bone and soft tissue tumours

Question 1

what are sarcomas ?

Answer 1

malignant tumours arising from connective tissues
spread along fascial planes
haematogenous spread to lungs
rarely to regional lymph nodes

Question 2

what are benign bone-forming tumours ?

Answer 2

osteoid osteoma

osteoblastoma

Question 3

what are malignant bone-forming tumours ?

Answer 3

osteosarcoma

Question 4

what are benign cartilage-forming tumours ?

Answer 4

enchondroma

osteochondroma

Question 5

what are malignant cartilage-forming tumours ?

Answer 5

chondrosarcoma

Question 6

what are benign fibrous tissue tumours ?

Answer 6

fibroma

Question 7

what are malignant fibrous tissue tumours ?

Answer 7

fibrosarcoma

malignant fibrous histiocytoma

Question 8

what are benign vascular tissue tumours ?

Answer 8

haemangioma

aneurysmal bone cyst

Question 9

what are malignant vascular tissue tumours ?

Answer 9

angiosarcoma

Question 10

what are benign adipose tumours ?

Answer 10

lipoma

Question 11

what are malignant adipose tissue tumours ?

Answer 11

liposarcoma

Question 12

what are malignant marrow tissue tumours ?

Answer 12

Ewing’s sarcoma
lymphoma
myeloma

Question 13

what are suspicious signs of a soft tissue tumour ?

Answer 13

deep - deep to fascia of any size
subcutaneous tumours >5cm
rapid growth, hard, craggy, non-tender

Question 14

what features of swelling should you beware of ?

Answer 14

rapidly growing
hard, fixed, craggy, indistinct margin
non-tender, but deep ache at night
recurred after excision

Question 15

what is the most common primary malignant bone tumour in young people ?

Answer 15

osteosarcoma

Question 16

what is the most common primary malignant ‘bone’ tumour in old people ?

Answer 16

myeloma

Question 17

what is the clinical presentation of a bone tumour ?

Answer 17

pain - activity related, progressive at rest and night
mass
abnormal xray

Question 18

what xray findings are suggestive of specific diseases ?

Answer 18

calcification - synovial sarcoma
myositis ossificans
phleboliths in haemangioma

Question 19

what xray signs suggest inactive tumour ?

Answer 19

clear margins
surrounding rim of reactive bone
cortical expansion can occur with aggressive lesions

Question 20

what xray features suggest aggressive tumour ?

Answer 20

less well defined margins
cortical destruction
periosteal reactive new bone growth occurs when the lesion destroys the cortex
onion skinning

Question 21

what conditions can you see multiple lesions on an isotope bone scan ?

Answer 21

osteochondroma
enchondroma
fibrous dysplasia
histiocytosis

Question 22

what are cardinal features of malignant primary bones tumours ?

Answer 22

increasing pain
unexplained pain
deep-seating boring nature
night pain
difficulty weight bearing
deep swelling

Question 23

what are clinical features of an osteosarcoma ?

Answer 23

pain - cardinal, worse at night
loss of function- limp, reduced ROM, stiff back
swelling
pathological fracture
joint effusion
deformity
neurovascular effects
systemic effects of neoplasia

Question 24

what is the investigation for osteosarcoma ?

Answer 24

MRI
bone scan
xray

Question 25

how do you treat Ewing's sarcoma ?

Answer 25

chemo surgery radiotherapy

Question 26

what are the 7 most common cancers which metastasise to bone ?

Answer 26

``` lung breast - commonest prostate kidney thyroid GI melanoma ```

Question 27

what is the survival rate for patients with pathological fractures ?

Answer 27

50% survive >6months | 30% survive >1year

Question 28

how do you prevent pathological fracture ?

Answer 28

early chemo prophylactic internal fixation bone cement

Question 29

what is the scoring system for fracture risk and what are the variables ?

Answer 29

Mirel's scoring site pain lesion size

Question 30

what are score 1 options on fracture risk assessment ?

Answer 30

upper limb mild pain blastic lesion <1/3rd

Question 31

what are score 2 options on fracture risk assessment ?

Answer 31

lower limb moderate pain mixed lesion 1/3-2/3rd

Question 32

what are score 3 options on fracture risk assessment ?

Answer 32

peritrochanter functional pain lytic lesion >2/3rd