Benign and Malignant Soft Tissue Tumours Flashcards
(59 cards)
In terms of soft tissue swellings, what are the key features to evaluate on examination?
- Site
- Size
- Definition (well or ill-defined)
- Consistency (cystic, soft or hard)
- Surface smooth or regular
- Mobile or fixed
- Temperature (checks for abscesses)
- Transilluminable (fluid filled)
- Pulsatility
- Overlying skin changes
- Local lymphadenopathy
What are the features that are suggestive of a benign neoplasm?
- Smaller size (<5cm)
- Fluctuation in size
- Cystic lesions
- Well-defined lesions
- Fluid filled lesions
- Soft/fatty lesions
What are the features suggestive of a malignant neoplasm in soft tissue?
- Larger lesions (>5cm)
- Rapid growth size
- Solid lesions
- Ill-defined lesions
- Irregular surface
- Associated lymphadenopathy
- Systemic upset
- Deep location
- Heterogenity/necrosis
- Gadolinium enhancement (moreso than non-maligant tissues)
What types of systemic upset are common in malignant soft tissue lesions?
- Weight loss
- Loss of appetite
- Fatigue
Why is a history of an extremely rapidly growing (one week) soft tissue lesion reassuring?
This is much more associated with reactive pseudotumour formation rather than malignancy
If there is doubt about the diagnosus of a certain swelling, what is the next step?
Imaging via MRI
or
Biopsy for histological diagnosis
What is the most common benign soft tissue lesion
a) In general
b) In orthopaedic practice
a) Leiomyoma (occur as fibroids in the uterus)
b) Lipoma
Where does a lipoma occur?
Subcutaneous fat
Rarely in muscle
Describe the common features of a subcutaneous lipoma
- Common
- Large
- Painless
- May not be particularly well defined
5.
What is a giant cell tumour of a tendon sheath?
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
How does a giant cell tumour present histologically?
- Pigmented lesion
- Multinucleated giant cells
- Haemosiderin is present (iron storage complex gives brown appearance)
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?
Knee joint
Pigmented villonodular synovitis (PVNS)
How can giant cell tumours be treated?
- Excision (high recurrence rate)
- Radiotherapy
What is the potential danger of leaving a pigmented villonodular synovitis in a joint such as the knee?
It may lead to joint destruction and arthritis
This may require synovectomy or total knee replacement
Angiosarcomas occur in which age groups?
Older
Angiosarcomas are the most common sarcoma to occur after what?
Previous radiotherapy
Which sarcomas often have a very unclear origin and what are they known as when extremely poorly differentiated?
Fibrosarcomas
Pleomorphic undifferentiated sarcoma
Where do liposarcomas most commonly manifest and why can they rarely be a cause of scrotal swelling?
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
What is the name of a malignant tumour of skeletal muscle?
Rhabdomyosarcoma
Which tumours have an unknown origin, most commonly manifest around the knee joint and commonly present with calcification on X-ray?
Synovial sarcoma
Synovial sarcoma is a bi-phasic tumour, what does this mean?
It contains both sarcomatous elements and epithelial elements
Synovial sarcomas are associated with which genetic defect?
Recurrent translocation (tX;18)
In what age bracket do sarcomas most commonly present?
50-70
What is the standard treatment for sarcomas once they have been identified?
Surgery with adjunctive chemo/radiotherpay
(surgery involves radical (removal or surrounding structures e.g. blood supply, lymph nodes etc.) or wide local excision)
