Soft tissue tumours Flashcards
what is a soft tissue tumour?
any non-bony connective tissue (tendon, muscle, ligament), nerves or vessels
diffuse swelling examples
synovitis
oedema
local swelling examples
inflammatory swellings (bursitis, rheumatoid arthritis or nodules)
infection (abscess)
cystic lesions (ganglion, meniscal cyst, Baker’s cyst)
benign neoplasm
malignant neoplasms
how is a unknown lesion diagnosed?
imaging by MRI or ultrasound - biopsy?
what is a lipoma?
the commonest benign soft tissue tumour
neoplastic proliferation of fat - usually subcutaneous but can occur in muscle
subcutaneous - large and may not be particularly well defined
how does lipoma present?
slow growing painless/ non-tender no underlying skin changes consistent if no symptoms can be left alone
what is a giant cell tumour of tendon sheath?
benign tumour
a small firm swelling usually found on the flexor tendon sheath of finger
if large enough can erode bone
macroscopically = pigmented lesion
histologically = multinucleated giant cells and haemosiderin
how does giant cell tumour of tendon sheath present?
usually on the flexor tendon sheath of the finger but can be on the wrist
they can be excised but there is a high chance of reoccurrence
when in a joint these lesions are - pigmented villonodular synovitis (PVNS)
- similar lesions
- localized/diffuse form
- can cause pain and effusions
malignant soft tissue tumours arising from connective tissues
sarcomas
most commonly in 50-70s
can occur at any age
cancer is graded and staged
types of soft tissue sarcomas
angiosarcoma - blood vessel
fibrosarcoma and malignant fibrous histocytoma - fibrous tissue
liposarcoma - fat
rhabdomyosarcoma - skeletal muscle
synovial sarcoma - synovial lining of joints or tendons
how are malignant soft tissue tumours treated?
surgery (radical/ wide local excision)
limb salvage surgery/ amputation
adjunctive chemotherapy &/or radiotherapy
what is a ganglion cyst?
around a synovial joint/tendon sheath
herniation/or out-pouching of a weak portion of joint capsule or tendon sheath
if developmental - juvenile Baker’s cyst
how does a ganglion cyst present and how is it managed?
commonly in wrist well defined quite firm readily trans illuminate excision if discomfort or cosmesis
what is bursitis?
inflamed bursa as a result of repeated pressure/ trauma e.g. bunions
bursa are small fluid filled sac lined by synovium around a joint which prevents friction between tendons bones muscle and skin
inflammatory bursitis -
how is bursitis managed?
can be caused by bacterial infection - bursal abscess or gout as well
recurrence of the bursitis may occur - excision may be required
potential issues with scarring
what is a sebaceeous cyst?
implantation dermoids
excision and/ or biopsy
examples of types of abscess?
cellulitis bursitis penetrating wound sebaceous cysts (don't resolve with antibiotics alone, incision and drainage)
blood tests for infection
CRP PV sometimes useful: blood cultures white cell count ESR
imaging for infection
x-ray
technetium scan
MRI
clinically relevant infections
acute osteomyelitis chronic osteomyelitis septic arthritis soft tissue infections the infected arthroplasty
how to deal with abscess
if there’s pus let it out
what antibiotics are the best guess to cover staph and strep?
flucloxacillin and benzylpenicillin
treatment for infection
know what bug you’re dealing with
operate if there is dead tissue or foreign body
target antibiotics for as long as it takes
biopsy and debridement often go together
IF THERE’S PUS LET IT OUT
