Bone And Soft Tissue Tumours

Question 1

What is a sarcoma?

Answer 1

Malignant tumours arising from connective tissues which spread along the fascial planes

Question 2

Spread of sarcomas

Answer 2

Via fascial planes,

Haematogenous spread to lungs

Question 3

If a patient greater than 50 presents with a bone tumour, what is likely?

Answer 3

It is likely to be metastatic

Question 4

Types of bone-forming tumours?

Answer 4

Benign- osteoid osteoma, osteoblastoma

Malignant- osteosarcoma

Question 5

Types of cartilage-forming tumours

Answer 5

Benign- enchondroma, osteochondroma

Malignant- chondrosarcoma

Question 6

Types of fibrous tissue tumours

Answer 6

Benign- fibroma,

Malignant- fibrosarcoma, malignant fibrous histiocytoma

Question 7

Types of vascular tissue tumours

Answer 7

Benign- haemangioma, aneurysmal bone cyst

Malignant- angiosarcoma

Question 8

Types of adipose tissue tumours

Answer 8

Benign- lipoma

Malignant- liposarcoma

Question 9

Types of marrow tissue tumours

Answer 9

Malignant- Ewing’s sarcoma, lymphoma, myeloma

Question 10

Tumour like lesions that can look like bone and soft tissue tumours

Answer 10

Simple bone cyst, fibrous cortical defect

Question 11

What is the commonest primary malignant bone in younger patients

Answer 11

Osteosarcoma

Question 12

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

Answer 12

Myeloma

Question 13

Investigations for bone tumours?

Answer 13

Examination, X-ray, MRI, isotope scans, angiography, PET, bone biopsy

Question 14

What is an inactive bone tumour look like on an XRAy

Answer 14

Clear margins,
surrounding rim of reactive bone,
Cortical expansion

Question 15

What does an aggressive bone tumour look like on Xray

Answer 15

Less well defined zone of transition,
Cortical destruction,
Sunburst pattern

Question 16

Cardinal features of malignant primary bone tumours

Answer 16

Increasing pain, 
Unexplained pain, 
Deep-seated boring nature pain, 
Night pain,
Difficulty weight bearing, 
Deep swelling

Question 17

Clinical features of osteosarcoma

Answer 17

Pain, 
Loss of function,
Swelling, 
Pathological fracture, 
Joint effusion, 
Deformity,
Neuromuscular effects, 
Systemic effects of neoplasia

Question 18

What type of pain do people with malignant bone tumours experience?

Answer 18

Increasing pain,
Not related to exercise,
Deep boring ache,
Worse at night

Question 19

Signs of bone tumours

Answer 19

Pain,
Loss of function eg limp, reduced joint movement, stiff back,
Swelling

Question 20

Treatment of Ewing’s sarcoma

Answer 20

Chemotherapy,
Surgery,
Radiotherapy

Question 21

Signs that a soft tissue tumour is malignant

Answer 21

Deep,
Subcutaneous >5cm,
Rapid growth, hard, craggy, non-tender

Question 22

Red flags for a soft tissue tumour

Answer 22

Rapidly growing, 
Hard, fixed, craggy surface,
Non-tender to palpitation,
Deep ache, 
Worse at night

Question 23

Most common sites of metastatic bone disease

Answer 23

Vertebrae > proximal femur > pelvis > ribs > sternum > skull

Question 24

The 7 commonest primary cancers which metastasise to the bone

Answer 24

Lung, 
Breast, 
Prostate, 
Kidney, 
Thyroid, 
GI tract, 
Melanoma

Question 25

Prevention of pathological fracture

Answer 25

Early chemotherapy, Prophylactic internal fixation, Embolisation

Question 26

What is Mirel’s Scoring system?

Answer 26

Fracture risk assessment based on site, pain, lesion and size

Question 27

What are worth score 1 in Mirel’s Scoring System?

Answer 27

Site-upper limb, Pain- mild, Lesion- blastic, Size- <1/3

Question 28

What are worth score 2 in Mirel’s Scoring System?

Answer 28

Site- lower limb Pain- moderate pain Lesion- blastic and lytic Size- 1/3 - 2/3

Question 29

What are worth score 3 in Mirel’s Scoring System?

Answer 29

Site- peritrochanter Pain- functional Lesion- lytic Size- >2/3

Question 30

Soft tissue tumour presentation

Answer 30

``` Painless, Mass deep to deep fascia, Any mass >5cm, Any fixed, hard or indurated mass, Any recurrent mass ```

Question 31

Investigations for soft-tissue tumour

Answer 31

MRI

Question 32

Bones most commonly affected in osteosarcoma

Answer 32

Proximal tibia Distal Femur, Humerus, Jaw

Question 33

Secondary causes of osteosarcoma

Answer 33

Paget's disease, | Irradiation

Question 34

What is seen on xray in Osteosarcoma

Answer 34

codman's triangle

Question 35

What is Ewing's sarcoma

Answer 35

Malignant round cell tumour of long bones Typically affecting diaphysis in adolescents ``` Most commonly affects: Pelvis, Femur, Tibia, Ribs, Spine ```

Question 36

Pathological features of Ewing's sarcoma

Answer 36

``` Small, Round, Blue cell tumour, Monomorphic tumour cells, Granular chromatin, Necrosis, ```

Question 37

Radiological features of Ewing's Sarcoma

Answer 37

Bone destruction Bone formation Perisoteal "Onion skin" reaction (Bone destruction leads to bone formation in concenteric layers) Periosteal elevation

Question 38

What is the chromosomal translocation association with Ewing's sarcoma

Answer 38

T11:22

Question 39

Xray appearance of Multiple Myeloma

Answer 39

Osteolytic lesions "punched out"

Question 40

Chondrosarcoma presentation and common sites

Answer 40

Common sites: - Pelvis - Shoulder - Humerus - Femur Presentation: - Pain (particularly at night) - Mass or swelling - Sciatica - Bladder symptoms

Question 41

Treatment for chondrosarcoma

Answer 41

Surgery | Insensitive to radio and chemotherapy

Question 42

Osteochondroma types

Answer 42

Solitary- Osteocartilaginous Exostosis- 1 tumour Can get Hereditary multiple exotoses (EXT1 + EXT2 genes) Normally affects ling bones so affects height

Question 43

Osteochondroma presentation

Answer 43

Hard painless mass, | Decreased height