Bone and Soft Tissue Tumours

Question 1

What is a sarcoma?

Answer 1

Malignant tumour arising from connective tissues

Question 2

What are some benign bone-forming tumours?

Answer 2

Osteoid osteoma

Osteoblastoma

Question 3

What are some malignant bone-forming tumours?

Answer 3

Osteosarcoma

Question 4

What are some benign cartilage-forming tumours?

Answer 4

Enchondroma

Osteochondroma

Question 5

What are some malignant cartilage-forming tumours?

Answer 5

Chondrosarcoma

Question 6

What are some benign fibrous tissue tumours?

Answer 6

Fibroma

Question 7

What are some malignant fibrous tissue tumours?

Answer 7

Fibrosarcoma

Malignant fibrous histiocytoma (MFH)

Question 8

What are some benign vascular tissue tumours?

Answer 8

Haemangioma

Aneurysmal bone cyst

Question 9

What are some malignant vascular tissue tumours?

Answer 9

Angiosarcoma

Question 10

What are some adipose tissue tumours?

Answer 10

Lipoma

Question 11

What are some malignant tissue tumours?

Answer 11

Liposarcoma

Question 12

What are some malignant marrow tissue tumours?

Answer 12

Ewing’s sarcoma
Lymphoma
Myeloma

Question 13

What symptoms and signs of bone tumours may present on history taking?

Answer 13

Pain, progressive at rest and night

Mass

Question 14

What should an examination for bone tumours involve or look for?

Answer 14

Measurement of mass 
Location
Shape 
Consistency 
Mobility 
Tenderness 
Local temperature 
Neuro-vascualr deficits

Question 15

What investigations should be used for bone tumours?

Answer 15

X rays 
CT 
MRI 
Isotope bone scan 
Angiography 
PET scan 
Biopsy

Question 16

What would you expect to see on an inactive x ray?

Answer 16

Clear margins

Surrounding rim of reactive bone

Question 17

What would you expect to see on the x ray of an aggressive tumour?

Answer 17

Less well defined zone of transition between lesion and normal bone (permeative growth)
Cortical destruction
Codman’s triangle, onion-skinning or sunburst pattern

Question 18

What can a CT scan be used to assess in bone tumours?

Answer 18

Assessing ossification and calcification
Integrity of cortex
Staging

Question 19

What can an isotope bone scan be used to assess in bone tumours?

Answer 19

Staging for skeletal metastasis

Multiple lesions

Question 20

What are the cardinal features of malignant primary bone tumours?

Answer 20

Increasing pain 
Unexplained pain 
Deep-seating boring nature 
Night pain 
Difficulty weight-bearing 
Deep swelling

Question 21

What are the clinical features of osteosarcoma?

Answer 21

Pain 
Loss of function 
Swelling 
Pathological fracture 
Joint effusion 
Deformity 
Neurovascular effects 
Systemic effects of neoplasia

Question 22

What are the specific features of pain associated with osteosarcoma?

Answer 22

Increasing pain, impending fracture (esp lower limb)
Analgesics eventually ineffective
Not related to exercise
Deep, boring ache worse at night

Question 23

What are the specific features of swelling associated with osteosarcoma?

Answer 23

Generally diffuse in malignancy
Generally near end of long bone
Once reaching noticeable size, enlargement may be rapid
Warmth over swelling and venous congestion

Question 24

What are the treatment options available for bone tumours?

Answer 24

Surgery
Chemotherapy
Radiotherapy

Question 25

What are the suspicious signs of a soft tissue tumours being malignant?

Answer 25

Deep tumours of any size Subcutaneous tumours >5cm Rapid growth, hard, craggy, non-tender

Question 26

What suspicious signs of swelling should be noted?

Answer 26

Rapidly growing Hard, fixed, craggy surface, indistinct margins Non-tender to palpation but associated with deep ache etc May be painless Recurred after previous excision

Question 27

What are the most common cancers which metastasise to bone?

Answer 27

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

Question 28

What are the prevention strategies for bone mets?

Answer 28

Early chemotherapy Prophylactic internal fixation Use of bone cement Aim for early painless weight bearing and mobilisation

Question 29

What is the system used to asses the risk of fracture?

Answer 29

Mirel's scoring system