Flashcards in Bone and soft tissue tumours Deck (46):
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
Name some benign and malignant cartilage forming tumours
Benign: enchondroma, osteochondroma
Name some benign and malignant fibrous tissue tumours
Malignant: fibrosarcoma, malignant fibrous histiocytoma (MFH)
Name some benign and malignant vascular tissue tumours
Benign: haemangioma, aneurysmal bone cyst
Name some benign and malignant adipose tissue tumours
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?
What are some features of history?
Pain, mass, abnormal x rays - incidental
What are the features of the pain associated with bone tumours?
-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
What investigation is very helpful for these masses?
When do phleboliths occur?
On x ray, what features indicate an inactive mass?
-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
-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
What is useful for investigating response to chemo?
A biopsy is useful in diagnosis. What would you do in a complete work up prior to biopsy?
-X-ray of affected limb/chest
What are cardinal features of malignant primary bone tumours?
-Deep seated boring nature
-Hard to weight bear
What are some clinical features of bone tumours?
-Loss of function
-Deformity (eg fixed flexion)
-Systemic neoplasia effects
Discuss the pain associated with bone tumours
-Inc pain - impending #
-Analgesics eventually ineffective
-Not related to exercise
-Deep boring ache, worse at night
Discuss loss of function associated with bone tumours
-Dec. joint movement
-Stiff back (esp child)
Discuss swelling associated with bone tumours
-Generally diffuse in malignancy/near end of long bone
-Warmth over swelling + venous congestion = active
Discuss pathological fracture associated with bone tumours
-Many causes (primary bone tumour rarest, osteoporosis commonest)
-Minimal trauma preceding
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
-Determines extension margins
What 3 treatments are important in bone tumours?
What must be considered in surgery in bone tumours?
-Salvaging bone (possible in most cases)
-Involvement of neurovascular structures
-Porrly performed biopsy
What are suspicious signs of soft tissue tumours?
-Deep tumours of any size
-Subcutaneous tumours >5cm
-Rapid growth, hard, craggy, non-tender
In soft tissue tumours what swelling should make you suspicious?
-Hard, fixed, craggy, indistinct margins
-Non-tender, assoc. with deep ache thats worse at night
-May be painless
-Recurred after previous excision
How common is metastatic bone disease?
-Secondary bone tumour 25x commoner than primary
-Bone most common metastasis site after lung and liver
Where does breast tumour commonly metastasise to?
Where does melanoma commonly metastasise to?
Most common place for secondary bone tumours?
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
How many patients with pathological # will survive over 6m and 1y?
6m - 50%
1y - 30%
How do pathological # get prevented?
-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
Explain Mirels scoring system
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