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MSK > Bone and Soft Tissue Tumours > Flashcards

Bone and Soft Tissue Tumours Flashcards

1
Q

What is a Sarcoma?

A
  • Malignant tumour which arises from Connective Tissue.
  • Spreads along fascial planes
  • Can spread haematogenous to lungs
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2
Q

Bone-forming tumours:

Benign

Malignant

A

Benign

  • Osteoid Osteoma
  • Osteoblastoma

Malignant

  • Osteosarcoma
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3
Q

Cartiage forming tumours?

  • Benign
  • Malignant
A

Benign

  • enchondroma
  • osteochondroma

Malignant

  • chondrosarcoma
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4
Q

Fibrous tumour tumours?

B and M

A

Benign

  • Fibroma

Malignant

  • fibrosarcoma
  • malignant fibrous and histiocytoma (MFH)
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5
Q

Vascular tissue tumour

Benign and Malignant

A

Benign

  • haemangioma
  • Aneurysmal bone cyst

Malignant

  • angiosarcoma
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6
Q

Adipose tumours

b and m

A

Benign

  • lipoma

Malignant

  • Liposarcoma
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7
Q

Bone marrow tissues?

A
  • Ewing’s Sarcoma
  • Lymphoma
  • Myeloma
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8
Q

What is the most common bone tumour in young people?

A

Osteosarcoma

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9
Q

What is the commonest primary bone tumour in eldelry?

A

Myeloma

Important to remember that bone tumour are quite rare, and that many bone tumours are much more commonly secondary mets.

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10
Q

How would a bone tumour tend to present?

A
  • Pain - progressive, worse at night
  • Mass
  • Abnormal X-ray
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11
Q

What factors would need to be looked at if someone presented with a mass?

A
  • General Health
  • Measurements of mass
  • Location
  • Shape
  • Consistency
  • Mobility
  • Tenderness
  • Local Temperature
  • Neuro-vascular deficits
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12
Q

Which investigation is the best for bone lesions?

What would this show in an inactive tumour?

What about an agressive tumour

A

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
      *
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13
Q

What is CT used for when looking at bone tumours?

A
  • Assessing ossification and calcification
  • Integrity of cortex
  • Best for assesing nidus (infection?) in osteiod osteoma
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14
Q

Why use an isotope bone scan?

what is a negative of this scan?

A
  • Staging skeletal mets.
  • Multiple lesions

Negatives

  • Frequently negative in Myeloma
  • Benign also demonstrate an increased uptake - so difficult to differentiate benign and malignant
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15
Q

Why use MRI scan in bone tumours?

Cons?

A
  • 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.

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16
Q

WHat investigation of the bone wuld be done following the imaging?

A

Bone biopsy

17
Q

What are the cardinal features of a primary bone tumour?

Examples of these?

A
  • Increasing pain
  • Unexplained pain
  • Deep-seating boring nature
  • Night pain
  • Difficulty weight bearing
  • Deep swelling

Osteosarcoma

Ewings Sarcoma

Chondrosarcoma

18
Q

What are the clinical features of osteosarcoma?

A
  • 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
19
Q

What are the common features of a swelling in osteosarcoma?

A
  • 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.
20
Q

What is the most common cause of a pathological fracture?

What are the common features of pathological fracture?

A

Osteoporosis

Minimal trauma and history of pain (in bone cancer).

21
Q

What is the investigation of choice in Osteosarcoma?

What is it good for showing?

A
  • MRI investigation of choice - v sensitive.
  • intraosseous (intramedullary) extent of tumour
  • extraosseous soft tissue extent of tumour
  • joint involvement
  • skip metastases
  • epiphyseal extension
22
Q

What is the treatment of primary malignant bone tumours?

A

Goal is to make free of disease

Chemotherapy (may be adjuvant in surgery)

Surgery – limb salvage, consider involvements of neurovascular structures

Radiotherapy

TEAM!!

23
Q

What are the signs suspicous of a soft tissue tumour?

A
  • deep (i.e. deep to deep fascia) tumours of any size
  • subcutaneous tumours > 5 cm
  • rapid growth, hard, craggy, non-tender
24
Q

Beware soft tissue swelling which is:….

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

All these may indicate that the tumour may be a nasty one which should be treated as primary or secondary malignant until proven otherwise.

25
Q

What is more common, primary or secndary bone tumours?

A

Secondary are 25x more common than primary.

26
Q

Which cancer often go to the bone when metastatic?

And with who should you suspect

A
  • 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
27
Q

How do you prevnt pathological fracture in bone cancer>

A
  • Early chemotherapy / DXT (Deep R-Ray Therapy - adjuvant )
  • Prophylactic internal fixation - lytic lesion + increasing pain
  • *
28
Q

What score is used in fracture risk assessment?

A
29
Q

What is the commonest soft tissue tumour?

A

Lipoma

MSK (33 decks)

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