Soft Tissue Tumours

Question 1

Name 4 risk factors Hodgkin’s lymphoma

Answer 1

• HIV
• EBV
• autoimmune eg rheumatoid arthritis, sarcoidosis
A family history
• bimodadal age distribution: peak at 20 and 75

Question 2

Symptoms Hodgkin’s lymphoma?

Answer 2

• Pain in lymph nodes when they drink alcohol
• systemic: fever, weight loss, night sweats
Fatigue
• itching
• cough
• shortness ff breath
• abdominal pain
•Recurrent infections

Lymphadenopathy! Non-tender, rubbery

Question 3

Investigations for Hodgkin’s lymphoma?

Answer 3

• Lactate dehydrogenase LDH raised
• lymph node biopsy!
- reed-sternbeg cell: abnormally large B cells with multiple nuclei that have nucleoli inside them. Owl appearance
• ct, MRI, pet

Question 4

Ann Arbor staging for lymphoma?

Answer 4

• Stage 1: confined to 1 region of lymph nodes aka cervical, inguinal or axilla
• stage 2: more than one region but on the same side of the diaphragm above or below
• stage 3: above and below
• stage 4: widespread including non-lymphatic organs eg lungs, liver.

Question 5

Management Hodgkin’s lymphoma?

Answer 5

• chemotherapy (ae=leukaemia, infertility)
• radiotherapy (as=cancer, damage to tissues, hypothyroid)

Question 6

Name 3 types non-hodgkin lymphoma

Answer 6

• Burkitt: associated with EBV, malaria, HIV
• malt (mucosa associated lymphoid tissue) lymphoma : stomach, H pylori
• diffuse large B cell lymphoma: rapidly growing painless mass > 65 age

Question 7

What is a sarcoma?

Answer 7

Malignant soft tissue tumour

Question 8

Most common sites sarcoma

Answer 8

• Extremity: thigh
• visceral
• retroperitoneal

Question 9

Name features that should arouse suspicion in a soft tissue tumour of malignancy

Answer 9

• Size >5 cm
• deep location: subfascial, intramuscular intra-abdominal
O immobile or fixation
• changes to existing lesion: size increase; pain, worsening compressive symptoms

Question 10

Preferred imaging for sarcomas?

Answer 10

MRI

Question 11

Sarcoma staging?

Answer 11

Tnmg

Tumour
T1 <5 cm in greatest dimension
T 2 5-10
T3 10-15
T4 > 15

Nodes
Ni

Metastasis
N1

Histologic grade
G 1 well differentiated
G 2 moderately differentiated
G 3 poorly differentiation

Question 12

What is malignant fat tissue tumour called?

Answer 12

Liposarcoma

Question 13

What is malignant skeletal muscle tissue tumour called?

Answer 13

Rhabdomyosarcoma

Question 14

What is malignant smooth muscle tissue tumour called?

Answer 14

Leiomyosarcoma

Question 15

Management sarcoma?

Answer 15

• Surgery! Complete excision with 1-2 em margin. Function and limb sparing
• adjuvant radiotherapy! Especially adjacent to vital structures, not clean excision

Chemo not affective!