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Yr 3 MSK > Bone and soft tissue tumours > Flashcards

Bone and soft tissue tumours Flashcards

1
Q

What is a sarcoma?

A

Malignant tumours arising from conn tissue. Spread along fascial planes

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2
Q

How do sarcomas spread to lungs?

A

Haematogenous spread to lungs.

Rarely spread to regional lymph nodes

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3
Q

Are benign or malignant tumours of skeleton more common?

A

Benign are more common, malignant are actully rare. Tumour in 50yo+ likely to be metastatic (secondaries v common)

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4
Q

Name some benign and malignant bone forming tumours

A

Benign: osteoid sarcoma, osteoblastoma
Malignant: osteosarcoma

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5
Q

Name some benign and malignant cartilage forming tumours

A

Benign: enchondroma, osteochondroma
Malignant: chondrosarcoma

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6
Q

Name some benign and malignant fibrous tissue tumours

A

Benign: fibroma
Malignant: fibrosarcoma, malignant fibrous histiocytoma (MFH)

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7
Q

Name some benign and malignant vascular tissue tumours

A

Benign: haemangioma, aneurysmal bone cyst
Malignant: angiosarcoma

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8
Q

Name some benign and malignant adipose tissue tumours

A

Benign: lipoma
Malignant: liposarcoma

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9
Q

Name some malignant marrow tissue tumours

A

Ewings sarcoma, lymphoma, myeloma

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10
Q

What are the characteristics of giant cell tumours?

A

Benign, locally destructive and rarely metastasise

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11
Q

What are some benign tumour like lesions?

A

Simple bone cyst, fibrous cortical defect

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12
Q

What is the commonest primary malignant bone tumour in younger/older patient?

A

Younger: osteosarcoma
Older: myeloma

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13
Q

What are some features of history?

A

Pain, mass, abnormal x rays - incidental

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14
Q

What are the features of the pain associated with bone tumours?

A
  • Activity related

- Progressive pain at rest and night

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15
Q

When might benign tumours present with pain?

A

Activity related pain if large enough to weaken bone

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16
Q

What features of the mass do you study on exam?

A
  • Patients general health
  • Measurements
  • Location
  • Shape
  • Consistency
  • Mobility
  • Tenderness
  • Local temp
  • Neuro-vascular deficits
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17
Q

What investigation is very helpful for these masses?

A

-X-ray

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18
Q

When do phleboliths occur?

A

In haemangiomas

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19
Q

On x ray, what features indicate an inactive mass?

A
  • Clear margins
  • Surrounding rim of reactive bone
  • Cortical expansion in aggressive benign lesions
20
Q

On x ray, what features indicate an aggressive mass?

A
  • Less well defined margin between lesion and normal bone
  • Cortical destruction
  • Periosteal reactive new bone growth occurs when lesion destroys cortex
  • Codmans triangle, onion skinning or sunburst pattern
21
Q

What are CTs used for in these masses?

A
  • Assessing ossification and calcification, integrity of cortex
  • Staging - primarily of lungs
22
Q

What are isotope bone scans used for in these masses?

A
  • Staging for skeletal metastasis

- Identifying multiple masses (osteochondroma, enchondroma) (not so much myeloma)

23
Q

What are MRI’s used for in these masses?

A
  • Size, extent, anatomical relationships
  • Accurate for limits of disease both within/outside bone
  • Specific for lipoma/haemangioma/haematoma. Non specific for benign vs malignant
24
Q

What are useful for vascular tumours?

A

Angiography. Pseudo-aneurysms, A-V malformations, embolisation of vasculat tumours

25
Q

What is useful for investigating response to chemo?

A

PET scan

26
Q

A biopsy is useful in diagnosis. What would you do in a complete work up prior to biopsy?

A
  • Bloods
  • X-ray of affected limb/chest
  • MRI
  • Bone scan
  • CT chest/abdo/pelvis
27
Q

What are cardinal features of malignant primary bone tumours?

A
  • Inc. pain
  • Unexplained pain
  • Deep seated boring nature
  • Night pain
  • Hard to weight bear
  • Deep swelling
28
Q

What are some clinical features of bone tumours?

A
  • Pain
  • Loss of function
  • Swelling
  • Pathological fracture
  • Joint effusion
  • Deformity (eg fixed flexion)
  • Neurovascular effects
  • Systemic neoplasia effects
29
Q

Discuss the pain associated with bone tumours

A
  • Inc pain - impending #
  • Analgesics eventually ineffective
  • Not related to exercise
  • Deep boring ache, worse at night
30
Q

Discuss loss of function associated with bone tumours

A
  • Limp
  • Dec. joint movement
  • Stiff back (esp child)
31
Q

Discuss swelling associated with bone tumours

A
  • Generally diffuse in malignancy/near end of long bone

- Warmth over swelling + venous congestion = active

32
Q

Discuss pathological fracture associated with bone tumours

A
  • Many causes (primary bone tumour rarest, osteoporosis commonest)
  • Minimal trauma preceding
33
Q

MRI is investigation of choice for bone tumours as it is v sensitive. What is it good for showing?

A
  • Intraosseous/Intramedullary extent of tumous
  • Extraosseous soft tissue extent of tumour
  • Joint involvement
  • Skip metastases
  • Epiphyseal extension
  • Determines extension margins
34
Q

What 3 treatments are important in bone tumours?

A
  • Chemo
  • RT
  • Surgery
35
Q

What must be considered in surgery in bone tumours?

A
  • Salvaging bone (possible in most cases)
  • Involvement of neurovascular structures
  • Pathological #
  • Porrly performed biopsy
36
Q

What are suspicious signs of soft tissue tumours?

A
  • Deep tumours of any size
  • Subcutaneous tumours >5cm
  • Rapid growth, hard, craggy, non-tender
37
Q

In soft tissue tumours what swelling should make you suspicious?

A
  • Rapidly growing
  • Hard, fixed, craggy, indistinct margins
  • Non-tender, assoc. with deep ache thats worse at night
  • May be painless
  • Recurred after previous excision
38
Q

How common is metastatic bone disease?

A
  • Secondary bone tumour 25x commoner than primary

- Bone most common metastasis site after lung and liver

39
Q

Where does breast tumour commonly metastasise to?

A

Bone

40
Q

Where does melanoma commonly metastasise to?

A

Lung

41
Q

Most common place for secondary bone tumours?

A

Vertebrae

42
Q

What are the 7 commonest tumours which metastasise to bone?

A
  1. LUNGS -smoker. CXR, sputum cytology
  2. BREAST -commonest: examine
  3. PROSTATE -osteosclerotic, PSA, PR
  4. KIDNEY -solitary, vascular. IVp and US, angiography and embolise
  5. THYROID -esp follicular Ca, examine
  6. GI - FOB, endoscopy, Ba studies, markers
  7. MELANOMA -examine
43
Q

How many patients with pathological # will survive over 6m and 1y?

A

6m - 50%

1y - 30%

44
Q

How do pathological # get prevented?

A
  • Early chemo
  • Prophylactic internal fixation determined by Mirels scoring system
  • Use of bone cement
  • Embolisation esp renal, thyroid
  • Only one long bone at a time (surgery)
  • Aim for early painless weight bearing and mobilisation post surgery
45
Q

Explain Mirels scoring system

A

Scored based on

  • Site
  • Pain
  • Lesion type
  • Size
46
Q

Should you assume lytic lesion is metastasis?

A

No, especially if solitary

Yr 3 MSK (12 decks)

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