Bone and soft tissue tumours Flashcards
what is a sarcoma?
a malignant tumour arising from connective tissues
where does sarcomas typically spread along?
spread along fascial planes
what is the most common site of osteosarcoma metastasis?
lungs
rarely to lymph nodes (rhambdomyosarccmas, epithelium sarcomas and synovial sarcomas)
what is the commonest soft tissue tumour?
lipoma
what are suspicious signs of a bone sarcoma tumour?
deep mass of any size
subcutaneous mass > 5cm
rapidly growing
hard, fixed, craggy surface, indistinct margins
non-tender to palpation
deep pain, esp at night and rest
anything that has reoccured after resection
what is the diagnostic investigation for a bone tumour?
core needle biopsy
what are the bone forming tumours?
benign;
osteoid osteoma
osteoblastoma
malignant;
- osteosarcoma
what are the cartilage forming tumours?
benign;
- endochondroma, osteochondroma
malignant;
- chondrosarcoma
what are the fibrous tissue tumours?
benign;
- fibroma
malignant;
- fibrosarcoma
- malignant fibrous histiocytoma
what are the marrow tissue tumours?
ewings sarcoma
lymphoma
myeloma
give 2 examples of tumour-like lesions in the bone?
bone cyst
fibrous cortical defect
what is the most common primary malignant bone tumour in an old and young patient?
old = myeloma young = osteosarcoma
what is the presentation of malignant bone tumours like?
- pain: unexplained, unrelenting pain, persistant, activity related, progressive at rest and night
- mass
give examples of differences in the presentation of a malignant bone tumour vs benign bone tumour.
malignant causes activity related pain
benign may have activity related pain if it is large enough to cause bone destruction
malignant causes pain that is worse at rest and night
malignant is painful but typically not tender
benign may be tender to touch
what is an osteoid osteoma and how do you treat it?
benign bone forming tumour
responds to steroids and NSAIDS
what would you look for in the examination of a mass which is suspected to be a bone tumour?
the patients general health measurement of mass location - tethered to bone, muscle fascia shape consistency mobility tenderness local temperature neurovascular deficits
what is myositis ossificans?
bone forms within muscle or soft tissue after injury
what is phleboliths ? and when would you find it?
calcification within veins
found in haemangiomas
what investigations would you carry out if you suspected a bone tumour?
x-ray isotope bone scan CT scan MRI scan PET (staging, response to chemo) core needle biopsy
what is Codman’s triangle? and when would you find it?
classic finding on x-ray in osteosarcoma
triangular area of new subperiosteal bone that is created when a lesion, often a tumour, raises the periosteum away from the bone
what are the cardinal features of pain in a malignant primary bone tumour?
increasing pain unexplained pain deep seated boring nature pain night pain difficulty weight bearing deep swelling
what is ewings sarcoma?
malignant tumour that arises from bone or the marrow tissue
typically affects younger patients, males > females
what is chondrosarcoma?
malignant tumour arising from connective tissue
- cartillage forming tumour
what is osteosarcoma?
malignant bone forming tumour
what are the common sites for osteosarcoma to arise?
distal femur
proximal tibia
proximal humerus
what are the clinical features of osteosarcoma?
pain (cardinal feature) loss of function swelling pathological fracture joint effusion deformity neurovascular effects systemic effects of neoplasia
what is the investigation of choice for suspected bone tumour?
MRI scan
what areas does ewings sarcoma most commonly affect?
knees pelvis arms ribs spine
what are the commonest primary cancers which metastasise to bone?
lung breast prostate kidney thyroid GI tract melanoma
where are the common sites of secondary bone metastases?
vertebrae > proximal femur > pelvis > ribs > sternum > skull
what is the survival rates for patients who have pathological fractureS?
50% will survive > 6 months
30% will survive > 1 year
what is the fracture risk assessment scoring system?
Mirel’s scoring system
how do we prevent pathological fractures?
early chemo/radiotherapy
prophylactic internal fixation: if lyric lesion + increasing pain (Mirel’s scoring system)
at what score on Merel’s scoring system would you consider prophylactic internal fixation?
score 8 or above
then examining a lump and you are differentiating whether it is a sarcoma or lipoma, what way can you make an estimate on what it is?
80% sarcomas are > 5cm
what feature on x-ray is suggestive of malignant bone tumour?
cortical destruction
