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MSK > Bone And Soft Tissue Tumours > Flashcards

Bone And Soft Tissue Tumours Flashcards

1
Q

What is a sarcoma?

A

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

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2
Q

Spread of sarcomas

A

Via fascial planes,

Haematogenous spread to lungs

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3
Q

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

A

It is likely to be metastatic

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4
Q

Types of bone-forming tumours?

A

Benign- osteoid osteoma, osteoblastoma

Malignant- osteosarcoma

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5
Q

Types of cartilage-forming tumours

A

Benign- enchondroma, osteochondroma

Malignant- chondrosarcoma

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6
Q

Types of fibrous tissue tumours

A

Benign- fibroma,

Malignant- fibrosarcoma, malignant fibrous histiocytoma

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7
Q

Types of vascular tissue tumours

A

Benign- haemangioma, aneurysmal bone cyst

Malignant- angiosarcoma

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8
Q

Types of adipose tissue tumours

A

Benign- lipoma

Malignant- liposarcoma

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9
Q

Types of marrow tissue tumours

A

Malignant- Ewing’s sarcoma, lymphoma, myeloma

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10
Q

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

A

Simple bone cyst, fibrous cortical defect

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11
Q

What is the commonest primary malignant bone in younger patients

A

Osteosarcoma

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12
Q

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

A

Myeloma

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13
Q

Investigations for bone tumours?

A

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

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14
Q

What is an inactive bone tumour look like on an XRAy

A

Clear margins,
surrounding rim of reactive bone,
Cortical expansion

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15
Q

What does an aggressive bone tumour look like on Xray

A

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

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16
Q

Cardinal features of malignant primary bone tumours

A 
Increasing pain, 
Unexplained pain, 
Deep-seated boring nature pain, 
Night pain,
Difficulty weight bearing, 
Deep swelling
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17
Q

Clinical features of osteosarcoma

A 
Pain, 
Loss of function,
Swelling, 
Pathological fracture, 
Joint effusion, 
Deformity,
Neuromuscular effects, 
Systemic effects of neoplasia
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18
Q

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

A

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

19
Q

Signs of bone tumours

A

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

20
Q

Treatment of Ewing’s sarcoma

A

Chemotherapy,
Surgery,
Radiotherapy

21
Q

Signs that a soft tissue tumour is malignant

A

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

22
Q

Red flags for a soft tissue tumour

A 
Rapidly growing, 
Hard, fixed, craggy surface,
Non-tender to palpitation,
Deep ache, 
Worse at night
23
Q

Most common sites of metastatic bone disease

A

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

24
Q

The 7 commonest primary cancers which metastasise to the bone

A 
Lung, 
Breast, 
Prostate, 
Kidney, 
Thyroid, 
GI tract, 
Melanoma
25
Q

Prevention of pathological fracture

A

Early chemotherapy,
Prophylactic internal fixation,
Embolisation

26
Q

What is Mirel’s Scoring system?

A

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

27
Q

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

A

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

28
Q

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

A

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

29
Q

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

A

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

30
Q

Soft tissue tumour presentation

A 
Painless, 
Mass deep to deep fascia,
Any mass >5cm, 
Any fixed, hard or indurated mass,
Any recurrent mass
31
Q

Investigations for soft-tissue tumour

A

MRI

32
Q

Bones most commonly affected in osteosarcoma

A

Proximal tibia
Distal Femur,

Humerus,
Jaw

33
Q

Secondary causes of osteosarcoma

A

Paget’s disease,

Irradiation

34
Q

What is seen on xray in Osteosarcoma

A

codman’s triangle

35
Q

What is Ewing’s sarcoma

A

Malignant round cell tumour of long bones

Typically affecting diaphysis in adolescents

Most commonly affects:
Pelvis,
Femur,
Tibia,
Ribs, 
Spine
36
Q

Pathological features of Ewing’s sarcoma

A 
Small,
Round,
Blue cell tumour,
Monomorphic tumour cells,
Granular chromatin,
Necrosis,
37
Q

Radiological features of Ewing’s Sarcoma

A

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

38
Q

What is the chromosomal translocation association with Ewing’s sarcoma

A

T11:22

39
Q

Xray appearance of Multiple Myeloma

A

Osteolytic lesions “punched out”

40
Q

Chondrosarcoma presentation and common sites

A

Common sites:

  • Pelvis
  • Shoulder
  • Humerus
  • Femur

Presentation:

  • Pain (particularly at night)
  • Mass or swelling
  • Sciatica
  • Bladder symptoms
41
Q

Treatment for chondrosarcoma

A

Surgery

Insensitive to radio and chemotherapy

42
Q

Osteochondroma types

A

Solitary- Osteocartilaginous
Exostosis- 1 tumour

Can get Hereditary multiple exotoses (EXT1 + EXT2 genes)

Normally affects ling bones so affects height

43
Q

Osteochondroma presentation

A

Hard painless mass,

Decreased height

MSK (40 decks)

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