bone and soft tissue tumours

Question 1

What is a very common bone tumour

Answer 1

Secondary tumour metastasising from another area

Question 2

What type of bone tumour is likely to be in an individual over 50

Answer 2

metastatic

Question 3

What are sarcomas

Answer 3

Malignant tumours arising from connective tissues

Question 4

Where do sarcomas spread to and how do they spread

Answer 4

They spread along fascial planes

Haematogenous spread to the lungs

rarely spread to regional lymph nodes

Question 5

What are the benign bone forming tumours and how do they present

Answer 5

osteoid osteoma and osteoblastoma

Present with night pain which is relieved by non steroidal

Question 6

What are the malignant bone forming tumours

Answer 6

name for malignancy is sarcoma

therefore the name is osteosarcoma

Question 7

What are the benign cartilage forming tumours

Answer 7

enchondroma - lies within the bone itself
osteochondroma - very close to the growth plates

Question 8

What is the malignant cartilage forming tumours

Answer 8

chondrosarcoma

Question 9

What are benign fibrous tissue tumours

Answer 9

fibroma

Question 10

What are malignant fibrous tissue tumours

Answer 10

fibrosarcoma
malignant fibrous histiocytoma

Question 11

What are the benign vascular tissue tumours

Answer 11

hemangioma - excessive number of blood vessels

Aneurysmal bone cyst - vascular tumours at the end of long bones which are very agressive

Question 12

What are the malignant vascular tissue tumours

Answer 12

Angiosarcoma

Question 13

What are benign adipose tissue tumours

Answer 13

lipoma

Question 14

What are malignant adipose tissue tumours

Answer 14

liposarcoma

Question 15

What are Malignant marrow tissue tumours

Answer 15

Ewing’s sarcoma in children

Lymphoma

Myeloma

Question 16

What are giant cell tumours

Answer 16

Benign Tumours made up of giant cells which occur at the end of long bones - tend to be locally destructive

Question 17

What are simple bone cysts

Answer 17

Usually in children and just a hole in the bone - weaken the bone leaving it susceptible to fracture

Question 18

What are fibrous cortical defect

Answer 18

Holes in the cortex of bone where there is fibrous tissue instead of bone cortex - can occasionally fracture

Question 19

What is the commonest primary malignant bone tumour in a younger patient

Answer 19

osteosarcoma - still very uncommon due to how uncommon primary bone tumours are

Question 20

What is the commonest primary malignant bone tumour in an old patient

Answer 20

Myeloma - still very uncommon due to how uncommon primary bone tumours are

Question 21

What is the classical presentation of bone tumours

Answer 21

Pain !!
mass
seen on abdominal xray

Question 22

What is the pain from bone tumours like

Answer 22

Activity related due to the bone weak

Progressive pain at rest and at NIGHT

Question 23

When do benign tumours present with activity related pain

Answer 23

if they are large enough to weaken the bone

Question 24

Describe osteoid osteomas

Answer 24

very small bone forming tumours which can create intense pain at night which can be relieved by NSAIDs

Question 25

When should swellings raise suspicion

Answer 25

If they are rapidly growing Hard, fixed, craggy surface with indistinct margins Non-tender on palpation but Associated with deep ache and pain which is worse at night (They can be painless) If they have recurred after being excised

Question 26

What investigations are done for bone and soft tissue tumours

Answer 26

Plain X rays- best for bone lesions and soft tissue lesions soft tissue lesions can be seen on X ray due to: calcification of synovial sarcoma myositis ossificans Calcification in hemangioma (phleboliths)

Question 27

What can be seen in xrays of benign bone tumours

Answer 27

clear margins with surrounding rim of reactive bone

Question 28

What can be seen on Xrays of malignant tumours

Answer 28

Cortical destruction Less well defined transition between lesion and normal growth (permeative growth - invading into the normal bone) When the cortex is destroyed by the lesion, periosteal reactive new bone growth occurs: Codmans triangle, onion-skinning or sunburst pattern

Question 29

What is the study of choice for primary bone and soft tissue tumours

Answer 29

Size, extent, anatomical relationships

Question 30

What is done to give a confirmed diagnosis

Answer 30

Biopsy which is examined histologically

Question 31

What is the usual investigations done for bone and soft tissue tumours

Answer 31

bloods xray of affected limb and chest MRI of lesion Bone scan CT chest, abdo and pelvis Biopsy of lesion

Question 32

How are biopsis done of bone tumours

Answer 32

needle core - drill a hole and take the samples out Open -biopsy - make a cut and then take the samples

Question 33

Who does osteosarcomas occur in most

Answer 33

Men 10-30 year olds

Question 34

Where are osteosarcomas most common

Answer 34

distal femur and proximal tibia

Question 35

What are the clinical features of osteosarcoma

Answer 35

pain loss of function - limp, reduced joint movement, stiff back (especially in children) swelling - late presentation as the tumour grows fracture - pathological joint effusion - if the tumour is next to a joint deformity neurovascular effects systemic effects of neoplasia - weight loss, loss of appetite, low grade temperature...

Question 36

Describe the swelling of osteosarcomas

Answer 36

widespread generally near the end of long bone enlargement of the swelling may be rapid warmth over the swelling and venous congestion means that it is biologically active - high bloodflow through it

Question 37

What is the history of a pathological fracture

Answer 37

Minimal trauma

Question 38

What are the investigations done for osteosarcoma

Answer 38

MRI scan very sensitive

Question 39

What is the treatment of osteosarcoma

Answer 39

chemotherapy radiotherapy Surgery: Limb salvage if possible - excision of bony tumour and keeping the limb

Question 40

What is the restrictions of limb salvage in osteosarcoma tumour excision

Answer 40

If neurovascular structures are involved

Question 41

What are the common primary cancers which metastasise to bone

Answer 41

lung breast prostate kidney thyroid GI tract melanoma

Question 42

Where are the most common sites of bone when tumours metastasise to bone

Answer 42

vertebra > proximal femur > pelvis > ribs > sternum > skull

Question 43

How are pathological fractures prevention

Answer 43

Early chemotherapy to reduce risk of developing secondary bone metastases Prophylatic internal fixation - if they have a lytic lesion and increasing pain - more than 2.5cm diameter or if there is more than 50% cortical destruction Use of bone cement

Question 44

What are the commonest type of soft tissue tumours

Answer 44

lipomas

Question 45

If a swelling is large and deep seated what is the suspicion

Answer 45

sarcoma

Question 46

How do soft tissue tumours present

Answer 46

Painless If it is deep to deep fascia and bigger than 5 cm be suspicious of sarcoma Any fixed, harm or indurated mass - suspicion of sarcoma

Question 47

What is the imaging done when a patient comes in with a soft tissue tumour

Answer 47

MRI