Bone and soft tissue tumours Flashcards
• Recognise the salient clinical features of bone & soft-tissue tumours • Differentiate clinical features of benign vs. malignant • Appreciation of investigations Understand rationale for treatment
Example of benign bone forming tumor (2)
Osteoiod osteoma
Osteoblastoma
Example of malignant bone forming tumor (1)
Osteosarcoma
Example of cartilage forming tumour
Benign (2)
Malignant (1)
Benign - enchondroma, osteochondroma
Malignant - chondrosarcoma
Example of fibrous tissue tumours
Benign (1)
Malignant (2)
Benign - fibroma
Malignant - fibrosarcoma, malignant fibrous histiocytoma (MFH)
Example of vascular tissue tumors
Benign (2)
Malignant (1)
Benign - hemangioma, aneurysmal bone cyst
Malignant - angiosarcoma
Example Adipose tissue tumor
Benign (1)
Malignant (1)
Benign - lipoma
Malignant - liposarcoma
Example of marrow tissue tumours
Malignant (3)
Which is most common primary malignant bone tumor in older patients?
Ewing’s sarcoma *
Lymphoma
Myeloma
Give 2 examples of benign tumor like lesions
Simple bone cyst
Fibrous cortical defect
3 clinical features of pain in bone tumour presentation
Activity related
Progressive pain at rest
Night pain
Describe radiographic features of myositis ossificans (4)
Extraosseus bone formation
Circumferential calcification
Lucent centre
String sign
Inactive radiographic features (3)
Clear margins
Surrounding rim of reactive bone
Cortical expansion (in aggressive benign lesions)
Agressive cancer radiographic features (6)
Codman’s triangle
Onion skinning
Sunburst pattern
Cortical destruction
Permeative growth of cancer - less well-defined border between lesion and normal bone
Periosteal reactive - new bone growth when lesion destroys cortex
CT x bone tumours
Function (3)
Best for…
- Assessment of ossification and calcification
- Assessment of cortical integrity
- Assessment of nidus in osteoid osteoma
Best for staging esp lung mets
In an isotope bone scan what is frequently negative?
MM
Which 4 conditions is MRI specific for?
Lipoma
Hemangioma
Hematoma
PVNS - pigmented villonodular synovitis
What is MRI unhelpful in determining with regards to bone tumours
Differentiating benign vs malignant
What is PET scan useful for with regards to bone tumours
Assessing response to chemotherapy
What are the 6 components of a full blood workup needed prior to a biopsy
FBC ESR, CRP Ca, phosphate, alkaline phosphatase LFTs - to assess mets spread Plasma protein electrophoresis -MM PSA - prostate mets
Investigation of bone tumours
State 6 imaging modalities
X-ray - affected site and lungs MRI CT - chest, abdo, pelvis Isotope bone scan PET Biopsy
What are the 5 cardinal features of malignant primary bone tumours?
3 describe the quality of the pain
Increasing, unexplained pain Night pain Deep-seated, boring pain Difficulty weight-bearing Deep swelling
Osteosarcoma
6 Clinical features
Pain, swelling and warmth Loss of ADL functions Pathological fracture Joint effusion Deformity Systemic effects - fever, weight loss
Osteosarcoma
what’s the first choice of investigation and why? (5 reasons why)
MRI * Because it is very sensitive to osteosarcoma Can visualize: 1. Intraosseous and extraosseous soft tissue extent of tumour 2. Joint involvement 3. Skip mets 4. Epiphyseal extension 5. Determine resection margin
What is a skip metastasis?
Defined as a lateral lymph node metastasis without central lymph node involvement
Ewing’s sarcoma
Definition
Epidemiology gender and age group
Malignant small round blue cell tumour
Male > female and 10-20 yo
Ewing’s sarcoma
Sites (6)
Pelvis Femur Humerus Ribs Mandible Clavicle
Ewing’s sarcoma
Clinical features
- Systemic symptoms
- Focal symptoms
Systemic symptoms - Intermittent fevers - Anemia - Leukocytosis - Increased ESR Focal symptoms - Localised pain - Swelling - Sporadic bone pain
Ewing’s sarcoma
Aetiology
Surgical indications (2)
Translocation between Ch11 and Ch22
Surgery indicated in:
- Pathological fractures
- Poorly performed biopsy
7 sites of bone metastatic disease
PBKTL
Lung Breast Prostate Kidney Thyroid GIT Melanoma
3 red flags of soft tissue tumours
- Deep tumors of any size
- Subcutaneous tumours > 5cm
- Rapid growth, hard, craggy, non-tender
Pathogenesis of metastasis
- Tumor invasion of normal stromal cells
- Increased local pressure
- Lymphovascular invasion resulting in dislodge emboli
- NK cells, vascular turbulence destroy tumor emboli but some survive
- Tumour emboli adhere to capillary bed of organ and tumor angiogenesis occurs
Most primary bone malignancies are radio-resistant except for 4
Multiple myeloma
Lymphoma
Ewing sarcoma
Metastatic carcinoma
Bone TB
5 diagnostic features
Hx - long hx of TB Single joint involvement Synovial hypertrophy Marked muscle wasting Periarticular osteoporosis
