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Year 3 > Bone and Soft Tissue Tumours > Flashcards

Bone and Soft Tissue Tumours Flashcards

1
Q

what is sarcoma?

A

malignant tumours arising from connective tissue

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2
Q

how do sarcomas spread?

A

along fascial planes

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3
Q

how can sarcomas spread to the lungs?

A

haematogenous spread

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4
Q

benign: bone forming tumour

A

osteoid
osteoma
osteoblastoma

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5
Q

benign: cartilage forming tumour

A

enchondroma

osteochondroma

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6
Q

benign: fibrous tissue tumour

A

fibroma

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7
Q

benign: vascular tissue tumours

A

haemangioma

aneurysmal bone cyst

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8
Q

benign: adipose tissue tumours

A

lipoma

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9
Q

benign: tumour like lesions

A

simple bone cyst

fibrous cortical defect

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10
Q

malignant: bone forming tumour

A

osteosarcoma

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11
Q

malignant: cartilage forming umour

A

chondrosarcoma

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12
Q

malignant: fibrous tissue tumours

A

fibrosarcoma

malignant fibrous histiocytoma (MFH)

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13
Q

malignant: vascular tissue tumours

A

angiosarcoma

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14
Q

malignant: adipose tissue tumours

A

liposarcoma

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15
Q

malignant: marrow tissue tumours

A

liposarcoma
Ewing’s sarcoma
lymphoma
myeloma

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16
Q

what tumours are locally destructive but rarely metastasise?

A

giant cell tumours

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17
Q

what is the commonest primary malignant bone tumour in younger patients?

A

osteosarcoma

18
Q

what is the commonest primary malignant “bone” tumour in older patients?

A

myeloma

19
Q

pain in bone tumours

A

activity related

progressive pain at rest and night

20
Q

when might benign bone tumours cause pain?

A

activity related if large enough to weaken bone

21
Q

examination of a patient with a potential bone tumour

A
  1. General health
  2. Mass
  3. Location
  4. Shape
  5. Consistency
  6. Mobility
  7. Tenderness
  8. Local temperature
  9. Neurovascular deficits
22
Q

investigations in a potential bone tumour

A 
plain x-ray
CT
Isotope bone scans
MRI
Angiography
PET
Biopsy
23
Q

investigations in a potential bone tumour: plain xray

A

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

24
Q

investigations in a potential bone tumour: CT

A

a. Assessment of ossification and calcification
b. Integrity of cortex
c. Best for assessing nidus in osteoid osteoma
d. Staging – primarily of lungs

25
Q

investigations in a potential bone tumour: isotope bone scan

A

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

26
Q

investigations in a potential bone tumour: MRI

A

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

27
Q

investigations in a potential bone tumour” angiography

A

a. Superseded by MRI
b. Pseudoaneurysms, A_V malformations
c. Embolization of vascular tumours – renal, ABC

28
Q

investigations in a potential bone tumour: PET

A

may be useful for investigating response to chemo

29
Q

investigations in a potential bone tumour: work up before biopsy

A

i. Bloods
ii. X-rays of affected limb and chest
iii. MRI of lesion
iv. Bone scan
v. CT chest, abdo and pelvis

30
Q

cardinal features of malignant primary bone tumours

A
  1. Increasing pain
  2. Unexplained pain
  3. Deep-seated boring nature
  4. Night pain
  5. Difficulty weight bearing
  6. Deep swelling
31
Q

clinical features of bone tumours

A 
pain
loss of function
swelling
pathological fracture
joint effusion
deformity
neurovascular effects
systemic effects of neoplasia
32
Q

pain in bone tumours

A

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

33
Q

loss of function in bone tumours

A

a. Limb
b. Reduced joint movement
c. Stiff back (esp. child)

34
Q

swelling in bone tumours

A

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

35
Q

pathological fractures in bone tumours

A

a. Many causes, of which primary bone tumour is one of the rarest – osteoporosis is commonest
b. Minimal trauma Hx of pain prior

36
Q

MRI is good at showing what when investigating bone tumours

A

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

37
Q

signs that a soft tissue tumour may be malignant

A

deep (deep to deep fascia) tumours of any size; SC tumours

> 5cm; rapid growth, hard, craggy, non-tender.

38
Q

when examining soft tissue tumours beware a swelling which is

A
  1. Rapid growing
  2. Hard, fixed, craggy surface, indistinct margins
  3. Non-tender to palpation but associated with deep ache, esp. worse at night
  4. Painless
  5. Recurred after previous excision
39
Q

a secondary bone tumour is how much more common than primary?

A

25 x

40
Q

order of metastatic bone sites

A 
vertebrae
proximal femur
pelvis
ribs
sternum
skull
41
Q

7 commonest primary cancers which metastasise to bone?

A 
lung
breast
prostate
kidney
thyroid
GIT
melanoma
42
Q

how can you prevent pathological fractures?

A

early chemotherapy and prophylactic internal fixation

Year 3 (164 decks)

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