Soft tissue tumours

Question 1

what is a soft tissue tumour?

Answer 1

any non-bony connective tissue (tendon, muscle, ligament), nerves or vessels

Question 2

diffuse swelling examples

Answer 2

synovitis

oedema

Question 3

local swelling examples

Answer 3

inflammatory swellings (bursitis, rheumatoid arthritis or nodules)
infection (abscess)
cystic lesions (ganglion, meniscal cyst, Baker’s cyst)
benign neoplasm
malignant neoplasms

Question 4

how is a unknown lesion diagnosed?

Answer 4

imaging by MRI or ultrasound - biopsy?

Question 5

what is a lipoma?

Answer 5

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

Question 6

how does lipoma present?

Answer 6

slow growing 
painless/ non-tender 
no underlying skin changes 
consistent 
if no symptoms can be left alone

Question 7

what is a giant cell tumour of tendon sheath?

Answer 7

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

Question 8

how does giant cell tumour of tendon sheath present?

Answer 8

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

Question 9

malignant soft tissue tumours arising from connective tissues

Answer 9

sarcomas
most commonly in 50-70s
can occur at any age
cancer is graded and staged

Question 10

types of soft tissue sarcomas

Answer 10

angiosarcoma - blood vessel
fibrosarcoma and malignant fibrous histocytoma - fibrous tissue
liposarcoma - fat
rhabdomyosarcoma - skeletal muscle
synovial sarcoma - synovial lining of joints or tendons

Question 11

how are malignant soft tissue tumours treated?

Answer 11

surgery (radical/ wide local excision)
limb salvage surgery/ amputation
adjunctive chemotherapy &/or radiotherapy

Question 12

what is a ganglion cyst?

Answer 12

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

Question 13

how does a ganglion cyst present and how is it managed?

Answer 13

commonly in wrist 
well defined 
quite firm 
readily trans illuminate 
excision if discomfort or cosmesis

Question 14

what is bursitis?

Answer 14

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 -

Question 15

how is bursitis managed?

Answer 15

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

Question 16

what is a sebaceeous cyst?

Answer 16

implantation dermoids

excision and/ or biopsy

Question 17

examples of types of abscess?

Answer 17

cellulitis 
bursitis 
penetrating wound 
sebaceous cysts 
(don't resolve with antibiotics alone, incision and drainage)

Question 18

blood tests for infection

Answer 18

CRP 
PV
sometimes useful:
blood cultures
white cell count 
ESR

Question 19

imaging for infection

Answer 19

x-ray
technetium scan
MRI

Question 20

clinically relevant infections

Answer 20

acute osteomyelitis 
chronic osteomyelitis 
septic arthritis 
soft tissue infections 
the infected arthroplasty

Question 21

how to deal with abscess

Answer 21

if there’s pus let it out

Question 22

what antibiotics are the best guess to cover staph and strep?

Answer 22

flucloxacillin and benzylpenicillin

Question 23

treatment for infection

Answer 23

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