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MSK 2 > Bone and Soft Tissue Tumours > Flashcards

Bone and Soft Tissue Tumours Flashcards

1
Q

What are the clinical signs in the presentation of bone and soft tissue tumours?

A

– Night pain

– Previous history of cancer

– Beware pts recurrent attendances at GP/ED

– Soft tissue mass

– Overlying skin changes

– Lymph nodes

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2
Q

What blood test results could give an indication that a patient may have leukeamia?

A

Low RBC count and low white cell count.

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3
Q

CRP and ESR are markers of what?

A

Inflammation - so in cancer often raised.

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4
Q

Cancer in bone can result in an increase in what ion in blood which can be fatal?

A

Ca2+

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5
Q

What is meant by sclerotic and lucent/lytic tumours?

A

Sclerotic tumours are bone forming and appear white on x-ray.

Luncent aka lytic tumours are bone dissolving and appeardark on x-ray.

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6
Q

Benign or malignant?

  • Osteoid Osteoma
  • Bone Cysts
  • Osteochondroma
  • Endchondroma
A

Benign

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7
Q

Name and summarise the bone tumour shown here.

A

Osteoid osteoma.

Benign.

Presents as night pain relieved by asprin.

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8
Q

Identify and summarise the bone tumour shown here:

A

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.

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9
Q

Identify and summarise the bone tumour shown here.

A

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.
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10
Q

Identify and summarise the bone tumour shown here.

A

Osteochondroma - benign.

Bone with a cartilage cap.

Common at the knee and common in children.

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11
Q

Enchondroma

A

Tumour located inside the bone that forms cartilage.

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12
Q

Identify and summarise the bone tumour shown here.

A

Enchondroma.

Tumour inside the bone that forms cartilage.

Commonly located in the hands and femur and humerus.

Mottled appearance in bone - increased fracture risk.

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13
Q

What can appear as bone cancer on x-ray but actually isn’t?

A
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14
Q

Different types of malignant bone tumours:

A
  • Metastasis
  • Multiple Myeloma
  • Primary

– Osteosarcoma

– Chondrosarcoma

– Fibrosarcoma

• Hematological

– Leukemia

– lymphoma

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15
Q

What is the most common form of malignant bone tumour?

A

Metastasis

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16
Q

Where can metastisis to bone originate from?

A
  • Breast (mixed)
  • Prostate (sclerotic)
  • Lung (lytic))
  • Renal (lytic, Vascular)
  • Thyroid (lytic)
  • Colon
17
Q

How does hypercalcemia present?

A
  • Confusion
  • Dehydration
  • Muscle weakness
  • Polyuria + Polydypsia
  • Nausea and vomitting
18
Q

Where are common sites of tumour metastisis in bone?

A

Spine, femur, humerus

19
Q

How can tumour metasistis to bone present?

A

Pain

Spinal cord compression

Cauda equina syndrome

Pathological fractures

20
Q

Cauda equina syndrome

A

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.
21
Q

Summary of multiple myeloma

A
  • 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.
22
Q

How do you test for multiple myeloma?

A

Test the urine for Bence jones proteins.

23
Q

How do patients present with multiple myeloma?

A

CRAB

HyperCalcemia

Renal Failure

Anaemia

Punched out Bony lesions

Pathological fractures.

24
Q

What condition is shown in this image?

A

Multiple Myeloma

25
Q

Histology of multiple myeloma:

A
26
Q

Primary bone tumours

A

Ewing’s

Fibrosarcoma

Osteosarcoma

27
Q

Which bone does osteosarcoma usually affect?

A

Around the knee - distal femur / proximal tibia.

28
Q

What is a risk factor for osteosarcoma and explains the bimodal distribution?

A

Osteosarcoma can be secondary to Paget’s disease.

29
Q

How does Osteosarcoma present?

A

• 20% metastasis at presentation

– Lung most common

– Other bony sites

• Signs and symptoms

– Pain

– Fever

– Swelling/ mass

– Raised Alkaline phosphatase

– High lactate dehydrogenase

30
Q

Osteosarcoma appearance and histology:

A
31
Q

Which type osteosarcoma is shown here?

A

Parosteal osteosarcoma

32
Q

Periosteal osteosarcoma

A

Sunburst appearance

33
Q

Where in the bone is a fibrosarcoma located?

A

Metaphysis

34
Q

Fibrosarcoma x-ray and histology

A
35
Q

Ewing’s affects which age group?

A

Children

36
Q

Ewing’s summary

A
  • Mean age 15
  • Systemic features • Soft tissue mass
  • Diaphyseal • Lytic + destructive + onion peel
  • 10% Mets to bone marrow
37
Q

Ewing’s x-ray and histology

A
38
Q

Adamanatinoma affects solely which bone?

A

Tibia

39
Q

Adamanatinoma x-ray and histology.

A

MSK 2 (20 decks)

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