Bone and Soft Tissue Tumours

Question 1

What is sarcoma and how does it spread?

Answer 1

• Malignant tumour arising from the connective tissue

- Spreads along the fascial planes and haematogenous spread to the lungs

Question 2

Which tumours form bone?

Answer 2

• Benign: osteoid osteoma and osteoblastoma

- Malignant: osteosarcoma

Question 3

Which tumours form cartilage?

Answer 3

• Benign: enchondroma and osteochondroma

- Malignant: chondrosarcoma

Question 4

Which tumours are fibrous tissue tumours?

Answer 4

• Benign: fibroma

- Malignant: fibrosarcoma an malignant histiocytoma

Question 5

Name the vascular tissue tumours

Answer 5

• Benign: haemangioma and aneurysmal bone cyst

- Malignant: angiosarcoma

Question 6

Name the adipose tissue tumours

Answer 6

• Benign: lipoma

- Malignant: liposarcoma

Question 7

Name the marrow tissue tumours

Answer 7

Ewing’s sarcoma, lymphoma and myeloma (all malignant)

Question 8

What are the suspicious signs of a soft tissue tumour?

Answer 8

• Deep tumours of any size
• Subcutaneous tumours > 5cm
• Rapid growth, hard, craggy and tender

Question 9

What is the most common bony tumour in patients over 50?

Answer 9

Metastasis

Question 10

What is the commonest primary malignant tumour in younger patients?

Answer 10

Osteosarcoma

Question 11

What is the commonest primary malignant tumour in older patients?

Answer 11

Myeloma

Question 12

How do bone and soft tissue tumours present?

Answer 12

• Pain (bony pain if bone tumour)
• Mass
• Incidental finding on XR

Question 13

What is the pain like in bony tumours?

Answer 13

• Activity related

- Progressive pain at night and at rest

Question 14

What investigations can be done?

Answer 14

• X-rays
• CT
• Isotope bone scan
• MRI
• Angiography
• PET
• Biopsy
• Bloods

Question 15

What will an inactive tumour look like on x-ray?

Answer 15

• Clear margins
• Surrounding rim of reactive bone
• Corticol expansion can occur with aggressive benign lesions

Question 16

What will an aggressive tumour look like on x-ray?

Answer 16

• Less well defined transition zone between lesion and normal bone
• Cortical destruction
• Periosteal reactive new bone growth
• Codman’s triangle, onion skinning or sunburst pattern

Question 17

What are the cardinal features of malignant primary bone tumours?

Answer 17

• Increasing and unexplained pain
• Deep seated boring nature
• Night pain
• Difficulty weight bearing
• Deep swelling

Question 18

Give three examples of malignant primary bone tumours

Answer 18

• Osteosarcoma
• Ewings sarcoma
• Chondrosarcoma

Question 19

What are the clinical features of bone tumours?

Answer 19

• Pain (worse at night and unrelated to exercise)
• Loss of function (limp, reduced joint movement and stiff back)
• Swelling
• Pathological fracture
• Joint effusion
• Deformity
• Neurovascular effects
• Systemic effects of neoplasia

Question 20

What investigation should be done for bone tumours?

Answer 20

MRI

Question 21

What are the treatment options for malignant bone cancers?

Answer 21

• Chemo
• Surgery
• Radiotherapy

Question 22

What are the common sites for metastases to go in the bone?

Answer 22

Vertebrae > proximal femur > pelvis > ribs > sternum > skull

Question 23

Which tumours commonly metastasise to the bone?

Answer 23

• Lung
• Breast
• Prostate
• Kidney
• Thyroid
• GI
• Melanoma

Question 24

How can pathological fractures be prevented?

Answer 24

• Early chemo
• Prophylactic internal fixation
• +/- use of bone cement

Question 25

Which scoring system is used to assess fracture risk?

Answer 25

Mirel’s Scoring system

Question 26

How do soft tissue tumours present?

Answer 26

• Painless
• Mass deep to the deep fascia
• Mass > 5cm
• Fixed, hard or indurated mass
• Any recurrent mass

Question 27

How should soft tissue tumours be investigated?

Answer 27

MRI