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Year 3 MSK pathologies > Bone and soft tissue tumours > Flashcards

Bone and soft tissue tumours Flashcards

1
Q

What is a saroma?

A

Malignant tumour that arises from connective tissues
Spread along fascial planes
Haematogenous spread to lungs
Rarely to regional lymph nodes

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2
Q

What is a bone tumour

A

Benign tumour of skeleton common

malignant tumours are rare although mets are very common especially in those over 50

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3
Q

What is are bone forming tumours called?

A

benign: osteoid osteoma, osteobalstoma
malignant: osteosarcoma

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4
Q

What is are cartilage forming tumours called?

A

Benign: enchonfroma, osteochondroma

Malignant: chondrosarcoma

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5
Q

What is are fibrous tissue tumours called?

A

Benign: fibroma

Malignant: fibrosarcoma, malignant fibrous, histiocytoma

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6
Q

What is are vascular tissue tumours called?

A

benign: heamangioma, aneurysmal bone cyst

Malignant: angiosarcoma

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7
Q

What is are adipose tumours called?

A

Benign: lipoma

Malignant: liposarcoma

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8
Q

What is are marrow tissue tumours called?

A

malignant: ewing’s sarcoma, lymphoma, myeloma

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9
Q

What is are tumour like lesions called?

A

benign: simple bone cycst, fibrous cortical defect

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10
Q

Describe how other tumours present

A

are locally destructive and rarely mestastasise, giant cell tumours

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11
Q

How do bone tumours typically present?

A 
Pain
Mass
Abnormal x-rays
incidental
bone tumours- PAIN
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12
Q

How do bone tumours present

A

Actively related if large enough to weaken bone

Progressive and pain at rest and night

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13
Q

What examinations can be used to look at bone tumours

A 
general health
Measurements of mass
location
shape
consistency
mobility
tenderness
local temerature
neuro-vascular deficits
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14
Q

What do x-rays show when looking at bone tumours

A

Clear margins, surroundign rim of bone
cortical expansion can occur with benign lesions
less well defined zones of transition between lesions adn normal bone
cortical destruction
Periosteal reactive new bone growth occurs when the lesion destroys the cortex
Codman’s triangle, onion skinning or sunburst pattern

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15
Q

How can CT’s be used in bone tumours?

A

Assess ossification and calcification
Integrity of the cortex
best for assessing nidus in osteoid ostemoa
Staging- primarily of lungs

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16
Q

How can isotope bone scan be used for bone tumours

A

Staging for skeltal metastasis
Multiple lesions- osteochondroma, enchondrome, fibrous dysplasia and histiocytosis
Frequently negative in myeloma
Benign also demonstrate increased uptake

17
Q

How can MRI be used for looking at bone tumours

A

Study of choice
Size, extend, anatomical relationships, accurate for limits of disease both within adn outside bone
Specific for lipomas, heamangiomas,heamatomas or OVNS, non specific for benign vs malignant

18
Q

What other investigations can be carried out to look at bone tumours

A

Angiogrpahy- superseeded by MRI
Pseudoaneurysms, A-V malformations
PET- may be useful ofr investigating response to chemo

19
Q

What must be done before a biopsy

A 
The ful lowrks
bloods, x ray of affected limb and chest
MRI of lesion
Bone scan
CT chest, abdo, pelvis
20
Q

What are the cardinal features of malignant bone tumours

A 
Increasing pain
Unexplained pain
Deep seated bori g antue
Night pain
Difficulty weight brearing
Deep swelling
21
Q

What are the clinical features of bone tumours

A 
Pain
loss of function
swelling
pathological fracture
joint effusion
deformity
neurovascular effects
systemic effects of neoplasm
22
Q

How does pain sepcifically present in bone tumours?

A 
cardinal feature
increasing pain- impending fracture
analgesics eventually ineffective
not related to exercise
deep boring ache, worse at night
23
Q

How does loss of function specifically present in bone tumours?

A

limp
reduced joint movement
stiff back

24
Q

How does swelling specifically present in bone tumours?

A

Generally diffuse in malignancy
Generally near end of long bone
Once reaching noticeable size, enlargement mat be rapid
Warmth over swelling and venous congestion
Pressure effects e.g. intrapelvic

25
Q

How does a patholgical fracture sepcifically present in bone tumours?

A

minimal truama

pain prior to fracture

26
Q

How does MR scan sepcifically present in bone tumours?

A

very good for showing intraosseous extent of tumour
Extraosseous soft tissue extent of tumour
Joint involvement
Skip metastases
Epiphyseal extension
Determines resection margins

27
Q

How is treatment of bone tumours carries out

A 
Aim is to be free of disease
Chemo
Surgery
Radiotherapy
Team effort
28
Q

What is involved in surgery

A

Limb salvage possible for most cases
Consider involvement of neurovascular structures
Pathological fractures

29
Q

Why are cartilage tumours difficult?

A

Benign but aggressive

30
Q

What is suspicious signs of a soft tissue tumour?

A

deep tumours of any size
Subcutaneous growth>5cm
Rapid growthm hard, craggy, non-tender
anyone with these signs should be referred

31
Q

What is suspicious swelling?

A

Rapidly growing
Hard, fixed craggy surface, indistinct margins
Non-tender to palpation but associated with deep ache, worse at night
May be painless
recurs after excision

32
Q

What is metastatic bone disease?

A

Secondary bone tumours are 25 times more common than primary ones
Most common site fo secondary after lung and liver

33
Q

What are the 7 most common cancers that metastasise to bone

A 
LUNG-smokers, CXR, sputum cytology
BREAST- examine
PROSTATE- PSA
KIDNEY- US
THYROID- examine
GI TRACT-FOB, barium studies, endocscopy
MELANOMA- examine
34
Q

How do you prevent a pathological fracture

What is survival like after a pathological fracture

A

Early chemotherapy
Pophylactic internal fixation- lytic lesion and increasing pain and/or 2.5cm diameter or 50% destruction. Better with Mirel’s scoring system

depends on the tumour

35
Q

What surgical prevention of fractures can be carried out

A

Embolisation especially renal,thyroid, wait 48hours before surgery.
Only one long bone at a time
Aim for early painless weight bearing and mobilisation
Fracture of non weight bone can be treated conservatiely but re fracture frequently

36
Q

What are some key points regarding metastatic bone disease?

A

Prognosis is steadily improving
Never assume a solid lytic lesion is a metastasis
Fractures rarely unite even if stabilised
prophylactic fixation is less traumatic for patient
Never rush to fix a pathological fracture
Decompress and stabilise spinal metastases
Constructs should allow for immediate weightbearing and aim to last the patients lifetime

37
Q

Describe a soft tissue tumour

A 
Painless
Mass deep to fascia
Any mass >5cm
Any fixed hard or indurated mass
Any recurring mass
Imaging studies conducted with an MRI

Year 3 MSK pathologies (34 decks)

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