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MSK Patrick Stenhouse > Benign and Malignant Soft Tissue Tumours > Flashcards

Benign and Malignant Soft Tissue Tumours Flashcards

1
Q

In terms of soft tissue swellings, what are the key features to evaluate on examination?

A
  1. Site
  2. Size
  3. Definition (well or ill-defined)
  4. Consistency (cystic, soft or hard)
  5. Surface smooth or regular
  6. Mobile or fixed
  7. Temperature (checks for abscesses)
  8. Transilluminable (fluid filled)
  9. Pulsatility
  10. Overlying skin changes
  11. Local lymphadenopathy
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2
Q

What are the features that are suggestive of a benign neoplasm?

A
  1. Smaller size (<5cm)
  2. Fluctuation in size
  3. Cystic lesions
  4. Well-defined lesions
  5. Fluid filled lesions
  6. Soft/fatty lesions
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3
Q

What are the features suggestive of a malignant neoplasm in soft tissue?

A
  1. Larger lesions (>5cm)
  2. Rapid growth size
  3. Solid lesions
  4. Ill-defined lesions
  5. Irregular surface
  6. Associated lymphadenopathy
  7. Systemic upset
  8. Deep location
  9. Heterogenity/necrosis
  10. Gadolinium enhancement (moreso than non-maligant tissues)
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4
Q

What types of systemic upset are common in malignant soft tissue lesions?

A
  1. Weight loss
  2. Loss of appetite
  3. Fatigue
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5
Q

Why is a history of an extremely rapidly growing (one week) soft tissue lesion reassuring?

A

This is much more associated with reactive pseudotumour formation rather than malignancy

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6
Q

If there is doubt about the diagnosus of a certain swelling, what is the next step?

A

Imaging via MRI

or

Biopsy for histological diagnosis

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7
Q

What is the most common benign soft tissue lesion

a) In general
b) In orthopaedic practice

A

a) Leiomyoma (occur as fibroids in the uterus)
b) Lipoma

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8
Q

Where does a lipoma occur?

A

Subcutaneous fat

Rarely in muscle

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9
Q

Describe the common features of a subcutaneous lipoma

A
  1. Common
  2. Large
  3. Painless
  4. May not be particularly well defined
    5.
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10
Q

What is a giant cell tumour of a tendon sheath?

A

A small firm swelling arising from a synovial tendon sheath or joint most commonly found on the flexor tendon sheath of a finger

It is the second most common hand swelling after ganglions

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11
Q

How does a giant cell tumour present histologically?

A
  1. Pigmented lesion
  2. Multinucleated giant cells
  3. Haemosiderin is present (iron storage complex gives brown appearance)
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12
Q

As well as the flexor tendon sheath of a finger, where else are giant cell tumours common and what are they called when present here?

A

Knee joint

Pigmented villonodular synovitis (PVNS)

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13
Q

How can giant cell tumours be treated?

A
  1. Excision (high recurrence rate)
  2. Radiotherapy
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14
Q

What is the potential danger of leaving a pigmented villonodular synovitis in a joint such as the knee?

A

It may lead to joint destruction and arthritis

This may require synovectomy or total knee replacement

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15
Q

Angiosarcomas occur in which age groups?

A

Older

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16
Q

Angiosarcomas are the most common sarcoma to occur after what?

A

Previous radiotherapy

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17
Q

Which sarcomas often have a very unclear origin and what are they known as when extremely poorly differentiated?

A

Fibrosarcomas

Pleomorphic undifferentiated sarcoma

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18
Q

Where do liposarcomas most commonly manifest and why can they rarely be a cause of scrotal swelling?

A

Deep fatty tissues in the abdomen

(almost NEVER subcutaneous fat)

The testes have their embryological origin in the abdomen so similar tissue is present around them compared with the abdomen which is also more susceptible to liposarcomas

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19
Q

What is the name of a malignant tumour of skeletal muscle?

A

Rhabdomyosarcoma

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20
Q

Which tumours have an unknown origin, most commonly manifest around the knee joint and commonly present with calcification on X-ray?

A

Synovial sarcoma

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21
Q

Synovial sarcoma is a bi-phasic tumour, what does this mean?

A

It contains both sarcomatous elements and epithelial elements

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22
Q

Synovial sarcomas are associated with which genetic defect?

A

Recurrent translocation (tX;18)

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23
Q

In what age bracket do sarcomas most commonly present?

A

50-70

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24
Q

What is the standard treatment for sarcomas once they have been identified?

A

Surgery with adjunctive chemo/radiotherpay

(surgery involves radical (removal or surrounding structures e.g. blood supply, lymph nodes etc.) or wide local excision)

25
Q

What is the most common hand swelling?

A

Ganglion cyst

26
Q

Why does a ganglion cyst develop?

A

Herniation of synovial fluid at a weak point in a joint capsule or tendon sheath

This weakness can be developmental or as a result of underlying joint damage

27
Q

Ganglion cysts are usually due to underlying ________________

A

Osteoarthritis

28
Q

Describe what a ganglion cyst is

A

A lesion comprised of an outpouching of synovial fluid with a fibrous outer lining with an inner synovial lining that commonly occurs around a synovial joint or synovial tendon sheath

They tend to be well defined, quite firm and transilluminate

29
Q

Where do ganglion cycts usually occur?

A

DIP joints, foot, ankle, knee, wrist

30
Q

What are the treatment options for a ganglion cyst?

A
  1. Aspiration (50% recurrence)
  2. Excision
31
Q

What is the term given to a ganglion cyst occuring at a DIP joint?

A

Mucous cyst

32
Q

Why are ganglion cysts not true cysts?

A

They are not lines by epithelium and instead just by a fibrous outerlining

33
Q

What is a Baker’s cyst?

A

A lesion caused due to an outpouching of synovial fluid in the popliteal fossa

A one-way valve is created to the semimembranosus or medial gastrocnemius bursa causing this build up

34
Q

In adults Baker’s cysts are usually as a result of what?

A

Osteoarthritis

35
Q

Why are Baker’s cysts generally not excised?

A

They have a high recurrence rate

Generally they go away on their own

36
Q

What is a bursa and what is its purpose?

A

A small fluid-filled sac lined by synovium that occurs around a joint that serve to prevent friction between bones, tendons, muscles and surrounding skin

37
Q

What are the most common bursae to become inflamed?

A
  1. Pre-patellar bursa
  2. Olecranon bursa
  3. 1st metatsarsal bursa
38
Q

What is the term given to a bursa present at the 1st metatarsal head?

A

Bunion

(this usually occurs as a result of hallux valgus)

39
Q

What are the main causes of bursitis?

A
  1. Repeated trauma or pressure
  2. Infection
  3. Gout
40
Q

With which cause of bursitis is recurrence most likely?

A

Inflammatory bursitis

Excision may be required

41
Q

By which other name are sebaceous cysts known?

A

Epidermal inclusion cysts

42
Q

Sebaceous cysts are not _________ and __________ increase in size

A

Sebaceous cysts are not painful and slowly increase in size

43
Q

How are sebaceous cysts characterised?

A

Being lined by squamous epithelium which produces abdundant keratin

(when ruptured, this degenerate keratin is released as a toothpaste like substance)

44
Q

What is an implantation dermoid?

A

A soft tissue swelling caused by penetrating trauma which forces epithelial cells into subcutaneous tissue

This forms a reactive cyst surrounded by a pseudocapsule

45
Q

What is the purpose of the punctum in the centre of a sebaceous (epidermoid) cyst?

A

Tethers the cyst to epidermis

46
Q

Where are sebaceous cysts not found?

A

Palms and soles

47
Q

What does an abscess consist of?

A
  1. Neutrophils
  2. Infective debris
  3. Cellular debris
  4. Infective organism
48
Q

Why may abscesses form?

A
  1. Cellulitis
  2. Infected wound
  3. Epidermoid cyst
  4. Blocked sweat gland
  5. Injection site
  6. Bursitis
49
Q

Why are antibiotics not useful in treating bursitis and what is the preferred treatment?

A

Antiobiotics cannot penetrate into the abscess (it does not have a blood supply)

Incision and drainage

50
Q

What is heterotopic ossification?

A

The presence of bone in soft tissue where it is not normally found

This can be seen after hip replacement, blunt trauma, due to osteophytes or osteoclast activity

51
Q

What is the treatment for herterotopic ossificans?

A
  1. Excision when mature (12 months)
  2. Radiotherapy post op
52
Q

What is a common confusion for intramuscular haematoma?

A

Osteosarcoma

53
Q

How can intramuscular haematoma be treated?

A

Indomethacin (NSAID)

54
Q

What are pseudotumours?

A

Tumours which mimic neoplasms, but are just reactive/inflammatory lesions

55
Q

Myositis ossificans and nodular fasciitis are examples of what?

A

Pseudotumours

56
Q

What is myositis ossificans?

A

Progressive ossification at an injury site for unknown reasons

57
Q

Where are ganglion cysts generally found?

A

Adjacent to a tendon or synovial joint

58
Q

Giant cell tumours of the tendon sheath generally occur on the __________ surface especially around the ___ _______ of the _________ and __________ fingers

A

Giant cell tumours of the tendon sheath generally occur on the palmar surface especially around the PIP joints of the index and middle fingers

59
Q

Why is excision usuall recommended for giant cell tumours of the tendon sheath?

A

It prevents local spread and deals with symptoms

MSK Patrick Stenhouse (60 decks)

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