Bone And Soft Tissue Tumours Flashcards
What is a sarcoma?
Malignant tumours arising from connective tissues which spread along the fascial planes
Spread of sarcomas
Via fascial planes,
Haematogenous spread to lungs
If a patient greater than 50 presents with a bone tumour, what is likely?
It is likely to be metastatic
Types of bone-forming tumours?
Benign- osteoid osteoma, osteoblastoma
Malignant- osteosarcoma
Types of cartilage-forming tumours
Benign- enchondroma, osteochondroma
Malignant- chondrosarcoma
Types of fibrous tissue tumours
Benign- fibroma,
Malignant- fibrosarcoma, malignant fibrous histiocytoma
Types of vascular tissue tumours
Benign- haemangioma, aneurysmal bone cyst
Malignant- angiosarcoma
Types of adipose tissue tumours
Benign- lipoma
Malignant- liposarcoma
Types of marrow tissue tumours
Malignant- Ewing’s sarcoma, lymphoma, myeloma
Tumour like lesions that can look like bone and soft tissue tumours
Simple bone cyst, fibrous cortical defect
What is the commonest primary malignant bone in younger patients
Osteosarcoma
What is the commonest primary malignant “bone “tumour in older patients?
Myeloma
Investigations for bone tumours?
Examination, X-ray, MRI, isotope scans, angiography, PET, bone biopsy
What is an inactive bone tumour look like on an XRAy
Clear margins,
surrounding rim of reactive bone,
Cortical expansion
What does an aggressive bone tumour look like on Xray
Less well defined zone of transition,
Cortical destruction,
Sunburst pattern
Cardinal features of malignant primary bone tumours
Increasing pain, Unexplained pain, Deep-seated boring nature pain, Night pain, Difficulty weight bearing, Deep swelling
Clinical features of osteosarcoma
Pain, Loss of function, Swelling, Pathological fracture, Joint effusion, Deformity, Neuromuscular effects, Systemic effects of neoplasia
What type of pain do people with malignant bone tumours experience?
Increasing pain,
Not related to exercise,
Deep boring ache,
Worse at night
Signs of bone tumours
Pain,
Loss of function eg limp, reduced joint movement, stiff back,
Swelling
Treatment of Ewing’s sarcoma
Chemotherapy,
Surgery,
Radiotherapy
Signs that a soft tissue tumour is malignant
Deep,
Subcutaneous >5cm,
Rapid growth, hard, craggy, non-tender
Red flags for a soft tissue tumour
Rapidly growing, Hard, fixed, craggy surface, Non-tender to palpitation, Deep ache, Worse at night
Most common sites of metastatic bone disease
Vertebrae > proximal femur > pelvis > ribs > sternum > skull
The 7 commonest primary cancers which metastasise to the bone
Lung, Breast, Prostate, Kidney, Thyroid, GI tract, Melanoma
Prevention of pathological fracture
Early chemotherapy,
Prophylactic internal fixation,
Embolisation
What is Mirel’s Scoring system?
Fracture risk assessment based on site, pain, lesion and size
What are worth score 1 in Mirel’s Scoring System?
Site-upper limb,
Pain- mild,
Lesion- blastic,
Size- <1/3
What are worth score 2 in Mirel’s Scoring System?
Site- lower limb
Pain- moderate pain
Lesion- blastic and lytic
Size- 1/3 - 2/3
What are worth score 3 in Mirel’s Scoring System?
Site- peritrochanter
Pain- functional
Lesion- lytic
Size- >2/3
Soft tissue tumour presentation
Painless, Mass deep to deep fascia, Any mass >5cm, Any fixed, hard or indurated mass, Any recurrent mass
Investigations for soft-tissue tumour
MRI
Bones most commonly affected in osteosarcoma
Proximal tibia
Distal Femur,
Humerus,
Jaw
Secondary causes of osteosarcoma
Paget’s disease,
Irradiation
What is seen on xray in Osteosarcoma
codman’s triangle
What is Ewing’s sarcoma
Malignant round cell tumour of long bones
Typically affecting diaphysis in adolescents
Most commonly affects: Pelvis, Femur, Tibia, Ribs, Spine
Pathological features of Ewing’s sarcoma
Small, Round, Blue cell tumour, Monomorphic tumour cells, Granular chromatin, Necrosis,
Radiological features of Ewing’s Sarcoma
Bone destruction
Bone formation
Perisoteal “Onion skin” reaction (Bone destruction leads to bone formation in concenteric layers)
Periosteal elevation
What is the chromosomal translocation association with Ewing’s sarcoma
T11:22
Xray appearance of Multiple Myeloma
Osteolytic lesions “punched out”
Chondrosarcoma presentation and common sites
Common sites:
- Pelvis
- Shoulder
- Humerus
- Femur
Presentation:
- Pain (particularly at night)
- Mass or swelling
- Sciatica
- Bladder symptoms
Treatment for chondrosarcoma
Surgery
Insensitive to radio and chemotherapy
Osteochondroma types
Solitary- Osteocartilaginous
Exostosis- 1 tumour
Can get Hereditary multiple exotoses (EXT1 + EXT2 genes)
Normally affects ling bones so affects height
Osteochondroma presentation
Hard painless mass,
Decreased height
