Bone and Soft Tissue Tumours

Question 1

what is sarcoma?

Answer 1

malignant tumours arising from connective tissue

Question 2

how do sarcomas spread?

Answer 2

along fascial planes

Question 3

how can sarcomas spread to the lungs?

Answer 3

haematogenous spread

Question 4

benign: bone forming tumour

Answer 4

osteoid
osteoma
osteoblastoma

Question 5

benign: cartilage forming tumour

Answer 5

enchondroma

osteochondroma

Question 6

benign: fibrous tissue tumour

Answer 6

fibroma

Question 7

benign: vascular tissue tumours

Answer 7

haemangioma

aneurysmal bone cyst

Question 8

benign: adipose tissue tumours

Answer 8

lipoma

Question 9

benign: tumour like lesions

Answer 9

simple bone cyst

fibrous cortical defect

Question 10

malignant: bone forming tumour

Answer 10

osteosarcoma

Question 11

malignant: cartilage forming umour

Answer 11

chondrosarcoma

Question 12

malignant: fibrous tissue tumours

Answer 12

fibrosarcoma

malignant fibrous histiocytoma (MFH)

Question 13

malignant: vascular tissue tumours

Answer 13

angiosarcoma

Question 14

malignant: adipose tissue tumours

Answer 14

liposarcoma

Question 15

malignant: marrow tissue tumours

Answer 15

liposarcoma
Ewing’s sarcoma
lymphoma
myeloma

Question 16

what tumours are locally destructive but rarely metastasise?

Answer 16

giant cell tumours

Question 17

what is the commonest primary malignant bone tumour in younger patients?

Answer 17

osteosarcoma

Question 18

what is the commonest primary malignant “bone” tumour in older patients?

Answer 18

myeloma

Question 19

pain in bone tumours

Answer 19

activity related

progressive pain at rest and night

Question 20

when might benign bone tumours cause pain?

Answer 20

activity related if large enough to weaken bone

Question 21

examination of a patient with a potential bone tumour

Answer 21

1. General health
2. Mass
3. Location
4. Shape
5. Consistency
6. Mobility
7. Tenderness
8. Local temperature
9. Neurovascular deficits

Question 22

investigations in a potential bone tumour

Answer 22

plain x-ray
CT
Isotope bone scans
MRI
Angiography
PET
Biopsy

Question 23

investigations in a potential bone tumour: plain xray

Answer 23

a. Calcification – synovial sarcoma
b. Myosistis ossificans
c. Phleboliths in haemangioma
d. In active
i. Clear margins
ii. Surrounding rim of reactive bone
iii. Cortical expansion can occur with aggressive benign lesions
e. Aggressive
i. Less well-defined zone of transition between lesion and normal bone
(permeative growth)
ii. Cortical destruction – malignancy
iii. Periosteal reactive new bone growth occurs when the lesion destroys the
cortex
iv. Codman’s triangle, onion-skinning, or sunburst pattern

Question 24

investigations in a potential bone tumour: CT

Answer 24

a. Assessment of ossification and calcification
b. Integrity of cortex
c. Best for assessing nidus in osteoid osteoma
d. Staging – primarily of lungs

Question 25

investigations in a potential bone tumour: isotope bone scan

Answer 25

a. Staging for skeletal metastasis b. Multiple lesions – osteochondroma, endochonroma, fibrous dysplasia and histiocytosis c. Frequently negative in myeloma d. Benign also demonstrate increased uptake

Question 26

investigations in a potential bone tumour: MRI

Answer 26

a. Study of choice b. Size, extent, anatomical relationships c. Accurate for limits of disease both within and outside bone d. Specific for lipoma, haemangioma, haematoma or PVNS e. Non-specific for benign vs malignant

Question 27

investigations in a potential bone tumour" angiography

Answer 27

a. Superseded by MRI b. Pseudoaneurysms, A_V malformations c. Embolization of vascular tumours – renal, ABC

Question 28

investigations in a potential bone tumour: PET

Answer 28

may be useful for investigating response to chemo

Question 29

investigations in a potential bone tumour: work up before biopsy

Answer 29

i. Bloods ii. X-rays of affected limb and chest iii. MRI of lesion iv. Bone scan v. CT chest, abdo and pelvis

Question 30

cardinal features of malignant primary bone tumours

Answer 30

1. Increasing pain 2. Unexplained pain 3. Deep-seated boring nature 4. Night pain 5. Difficulty weight bearing 6. Deep swelling

Question 31

clinical features of bone tumours

Answer 31

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

Question 32

pain in bone tumours

Answer 32

a. Cardinal features b. Increasing pain – impending # (esp. ll) c. Analgesics eventually ineffective d. Not related to exercise e. Deep boring ache i. Worse at night

Question 33

loss of function in bone tumours

Answer 33

a. Limb b. Reduced joint movement c. Stiff back (esp. child)

Question 34

swelling in bone tumours

Answer 34

a. Generally, diffuse in malignancy b. Generally near end of long bone c. Once reaching noticeable size, enlargement may be rapid d. Warmth over swelling + venous congestion = active e. Pressure effects

Question 35

pathological fractures in bone tumours

Answer 35

a. Many causes, of which primary bone tumour is one of the rarest – osteoporosis is commonest b. Minimal trauma Hx of pain prior

Question 36

MRI is good at showing what when investigating bone tumours

Answer 36

i. Intraosseous (intramedullary) extent of tumour ii. Extraosseous soft tissue extent of tumour iii. Joint involvement iv. Skip metastases v. Epiphyseal extension c. Determines resection margins

Question 37

signs that a soft tissue tumour may be malignant

Answer 37

deep (deep to deep fascia) tumours of any size; SC tumours | > 5cm; rapid growth, hard, craggy, non-tender.

Question 38

when examining soft tissue tumours beware a swelling which is

Answer 38

1. Rapid growing 2. Hard, fixed, craggy surface, indistinct margins 3. Non-tender to palpation but associated with deep ache, esp. worse at night 4. Painless 5. Recurred after previous excision

Question 39

a secondary bone tumour is how much more common than primary?

Answer 39

25 x

Question 40

order of metastatic bone sites

Answer 40

``` vertebrae proximal femur pelvis ribs sternum skull ```

Question 41

7 commonest primary cancers which metastasise to bone?

Answer 41

``` lung breast prostate kidney thyroid GIT melanoma ```

Question 42

how can you prevent pathological fractures?

Answer 42

early chemotherapy and prophylactic internal fixation