Week 1 - G - Benign/Malignant Soft Tissue Tumours - Lipoma/Giant cell/Ganglion & Sebaceous cyst/Bursitis/Abscesses & Sarcomas Flashcards
A soft tissue swelling may present to orthopaedics if situated on an arm or leg. Soft tissue swellings may be diffuse (as in synovitis or oedema) or local. What do local swellings include?
Local swellings include
* Inflammatory swellings - bursitis, rheumatoid nodules
* INfection - abscesses
* Cystic lesions - ganglion cyst, meniscal cyst, Baker’s cyst
* Lipoma
* and Malignant neoplasms
What questions do you usually ask for a localised swelling?
How long the lump has been present
Whether the lump is painful
If it is growing or fluctuating in size
Whether it is solitary or multiple
Findings to look for on examination of a soft tissue tumour: * Site * Size * Definition – well defined or ill defined * Consistency – cystic, solid, soft, hard * Surface – smooth or irregular * Mobility or Fixity – to skin or deep tissues * Temperature – abscess * Transilluminable – fluid filled * Pulsatility * Overlying skin changes * Local lymphadenopathy
Which findings suggest a benign soft tissue neoplasm?
Features suggestive of a benign soft tissue neoplasm include
- * Smaller size
- * Fluctuation in size (malignant tumours do not regress in size)
- * Cystic lesions
- * Well defined lesions
- * Mobile lesions
- * FLuid filled lesions
- * Soft and fatty lesions
Findings to look for on examination of a soft tissue tumour: * Site * Size * Definition – well defined or ill defined * Consistency – cystic, solid, soft, hard * Surface – smooth or irregular * Mobility or Fixity – to skin or deep tissues * Temperature – abscess * Transilluminable – fluid filled * Pulsatility * Overlying skin changes * Local lymphadenopathy
Which findings suggest a malignant soft tissue neoplasm?
Features suggestive of a malignant soft tissue neoplasm include
- * Larger lesions (>5cm), rapid growth in lesion
- * Ill-defined lesions
- * Solid lesion
- * Irregular surface
- * Associated lymphadeopathy and systemic upset
What investigations may be necessary for any lesions where the nature of the swelling is unknown?
Any lesions where the nature of the swelling is unknown may need imaging by
* MRI (or ultrasound to confirm a cystic lesion)
* or biopsy for histological diagnosis
Benign soft tissue tumours can involve any of the non‐bony connective tissues, nerves or vessels. What is the commonest benign soft tissue tumour? Where does it occur?
The commonest benign soft tissue tumour is a lipoma - a neoplastic proliferation of fat
Lipomas usually occur in the subcutaneous fat but can occur in muscle
How would you describe a lipoma on examination?
Lipoma’s have smooth, imprecise margins and are not fixed to skin or deeper structures
What is the giant cell tumour of tendon sheath? Why can it also be known as giant cell synovium?
Giant cell tumour of the tendon sheath is a rare benign tumour which can develop on the tendon sheaths around the body
A tendon sheath is a layer of membrane around a tendon known as synovium hence the name giant cell synovium
What does the giant cell tumour of the tendon sheath feel like and which tendon sheath is normally affected?
Giant cell tumour of tendon sheath feels like a small firm swelling usually found on the flexor tendon sheath of the finger (wiki states - most commonly attached to the tendons of the fingers, hands, and wrists, with a predilection for the flexor surfaces)
How does the giant tumour of tendon sheath appear both macroscopically and histologically?
Macroscopically, the giant cell tumour of tendon sheath is a pigmented lesions
Histologically, they contain multinucleated giant cells and haemosiderin
What is the treatment of giant cell tumour of tendon sheath?
They can be excised but they have a fairly high chance of recurrence
What is it known as when giant cell tumours of the tendon sheath occur within a joint? Which joints is commonly affected?
When giant cell tumour of the tendon sheath occurs in a joint, it is known as Pigmented villonodular synovitis (PVNS) , also known as intra-articular giant-cell tumor of the tendon sheath
Most commonly affects the knee joint
What is a ganglion cyst and where do they occur around?
A ganglion cyst is a small sac of fluid that occurs around a synovial joint or a synovial tendon sheath - most commonly the wrist
What may cause the development of a ganglion cyst?
They may form as a result of herniation or out-pouching of a weak portion of joint capsule or tendon
Weakness can be developmental or as a result of underlying joints damage/arthritis
How would you describe a ganglion cyst on examination? What test can be done to make sure it is a ganglion cyst?
Ganglion cysts are well defined, may be quite firm and when transilluminate when a transillumination test is carried out (shining a light on it)
What is the treatment of a ganglion cyst?
Treatment is usually not necessary however excision may be required for local discomfort or cosmesis
What is bursitis? Define a bursa
Bursitis is inflammation of the bursa - a small fluid filled sac lined by synovium around a joint which prevents friction between tendons, bones, muscles and skin
There are numerous bursae around different joints and bony prominences. Name commonly inflamed bursae which usually occur after repeated pressure or trauma and which may present as a soft tissue swelling?
Pre-patellar bursitis (housemaid’s knee)
Olecranon bursitis
Bunions - bursitis over the medial 1st metatarsal head in hallux valgus
Bacterial infection can cause a bursal abscess (usually from a small wound on the limb) and gout may cause a bursitis. What may happen to the burse in an inflammatory bursitis?
With inflammatory bursitis the fluid component of the swelling usually subsides but a thickened bursal sac may be left.
What is a seabeous cyst?
Sebaceous cysts are common noncancerous cysts of the skin.
A sebaceous cyst is a closed sac found under the skin, usually on the trunk, neck, or face
What is an abscess? What are the symptoms?
An abscess is a collection of pus that has built up within the tissue of the body.
* Signs and symptoms of abscesses include redness, pain, warmth, and swelling.
* The swelling may feel fluid-filled when pressed.
What is the treatment of an abscess?
Abscesses will not resolve with antibiotics alone and require incision and drainage
Malignant soft tissue tumours arising from the connective tissues are known as what? What percentage of all malignant tumours do they account for?
Malignant soft tissue tumours arising from the connective tissues are known as sarcomas
They are relatively uncommon and account for less than 1% of all malignant tumours
Sarcomas can arise from and are named according to the tissue type from which they arise Where do each of these soft tissue tumours arise from
Angiosarcoma
Fibrosarcoma and malginant fibrous histiocyoma
Liposarcoma
Rhabdomyosarcoma
Synovial sarcoma
Angiosarcoma - arises from blood vessels
Fibrosarcoma and malignant fibrous histiocytoma - arise from fibrous tissue
Liposarcoma - arises from fat
Rhabdomyosarcoma - arises from skeletal muscle
Synovial sarcoma - arises from synovial lining of joints or tendons
