Bone and Soft Tissue Tumours Flashcards
(30 cards)
What is a sarcoma?
Malignant tumour of connective or non-epithelial tissue
bone, cartilage, fat, vascular or haematopoietic tissues
Bone tumours can be…
Benign (normally)
Malignant (rare)
Secondary (common)
a bony tumour if Pt. >50 y/o likely to be metastatic
How do sarcomas spread?
Along fascial planes (rarely)
Haematogenous (to lungs)
Lymphatic (regional, rarer, found in rhabdomyosarcomas, epithelioid, synovial sarcomas)
Grades of sarcoma?
Low, medium, high
Often present as aggressive, high grade tumours
Investigations for Sarcoma?
MRI better than x-ray (better dermarcation, shows soft tissue and bone involvement leading to better management)
Types of bone-forming tumour
Benign: osteoid osteoma, osteoblastoma
Malignant: osteosarcoma
Types of cartilage-forming tumour
Benign: endochondroma, osteochondroma
Malignant: chondrosarcoma
How are chondrosarcomas treated?
Low grade can be curetted
Unresponsive to chemotherapy or radiotherapy
Types of fibrous tissue tumour
Benign: fibroma Malignant: fibrosarcoma, malignant fibrous histiocytoma (MFH)
Describe malignant fibrous histiocytoma (MFH) and who it normally presents in
Pleomorphic
High grade
Most common type of soft tissue sarcoma for extremities
Over 50s, more common in men
Types of vascular tissue tumour
Benign: haemangioma, aneurysmal bone cyst
Malignant: angiosarcoma (aggressive)
Types of adipose tissue tumour
Benign: lipoma
Malignant: liposarcoma
Types of marrow tissue tumour
Malignant: Ewing’s sarcoma, lymphoma, myeloma
Ewing’s sarcoma is common in…
Adolescents (14-18)
Myeloma presentation
Bone problems
Multiple lytic lesions
Negative isotope bone scans (plasma cells are affected, osteocytes not affected)
Describe Giant cell tumours
Usually benign (2% malignant)
Difficult to treat, unpredictable Uncommon
Characterized by the presence of multinucleated giant cells (osteoclast-like cells)
If malignant degeneration does occur, metastasises to the lungs.
Tumour like lesions include…
Simple bone cysts Fibrous cortical defects
Examination of tumours and lumps
General health Location Shape Consistency Mobility/tethered (to muscle/bone/fat), Pain Local temperature Neurovascular deficit
Using X-ray to investigate tumours, benign and malignant
Useful for bone lesions.
Benign tumours: clear margins, surrounded by reactive bone - maybe cortical invasion
Malignant: Poorly defined transition zone. Cortical destruction, new growth, ‘Onion skinning’: periosteum stretches up to give way to new bone
When to use CT scanning for tumours
Staging (esp. if lung co-involvement)
Assessing ossification and calcification
Assess cortical integrity
Checking for lucent nidus in osteoid osteoma (central zone: atypical bone enclosed in well vascularized stroma, outer sclerosis)
Isotope bone scans are used for…
Staging skeletal metastases
Ruling out myeloma (-ve Isotope scan)
Identifying multiple lesions of chondromas, early and malignant dysplasias
Increased uptake in benign tumours also
When is MRI used for sarcomas?
Study of choice
Size, extent, anatomical relationships (To plan resection), shows disease limit in/out of bone
Specific for lipomas, haematoma, haemangioma, pigmented villonodular synovitis (nodular mass)
Not specific for weighing up benign vs. malignant (need histology etc.)
What is pigmented villonodular synovitis?
Thickened, overgrown synovium
Leads to swelling, joint instability
When is angiography used in tumours?
(rarely used)
Check involvement of vascular tree
Check integrity of vessels (MRI superior)
Check for embolisation of vascular tumours
