Soft Tissue Tumours

Question 1

What 10 bits of info do you need to obtain from a soft tissue tumour?

Answer 1

Size and site
Definition- Well or ill defined
Consistency- Cyst, solid, soft, hard
Surface- Smooth or irregular
Mobile or fixed- To skin or deeper tissue
Temperature
Transilluminable- Fluid filled
Pulsatility
Overlying skin changes
Local lymphadenopathy

Question 2

What factors suggest a benign lesion?

Answer 2

Small, fluctuation in size, well defined, cystic/fluid filled, soft or fatty.

Question 3

What factors suggest a malignant lesion?

Answer 3

Large lesion (>5cm), rapid growth, solid, ill defined, irregular surface, lymphadenopathy and systemic involvement.

Question 4

What are the two best investigations for identifying soft tissue lesions?

Answer 4

MRI and biopsy

Question 5

What are the three important benign soft tissue tumours we need to know?

Answer 5

Lipoma
Giant Cell Tumour of Tendon Sheath
Pigmented villonodular synovitis (PVNS)

Question 6

What is a lipoma?

Answer 6

Proliferation of fat in subcutaneous fat or muscle.

Question 7

How does a lipoma look?

Answer 7

Large and ill defined. Most common benign soft tissue tumour.

Question 8

What is a Giant Cell Tumour of Tendon Sheath?

Answer 8

Small firm swelling under tendon sheath of fingers.

Question 9

How does a Giant Cell Tumour of Tendon Sheath look like?

Answer 9

Pigmented and have multinucleated giant cells.

Question 10

How does Giant Cell Tumour of Tendon Sheath present?

Answer 10

Can be painful and erode surrounding structures.

Question 11

How do you treat Giant Cell TUmour of Tendon SHeath?

Answer 11

Excise but high chance of recurrence.

Question 12

What is Pigmented Villonodular Synovitis (PVNS)

Answer 12

Same of Giant Cell Tumour of Tendon Sheath but in synovial joint.

Question 13

What is the suffix for malignant soft tissue tumours?

Answer 13

‘Sarcoma’

Question 14

Are sarcomas rare or common?

Answer 14

Pretty rare

Question 15

What is the common age for developing a sarcoma?

Answer 15

50-70

Question 16

How do you treat a sarcoma?

Answer 16

Excise and treat with radio and chemotherapy as appropriate.

Question 17

What is an angiosarcoma?

Answer 17

Malignant tumour of blood vessel

Question 18

What is a fibrosarcoma?

Answer 18

Malignant tumour of fibrous tissue

Question 19

What is a liposarcoma?

Answer 19

Malignant tumour of fat

Question 20

What is a rhabdomyosarcoma?

Answer 20

Malignant tumour of skeletal muscle

Question 21

What is a synovial sarcoma?

Answer 21

Malignant tumour of synovial lining

Question 22

What are the five types of malignant soft tissue tumours we need to know?

Answer 22

Liposarcoma
Fibrosarcoma
Angiosarcoma
Rhabdomyosarcoma
Synovial Sarcoma

Question 23

What are the four non-tumour swellings of soft tissue we need to know?

Answer 23

Ganglion cyst
Bursitis
Sebaceous cyst
Abscess

Question 24

What is a ganglion cyst?

Answer 24

A herniation of the capsule round a synovial joint or tendon sheath. Can be developmental or traumatic.

Question 25

How do ganglion cysts usually present?

Answer 25

Well defined, firm and transilluminated

Question 26

How do you treat a ganglion cyst?

Answer 26

Usually just leave but if problematic excise.

Question 27

Give two examples of ganglion cysts.

Answer 27

Baker's cyst and wrist ganglion

Question 28

What is a Baker's cyst?

Answer 28

Ganglion cyst found in the popliteal fossa. | Can be swollen and painful but usually asymptomatic.

Question 29

What are come causes of a Baker's cyst and some complications of its rupture?

Answer 29

OA, RA, meniscal tear | DVT and compartment syndrome

Question 30

What is bursitis?

Answer 30

Inflammation of the bursa (fluid filled sack round joint the prevent friction).

Question 31

What causes bursitis?

Answer 31

Repeated pressure, trauma, bacterial infection and gout.

Question 32

Where are common places to get a bursitis?

Answer 32

Pre-patella Olecranon Metatarsals (Bunion)

Question 33

How do you treat a bursitis?

Answer 33

Usually leave but can reoccur so may need to be excised.

Question 34

What is a sebaceous cyst?

Answer 34

Skin swelling that can masquerade as MSK

Question 35

What is an abscess?

Answer 35

Walled off area of infection. Avascular.

Question 36

What can cause an MSK abscess?

Answer 36

Infection, penetrating wound, bursitis, cellulitis

Question 37

How do you treat an abscess?

Answer 37

Incise and drain. Antibiotics.