Soft Tissue Tumours

Question 1

A soft tissue swelling may present to orthopaedics if situated on any _______ or _______

Answer 1

A soft tissue swelling may present to orthopaedics if situated on any arm or leg

Question 2

Soft tissue swellings may be diffuse like in _______ and ______ or may be __________

Answer 2

Soft tissue swellings may be diffuse like in oedema and synovitis or may be local

Question 3

Local swelling may include 5 category of swelling - name them

Answer 3

Inflammatory swellings (e.g. bursitis & rheumatoid nodules)
Infections (abscesses)
cystic lesions (e.g. baker’s cyst, ganglion & meniscal cysts)
benign neoplasms
Malignant neoplasms

Question 4

What should you ask in a history about a lump?

Answer 4

How long has it been present?
painful?
Fluctuating in size/growing?
Solitary or multiple?

Question 5

What do you look for on examination of a lump? (11)

Answer 5

Site/size/definition (well or ill defined)/consistency/surface (smooth or irregular)/mobility/temperature (abscess?)/transilluminable (fluid filled)/pulsatility/overlying skin change/local lymphadenopathy

Question 6

Do the following features suggest a benign/malignant lump?

“Small, fluctuating size, cystic, well defined, fluid filled, soft lesion”

Answer 6

Benign - the fluctuating size is almost enough alone to categorically state this is benign as malignancy does not regress.

Question 7

What size suggests a malignant lump?

Answer 7

> 5cm

Question 8

Rapid growth and solid lesions which are ill defined, have an irregular surface with an associated lymphadenopathy and systemic upset is suggestive of a malignancy - true/false

Answer 8

true

Question 9

Any lesion with clinical suspicion should be ______ (_______ for cystic lesion confirmation) or ________.

Answer 9

Any lesion with clinical suspicion should be given an MRI (ultrasound for cystic lesion confirmation) or biopsy (for histology).

Question 10

The most common benign soft tissue tumour is a(n) _____________

Answer 10

a lipoma

Question 11

A lipoma is a __________ which usually occurs in the ________ but can occur in __________

Answer 11

A lipoma is a proliferation of fat which usually occurs in the s/c fat but can occur in muscle

Question 12

Subcutaneous lipoma is always well defined and small - true/false

Answer 12

false - they can be large and ill-defined

Question 13

S/c lipoma is not always well defined or small - how are they diagnosed normally?

Answer 13

They are normally diagnosed based on their location and consistency

Question 14

name this tumour:

“a small, firm swelling usually found on the flexor tendon sheath of a finger.”

Answer 14

Giant cell tumour of the tendon sheath

Question 15

GCTs of the tendon sheath are never painful - true/false

Answer 15

False - they can be painful

Question 16

GCTs of the tendon sheath can cause local destruction of bone - true/false

Answer 16

True - they can but only if they’re large enough.

Question 17

Malignant tumours of soft tissue arising from the connective tissues are known as _____________

Answer 17

Malignant tumours of soft tissue arising from the connective tissues are known as sarcoma

Question 18

Sarcomas are relatively common/rare and account for __% of all malignant tumours.

Answer 18

Sarcomas are relatively rare and account for 1% of all malignant tumours.

Question 19

Sarcomas are named from the tissue they arise from. Name the following tumours: 
Arising from the blood vessels 
Arise from fibrous tissues (2) 
Arise from fat
Malignant tumour of skeletal muscles
Arises from synovial lining

Answer 19

Sarcomas are named from the tissue they arise from. Name the following tumours:
Arising from the blood vessels - angiosarcoma
Arise from fibrous tissues - fibrosarcoma and malignant fibrous histiocytoma
Arise from fat - liposarcoma
Malignant tumour of skeletal muscle - rhabdomyosarcoma

Question 20

What age do sarcomas present? can they present at any age?

Answer 20

Normally 50-70year old.

Yes they can

Question 21

if there is any doubt over the nature of the swelling you should _______ __ _ _________ and _______/_______

Answer 21

if there is any doubt over the nature of the swelling you should refer to a specialist and image/biopsy

Question 22

What is the treatment for a sarcoma?

Answer 22

Surgery with chemotherapy and/or radiotherapy

Question 23

How is the surgery for sarcoma preferably done? If this doesn’t work, what is the next step?

Answer 23

Radical or wide local excision to salvage the limb. if this fails or a functional limb cannot be retained, move to a more radical solution; amputation

Question 24

Where does a ganglion cyst occur?

Answer 24

Around a synovial joint or a synovial tendon sheath

Question 25

Why do ganglia form?

Answer 25

herniation or out pouching of a weak portion of joint capsule or tendon sheath.

Question 26

The weakness for a ganglion can be developmental - true or false? Give an (other?) example of a developmental weakness

Answer 26

True. Juvenile baker's cyst

Question 27

The weakness for a ganglion can be secondary to underlying joint damage e.g. arthritis with a build up of pressure in the joint - true/false.

Answer 27

True

Question 28

Name three swellings that can be caused by a build of pressure within the joint

Answer 28

Adult Baker's cyst mucous cyst of the DIP joint Wrist ganglion

Question 29

Do we normally treat ganglions?

Answer 29

No, we can treat them if they cause pain or if they are cosmetically displeasing but they are very likely to return.