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MSK > Bone and soft tissue tumours > Flashcards

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?

A

Myeloma

25
Q

How do bone tumours present?

A

*Pain
Mass
Abnormal x-rays, often picked up incidentally

26
Q

What is the pain in bone tumours associated with?

A

Activity related

Progressive pain at rest & night

27
Q

When might benign tumours present with activity related pain?

A

If large enough to weaken bone

e.g. osteoid osteoma

28
Q

What should be examined in someone with suspected bone tumour?

A 
Measurements of mass
Location
Shape
Consistency
Mobility
Tenderness
Local temp
Neurovascular deficits
29
Q

What are the investigations for suspected bone tumour?

A 
Plain XR
CT
Isotope bone scan
*MRI
Angiography
PET
Biopsy
30
Q

What can be seen on x-ray for suspected bone tumours?

A

Calcification - synovial sarcoma
Myositis ossificans
Phleboliths in haemangioma

31
Q

What is seen in inactive bone on x-ray?

A

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

32
Q

What is myositis ossificans?

A

Where bone tissue forms inside muscle or other soft tissue after an injury

33
Q

What is phleboliths with haemangioma?

A

Phleboliths are calcified thrombi found within vascular channels, often in the presence of hemangioma or vascular malformation

34
Q

What can be seen in x-rays of aggressive tumours?

A

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
Q

What is Codman’s triangle?

A

The triangular area of new subperiosteal bone that is created when a lesion, often a tumour, raises the periosteum away from the bone

36
Q

What does a CT assess?

A

Ossification and calcification
Integrity of cortex
Assessing nidus in osteoid osteoma
Staging

37
Q

What can an MRI assess?

A

Size, extent, anatomical relationships

Limits of disease

38
Q

What is MRI not specific for?

A

Benign vs malignant

39
Q

What is MRI specific for?

A

Lipoma, haemangioma, haematoma or PVNS

40
Q

What should be done prior to bone biopsy?

A 
Bloods
XR
MRI of lesion
Bone scan
CT chest, abdo, pelvis
41
Q

What are the cardinal features of malignant primary bone tumours?

A 
Increasing pain
Unexplained pain
Deep-seated boring nature
Night pain
Difficulty weight-bearing
Deep swelling
42
Q

What are the clinical features of osteosarcoma?

A 
Pain
Loss of function
Swelling
Pathological fracture
Joint effusion
Deformity
Neuromuscular effects
Systemic effects of neoplasia
43
Q

What is the cardinal feature of osteosarcoma?

A

Pain

44
Q

What is the pain like in osteosarcoma?

A

Deep boring ache
Worse at night
Analgesics ineffective
Not related to exercise

45
Q

How does loss of function present in osteosarcoma?

A 
Limp
Reduced joint movement
Stiff back (children)
46
Q

How does swelling present in osteosarcoma?

A

Diffuse in malignancy
Near end of long bone
One noticeable size, enlargement may be rapid
Warmth over swelling

47
Q

What is the commonest reason for pathological fracture?

A

Osteoporosis

48
Q

What are the investigations for suspected osteosarcoma?

A

MRI

49
Q

What is MRI good for showing re: osteosarcoma?

A 
Intraosseous extent of tuour
Extraosseous soft tissue extent of tumour
Joint involvement
Skip metastases
Epiphyseal extension
Determines resection margins
50
Q

What is the treatment for osteosarcoma?

A

Surgical excision of primary lesion
Chemotherapy
Radiotherapy

51
Q

What are the most common primary cancers which metastasise to bone?

A 
Lung
Breast
Prostate
Kidney
Thyroid
GI tract
Melanoma
52
Q

How can pathological fractures in bone tumours be prevented?

A

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

53
Q

What is the scoring system for fracture risk assessment in lone bone metastasis?

A

Mirel’s Scoring System

54
Q

What does Mirel’s Scoring system look at when assessing fracture risk in lone bone metastasis?

A

Site, pain, lesion, size

55
Q

What is commonest soft tissue tumour?

A

Lipoma

56
Q

What are the features of soft tissue tumours?

A 
Painless
Mass deep to deep fascia
Any mass >5cm
Any fixed, hard or indurated mass
Any recurrent mass
57
Q

What investigation is best for suspected soft-tissue tumour?

A

MRI

MSK (17 decks)

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