Bone and soft tissue tumours

Question 1

what is a sarcoma?

Answer 1

a malignant tumour arising from connective tissues

Question 2

where does sarcomas typically spread along?

Answer 2

spread along fascial planes

Question 3

what is the most common site of osteosarcoma metastasis?

Answer 3

lungs

rarely to lymph nodes (rhambdomyosarccmas, epithelium sarcomas and synovial sarcomas)

Question 4

what is the commonest soft tissue tumour?

Answer 4

lipoma

Question 5

what are suspicious signs of a bone sarcoma tumour?

Answer 5

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

Question 6

what is the diagnostic investigation for a bone tumour?

Answer 6

core needle biopsy

Question 7

what are the bone forming tumours?

Answer 7

benign;
osteoid osteoma
osteoblastoma

malignant;
- osteosarcoma

Question 8

what are the cartilage forming tumours?

Answer 8

benign;
- endochondroma, osteochondroma

malignant;
- chondrosarcoma

Question 9

what are the fibrous tissue tumours?

Answer 9

benign;
- fibroma

malignant;

• fibrosarcoma
• malignant fibrous histiocytoma

Question 10

what are the marrow tissue tumours?

Answer 10

ewings sarcoma
lymphoma
myeloma

Question 11

give 2 examples of tumour-like lesions in the bone?

Answer 11

bone cyst

fibrous cortical defect

Question 12

what is the most common primary malignant bone tumour in an old and young patient?

Answer 12

old = myeloma
young = osteosarcoma

Question 13

what is the presentation of malignant bone tumours like?

Answer 13

• pain: unexplained, unrelenting pain, persistant, activity related, progressive at rest and night
• mass

Question 14

give examples of differences in the presentation of a malignant bone tumour vs benign bone tumour.

Answer 14

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

Question 15

what is an osteoid osteoma and how do you treat it?

Answer 15

benign bone forming tumour

responds to steroids and NSAIDS

Question 16

what would you look for in the examination of a mass which is suspected to be a bone tumour?

Answer 16

the patients general health
measurement of mass
location - tethered to bone, muscle fascia
shape 
consistency
mobility
tenderness
local temperature
neurovascular deficits

Question 17

what is myositis ossificans?

Answer 17

bone forms within muscle or soft tissue after injury

Question 18

what is phleboliths ? and when would you find it?

Answer 18

calcification within veins

found in haemangiomas

Question 19

what investigations would you carry out if you suspected a bone tumour?

Answer 19

x-ray 
isotope bone scan 
CT scan
MRI scan 
PET (staging, response to chemo)
core needle biopsy

Question 20

what is Codman’s triangle? and when would you find it?

Answer 20

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

Question 21

what are the cardinal features of pain in a malignant primary bone tumour?

Answer 21

increasing pain
unexplained pain
deep seated boring nature pain 
night pain
difficulty weight bearing 
deep swelling

Question 22

what is ewings sarcoma?

Answer 22

malignant tumour that arises from bone or the marrow tissue
typically affects younger patients, males > females

Question 23

what is chondrosarcoma?

Answer 23

malignant tumour arising from connective tissue

- cartillage forming tumour

Question 24

what is osteosarcoma?

Answer 24

malignant bone forming tumour

Question 25

what are the common sites for osteosarcoma to arise?

Answer 25

distal femur
proximal tibia
proximal humerus

Question 26

what are the clinical features of osteosarcoma?

Answer 26

pain (cardinal feature)
loss of function
swelling
pathological fracture
joint effusion
deformity 
neurovascular effects
systemic effects of neoplasia

Question 27

what is the investigation of choice for suspected bone tumour?

Answer 27

MRI scan

Question 28

what areas does ewings sarcoma most commonly affect?

Answer 28

knees
pelvis
arms
ribs
spine

Question 29

what are the commonest primary cancers which metastasise to bone?

Answer 29

lung
breast
prostate
kidney
thyroid
GI tract
melanoma

Question 30

where are the common sites of secondary bone metastases?

Answer 30

vertebrae > proximal femur > pelvis > ribs > sternum > skull

Question 31

what is the survival rates for patients who have pathological fractureS?

Answer 31

50% will survive > 6 months

30% will survive > 1 year

Question 32

what is the fracture risk assessment scoring system?

Answer 32

Mirel’s scoring system

Question 33

how do we prevent pathological fractures?

Answer 33

early chemo/radiotherapy

prophylactic internal fixation: if lyric lesion + increasing pain (Mirel’s scoring system)

Question 34

at what score on Merel’s scoring system would you consider prophylactic internal fixation?

Answer 34

score 8 or above

Question 35

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?

Answer 35

80% sarcomas are > 5cm

Question 36

what feature on x-ray is suggestive of malignant bone tumour?

Answer 36

cortical destruction