Bone + soft tissue TUMOURS - TABLE

Question 1

What are sarcomas?

Divided in 2 broad categories

Answer 1

A group of RARE solid tumours of connective tissue

Sarcoma of soft tissues (including fat, muscle, nerve and nerve sheath, blood vessels, and other connective tissue) and sarcoma of bone

Question 2

Most important clinical features of soft tissue tumours

Answer 2

painless
mass deep to deep fascia
any mass >5cm
any fixed, hard or indurated mass
any recurrent mass

Question 3

Most important clinical features of bone tumours

Answer 3

Pain - persistent, increasing, non-mechanical / rest, nocturnal

Deep seated mass

Question 4

Differentiate clinical features of benign v malignant soft tissue tumours

Answer 4

.

Question 5

Differentiate clinical features of benign (COMMON) v malignant (primary - RARE, secondary (mets) - COMMON) bone tumours

Answer 5

Malignant

• Increasing pain
• unexplained pain
• Deep-seated boring nature
• Night pain
• Difficulty weight-bearing
• Deep swelling – LATE FEATURE

Question 6

Suspicious signs of soft tissue tumours being malignant

Answer 6

Deep tumours of any size
Subcutaneous tumours >5cm
Rapid growth
hard, fixed, craggy surface
non-tenderto palpation

Question 7

Benign and malignant bone tumours - which is more common

Answer 7

Benign more common than primary malignant

Primary malignant tumours rare but SECONDARY MALIGNANT (mets) COMMON

Question 8

Examination of tumour mass

Answer 8

measurements of tumour mass
location
shape
consistency
Mobility – tethered to bone, deep compartment, fascia?
tenderness
local temperature – may be increased in large tumours
neuro-vascular deficits

Question 9

Investigations of tumour masses

Answer 9

Plain XR - best for bone tumours
CXR
CT
MRI
Isotope bone scan - for bone tumours; usually for staging of METS

then biopsy

Question 10

X-rays of inactive tumour masses show

Answer 10

Clear margins

Surrounding rim of reactive bone

Question 11

X-rays of aggressive tumour masses show

Answer 11

Less well defined zone of transition between lesion and normal bone (permeative growth)

Cortical destruction = malignancy

Question 12

What findings can CT show for tumour masses

Answer 12

Assessing ossification and calcification
Integrity of cortex
best for assessing nidus in osteoid osteoma
Staging - primarily of lungs

Question 13

Cancers that metastasise to bone

Answer 13

• lung
• breast
• prostate
• kidney

Question 14

What’s more common - solitary lipomas or sarcomas

Answer 14

Solitary lipomas (benign)