Bone and soft tissue tumours Flashcards
(46 cards)
What is a sarcoma?
Malignant tumours arising from conn tissue. Spread along fascial planes
How do sarcomas spread to lungs?
Haematogenous spread to lungs.
Rarely spread to regional lymph nodes
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)
Name some benign and malignant bone forming tumours
Benign: osteoid sarcoma, osteoblastoma
Malignant: osteosarcoma
Name some benign and malignant cartilage forming tumours
Benign: enchondroma, osteochondroma
Malignant: chondrosarcoma
Name some benign and malignant fibrous tissue tumours
Benign: fibroma
Malignant: fibrosarcoma, malignant fibrous histiocytoma (MFH)
Name some benign and malignant vascular tissue tumours
Benign: haemangioma, aneurysmal bone cyst
Malignant: angiosarcoma
Name some benign and malignant adipose tissue tumours
Benign: lipoma
Malignant: liposarcoma
Name some malignant marrow tissue tumours
Ewings sarcoma, lymphoma, myeloma
What are the characteristics of giant cell tumours?
Benign, locally destructive and rarely metastasise
What are some benign tumour like lesions?
Simple bone cyst, fibrous cortical defect
What is the commonest primary malignant bone tumour in younger/older patient?
Younger: osteosarcoma
Older: myeloma
What are some features of history?
Pain, mass, abnormal x rays - incidental
What are the features of the pain associated with bone tumours?
- Activity related
- Progressive pain at rest and night
When might benign tumours present with pain?
Activity related pain if large enough to weaken bone
What features of the mass do you study on exam?
- Patients general health
- Measurements
- Location
- Shape
- Consistency
- Mobility
- Tenderness
- Local temp
- Neuro-vascular deficits
What investigation is very helpful for these masses?
-X-ray
When do phleboliths occur?
In haemangiomas
On x ray, what features indicate an inactive mass?
- Clear margins
- Surrounding rim of reactive bone
- Cortical expansion in aggressive benign lesions
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
What are CTs used for in these masses?
- Assessing ossification and calcification, integrity of cortex
- Staging - primarily of lungs
What are isotope bone scans used for in these masses?
- Staging for skeletal metastasis
- Identifying multiple masses (osteochondroma, enchondroma) (not so much myeloma)
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
What are useful for vascular tumours?
Angiography. Pseudo-aneurysms, A-V malformations, embolisation of vasculat tumours
