Musculoskeletal Swellings Flashcards
Are musculoskeletal swellings mostly symptomatic or asymptomatic
Asymptomatic
Main sites of bone tumors
Long bones of lower limb 60%
Pelvis, coccyx, sacrum 18%
Upper limbs 13%
Are there obvious cause to musculoskeletal swelling
No
Predisposing factors
Ionizing radiation Pagets dx Fibrous dysplasia Retinoblastoma Positive family hx
Classification
Benign
Intermediate
Malignant
Common benign tumor
Osteochondroma
Osteid osteoma
Chondroma
Malignant tumors
Multiple myeloma
Chondrosarcoma
Giant cell tumor
Ewing’s sarcoma
Enneking classification
I low grade II high grade III metastases A Intracompartmental B extracompartmental
history
Soft tissue mass
Produce pain or disability
Night pain and sweats not relieved by analgesics ? => malignancy
Age => 5y likely infection/ eosinophilic granuloma. Late teen likely giant cell tumor/ osteoblastoma
Race => black likely Ewing sarcoma
Examination
Look for Mass or pain
Look for asymmetry , deformity , swelling
Palpate for mass and it’s composition
Malignant tumor => firm, non tender, inflammation signs
Investigations
Plain x rays => large zone of transition ? Periostal rxn ?
Scan
Biopsy
Main tumors of the ribs
Mets
Enchondroma
Chondrosarcoma
Ewing
Main tumors of the spine
Mets Myeloma Osteoblastoma Chordoma Hemangioma ABC Osteoid ostema
Main tumors of the pelvis
Osteosarcoma Chondrosarcoma SBC Lymphoma Ewing EG Chordoma
Main tumors of hands
Endhondroma
Main tumors of proximal femur
SBC FD Enchondroma Ewing EG
Tumors of around the knee
AII , osteosarcoma
Ewing
Epiphysis tumors types
Chondroblastoma
Metaphysis tumors type
Osteosarcoma
MFH
Enchondroma
Diaphysis tumors types
Adamantinoma
Osteoid osteoma
Chondromyxoid fibroma
If you see sunray appearance / codmans triangle, most likely diagnosis ?
Osteosarcoma
Malignant lesion
If you see onion peel appearance , most likely diagnosis ?
Ewing sarcoma
Malignant lesion
Chronic osteomyelitis
If you see soap bubble appearance, most likely diagnosis ?
Osteoclastoma
Adamantinoma
If you see ground glass appearance, most likely diagnosis ?
Fibrous dysplasia
If you see patchy calcification , most likely diagnosis ?
Chondrogenic tumors
If you homogenous calcification, most likely diagnosis ?
Osteogenic tumors like osteosarcoma
Lab for diagnosis
FBC (leukemia ?)
C reactive protein (inflammation ?)
ESR (ewing sarcoma ? Leukemia? Eosinophilic granuloma ? Infection ?)
Alkaline phosphatase (osteosarcoma? Ewing sarcoma? Lymphoma ? Metastatic bone tumor ?)
How to exclude the diagnosis of prostate cancer
PSA
How to exclude the diagnosis of MYELOMA
Serum electrophoresis
Urinary bence jones proteins
Types of biopsies possible
Needle (most common )
Incisional
Excisional
Commonest benign bone tumor
Osteochondroma
Population at risk Osteochondroma
10-20y
Main sites Osteochondroma
Distal femur Prox tibia Prox humerus Pelvis Scapula
Clnical features Osteochondroma
Asymptomatic unless fracture of stalk or pressure on surrounding tissue causing pain
X-ray Osteochondroma
Eccentric protrusion
Osteochondroma histo
Pedunculated
Cauliflower or sessile
Treatment Osteochondroma
None
Excision if pain
Chances of malignant pain in Osteochondroma
1-5%
