Musculo-skeletal soft tissue tumours

Question 1

what do soft tissue tumours often present as

Answer 1

a lump or swelling

Question 2

what may soft tumours be associated with

Answer 2

pain or discomfort

Question 3

are superficial lesions more or less likely to be malignant

Answer 3

less likely

Question 4

what is a ganglion cyst

Answer 4

a lump found near a joint capsule or tendon sheath

Question 5

what part of the body do ganglion cysts often arise

Answer 5

the wrist

Question 6

what changes are seen in a ganglion cyst

Answer 6

degenerative change within the connective tissue and secondary inflammatory changes

Question 7

what is seen histologically in ganglion cysts

Answer 7

a space with myxoid material

Question 8

is a ganglion a true cyst, and why/why not

Answer 8

no not a true cyst because it has no epithelial lining

Question 9

describe the pathology seen with nodular fasciitis

Answer 9

cellular proliferation of fibroblastic and myofibroblastic cells

Question 10

what are some properties of nodular fasciitis

Answer 10

self limiting disorder and a rapidly growing tumour

Question 11

what group of people is nodular factiitis usually seen in

Answer 11

young adults, history of trauma in 25% cases

Question 12

what histological changes are seen in nodular fasciitis

Answer 12

stellate + spindle tissue culture appearance, haemorrhage, mitosis and increased plump cells

Question 13

what other tumour is similar to nodular fasciitis

Answer 13

myositis ossificans

Question 14

what is there usually a history of in myositis ossificans

Answer 14

trauma

Question 15

what is myositis ossificans associated with

Answer 15

insertions of large muscles of arms and legs

Question 16

what pathology is seen with myositis ossificans

Answer 16

cellular proliferation but with evidence of bone formation and zonation
(recognition of organisation is critical)

Question 17

what group of people is superficial fibromatoses most commonly seen in

Answer 17

men > women, average age 60

common

Question 18

what condition is superficial fibromatoses associated with

Answer 18

Dupuytren’s

Question 19

describe the cause of superficial fibromatoses

Answer 19

idiopathic

associated with alcohol, diabetes and anticonvulsants

Question 20

describe the pathology seen in Dupuytren’s

Answer 20

firm grey-white tissue, nodules + fascicles, bland fibroblasts, dense collagen

Question 21

describe deep fibromatoses

Answer 21

desmoid tumour, large infiltrative masses that do not metastasise

Question 22

what group of people is deep fibromatoses often seen in

Answer 22

often young adults, teen to 30s

Question 23

what sites does deep fibromatoses involve

Answer 23

musculo-aponeurotic tissue of abdominal wall, mesenteric tissue, limb girdles

Question 24

what are the 2 different types of tenosynovitis

Answer 24

giant cell tumour of tendon sheath and pigmented villonodular synovitis
(similar histology)

Question 25

what parts of the body does giant cell tumour of the tendon sheath involve

Answer 25

the digits and wrist

Question 26

what joints does pigmented villonodular synovitis affect

Answer 26

large joints

Question 27

what pathology is seen with giant cell tumour of tendon sheath

Answer 27

reactive proliferation

Question 28

describe the recurrence of the different types of tenosynovitis

Answer 28

giant cell tumour of tendon sheath = excise, rarely recurs

pigmented villonodular synovitis = more likely to recurt

Question 29

what is the nomenclature of benign and malignant soft tissue tumours

Answer 29

benign = oma
malignant = sarcoma

Question 30

what are the grading features of sarcomas

Answer 30

degree of differentiation, degree of proliferation(mitotic count), presence of coagulative necrosis