Bone and Soft Tissue tumours

Question 1

What is sarcoma?

Answer 1

Malignant tumours arising from connective tissues.

They spread along fascial planes and if haematogenous then spread to lungs or lymph nodes.

Question 2

What are some examples of benign bone forming tumours ?

Answer 2

Osteoid osteoma

Osteoblastoma

Question 3

What are some examples of malignant bone forming tumours?

Answer 3

Osteosarcoma

Question 4

What are some examples of benign cartilage forming tumours?

Answer 4

Enchondroma

Osteochondroma

Question 5

What are some examples of malignant cartilage forming tumours?

Answer 5

Chondrosarcoma

Question 6

What are some examples of benign fibrous tissue tumours?

Answer 6

Fibroma

Question 7

What are some examples of malignant fibrous tissue tumours?

Answer 7

Fibrosarcoma, malignant fibrous histiocytoma.

Question 8

What are some examples of vascular tissue tumours?

Answer 8

Benign - haemangioma, aneurysmal bone cyst

Malignant - angiosarcoma

Question 9

What are some examples of adipose tissue tumours?

Answer 9

Benign - lipoma

Malignant - liposarcoma

Question 10

What are some examples of marrow tissue tumours?

Answer 10

Ewing’s sarcoma, lymphoma and myeloma.

Question 11

What are some suspicious signs of soft tissue tumours?

Answer 11

Deep tumours of any size
Subcutaneous tumours >5cm
Rapid growth
Hard, craggy or non-tender tumours. 
Indistinct margins
Recurred after previous excision.

Question 12

What sort of pain is experienced in Bone tumours?

Answer 12

Activity related pain

Progressive pain at rest and nighttime.

Question 13

What investigations would you carry out for bone lesions?

Answer 13

Plain X-ray (most useful)
CT
Isotope bone scan
MRI

Question 14

What may you see on an x-ray of an inactive bone lesion?

Answer 14

Clear margins
Surrounding rim of reactive bone
Cortical expansion can occur with aggressive benign lesions.

Question 15

What may you see on an x-ray of an aggressive bone lesion?

Answer 15

Less well defined zone of transition between lesions and normal bone.
Cortical destruction
Periosteal reactive new bone growth occurs when lesion destroys cortex.
Codma’s triangle, onion-skinning or sunburst pattern.

Question 16

What is needed before a biopsy is taken?

Answer 16

Bloods
X-rays of affected limb and Chest
MRI of lesion
Bone scan
CT chest, abdo and pelvis.

Question 17

What are the cardinal features of malignant primary bone tumours?

Answer 17

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

Question 18

What are the clinical features of Osteosarcoma?

Answer 18

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

Question 19

What features of swelling would you notice in someone with osteosarcoma?

Answer 19

Generally diffuse in malignancy
Near end of long bone
Enlargement may be rapid if tumour is reaching a noteable size.
Warmth over swelling and venous congestion.
Pressure affects.

Question 20

What sites within bone are common for secondary metastatic bone disease?

Answer 20

Vertebrae
Proximal femur
Pelvis
Ribs
Sternum
Skull

Question 21

What are some common primary cancer that’s metastasise to bone?

Answer 21

Lung
Breast
Prostate
Kidney
Thyroid
GI tract
Melanoma

Question 22

How are pathological fractures prevented?

Answer 22

Early chemo/DXT
Prophylactic internal fixation with potential use of bone cement.
Embolisation

Question 23

What is used to assess fracture risk?

Answer 23

Mirel’s scoring system

Score 1 = upper limb, mild pain, plastic lesion, <1/3 in size.

Score 2 = lower limb, moderate pain, mixed lesion, 1/3-2/3 in size.

Score 3 = peritrochanter, functional pain, lytic lesion, >2/3 size.

Maximum score is 12. If >8 then prophylactic fixation is recommended prior to radiotherapy.

Question 24

What is required if surgery is indicated for spinal metastases?

Answer 24

Decompression and stabilisation.