Bone and Soft Tissue Tumours Flashcards
what is sarcoma?
malignant tumours arising from connective tissue
how do sarcomas spread?
along fascial planes
how can sarcomas spread to the lungs?
haematogenous spread
benign: bone forming tumour
osteoid
osteoma
osteoblastoma
benign: cartilage forming tumour
enchondroma
osteochondroma
benign: fibrous tissue tumour
fibroma
benign: vascular tissue tumours
haemangioma
aneurysmal bone cyst
benign: adipose tissue tumours
lipoma
benign: tumour like lesions
simple bone cyst
fibrous cortical defect
malignant: bone forming tumour
osteosarcoma
malignant: cartilage forming umour
chondrosarcoma
malignant: fibrous tissue tumours
fibrosarcoma
malignant fibrous histiocytoma (MFH)
malignant: vascular tissue tumours
angiosarcoma
malignant: adipose tissue tumours
liposarcoma
malignant: marrow tissue tumours
liposarcoma
Ewing’s sarcoma
lymphoma
myeloma
what tumours are locally destructive but rarely metastasise?
giant cell tumours
what is the commonest primary malignant bone tumour in younger patients?
osteosarcoma
what is the commonest primary malignant “bone” tumour in older patients?
myeloma
pain in bone tumours
activity related
progressive pain at rest and night
when might benign bone tumours cause pain?
activity related if large enough to weaken bone
examination of a patient with a potential bone tumour
- General health
- Mass
- Location
- Shape
- Consistency
- Mobility
- Tenderness
- Local temperature
- Neurovascular deficits
investigations in a potential bone tumour
plain x-ray CT Isotope bone scans MRI Angiography PET Biopsy
investigations in a potential bone tumour: plain xray
a. Calcification – synovial sarcoma
b. Myosistis ossificans
c. Phleboliths in haemangioma
d. In active
i. Clear margins
ii. Surrounding rim of reactive bone
iii. Cortical expansion can occur with aggressive benign lesions
e. Aggressive
i. Less well-defined zone of transition between lesion and normal bone
(permeative growth)
ii. Cortical destruction – malignancy
iii. Periosteal reactive new bone growth occurs when the lesion destroys the
cortex
iv. Codman’s triangle, onion-skinning, or sunburst pattern
investigations in a potential bone tumour: CT
a. Assessment of ossification and calcification
b. Integrity of cortex
c. Best for assessing nidus in osteoid osteoma
d. Staging – primarily of lungs
investigations in a potential bone tumour: isotope bone scan
a. Staging for skeletal metastasis
b. Multiple lesions – osteochondroma, endochonroma, fibrous dysplasia and histiocytosis
c. Frequently negative in myeloma
d. Benign also demonstrate increased uptake
investigations in a potential bone tumour: MRI
a. Study of choice
b. Size, extent, anatomical relationships
c. Accurate for limits of disease both within and outside bone
d. Specific for lipoma, haemangioma, haematoma or PVNS
e. Non-specific for benign vs malignant
investigations in a potential bone tumour” angiography
a. Superseded by MRI
b. Pseudoaneurysms, A_V malformations
c. Embolization of vascular tumours – renal, ABC
investigations in a potential bone tumour: PET
may be useful for investigating response to chemo
investigations in a potential bone tumour: work up before biopsy
i. Bloods
ii. X-rays of affected limb and chest
iii. MRI of lesion
iv. Bone scan
v. CT chest, abdo and pelvis
cardinal features of malignant primary bone tumours
- Increasing pain
- Unexplained pain
- Deep-seated boring nature
- Night pain
- Difficulty weight bearing
- Deep swelling
clinical features of bone tumours
pain loss of function swelling pathological fracture joint effusion deformity neurovascular effects systemic effects of neoplasia
pain in bone tumours
a. Cardinal features
b. Increasing pain – impending # (esp. ll)
c. Analgesics eventually ineffective
d. Not related to exercise
e. Deep boring ache
i. Worse at night
loss of function in bone tumours
a. Limb
b. Reduced joint movement
c. Stiff back (esp. child)
swelling in bone tumours
a. Generally, diffuse in malignancy
b. Generally near end of long bone
c. Once reaching noticeable size, enlargement may be rapid
d. Warmth over swelling + venous congestion = active
e. Pressure effects
pathological fractures in bone tumours
a. Many causes, of which primary bone tumour is one of the rarest – osteoporosis is commonest
b. Minimal trauma Hx of pain prior
MRI is good at showing what when investigating bone tumours
i. Intraosseous (intramedullary) extent of tumour
ii. Extraosseous soft tissue extent of tumour
iii. Joint involvement
iv. Skip metastases
v. Epiphyseal extension
c. Determines resection margins
signs that a soft tissue tumour may be malignant
deep (deep to deep fascia) tumours of any size; SC tumours
> 5cm; rapid growth, hard, craggy, non-tender.
when examining soft tissue tumours beware a swelling which is
- Rapid growing
- Hard, fixed, craggy surface, indistinct margins
- Non-tender to palpation but associated with deep ache, esp. worse at night
- Painless
- Recurred after previous excision
a secondary bone tumour is how much more common than primary?
25 x
order of metastatic bone sites
vertebrae proximal femur pelvis ribs sternum skull
7 commonest primary cancers which metastasise to bone?
lung breast prostate kidney thyroid GIT melanoma
how can you prevent pathological fractures?
early chemotherapy and prophylactic internal fixation
