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Bone and soft tissue tumours Flashcards

1
Q

What are the two types of malignant bone tumour?

A

Primary

Secondary

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2
Q

What are sarcomas?

A

Malignant tumours arising from connective tissues

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3
Q

How does sarcoma spread?

A

Along fascial planes

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4
Q

How does sarcoma spread to the lungs?

A

Haematogenous spread

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5
Q

What does sarcoma rarely spread to?

A

Regional lymph nodes

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6
Q

What are examples of benign bone-forming tumours?

A

Osteoid osteoma

Osteoblastoma

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7
Q

What is an example of a malignant bone-forming tumours?

A

Osteosarcoma

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8
Q

What are examples of benign cartilage-forming tumours?

A

Enchondroma

Osteochondroma

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9
Q

What is an example of a malignant cartilage-forming tumour?

A

Chrondrosarcoma

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10
Q

What is an example of a benign fibrous tissue tumour?

A

Fibroma

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11
Q

What are example of malignant fibrous tissue tumours?

A

Fibrosarcoma

Malignant fibrous histiocytoma (MFH)

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12
Q

What are examples of benign vascular tissue tumours?

A

Haemangioma

Aneurysmal bone cyst

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13
Q

What is an example of malignant vascular tissue tumour?

A

Angiosarcoma

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14
Q

What is an example of benign adipose tissue tumour?

A

Lipoma

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15
Q

What is an example of malignant adipose tissue tumour?

A

Liposarcoma

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16
Q

What are examples of malignant marrow tissue tumours?

A

Ewing’s sarcoma
Lymphoma
Myeloma

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17
Q

What are benign, locally destructive tumours that rarely metastasise?

A

Giant cell tumours (GCT)

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18
Q

What are benign tumour-like lesions?

A

Simple bone cyst

Fibrous cortical defect

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19
Q

What are suspicious signs of a malignant soft tissue tumour?

A

Deep tumours of any size
Subcutaneous tumours >5cm
Rapid growth, hard, craggy, non-tender

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20
Q

What swellings should you beware of?

A

Rapidly growing
Hard, fixed, craggy surface, indistinct margins
Non-tender to palpation, but assoc. with deep ache, esp. worse at night
May be painless
Recurred after previous excision

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21
Q

Which type of bone tumour is more common: benign or malignant?

A

Benign

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22
Q

What is a bone tumour in a patient >50 likely to be?

A

Metastatic

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23
Q

What is commonest primary malignant bone tumour in younger patients?

A

Osteosarcoma

24
Q

What is the commonest primary malignant bone tumour in an older patient?

25
How do bone tumours present?
*Pain Mass Abnormal x-rays, often picked up incidentally
26
What is the pain in bone tumours associated with?
Activity related | Progressive pain at rest & night
27
When might benign tumours present with activity related pain?
If large enough to weaken bone | e.g. osteoid osteoma
28
What should be examined in someone with suspected bone tumour?
``` Measurements of mass Location Shape Consistency Mobility Tenderness Local temp Neurovascular deficits ```
29
What are the investigations for suspected bone tumour?
``` Plain XR CT Isotope bone scan *MRI Angiography PET Biopsy ```
30
What can be seen on x-ray for suspected bone tumours?
Calcification - synovial sarcoma Myositis ossificans Phleboliths in haemangioma
31
What is seen in inactive bone on x-ray?
Clear margins Surround rim of reactive bone Cortical expansion can occur with aggressive benign lesions
32
What is myositis ossificans?
Where bone tissue forms inside muscle or other soft tissue after an injury
33
What is phleboliths with haemangioma?
Phleboliths are calcified thrombi found within vascular channels, often in the presence of hemangioma or vascular malformation
34
What can be seen in x-rays of aggressive tumours?
Less well defined zone of transition between lesion and normal bone Cortical destruction = malignancy Periosteal reactive new bone growth occurs when lesion destroys cortex Codman's triangle, onion-skinning or sunburst pattern
35
What is Codman's triangle?
The triangular area of new subperiosteal bone that is created when a lesion, often a tumour, raises the periosteum away from the bone
36
What does a CT assess?
Ossification and calcification Integrity of cortex Assessing nidus in osteoid osteoma Staging
37
What can an MRI assess?
Size, extent, anatomical relationships | Limits of disease
38
What is MRI not specific for?
Benign vs malignant
39
What is MRI specific for?
Lipoma, haemangioma, haematoma or PVNS
40
What should be done prior to bone biopsy?
``` Bloods XR MRI of lesion Bone scan CT chest, abdo, pelvis ```
41
What are the cardinal features of malignant primary bone tumours?
``` Increasing pain Unexplained pain Deep-seated boring nature Night pain Difficulty weight-bearing Deep swelling ```
42
What are the clinical features of osteosarcoma?
``` Pain Loss of function Swelling Pathological fracture Joint effusion Deformity Neuromuscular effects Systemic effects of neoplasia ```
43
What is the cardinal feature of osteosarcoma?
Pain
44
What is the pain like in osteosarcoma?
Deep boring ache Worse at night Analgesics ineffective Not related to exercise
45
How does loss of function present in osteosarcoma?
``` Limp Reduced joint movement Stiff back (children) ```
46
How does swelling present in osteosarcoma?
Diffuse in malignancy Near end of long bone One noticeable size, enlargement may be rapid Warmth over swelling
47
What is the commonest reason for pathological fracture?
Osteoporosis
48
What are the investigations for suspected osteosarcoma?
MRI
49
What is MRI good for showing re: osteosarcoma?
``` Intraosseous extent of tuour Extraosseous soft tissue extent of tumour Joint involvement Skip metastases Epiphyseal extension Determines resection margins ```
50
What is the treatment for osteosarcoma?
Surgical excision of primary lesion Chemotherapy Radiotherapy
51
What are the most common primary cancers which metastasise to bone?
``` Lung Breast Prostate Kidney Thyroid GI tract Melanoma ```
52
How can pathological fractures in bone tumours be prevented?
Early chemo/DXT Prophylactic internal fixation +/- use of bone cement
53
What is the scoring system for fracture risk assessment in lone bone metastasis?
Mirel's Scoring System
54
What does Mirel's Scoring system look at when assessing fracture risk in lone bone metastasis?
Site, pain, lesion, size
55
What is commonest soft tissue tumour?
Lipoma
56
What are the features of soft tissue tumours?
``` Painless Mass deep to deep fascia Any mass >5cm Any fixed, hard or indurated mass Any recurrent mass ```
57
What investigation is best for suspected soft-tissue tumour?
MRI

MSK (17 decks)

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