Bone and Soft Tissue Tumours Flashcards
What is a Sarcoma?
- Malignant tumour which arises from Connective Tissue.
- Spreads along fascial planes
- Can spread haematogenous to lungs
Bone-forming tumours:
Benign
Malignant
Benign
- Osteoid Osteoma
- Osteoblastoma
Malignant
- Osteosarcoma
Cartiage forming tumours?
- Benign
- Malignant
Benign
- enchondroma
- osteochondroma
Malignant
- chondrosarcoma
Fibrous tumour tumours?
B and M
Benign
- Fibroma
Malignant
- fibrosarcoma
- malignant fibrous and histiocytoma (MFH)
Vascular tissue tumour
Benign and Malignant
Benign
- haemangioma
- Aneurysmal bone cyst
Malignant
- angiosarcoma
Adipose tumours
b and m
Benign
- lipoma
Malignant
- Liposarcoma
Bone marrow tissues?
- Ewing’s Sarcoma
- Lymphoma
- Myeloma
What is the most common bone tumour in young people?
Osteosarcoma
What is the commonest primary bone tumour in eldelry?
Myeloma
Important to remember that bone tumour are quite rare, and that many bone tumours are much more commonly secondary mets.
How would a bone tumour tend to present?
- Pain - progressive, worse at night
- Mass
- Abnormal X-ray
What factors would need to be looked at if someone presented with a mass?
- General Health
- Measurements of mass
- Location
- Shape
- Consistency
- Mobility
- Tenderness
- Local Temperature
- Neuro-vascular deficits
Which investigation is the best for bone lesions?
What would this show in an inactive tumour?
What about an agressive tumour
X-ray
Inactive
- Clear margins
- Surrounding rim of reactive bone
Aggressive
- Less well-defined zone of transition between lesion and normal bone.
- Cortical destruction = malignancy
- Periosteal reactive new bone growth occurs when the lesion the cortex.
- Codmans’s traingle, onion skinning, sunburst pattern
*
- Codmans’s traingle, onion skinning, sunburst pattern
What is CT used for when looking at bone tumours?
- Assessing ossification and calcification
- Integrity of cortex
- Best for assesing nidus (infection?) in osteiod osteoma
Why use an isotope bone scan?
what is a negative of this scan?
- Staging skeletal mets.
- Multiple lesions
Negatives
- Frequently negative in Myeloma
- Benign also demonstrate an increased uptake - so difficult to differentiate benign and malignant
Why use MRI scan in bone tumours?
Cons?
- Size, extent anatomical relationships
- Accurate for limits of disease both inside and outside of bone.
- Specific for lipoma, haemangioma, haematoma and PVNS.
CON
Non-specific for benign vs. malignant.
WHat investigation of the bone wuld be done following the imaging?
Bone biopsy
What are the cardinal features of a primary bone tumour?
Examples of these?
- Increasing pain
- Unexplained pain
- Deep-seating boring nature
- Night pain
- Difficulty weight bearing
- Deep swelling
Osteosarcoma
Ewings Sarcoma
Chondrosarcoma
What are the clinical features of osteosarcoma?
-
Pain - cardinal feature - increasing up to an impending fracture
- deep boring pain that is worse at night.
- joint movement and stiff back especially if a child
- Swelling
- Pathological fracture
- Joint effusion
- Deformity
- Neurovascular effects
- Systemic effects of neoplasia
What are the common features of a swelling in osteosarcoma?
- Generally diffuse in malignancy
- Generally near the end of a long bone
- Enlargemetn may be rapid
- Warmth and venous congestion over swelling.
- Pressure effects - such as the impact if intrapelvic.
What is the most common cause of a pathological fracture?
What are the common features of pathological fracture?
Osteoporosis
Minimal trauma and history of pain (in bone cancer).
What is the investigation of choice in Osteosarcoma?
What is it good for showing?
- MRI investigation of choice - v sensitive.
- intraosseous (intramedullary) extent of tumour
- extraosseous soft tissue extent of tumour
- joint involvement
- skip metastases
- epiphyseal extension
What is the treatment of primary malignant bone tumours?
Goal is to make free of disease
Chemotherapy (may be adjuvant in surgery)
Surgery – limb salvage, consider involvements of neurovascular structures
Radiotherapy
TEAM!!
What are the signs suspicous of a soft tissue tumour?
- deep (i.e. deep to deep fascia) tumours of any size
- subcutaneous tumours > 5 cm
- rapid growth, hard, craggy, non-tender
Beware soft tissue swelling which is:….
- 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
All these may indicate that the tumour may be a nasty one which should be treated as primary or secondary malignant until proven otherwise.
What is more common, primary or secndary bone tumours?
Secondary are 25x more common than primary.
Which cancer often go to the bone when metastatic?
And with who should you suspect
- Lung - smokers, CXR, Sputum cytology
- Breast - examine
- Prostate - osteo-sclerotic, PR and PSA
- Kidney - solitary, vascular, IVP nad US, angiography and embolise
- Thyroid - Esp. follicular cancer, examine
- GI Tract - FOB, endoscopy, Ba study, markers
- Melanoma - examine
How do you prevnt pathological fracture in bone cancer>
- Early chemotherapy / DXT (Deep R-Ray Therapy - adjuvant )
- Prophylactic internal fixation - lytic lesion + increasing pain
- *
What score is used in fracture risk assessment?
What is the commonest soft tissue tumour?
Lipoma
