Bone and soft tissue tumours

Question 1

Define “sarcoma”

Answer 1

Sarcoma mean a malignant tumour arising from connective tissue

Question 2

Which bone/soft tissue tumour is the most common tumour in young patients?

Answer 2

Osteosarcoma; a malignant bone-forming tumour

Question 3

Which bone/soft tissue tumour is the most common tumour in older patients?

Answer 3

Myeloma; a tumour of plasma cells (bone marrow)

Question 4

Give a benign example of each of these types of tumours:

• bone-forming tumour
• cartilage-forming tumour
• fibrous tissue tumour
• vascular tissue tumour
• adipose tissue tumour

Answer 4

bone-forming tumour = osteoid osteoma, osteoblastoma
cartilage-forming tumour = enchondroma, osteochondroma
fibrous tissue tumour = fibroma
vascular tissue tumour = haemangioma
adipose tissue tumour = lipoma

Question 5

Give a malignant example of each of these types of tumours:

• bone-forming tumour
• cartilage-forming tumour
• fibrous tissue tumour
• vascular tissue tumour
• adipose tissue tumour
• marrow tissue tumour

Answer 5

bone-forming = osteosarcoma
cartilage-forming = chondrosarcoma
fibrous tissue = fibrosarcoma
vascular tissue = angiosarcoma
adipose tissue = liposarcoma
marrow tissue = Ewing's sarcoma, lymphoma, myeloma

Question 6

Which primary tumours most commonly metastasise to the bone?

Answer 6

Myeloma
Lung cancer (bronchus)
Breast cancer
Prostate cancer
Renal cancer
Thyroid cancer

Question 7

Describe the potential MSK manifestations of malignancy (any malignancy, not just bone tumours)

Answer 7

Polyarthritis
Dermatomyositis (skin rash, muscle weakness, and muscle inflammation)
Polymyositis (chronic inflammation of the muscles)
Hypophosphataemic osteomalacia
Hypertrophic osteoarthropathy (includes clubbing)
Vasculitis and/or connective tissue disease
Raynaud’s syndrome
Polymyalgia rheumatica-like syndrome

Question 8

Describe the classic presentation of osteosarcoma

Answer 8

Local pain, swelling and tenderness
Erythema
Mass may be felt

Question 9

Describe the clinical presentation of osteoid osteoma

Answer 9

Most common in young males

Severe dull pain which is worse at night and relieved by NSAIDs (especially aspirin) - relief is immediate

Question 10

Describe the clinical presentation of osteochondroma

Answer 10

Rarely presents; usually asymptomatic. May cause some pain/tingling due to strain on nearby nerves/vessels.

Question 11

Describe the presentation of enchondroma

Answer 11

Rarely presents; usually asymptomatic. Pain and swelling can occur in very large tumours

Question 12

Describe the clinical presentation of myeloma

Answer 12

Usually seen in patients over 50 years of age
Pain (usually backache but sometimes ribs)
Pathological fractures
Anaemia, recurrent infection
Renal failure
Signs of hypercalcaemia
Signs of hyperviscosity (dizziness, blurred vision, headaches, epistaxis, cerebrovascular event)

Question 13

What blood test results would suggest myeloma?

Answer 13

Low Hb
High ESR
High calcium
High immunoglobulin (due to paraproteins)
High urea and creatinine
Neutropenia, Leukopenia

Question 14

Describe the presentation of Ewing’s sarcoma

Answer 14

Usually localised in the diaphysis of long and flat bones e.g. femur, pelvis and spine
Bone pain, swelling, tenderness
May also have fever (will have raised WCC)

Question 15

Osteosarcoma is a complication of which metabolic bone disease?

Answer 15

Paget’s disease