soft tissue and tumour

Question 1

definition of a lesion, dysplasia, metaplasia, tumour and neoplasia

Answer 1

lesion=any abnormality of a tissue

dysplasia: abnormal ratio of undiff to diff
metaplasia: abnormal change of one diff cell type to another

neoplasia: new abnormal formation of tissue the growth of which exceeds and is uncoordinated to that of the normal tissues and persists even when stimulus is removed

Question 2

benign versus malignant tumours

Answer 2

benign

• well diff
• slow growth
• capsule yes
• localised and contained

malig

• poor diff
• fast
• no capsule, invades
• spreading

Question 3

difference between a sarcoma and a lipoma

Answer 3

sarcoma= tissue which includes bone
lipoma=fat tissue

sarcoma
-fixed and non mobile
>5 cm

Question 4

definition of lytic, blastic, explansile, invasive, well-circumsided, diffuse and multi-loculated

in describing bone tumours

Answer 4

lytic: removes bone
blastic: deposits bone
expansile: expands the normal bony contours
invasive:
well circumscribed: defined boundary
diffuse: no obvious boundary
multi-loculated many lobes

Question 5

what colour is lytic and what colour is blastic

Answer 5

lytic=darker black

blastic=white

Question 6

% of bone tumours that are metastatic

Answer 6

90%

Question 7

carcinomas that commonly spread to bone

Answer 7

• prostate
• breast
• kidney
• thyroid
• lung
• lead kettle

Question 8

bone tumour presentation

Answer 8

-pain
-soft tissue lumps and bumps
-hypercalcaemia
-signs of cancer
can be an incidental finding

Question 9

what is a red herring event

Answer 9

something that is attributed to another event but then it doesn’t get better

Question 10

what LFT marker should be checked in particular

Answer 10

ALK phos

Question 11

treatment of bone tumours

Answer 11

• bisphosphonate for hypercalcaemia
• radiotherapy for pain
• chemotherapy
• operative

Question 12

when might operative management be requird

Answer 12

• for primary bone tumour
• for metastasis if
• uncontrolled pain
• pathological #
• palliation (fungating tumour due to artery)

Question 13

3 options for operative management for metastatic

Answer 13

-excision
-stabilise
-replace
implant must last longer than the patient

Question 14

4 options for primary bone cancer surgery

Answer 14

1. intralesional curettage=scoop it out or marginal excision in benign
2. wide local excision (include surrounding healthy tissue)
3. radical excision- includes the muscles of that compartment also
4. amputation

Question 15

what is the most common primary sarcoma of the bone

Answer 15

osteosarcoma

Question 16

who does osteosarcoma occur in

Answer 16

children and young adults

-rarely in elderly adults with pagets

Question 17

clinical features of osteosarcoma

Answer 17

• progressive pain
• fever
• swelling
• mass
• around knee often

Question 18

sarcoma definition

Answer 18

a malignant tumour of connective or other non-epithelial tissue

Question 19

imaging of an osteosarcoma

Answer 19

• blastic and lytic

- codman’s triange:a periosteal reaction as lesion raises the periosteum away and get new subperiosteal bone underneath

Question 20

diagnosis of osteosarcoma

Answer 20

• x-ray
• mri show hot
• ct for pulmonary metastases

Question 21

primary causes of osteosarcoma

Answer 21

seen in 10-20 year olds with LiFraumeni syndrome, retinoblastoma and familial

Question 22

secondary cases of osteosarcoma

Answer 22

seen in areas of pagetic bone or fibrous dysplasia or sites of previous radioactivity

Question 23

treatment osteosarcoma

Answer 23

• chemo for 8-12 weeks
• surgical resection with limb salvage where possible
• maintenance chemotherapy 6-12 months

Question 24

survival osteosarcoma

Answer 24

76%

Question 25

poor prognostic factors of osteosarcoma

Answer 25

• tumour size and site

- advanced stage of disease

Question 26

red flags for lumps

Answer 26

size >5cm
change or rapid growth
pain
previous sarcoma

Question 27

hypercalcaemia symptoms

Answer 27

stones
bones 
groans
moans
thrones-polyuria

Question 28

treatment for hypercalcaemia

Answer 28

hydration

bisphosphonates

Question 29

what is multiple myeloma

Answer 29

tumour of myeloma or bone marrow that produces plasma cells

Question 30

what is the most common primary bone malignancy in >40 years

Answer 30

multiple myeloma

Question 31

survival with multiple myeloma

Answer 31

5 years 30% and 10 years 11%

Question 32

what is multiple myeloma pathophysiology

Answer 32

neoplastic proliferation of plasma cells (b cells) that produce immunoglobulin
-they go rogue

Question 33

test for multiple myeloma 3

Answer 33

-get bence jones protein=proteinuria
-pepper pot skulls: x-ray
lytic lesions
-low wcc and esr and calcium raised

Question 34

treatment multiple myeloma

Answer 34

• chemotherapy
• steroids
• bisphosphonates