Bone and Soft Tissue Tumours

Question 1

Sarcoma

Answer 1

Malignant tumours arising from connective tissues. They tend to spread along fascial planes, haematogenous spread to lungs and regional lymph nodes.

Question 2

Bone tumour in a patient > 50

Answer 2

Metastatic

Question 3

Benign bone tumours

Answer 3

Osteoid Osteoma, Osteoblastoma

Question 4

Malignant bone tumours

Answer 4

Osteosarcoma

Question 5

Benign cartilage tumours

Answer 5

Enchondroma, osteochondroma

Question 6

Malignant cartilage tumours

Answer 6

Chondrosarcoma

Question 7

Benign fibrous tissue tumours

Answer 7

Fibroma

Question 8

Malignant fibrous tissue tumours

Answer 8

Fibrosarcoma, malignant fibrous histiocytoma

Question 9

Marrow Tissue tumours

Answer 9

Ewings sarcoma, lymphoma, myeloma

Question 10

Incidence of Osteosarcoma

Answer 10

3/million/year

Question 11

Incidence of Chondrosarcoma

Answer 11

2/million/year

Question 12

Incidence of Ewings Tumours

Answer 12

1.5/million/year

Question 13

Incidence of malignant fibrous histiocytoma

Answer 13

<1/million/year

Question 14

Commonest primary malignant bone tumour in young patient

Answer 14

Osteosarcoma

Question 15

Commonest primary malignant bone tumour in older patient

Answer 15

Myeloma

Question 16

Benign Tumours presentation

Answer 16

Benign tumours may present with activity related pain if large enough to weaken bone

Question 17

Examination of Tumours

Answer 17

General health
measurements of mass
location
shape
consistency
mobility
tenderness
local temperature
neuro-vascular deficits

Question 18

Investigations of leg pain

Answer 18

Plain x-rays - most useful for bone lesions
Calcification - synovial sarcoma
Myositis ossificans
Phleboliths in haemangioma

Question 19

Inactive X-ray

Answer 19

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

Question 20

X-ray of aggressive bone tumours

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 of bone tumours

Answer 21

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

Question 22

Isotope Bone Scan of 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 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

Angiography tumours

Answer 24

Psuedoaneurysms, A-V malformations

Embolisation of vascular tumours - Renal, ABC

Question 25

PET of Tumours

Answer 25

Monitor the response to chemotherapy

Question 26

Biopsy of Tumours

Answer 26

Complete workup prior with bloods, X-ray, MRI of lesion, bone scan, CT chest, abdo and pelvis

Question 27

Cardinal features of malignant primary bone tumours

Answer 27

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

Question 28

Clinical features of Bone Tumours

Answer 28

``` pain loss of function swelling pathological fracture joint effusion deformity neurovascular effects systemic effects of neoplasia ```

Question 29

Pain bone tumours

Answer 29

This is a cardinal feature Increasing pain (impending fracture) Analgesic ineffective Deep boring ache which is worse at night

Question 30

Loss of function

Answer 30

Limp Reduced joint movement Back stiffness

Question 31

Swelling

Answer 31

generally diffuse in malignancy generally near end of long bone once reaching noticeable size, enlargement may be rapid warmth over swelling + venous congestion = active! pressure effects e.g. intrapelvic

Question 32

Pathological Fracture

Answer 32

n.b. many causes, of which primary bone tumour (benign or malignant) is one of rarest, c.f. osteoporosis commonest minimal trauma + h/o pain prior to # !!

Question 33

Treatment of bone tumours

Answer 33

Goal is to make free of disease Chemotherapy Surgery Radiotherapy

Question 34

Surgical treatment of bone tumours

Answer 34

Limb salvage possible for most cases Consider involvement of neurovascular structures pathological #s

Question 35

Suspicious signs of Soft Tissue Tumours

Answer 35

deep (i.e. deep to deep fascia) tumours of any size subcutaneous tumours > 5 cm rapid growth, hard, craggy, non-tender

Question 36

Beware of a swelling which is

Answer 36

rapidly growing hard, fixed, craggy surface, indistinct margins non-tender to palpation, but assoc. with deep ache, esp. worse at night

Question 37

Which cancer commonly spreads to bone

Answer 37

Lung, breast, prostate, kidney, thyroids, GI tract, melanoma

Question 38

Site of boney mets in order of frequency

Answer 38

vertebrae > proximal femur > pelvis > ribs > sternum > skull

Question 39

Prevention of pathological fractures

Answer 39

Early chemotherapy Internal fixation Use of bone cement

Question 40

Clinical features of soft-tissue tumours

Answer 40

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