A

Ewing’s sarcoma
Lymphoma
Myeloma

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13
Q

What is the commonest primary malignant bone tumour in younger patients?

What is the commonest primary malignant “bone” tumour in older patients?

A

Younger = osteosarcoma

Older = Myeloma

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14
Q

What is the pain like in bone tumours?

A

Activity related

Progressive pain at rest and at night

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15
Q

When will benign tumours of bone present with activity related pain?

A

If large enough to weaken bone

osteoid osteoma

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16
Q

How do you examine thses lumps?

What are you looking at?

A 
General health
Measurements of mass
Location
Shape
Consistency
Mobility
Tenderness
Local temperature
Neuro-vascular deficits
17
Q

What are the investigations for these tumours?

A

Plain X-rays
-Most useful for bone lesions

Calcification - synovial sarcoma

Myositis ossificans

Phleboliths in haemangioma

18
Q

What is myositis ossificans?

A

Myositis ossificans comprises two syndromes characterized by heterotopic ossification (calcification) of muscle.

19
Q

What is a phlebolith?

A

A phlebolith is a small local, usually rounded, calcification within a vein. These are very common in the veins of the lower part of the pelvis, and they are generally of no clinical importance. When located in the pelvis they are sometimes difficult to differentiate from kidney stones in the ureters on X-ray.

20
Q

How can you tell is a growth/ lesion is inactive from an x-ray?

(3 marks)

A

Clear margins

Surrounding rim of reactive bone

Cortical expansion can occur with aggressive benign lesions

21
Q

How can you tell if a growth/ lesion is aggressive on an 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

22
Q

What is Codman’s traingle?

A

Codman triangle (previously referred to as Codman’s triangle) is the triangular area of new subperiosteal bone that is created when a lesion, often a tumour, raises the periosteum away from the bone

23
Q

What is CT good for in bone tumours?

4 points

A

Assessing osification and calcification

Integrity of cortex

Best for assessing nidus in osteoid osteoma

Staging - primarily of lungs

24
Q

What are isotope bone scans good for in bone tumours?

A

Staging for skeletal metastasis

Multiple lesions - osteochondrome, enchondroma, fibrous dysplasia and histiocytosis

Benign also demonstrate increased uptake

25
Q

Isotope bone scans are frequently negative in what?

26
Q

What are MRI scans good for 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

27
Q

What investigations should you carry out before biopsy?

5 marks

A

Bloods

X-rays of affected limb and chest

MRI of lesion

Bone scan

CT chest, abdo and pelvis

28
Q

What are the cardinal features of malignant primary bone tumours?

A 
Increasing pain
Unexplained pain
Deep-seated boring nature
Night pain
Difficulty weight-bearing
Deep swelling
29
Q

What are the clinical features of osteosarcoma?

A
  • Pain
  • Loss of function
  • Swelling
  • Pathological fracture
  • Joint effusion
  • Deformity
  • Neurovascular effects
  • Systemic effects of neoplasia
30
Q

Describe the pain in osteosarcoma

what is its character? how bad is it? is it related to exercise?

A

Cardinal feature

Increasing pain - impending fracture (esp. lower limb)

Analgesics eventually ineffective

Not related to exercise

DEEP BORING ACHE, WORSE AT NIGHT

31
Q

What is the swelling (“tumour”) like in osteosarcoma?

A

Generally diffuse in malignancy

Generally near end of long bone

Once reaching noticeable size, enlargement may be rapid

Warmth over swelling + venous congestion = active

Pressure effects e.g. intrapelvic

32
Q

What should you remember about pathological bone fracture primary bone tumour?

A

Many causes of pathological fracture of which this is one of the rarest

c.f. osteoporosis commonest

33
Q

What are the treatments for bone tumours?

A

Goal is to make free of disease

Chemotherapy
Surgery
Radiotherapy

TEAM!!

34
Q

What are the suspicious signs of soft tissue tumours?

signs they may be malignant

A

Deep (i.e. deep to deep fascia) tumours of any size

Subcutaneous tumours >5cm

Rapid growth, hard, craggy, non-tender

35
Q

What features of a swelling are considered suspicious of malignant tumour until proven otherwise?

A

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

36
Q

List the common sites of secondary metastatic bone tumours from most common to least

(6 marks)

A 
Vertebrae
Proximal femur
Pelvis
Ribs
Sternum
Skull
37
Q

What are the 7 commonest primary cancers which metastasise to bone?

A 
Lung
Breast (commonest)
Prostate
Kidney
Thyroid (esp follicular)
GI tract
Melanoma
38
Q

How can you prevent pathological fractures in bone tumour disease?

A

Early chemo/ DXT

prophylactic internal fixation - lytic lesion + increasing pain and/or 2.5cm dam and/or 50% cortical destruction

Use of bone cement

39
Q

What score assessment can you use for fracture risk assessment?

A

Mirel’s scoring system

Muscluloskeletal Systems (29 decks)

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