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Musculoskeletal > bone and soft tissue tumours > Flashcards

bone and soft tissue tumours Flashcards

1
Q

sarcoma

A

malignant tumours arising from connective tissues
spread along fascial planes
haematogenous spread to lungs

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2
Q

Bone tumours

A

primary malignant not common

secondaries common

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3
Q

Bone forming tumours

A

benign- osteoid osteoma, osteoblastoma

malignant- osteosarcoma

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4
Q

Cartilage- forming tumours

A

benign- enchondroma
osteochondroma
malignant- chondrosarcoma

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5
Q

fibrous tissue

A

fibroma
fibrosarcoma
malignant fibrous histiocytoma

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6
Q

vascular tissue

A

benign: haemangioma

angiosarcoma

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7
Q

adipose tissue

A

lipoma

liposarcoma

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8
Q

marrow tissue tumours

A

Malignant: Ewing’s sarcoma
lyphoma
myeloma

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9
Q

Giant cell tumours

A

locally destructive, rarely metastasize

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10
Q

osteosarcoma

A

commonest primary malignant bone tumour in younger patient

3 per million

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11
Q

myeloma

A

commonest primary malignant bone tumour in older patient

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12
Q

Bone tumours

A 
pain
activity related
increasing
progressive
unrelenting
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13
Q

soft tissue

A

painless

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14
Q

osteoid osteoma

A

painful benign tumour

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15
Q

investigations

A 
isotope bone scan
FBC (anaemia), blood film
ESR, CRP
Ca++, phosphate, Alk Phos
LFTs (metastatic spread)
plasma protein electrophoresis (Igs- myeloma)
PSA( prostate)
exclude leukemia and infection
plain x rays
synovial sarcoma- calcification
phleboliths in haemangiomas
fat density in lipoma
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16
Q

Xrays

A 
inactive:
clear margins
cortical expansion can occur
malignant:
less well defined zone of transition (permeative growth)
cortical destruction= malignancy
periosteal reactive-new bone growth occurs because of^
CODMAN'S TRIANGLE
SUNBURST PATTERN
ONION SKINNING
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17
Q

Bony destruction and periosteal reaction

A

plain radiographs

CXR 80%

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18
Q

MRI scan

A 
best for showing
intraosseous soft tissue extent
joint involvement
skin lesions
epiphyseal extenstion
aid to determine resection margins
specific for lipoma
haemangioma
haematoma
Non specific for benign vs malignant
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19
Q

CT

A

assessing ossification and calcification
integrity of cortex
good for subtle bony cortical destruction
best for assessing nidus in osteoid osteoma
STAGING -lungs

20
Q

isotope bone scans

A 
staging for skeletal metatasis
benign also uptake
multiple lesions- osteochondroma
entochondroma
fibrous dysplasia
histiocytosis
-ve in myeloma
21
Q

isotope bone scans

A

technetium
detect skeletal sread
non specific but sensitive

22
Q

angiography

A

defines vascular characteristics

renal metastasis

23
Q

biopsy

A

open
core
excision

24
Q

malignancy

A

size
histological grade
metastases
soft tissue- depth

25
Q

low grade

A

well differentited
few mitoses
moderate cytological atypia
< 25% risk for metastases

26
Q

High grade

A

stage II
poorly differentiated
high mitotic rate
high cell /matrix ratio

27
Q

compartments

A 
IA and IIA contained within well defined anatomical compartments (barriers to tumour growth)
cortical bone
articular cartilage
fascial septa
joint capsule
IB &amp; IIB
extend beyond compartment of origin
III lesion has metastasised
regardless of size or histological grade
28
Q

osteosarcoma

A 
pain- not related to exercise
deep boring ache, worse at night
loss of function
swelling
pathological fracture
 joint effusion
stiff back
29
Q

swelling in osteosarcoma

A

warmth+ venous congestion
pressure effects
near end of long bone

30
Q

chemotherapy

A

70% survival rate 5 year
less well defined for adult soft tissue
not used for cartilaginous/ low grade
adjuvant therapy

31
Q

resection and reconstruction

A 
wide surgical margins
marginal with adjuvant
osteoarticular allograft
endoprosthetic reconstruction
rotaionoplasty
32
Q

surgical margins

A

intralesional
marginal
wide
radical

33
Q

Amputation vs salvage

A

will survival be affectd
short long term morbidity
function of limb compared to prosthesis
recurrence

34
Q

radiontherapy sensitivity

A

cell position in cell cycle
tissue oxygenation
DNA damage repair
inability to undergo apoptosis

35
Q

exceptions to radiotherapy

most are radioresistant

A

multiple myeloma
lymphoma
ewings
metastic carcinoma

36
Q

radiotherapy

A

reduce local recurrence of soft tissue sarcome
pre operatively to reduce tumour volume
complications: skin, osteonecrosis, sarcoma- 10 yrs

37
Q

hereditary multiple exostoses

A

autosomal dominant
cartilage capped bony outgrowths typically near physes of long bones
sessile/ pedunculated
periochondrol covering similiar to growth plate
benign bone tumour

38
Q

suspicious tumours

A

deep tumours
subcu > 5cm
rapid growth, hard craggy, non tender but associated with deep ache ie worse at night
previously excised swellings recurring

39
Q

metastatic bone disease

A

breast commonly goes to bone
melanoma commonly goes to lung
order of frequency:
vertebrae> proximal femur> pelvis> ribs> sternum> skull

40
Q

7 commonest primary cancers metastasizing to bone

A 
LUNG- smoker, CXR, sputum cytology
BREAST- commonest
Prostate- osteosclerotic
Kidney- solitary, vascular, angiography &amp;embolise, IVP and US
Thyroid- esp follicular Ca
GI tract- FOB, endoscopy
Melanoma- examine
41
Q

pathogenesis of metastasis

A

local invasion of normal stromal cells by primary tumour
-increased local pressure + dissection by tumour cells along lines of least resistance
-tumour cells invade local lymphatics& vessels point of embolisation
Tumour emboli normally destoyed by killer cells, vascular turbulence

surviving tumour emboli embedded and adherent to distant capillary bed of preffered organ

42
Q

mechanism of bone invasion

A

red marrow bones only eg vertebrae, ribs

rare distal to knee elbow usually suqamous Ca lung

43
Q

vertebral valveless weins of bateson

A

breast prostate renal-> plexus-> bone

44
Q

hypercalcemia

A 
nausea vomiting
anorexia
lethargy
confusion 
coma
45
Q

pathological fracture

A

prophylactic internal fixation

mirel’s scoring system

46
Q

fixation of pathological fractures or lytic lesions

A

high failure rate

never rush to fix fracture check if metastatic

47
Q

summary

A

bone tumours:
unexplained pain
hard fixed swelling

Soft tissue tumours:
swelling > 5 cm
any swelling deep to deep fascia
may be painless
recurring swelling

Musculoskeletal (28 decks)

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