Bone and soft tissue tumours Flashcards Preview

Yr 3 MSK > Bone and soft tissue tumours > Flashcards

Flashcards in Bone and soft tissue tumours Deck (46):
1

What is a sarcoma?

Malignant tumours arising from conn tissue. Spread along fascial planes

2

How do sarcomas spread to lungs?

Haematogenous spread to lungs.

Rarely spread to regional lymph nodes

3

Are benign or malignant tumours of skeleton more common?

Benign are more common, malignant are actully rare. Tumour in 50yo+ likely to be metastatic (secondaries v common)

4

Name some benign and malignant bone forming tumours

Benign: osteoid sarcoma, osteoblastoma
Malignant: osteosarcoma

5

Name some benign and malignant cartilage forming tumours

Benign: enchondroma, osteochondroma
Malignant: chondrosarcoma

6

Name some benign and malignant fibrous tissue tumours

Benign: fibroma
Malignant: fibrosarcoma, malignant fibrous histiocytoma (MFH)

7

Name some benign and malignant vascular tissue tumours

Benign: haemangioma, aneurysmal bone cyst
Malignant: angiosarcoma

8

Name some benign and malignant adipose tissue tumours

Benign: lipoma
Malignant: liposarcoma

9

Name some malignant marrow tissue tumours

Ewings sarcoma, lymphoma, myeloma

10

What are the characteristics of giant cell tumours?

Benign, locally destructive and rarely metastasise

11

What are some benign tumour like lesions?

Simple bone cyst, fibrous cortical defect

12

What is the commonest primary malignant bone tumour in younger/older patient?

Younger: osteosarcoma
Older: myeloma

13

What are some features of history?

Pain, mass, abnormal x rays - incidental

14

What are the features of the pain associated with bone tumours?

-Activity related
-Progressive pain at rest and night

15

When might benign tumours present with pain?

Activity related pain if large enough to weaken bone

16

What features of the mass do you study on exam?

-Patients general health
-Measurements
-Location
-Shape
-Consistency
-Mobility
-Tenderness
-Local temp
-Neuro-vascular deficits

17

What investigation is very helpful for these masses?

-X-ray

18

When do phleboliths occur?

In haemangiomas

19

On x ray, what features indicate an inactive mass?

-Clear margins
-Surrounding rim of reactive bone
-Cortical expansion in aggressive benign lesions

20

On x ray, what features indicate an aggressive mass?

-Less well defined margin between lesion and normal bone
-Cortical destruction
-Periosteal reactive new bone growth occurs when lesion destroys cortex
-Codmans triangle, onion skinning or sunburst pattern

21

What are CTs used for in these masses?

-Assessing ossification and calcification, integrity of cortex
-Staging - primarily of lungs

22

What are isotope bone scans used for in these masses?

-Staging for skeletal metastasis
-Identifying multiple masses (osteochondroma, enchondroma) (not so much myeloma)

23

What are MRI's used for in these masses?

-Size, extent, anatomical relationships
-Accurate for limits of disease both within/outside bone
-Specific for lipoma/haemangioma/haematoma. Non specific for benign vs malignant

24

What are useful for vascular tumours?

Angiography. Pseudo-aneurysms, A-V malformations, embolisation of vasculat tumours

25

What is useful for investigating response to chemo?

PET scan

26

A biopsy is useful in diagnosis. What would you do in a complete work up prior to biopsy?

-Bloods
-X-ray of affected limb/chest
-MRI
-Bone scan
-CT chest/abdo/pelvis

27

What are cardinal features of malignant primary bone tumours?

-Inc. pain
-Unexplained pain
-Deep seated boring nature
-Night pain
-Hard to weight bear
-Deep swelling

28

What are some clinical features of bone tumours?

-Pain
-Loss of function
-Swelling
-Pathological fracture
-Joint effusion
-Deformity (eg fixed flexion)
-Neurovascular effects
-Systemic neoplasia effects

29

Discuss the pain associated with bone tumours

-Inc pain - impending #
-Analgesics eventually ineffective
-Not related to exercise
-Deep boring ache, worse at night

30

Discuss loss of function associated with bone tumours

-Limp
-Dec. joint movement
-Stiff back (esp child)

31

Discuss swelling associated with bone tumours

-Generally diffuse in malignancy/near end of long bone
-Warmth over swelling + venous congestion = active

32

Discuss pathological fracture associated with bone tumours

-Many causes (primary bone tumour rarest, osteoporosis commonest)
-Minimal trauma preceding

33

MRI is investigation of choice for bone tumours as it is v sensitive. What is it good for showing?

-Intraosseous/Intramedullary extent of tumous
-Extraosseous soft tissue extent of tumour
-Joint involvement
-Skip metastases
-Epiphyseal extension
-Determines extension margins

34

What 3 treatments are important in bone tumours?

-Chemo
-RT
-Surgery

35

What must be considered in surgery in bone tumours?

-Salvaging bone (possible in most cases)
-Involvement of neurovascular structures
-Pathological #
-Porrly performed biopsy

36

What are suspicious signs of soft tissue tumours?

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

37

In soft tissue tumours what swelling should make you suspicious?

-Rapidly growing
-Hard, fixed, craggy, indistinct margins
-Non-tender, assoc. with deep ache thats worse at night
-May be painless
-Recurred after previous excision

38

How common is metastatic bone disease?

-Secondary bone tumour 25x commoner than primary
-Bone most common metastasis site after lung and liver

39

Where does breast tumour commonly metastasise to?

Bone

40

Where does melanoma commonly metastasise to?

Lung

41

Most common place for secondary bone tumours?

Vertebrae

42

What are the 7 commonest tumours which metastasise to bone?

1. LUNGS -smoker. CXR, sputum cytology
2. BREAST -commonest: examine
3. PROSTATE -osteosclerotic, PSA, PR
4. KIDNEY -solitary, vascular. IVp and US, angiography and embolise
5. THYROID -esp follicular Ca, examine
6. GI - FOB, endoscopy, Ba studies, markers
7. MELANOMA -examine

43

How many patients with pathological # will survive over 6m and 1y?

6m - 50%
1y - 30%

44

How do pathological # get prevented?

-Early chemo
-Prophylactic internal fixation determined by Mirels scoring system
-Use of bone cement
-Embolisation esp renal, thyroid
-Only one long bone at a time (surgery)
-Aim for early painless weight bearing and mobilisation post surgery

45

Explain Mirels scoring system

Scored based on
-Site
-Pain
-Lesion type
-Size

46

Should you assume lytic lesion is metastasis?

No, especially if solitary