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14. Year 2: Musculoskeletal > Bone and Soft Tissue Tumours > Flashcards

Bone and Soft Tissue Tumours Flashcards

1
Q

What are the two different categories of tumours?

A
  • Benign
  • Malignant
    • Primary
    • Secondary
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2
Q

What is a sarcoma?

A

Is malignant tumour arising from connective tissues

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3
Q

How do sarcomas spread?

A
  • Spreads along fascial planes
  • Haematogenous spread to lungs
  • Rarely to regional lymph nodes
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4
Q

For bone tumours, which of benign and malignant is more common?

A

Benign are common, malignant are rare

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5
Q

Are bone secondaries common or rare?

A

Bony secondary’s are very common, if bony tumour patient is >50 years likely to be metastatic

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6
Q

What are benign and malignant bone forming tumours?

A
  • Benign
    • Osteoid osteoma, osteoblastoma
  • Malignant
    • Osteosarcoma
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7
Q

What are benign and malignant cartilage forming tumours?

A
  • Benign
    • Enchondroma, osteochondroma
  • Malignant
    • Chondrosarcoma
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8
Q

What are benign and malignant fibrous tissue tumours?

A
  • Benign
    • Fibroma
  • Malignant
    • Fibrosarcoma, malignant fibrous histiocytoma
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9
Q

What are benign and malignant vascular tissue tumours?

A
  • Benign
    • Haemangioma, aneurysmal bone cyst
  • Malignant
    • Angiosarcoma
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10
Q

What are benign and malignant adipose tissue tumours?

A
  • Benign
    • Lipoma
  • Malignant
    • Liposarcoma
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11
Q

What are bone marrow tumours?

A
  • Malignant
    • Ewing’s sarcoma, lymphoma, myeloma
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12
Q

What does GCT stand for?

A

Giant cell tumours

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13
Q

Are giant cell tumours (GCT) benign or malignant?

A
  • Giant cell tumours (GCT)
    • Are benign, locally destructive and can rarely metastasis
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14
Q

What are some examples of tumour like lesions?

A
  • Benign
    • Simple bone cyst
    • Fibrous cortical defect
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15
Q

What are the most common malignant bone tumours in younger and older patients?

A
  • Osteosarcoma in younger patient
  • Myeloma in older patient
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16
Q

What is a common history of tumours?

A
  • Pain
  • Mass
  • Abnormal x-rays (usually incidental)
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17
Q

Describe the pain due to bone tumours?

A
  • Pain
    • Activity related
    • Progressive pain at rest and night
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18
Q

How do benign bone tumours often present?

A
  • May present with activity related pain if large enough to weaken bone
  • Example is osteoid osteoma
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19
Q

What parts of examination are important for bone tumours?

A
  • General health
  • measurements of mass
  • location
  • shape
  • consistency
  • mobility
  • tenderness
  • local temperature
  • neuro-vascular deficits
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20
Q

What investigations are done for tumours?

A
  • Plain x-rays - most useful for bone lesions
    • Calcification - synovial sarcoma
    • Myositis ossificans
    • Phleboliths in haemangioma
    • Inactive
      • Clear margins
      • Surrounding rim of reactive bone
      • Cortical expansion can occur with aggressive benign lesions
    • Aggressive
      • Less well defined zone of transition between lesion and normal bone
      • Cortical destruction is an indicator of malignancy
  • CT
    • Assessing ossification and calcification
    • Integrity of cortex
    • Staging
  • Isotope bone scan
    • Staging for skeletal metastasis
    • Specific for osteochondroma, enchondroma, fibrous dysplasia and histiocytosis
  • MRI
    • Size, extend, anatomical relationship
    • Specific for lipoma, haemangioma, haematoma or PVNS
  • Angiography
    • Embolism of vascular tumours
  • PET
    • May be useful for investigating response to chemotherapy
  • Biopsy
    • Is how tumour is defined (what kind of tumour)
    • Before biopsy, bloods and x-ray, maybe MRI of lesion, bone scan and CT of chest
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21
Q

What kind of tumours are plain x-rays most useful for?

A

Bone tumours

22
Q

How do inactive and aggresive tumours differ on plain x-rays?

A
  • Inactive
    • Clear margins
    • Surrounding rim of reactive bone
    • Cortical expansion can occur with aggressive benign lesions
  • Aggressive
    • Less well defined zone of transition between lesion and normal bone
    • Cortical destruction is an indicator of malignancy
23
Q

What is CT useful for for bone tumours?

A
  • Assessing ossification and calcification
  • Integrity of cortex
  • Staging
24
Q

What imaging technique is used to stage skeletal metastasis?

A

Isotope bone scan

25
Q

What are MRIs useful for?

A
  • Size, extend, anatomical relationship
26
Q

Isotope bone scans are specific for what tumours?

A
  • Specific for osteochondroma, enchondroma, fibrous dysplasia and histiocytosis
27
Q

MRI are specific for what tumours?

A

Specific for lipoma, haemangioma, haematoma or PVNS

28
Q

What is angiography useful for?

A
  • Embolism of vascular tumours
29
Q

What are PET scans useful for?

A
  • May be useful for investigating response to chemotherapy
30
Q

What is done to define a tumour (as benign or malignant)?

A
  • Biopsy
    • Is how tumour is defined (what kind of tumour)
    • Before biopsy, bloods and x-ray, maybe MRI of lesion, bone scan and CT of chest
31
Q

What is the presentation of malignant primary bone tumours?

A
  • Cardinal features
    • Increasing pain
    • unexplained pain
    • Deep-seated boring nature
    • Night pain
    • Difficulty weight-bearing
    • Deep swelling
32
Q

What are some examples of malignant primary bone tumours?

A
  • Osteosarcoma
  • Ewings sarcoma
  • Chondrosarcoma
33
Q

Does osteosarcoma affect more males or females?

A

Males

34
Q

What are the clinical features of osteosarcoma?

A
  • Pain
    • Cardinal feature
    • Analgesics eventually ineffective
    • Not related to exercise
    • Character – deep boring ache, worse at night
  • loss of function
    • Limp
    • Reduced joint movement
    • Stiff back
  • Swelling
  • pathological fracture
  • joint effusion
  • deformity
  • neurovascular effects
  • systemic effects of neoplasia
35
Q

What investigation should be done for osteosarcoma?

A
  • MR scan
    • Investigation of choice
    • Very good for showing
      • intraosseous (intramedullary) extent of tumour
      • extraosseous soft tissue extent of tumour
      • joint involvement
      • skip metastases
      • epiphyseal extension
    • Determines resection margins
36
Q

What is the treatment of osteosarcoma?

A
  • Chemotherapy
  • Surgery
    • Limb salvage usually possible
    • Consider involvement of neurovascular structures
  • Radiotherapy
37
Q

Is primary or metastatic bone disease more common?

A

Metastatic bone tumours 25x more common than primary:

  • Most common site for secondary’s after lung and liver
38
Q

What area of the body most commonly metastasises to bone?

A

Breast

39
Q

What site of the skeleton is most common for secondary tumours in order of 1 to 6?

A
  1. Vertebrae
  2. Proximal femur
  3. Pelvis
  4. Ribs
  5. Sternum
  6. Skull
40
Q

What are the 7 most common primary timours that metastasis to bone in order?

A
  1. LUNG - smoker; CXR, sputum cytology
  2. BREAST - commonest; examine!
  3. PROSTATE - osteosclerotic 2°; PR, PSA
  4. KIDNEY - solitary, vascular; IVP + US, angiography & embolise
  5. THYROID - esp. follicular Ca; examine
  6. GI TRACT - FOB, endoscopy, Ba studies, markers
  7. MELANOMA - examine!
41
Q

What is a pathological fracture?

A

Bone fracture that is caused by disease

42
Q

How are pathological fractures prevented?

A
  • Early chemotherapy
  • Prophylactic internal fixation
43
Q

What scoring system is used to assess risk of pathological fractures?

A

Mirel’s scoring system

44
Q

Describe Mirel’s scoring system?

A

Max score is 12, lesion score of 8 or above then prophylactic action is recommended

Assesses: site, pain, lesion, size

45
Q

Describe the character of pain due to bone cancer?

A
  • Persistent
  • Increasing
  • Non-mechanical/rest
  • Nocturnal
46
Q

What is the most common soft tissue tumour?

A

Lipoma is most common soft tissue tumour

47
Q

As the size of tumour increases, is it more likely to be sarcoma or liposarcoma?

A

Sarcoma

48
Q

Describe the clinical features of soft tissue tumours?

A
  • Painless
  • Be suspicious of malignancy if
    • Deep to deep fascia
    • More than 5cm
    • Fixed, hard or indurated mass
    • Any recurrent mass
49
Q

When should you be suspicious of malignancy for soft tissue tumours?

A
  • Deep to deep fascia
  • More than 5cm
  • Fixed, hard or indurated mass
  • Any recurrent mass
50
Q

What is the imaging study of choice for soft tissue tumours?

A

MRI

14. Year 2: Musculoskeletal (40 decks)

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