Bone + Soft Tissue Tumours

Question 1

What is the most common benign bone tumour?

Answer 1

Osteochondroma

Question 2

What is an osteochondroma and who gets them?

Answer 2

Bony outgrowth on the external surface with a cartilaginous cap
Age 10-20

Question 3

What does an osteochondroma look like on xray?

Answer 3

Pedunculated bony outgrowth

Question 4

What is the management of an osteochondroma?

Answer 4

Only needs to be excised if growing or painful

Question 5

What is an enchondroma?

Answer 5

Intramedullary, metaphyseal, cartilaginous tumour

Caused by failure of normal endochondral ossification at growth plate

Question 6

What does an enchondroma look like on xray?

Answer 6

Lucent oval + intact cortex

Question 7

What is the management for an enchondroma?

Answer 7

If risk of impending fracture –> curettage + filled with bone graft

Question 8

What is another name for osteoclastomas?

Answer 8

Giant cell tumours

Question 9

What are osteoclastomas?

Answer 9

Giant cell tumour of epiphysis of long bones

–> pain, swelling and limitation of joint movement

Question 10

What do osteoclastomas look like on xray?

Answer 10

Eccentric lytic area giving a ‘soap bubble’ appearance

Question 11

What is the management of osteoclastomas/giant cell tumours?

Answer 11

Surgical resection

Question 12

What are osteoid osteomas and how do they present?

Answer 12

Small tumours at metaphysis of long bones
Males ages 10-20
Localised progressive pain, worse at night

Question 13

What do osteoid osteomas look like on xray?

Answer 13

Small lucent nidus surrounded by halo of reactive bone

Question 14

What is the management of osteoid osteomas?

Answer 14

Conservative with NSAIDs for bone pain or

Surgical resection

Question 15

What is a simple bone cyst?

Answer 15

Benign, fluid filled cyst

Metaphyseal in long bones, talus or calcaneus

Question 16

What is an aneurysmal bone cyst and how is it managed?

Answer 16

Cyst containing multiple chambers filled with blood or serum
Locally aggressive causing cortical expansion + destruction
Painful + risk of fracture
–> curettage + grafting/bone cement

Question 17

Which cancers commonly metastasise to bone?

Answer 17

Prostate 
Breast
Kidney
Thyroid
Lung 
(PbKTL)

Question 18

What is the general management of bony mets?

Answer 18

Palliative usually

Can prophylactically nail long bones at risk of fracture

Question 19

What type of bony lesions does prostate cancer cause?

Answer 19

Sclerotic

Question 20

What type of bony lesions does breast cancer cause?

Answer 20

Can be sclerotic or lytic

Question 21

What type of bony lesions does lung cancer cause?

Answer 21

Lytic

Question 22

What type of bony lesions does renal cancer cause?

Answer 22

Large, vascular, lytic ‘blow out’ lesions

Question 23

How do primary bone cancers present?

Answer 23

Often misdiagnosed as muscular pain (present late)
Bone pain, worse at night/unexplained persistent pain
May be ill-defined bony swelling

Question 24

What is the most common cause of malignant bone tumour?

Answer 24

Metastases from other cancers

Question 25

What is the most common primary bone cancer?

Answer 25

Osteosarcoma

Question 26

What age is osteosarcoma most commonly seen?

Answer 26

Age 10-14 or | > 65 due to Paget's disease

Question 27

What is the clinical presentation of osteosarcoma?

Answer 27

Localised constant pain + tender soft tissue mass | Most commonly at metaphysis of distal femur or proximal tibia

Question 28

What does osteosarcoma look like on xray?

Answer 28

Medullary and cortical bone destruction + significant periosteal reactions --> Codman's triangle or 'sunburst' pattern

Question 29

What is the management of osteosarcoma?

Answer 29

Biopsy to confirm | Aggressive surgical resection + chemotherapy

Question 30

What is a chondrosarcoma?

Answer 30

Cartilage producing tumour of axial skeleton (pelvis, shoulders, ribs) --> painful enlarging mass Less aggressive than osteosarcoma

Question 31

What age group most commonly get chondrosarcomas?

Answer 31

Age 40-60

Question 32

What do chondrosarcomas look like on xray?

Answer 32

Lytic lesions with calcification, cortical remodelling + endosteal scalloping

Question 33

What is Ewing's sarcoma?

Answer 33

Paediatric malignancy with poor prognosis | Arise from primitive poorly differentiated neuroectodermal cells in diaphysis of long bones

Question 34

What is the clinical presentation of Ewing's sarcoma?

Answer 34

Painful, enlarging, tender, warm mass | --> often mistaken for osteomyelitis

Question 35

What does Ewing's sarcoma look like on xray?

Answer 35

Lytic lesion + periosteal reaction --> onion skin

Question 36

How can lymphoma affect bone?

Answer 36

``` Primary bone tumour from marrow --> Non Hodgkins Or lymphoma (any type) can metastasise to bone ```

Question 37

Which other cancer might present with bone lesions?

Answer 37

Myeloma

Question 38

What is the most common soft tissue tumour?

Answer 38

Lipoma

Question 39

What is a lipoma?

Answer 39

Benign proliferation of subcutaneous fat --> soft fatty lump under skin Dos not need excised

Question 40

What is a ganglion cyst?

Answer 40

Lump near a joint capsule or tendon sheath Not a true cyst - no epithelial lining Well defined, firm, transilluminate

Question 41

Where are some common sites for ganglion cysts?

Answer 41

Due to arthritis/joint damage: - wrist - Baker's cyst in knee - Mucous cyst of DIP joint