Bone and soft tissue tumours

Question 1

Sarcoma Features

Answer 1

Malignant
Arise from Connective Tissue
Spread along Fascial Planes
Haematogenous Spread to Lungs

Question 2

Bone Tumours what is common

Answer 2

Benign

Secondary Bone Common

Question 3

Bone Tumour in Patient >50

Answer 3

Likely Metastatic

Question 4

Benign Bone Tumours (2)

Answer 4

Osteoid Osteoma

Osteoblastoma

Question 5

Malignant Bone Tumour

Answer 5

Osteosarcoma

Question 6

Cartilage Forming Benign Tumour

Answer 6

Enchondroma, Osteochondroma

Question 7

Cartilage Forming Malignant Tumour

Answer 7

Chondrosarcoma

Question 8

Fibrous Tissue Benign Tumour

Answer 8

Fibroma

Question 9

Fibrous Tissue Malignant Tumour

Answer 9

Fibrosarcoma, Malignant Fibrous Histocytoma

Question 10

Vascular Tissue Benign Tumour

Answer 10

Haemangioma, Aneurysmal Bone Cyst

Question 11

Vascular Tissue Malignant Tumour

Answer 11

Angiosarcoma

Question 12

Adipose Tissue Benign Tumour

Answer 12

Lipoma

Question 13

Adipose Tissue Malignant Tumour

Answer 13

Liposarocma

Question 14

Marrow Tissue Malignant Tumour

Answer 14

Ewing sarcoma
Lymphoma
Myeloma

Question 15

What are Giant Cell Tumours

Answer 15

Benign
Local Destructive
Rarely Move

Question 16

Most common Primary Bone tumours

Answer 16

Osteosarcoma (3 per million) most common in younger patient

Question 17

commonest primary malignant “bone” tumour in older patient

Answer 17

myeloma

Question 18

commonest primary malignant bone tumour in younger patient

Answer 18

osteosarcoma

Question 19

A tumour is inactive if on x-ray

Answer 19

clear margins
surrounding rim of reactive bone
cortical expansion can occur with aggressive benign lesions

Question 20

a tumour is aggressive is on x-ray

Answer 20

less well defined zone of transition between lesion and normal bone (permeative growth)
cortical destruction = malignancy
Periosteal reactive new bone growth occurs when the lesion destroys the cortex.
- Codman’s triangle, onion-skinning or sunburst pattern

Question 21

CT in tumours is best for assessing

Answer 21

Assessing ossification and calcification
integrity of cortex
best for assessing nidus in osteoid osteoma
Staging - primarily of lungs

Question 22

isotope bone scans in bone tumours

Answer 22

Staging for skeletal metastasis
Multiple lesions - osteochondroma, enchondroma, fibrous dysplasia & histiocytosis
Frequently negative in Myeloma
Benign also demonstrate increased uptake

Question 23

MRI in bone tumours

Answer 23

Study of choice
size, extent, anatomical relationships
Accurate for limits of disease both within and outside bone
Specific for Lipoma, haemangioma, haematoma or PVNS.
Non-specific for benign vs. malignant

Question 24

prior to biopsy do

Answer 24

Bloods
X-rays of affected Limb 
& Chest
MRI of lesion
Bone Scan
CT Chest, abdo & pelvis

Question 25

Malignant Primary Bone Tumour Features

Answer 25

``` Cardinal features Increasing pain unexplained pain Deep-seated boring nature Night pain Difficulty weight-bearing Deep swelling ```

Question 26

Malignant primary bone tumour examples

Answer 26

Osteosarcoma Ewings sarcoma Chondrosarcoma

Question 27

Osteosarcoma Features

Answer 27

pain loss of function swelling pathological fracture joint effusion deformity neurovascular effects systemic effects of neoplasia impending fracture esp lower limb analgesics eventually ineffective deep boring ache at night limp reduced joint movement stiff back (esp. child)

Question 28

If there is warmth over swelling and venous congestion what does this mean

Answer 28

active

Question 29

Investigations for Bone Tumours

Answer 29

``` investigation of choice - very sensitive VG for showing intraosseous (intramedullary) extent of tumour extraosseous soft tissue extent of tumour joint involvement skip metastases epiphyseal extension determines resection margins ```

Question 30

Ewing sarcoma Treatment

Answer 30

Chemo Surgery Radio

Question 31

Suspicious signs of Malignant soft tissue tumours

Answer 31

deep (i.e. deep to deep fascia) tumours of any size subcutaneous tumours > 5 cm rapid growth, hard, craggy, non-tender rapidly growing hard, fixed, craggy surface, indistinct margins non-tender to palpation, but assoc. with deep ache, esp. worse at night BEWARE – may be painless Recurred after previous excision

Question 32

What is the most common site for secondary tumours after lung and liver

Answer 32

bone

Question 33

breast cancer most commonly goes to

Answer 33

bone

Question 34

melanoma commonly goes to

Answer 34

lung

Question 35

which bone does metatstates usually go to

Answer 35

vertebrae

Question 36

7 commonest primary cancers which metastases to bone

Answer 36

``` Lung Breast Prostate Kidney Thyroid GI Melanoma ```

Question 37

Breast Cancer soft tissue metastases

Answer 37

decreases survival compared to bone tumours

Question 38

pathological fracture prevention

Answer 38

prophylactic internal fixation if lytic lesion, pain and or >2.5cm diameter or >50% cortical destruction

Question 39

What is fracture risk assessment called

Answer 39

Mirel's Scoring

Question 40

Risk is highest in Mirel's Scoring System for what type of fracture

Answer 40

Site: Peritrochanter Functional Pain Lytic Lesion >2/3 Size

Question 41

Fixation of pathological fractures or lytic lesions around where has high fail rate

Answer 41

Hip/Proximal femur

Question 42

what has low failure rate for hip/proximal femur pathological fractures/lytic lesion

Answer 42

cemented hip prosthesis

Question 43

when surgery is indicated for spinal mets what else should be done

Answer 43

decompression | stabilisation

Question 44

If Solitary Lipoma is >10cm what does this mean

Answer 44

Bad

Question 45

Commonest soft tissue tumour

Answer 45

Lipoma

Question 46

Soft tissue presentation

Answer 46

``` painless mass deep to deep fascia any mass >5cm any fixed, hard or indurated mass any recurrent mass ``` Imaging studies - MRI

Question 47

Peak age incidence of osteosarcoma

Answer 47

10-25

Question 48

peak age of Ewing sarcoma

Answer 48

10-18

Question 49

peak age of chondrosarcoma

Answer 49

45-60

Question 50

If soft tissue sarcoma is deep seated or >5cm

Answer 50

refer to specialist