Bone and Soft Tissue Tumours Flashcards
Sarcoma
Malignant tumours arising from connective tissues. They tend to spread along fascial planes, haematogenous spread to lungs and regional lymph nodes.
Bone tumour in a patient > 50
Metastatic
Benign bone tumours
Osteoid Osteoma, Osteoblastoma
Malignant bone tumours
Osteosarcoma
Benign cartilage tumours
Enchondroma, osteochondroma
Malignant cartilage tumours
Chondrosarcoma
Benign fibrous tissue tumours
Fibroma
Malignant fibrous tissue tumours
Fibrosarcoma, malignant fibrous histiocytoma
Marrow Tissue tumours
Ewings sarcoma, lymphoma, myeloma
Incidence of Osteosarcoma
3/million/year
Incidence of Chondrosarcoma
2/million/year
Incidence of Ewings Tumours
1.5/million/year
Incidence of malignant fibrous histiocytoma
<1/million/year
Commonest primary malignant bone tumour in young patient
Osteosarcoma
Commonest primary malignant bone tumour in older patient
Myeloma
Benign Tumours presentation
Benign tumours may present with activity related pain if large enough to weaken bone
Examination of Tumours
General health measurements of mass location shape consistency mobility tenderness local temperature neuro-vascular deficits
Investigations of leg pain
Plain x-rays - most useful for bone lesions
Calcification - synovial sarcoma
Myositis ossificans
Phleboliths in haemangioma
Inactive X-ray
clear margins
surrounding rim of reactive bone
cortical expansion can occur with aggressive benign lesions
X-ray of aggressive bone tumours
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
CT of bone tumours
Assessing ossification and calcification
integrity of cortex
best for assessing nidus in osteoid osteoma
Staging - primarily of lungs
Isotope Bone Scan of bone tumours
Staging for skeletal metastasis
Multiple lesions - osteochondroma, enchondroma, fibrous dysplasia & histiocytosis
Frequently negative in Myeloma
Benign also demonstrate increased uptake
MRI bone tumours
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
Angiography tumours
Psuedoaneurysms, A-V malformations
Embolisation of vascular tumours - Renal, ABC
PET of Tumours
Monitor the response to chemotherapy
Biopsy of Tumours
Complete workup prior with bloods, X-ray, MRI of lesion, bone scan, CT chest, abdo and pelvis
Cardinal features of malignant primary bone tumours
Increasing pain unexplained pain Deep-seated boring nature Night pain Difficulty weight-bearing Deep swelling
Clinical features of Bone Tumours
pain loss of function swelling pathological fracture joint effusion deformity neurovascular effects systemic effects of neoplasia
Pain bone tumours
This is a cardinal feature
Increasing pain (impending fracture)
Analgesic ineffective
Deep boring ache which is worse at night
Loss of function
Limp
Reduced joint movement
Back stiffness
Swelling
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
Pathological Fracture
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 # !!
Treatment of bone tumours
Goal is to make free of disease
Chemotherapy
Surgery
Radiotherapy
Surgical treatment of bone tumours
Limb salvage possible for most cases
Consider involvement of neurovascular structures
pathological #s
Suspicious signs of Soft Tissue Tumours
deep (i.e. deep to deep fascia) tumours of any size
subcutaneous tumours > 5 cm
rapid growth, hard, craggy, non-tender
Beware of a swelling which is
rapidly growing
hard, fixed, craggy surface, indistinct margins
non-tender to palpation, but assoc. with deep ache, esp. worse at night
Which cancer commonly spreads to bone
Lung, breast, prostate, kidney, thyroids, GI tract, melanoma
Site of boney mets in order of frequency
vertebrae > proximal femur > pelvis > ribs > sternum > skull
Prevention of pathological fractures
Early chemotherapy
Internal fixation
Use of bone cement
Clinical features of soft-tissue tumours
painless mass deep to deep fascia any mass >5cm any fixed, hard or indurated mass any recurrent mass
MRI
