Bone and Soft Tissue Tumours Flashcards
What are the clinical signs in the presentation of bone and soft tissue tumours?
– Night pain
– Previous history of cancer
– Beware pts recurrent attendances at GP/ED
– Soft tissue mass
– Overlying skin changes
– Lymph nodes
What blood test results could give an indication that a patient may have leukeamia?
Low RBC count and low white cell count.
CRP and ESR are markers of what?
Inflammation - so in cancer often raised.
Cancer in bone can result in an increase in what ion in blood which can be fatal?
Ca2+
What is meant by sclerotic and lucent/lytic tumours?
Sclerotic tumours are bone forming and appear white on x-ray.
Luncent aka lytic tumours are bone dissolving and appeardark on x-ray.
Benign or malignant?
- Osteoid Osteoma
- Bone Cysts
- Osteochondroma
- Endchondroma
Benign
Name and summarise the bone tumour shown here.
Osteoid osteoma.
Benign.
Presents as night pain relieved by asprin.
Identify and summarise the bone tumour shown here:
Osteoblastoma.
A larger version of an osteoid osteoma - benign.
Common in the femur and spine.
Treated with painkillers NSAID’s.
Normally self-resolves can be treated with radiofrequency ablation.
Identify and summarise the bone tumour shown here.
Bone cyst - benign.
2 Types:
- Simple - Bone expands and is filled with air or fat.
- Aneurysmal - filled with fluid (usually blood).
- Type identified with MRI.
- Only intervention needed in cases of fracture.
Identify and summarise the bone tumour shown here.
Osteochondroma - benign.
Bone with a cartilage cap.
Common at the knee and common in children.
Enchondroma
Tumour located inside the bone that forms cartilage.
Identify and summarise the bone tumour shown here.
Enchondroma.
Tumour inside the bone that forms cartilage.
Commonly located in the hands and femur and humerus.
Mottled appearance in bone - increased fracture risk.
What can appear as bone cancer on x-ray but actually isn’t?
Different types of malignant bone tumours:
- Metastasis
- Multiple Myeloma
- Primary
– Osteosarcoma
– Chondrosarcoma
– Fibrosarcoma
• Hematological
– Leukemia
– lymphoma
What is the most common form of malignant bone tumour?
Metastasis
Where can metastisis to bone originate from?
- Breast (mixed)
- Prostate (sclerotic)
- Lung (lytic))
- Renal (lytic, Vascular)
- Thyroid (lytic)
- Colon
How does hypercalcemia present?
- Confusion
- Dehydration
- Muscle weakness
- Polyuria + Polydypsia
- Nausea and vomitting
Where are common sites of tumour metastisis in bone?
Spine, femur, humerus
How can tumour metasistis to bone present?
Pain
Spinal cord compression
Cauda equina syndrome
Pathological fractures
Cauda equina syndrome
Cauda equina syndrome (CES) occurs when the nerve roots of the cauda equina are compressed and disrupt motor and sensory function to the lower extremities and bladder.
- can lead to paralysis and permanent incontinence.
Summary of multiple myeloma
- Neoplastic plasma cells - haematological malignancy.
- Plamsa cells produce immunoglobulins which have heavy chains and light chains. Kidney can filter out heavy chains but not light chains.
- Light chains = bence jones proteins.
How do you test for multiple myeloma?
Test the urine for Bence jones proteins.
How do patients present with multiple myeloma?
CRAB
HyperCalcemia
Renal Failure
Anaemia
Punched out Bony lesions
Pathological fractures.
What condition is shown in this image?
Multiple Myeloma
Histology of multiple myeloma:
Primary bone tumours
Ewing’s
Fibrosarcoma
Osteosarcoma
Which bone does osteosarcoma usually affect?
Around the knee - distal femur / proximal tibia.
What is a risk factor for osteosarcoma and explains the bimodal distribution?
Osteosarcoma can be secondary to Paget’s disease.
How does Osteosarcoma present?
• 20% metastasis at presentation
– Lung most common
– Other bony sites
• Signs and symptoms
– Pain
– Fever
– Swelling/ mass
– Raised Alkaline phosphatase
– High lactate dehydrogenase
Osteosarcoma appearance and histology:
Which type osteosarcoma is shown here?
Parosteal osteosarcoma
Periosteal osteosarcoma
Sunburst appearance
Where in the bone is a fibrosarcoma located?
Metaphysis
Fibrosarcoma x-ray and histology
Ewing’s affects which age group?
Children
Ewing’s summary
- Mean age 15
- Systemic features • Soft tissue mass
- Diaphyseal • Lytic + destructive + onion peel
- 10% Mets to bone marrow
Ewing’s x-ray and histology
Adamanatinoma affects solely which bone?
Tibia
Adamanatinoma x-ray and histology.
