soft tissue and tumour Flashcards
definition of a lesion, dysplasia, metaplasia, tumour and neoplasia
lesion=any abnormality of a tissue
dysplasia: abnormal ratio of undiff to diff
metaplasia: abnormal change of one diff cell type to another
neoplasia: new abnormal formation of tissue the growth of which exceeds and is uncoordinated to that of the normal tissues and persists even when stimulus is removed
benign versus malignant tumours
benign
- well diff
- slow growth
- capsule yes
- localised and contained
malig
- poor diff
- fast
- no capsule, invades
- spreading
difference between a sarcoma and a lipoma
sarcoma= tissue which includes bone
lipoma=fat tissue
sarcoma
-fixed and non mobile
>5 cm
definition of lytic, blastic, explansile, invasive, well-circumsided, diffuse and multi-loculated
in describing bone tumours
lytic: removes bone
blastic: deposits bone
expansile: expands the normal bony contours
invasive:
well circumscribed: defined boundary
diffuse: no obvious boundary
multi-loculated many lobes
what colour is lytic and what colour is blastic
lytic=darker black
blastic=white
% of bone tumours that are metastatic
90%
carcinomas that commonly spread to bone
- prostate
- breast
- kidney
- thyroid
- lung
- lead kettle
bone tumour presentation
-pain
-soft tissue lumps and bumps
-hypercalcaemia
-signs of cancer
can be an incidental finding
what is a red herring event
something that is attributed to another event but then it doesn’t get better
what LFT marker should be checked in particular
ALK phos
treatment of bone tumours
- bisphosphonate for hypercalcaemia
- radiotherapy for pain
- chemotherapy
- operative
when might operative management be requird
- for primary bone tumour
- for metastasis if
- uncontrolled pain
- pathological #
- palliation (fungating tumour due to artery)
3 options for operative management for metastatic
-excision
-stabilise
-replace
implant must last longer than the patient
4 options for primary bone cancer surgery
- intralesional curettage=scoop it out or marginal excision in benign
- wide local excision (include surrounding healthy tissue)
- radical excision- includes the muscles of that compartment also
- amputation
what is the most common primary sarcoma of the bone
osteosarcoma
who does osteosarcoma occur in
children and young adults
-rarely in elderly adults with pagets
clinical features of osteosarcoma
- progressive pain
- fever
- swelling
- mass
- around knee often
sarcoma definition
a malignant tumour of connective or other non-epithelial tissue
imaging of an osteosarcoma
- blastic and lytic
- codman’s triange:a periosteal reaction as lesion raises the periosteum away and get new subperiosteal bone underneath
diagnosis of osteosarcoma
- x-ray
- mri show hot
- ct for pulmonary metastases
primary causes of osteosarcoma
seen in 10-20 year olds with LiFraumeni syndrome, retinoblastoma and familial
secondary cases of osteosarcoma
seen in areas of pagetic bone or fibrous dysplasia or sites of previous radioactivity
treatment osteosarcoma
- chemo for 8-12 weeks
- surgical resection with limb salvage where possible
- maintenance chemotherapy 6-12 months
survival osteosarcoma
76%
poor prognostic factors of osteosarcoma
- tumour size and site
- advanced stage of disease
red flags for lumps
size >5cm
change or rapid growth
pain
previous sarcoma
hypercalcaemia symptoms
stones bones groans moans thrones-polyuria
treatment for hypercalcaemia
hydration
bisphosphonates
what is multiple myeloma
tumour of myeloma or bone marrow that produces plasma cells
what is the most common primary bone malignancy in >40 years
multiple myeloma
survival with multiple myeloma
5 years 30% and 10 years 11%
what is multiple myeloma pathophysiology
neoplastic proliferation of plasma cells (b cells) that produce immunoglobulin
-they go rogue
test for multiple myeloma 3
-get bence jones protein=proteinuria
-pepper pot skulls: x-ray
lytic lesions
-low wcc and esr and calcium raised
treatment multiple myeloma
- chemotherapy
- steroids
- bisphosphonates
