Msk Derm - Soft Tissue Tumours

Front 1

What are soft tissues?

Back 1

tissues of the MSK that attach to and support the boney skeleton

Front 2

What are the two ways that we classify soft tissue lesions?

Back 2

-cell of origin
-cell of differentiation that the cell tries to recapitulate

Front 3

What are examples of the common, uncommon, and rare soft tissue lesions

Back 3

lipoma
synovial sarcoma
extraskeletal myxoid chondrosarcoma

Front 4

What are examples of soft tissue tumors that occur in different age groups?

Back 4

-child: rhabdomyosarcoma
-adol: snovial sarcoma
-young adult: synovial sarcoma
-adult: liposarcoma

Front 5

How do soft tissue lesions present?

Back 5

-painless
-enlarging mass
-location: lower 40%, upper 20%, h/n 0%, trunk and retroperitoneum 30%

Front 6

Superficial tumors are ________ (more/less) likely to be benign whereas deep tumors are ________ (more/less) likely to be malignant.

Back 6

more
more

Front 7

Should you excise a lesion for biopsy yourself? What about a fine needle aspiration?

Back 7

NO and NO!!

Front 8

What are the features of differentiation?

Back 8

-cell features
-architectural pafeatures
-growth patterns
-antibodies to detect proteins
-molecular studies

Front 9

What are the three categories of soft tissue lesions?

Back 9

-benign
-intermediate
-malignant

Front 10

What are the features of benign, intermediate, and malignant soft tissue lesions?

Back 10

-benign: self limited, not recuring, no mets
-intermed: local aggression, not metastatic
-malignant: locally aggressive, recurs locally

Front 11

What are the types of fibroblastic tumors?

Back 11

benign - fibroma
intermed - fibromatosis
malignant: fibromyxoid sarcoma

Front 12

What are the types of lipogenic tumors?

Back 12

benign - lipoma
malignant - liposarcoma

Front 13

What are teh types of smooth muscle tumor

Back 13

benign - leiomyoma
malignant - leiomyosarcoma

Front 14

What is a characteristic of smooth muscle tumors?

Back 14

they tend to grow in fasciles where bundles grow at 90 degrees

Front 15

What are the types of skeletal muscle tumors?

Back 15

benign - rhabdomyoma
malignant - rhabdomyosarcoma

Front 16

What is a characteristic of skeleteal muscle tumors?

Back 16

cross-striations

Front 17

What are the types of vascular tumors?

Back 17

benign - hemangioma
intermed - hemangioendothelioma
malignant - angiosarcoma

Front 18

What are the types of peripheral nerve sheath tumors?

Back 18

benign - neurofibroma, schwannoma, perineurioma
malignant - malignant peripheral nerve sheath tumor

Front 19

What does a neurofibroma consist of?

Back 19

a mixture of axon, Schwann, and perineurial cells

Front 20

What are the types of cartilaginous tumors?

Back 20

benign - chondroma
malignant - mesenchymal chondrosarcoma

Front 21

What are the types of osseous tumors?

Back 21

benign - myositis ossificans
malignant - osteosarcoma of soft tissue

Front 22

What are the types of tumors of uncertain origin?

Back 22

synovial sarcoma
Ewing sarcoma
epithelioid sarcoma
alveolar soft part sarcoma
clear cell sarcoma

Front 23

How are bone tumors classified?

Back 23

based on the normal tissues they are trying to recapitulate

Front 24

What are the types of chondrogenic tumors?

Back 24

benign - osteochondroma, chondroma,
malignant - chondrosarcoma

Front 25

What are the types of osteogenic tumors?

Back 25

benign - osteoid osteoma, osteoblastoma
malignant - osteosarcoma

Front 26

What are the types of fibrogenic tumors?

Back 26

benign - non-ossifying fibroma, fibrous dysplaia
malignant - malignant fibrous histiocytoma of bone

Front 27

What are the types of osteo tumors of unknown origin?

Back 27

benign - giant cell, unicameral, anuerysmal

Front 28

What are the neuroectodermal tumors?

Back 28

malignant - Ewing sarcoma

Front 29

What are the notochordal tumors?

Back 29

malignant - chordoma

Front 30

Where can Ewing sarcoma, lymphoma and myeloma arise in a bone?

Back 30

anywhere

Front 31

Where can Giant cell, clear cell, and chondrosarcoma arise in a bone?

Back 31

-at the epiphysis

Front 32

If a kid or adolescent presents with a bone tumor, is it likely to be primary or metastatic?

Back 32

more likely to be a primary bone tumor

Front 33

In older adults, is it like to be a primary tumor?

Back 33

No. It is likely metastatic or hematopoetic

Front 34

What is the clinical presentation of bone tumors?

Back 34

-found incidentally
-pain
-mass
-fracture

Front 35

What is the characteristic of pain in bone tumors?

Back 35

-not associated with trauma
-persistent
-increasing intensity

Front 36

What can the masses in bone tumors do?

Back 36

-they expand the bone
-they involve the surface of the bone
-they infiltrate the cortex and surrounding soft tissue

Front 37

What are the red flags for bone tumors?

Back 37

-pain: nocturnal, persistent, increasing intensity
-enlarging mass
-fracture

Front 38

T/F: benign and malignant tumors present with similar symptoms

Back 38

true

Front 39

What is the investigation for bone tumors?

Back 39

-xray: but can be falsely negative
-bone scan: most sensitive but can be false positive
-CT and MR: good sensitive and specific

Front 40

How does bone react to neoplasm?

Back 40

-resorption (lysis - hole)
-formation (blastic or sclerotic)
-mixed lysis and sclerosis (bone remodelling induced by tumor)

Front 41

What are some benign features of bone tumor on xray?

Back 41

-circumscribed margins
-sclerotic rim of reactive bone
-expansile growth pattern

Front 42

What are some malignant features of bone tumor on xray?

Back 42

-poorly circumscribed
-multiple bones
-elevated periosteum

Front 43

What is an osteoma?

Back 43

-a benign bone forming lesion
-common in head and neck area

Front 44

What is an osteoid osteoma?

Back 44

-small (< 2 cm) benign solitary bone forming lesion characterized by pain that is worse at night and is relieved by aspirin
-mostly in young people

Front 45

What is osteoblastoma?

Back 45

-benign
-larger (> 2 cm) lesion
-pain not relieved by aspirin
-likes the axial skeleton

Front 46

What is an osteosarcoma?

Back 46

-malignant
-produces osteoid (collagen), bone or both
-can be primary or secondary
-pulmonary metastases

Front 47

Where does osteosarcoma tend to occur?

Back 47

-metaphysis of long bone in youngsters
-flat bones and long bones of adults

Front 48

What is the main prognostic indicator for osteosarcoma?

Back 48

-more than 90% of tumor necrosis following treatment

Front 49

What is osteochondroma?

Back 49

-protrudes from surface of bone
-characterized by a cartilageous cap with a bony stalk

Front 50

What is enchondroma?

Back 50

-benign cartilaginous tumor located within the bone

Front 51

What is chondroblastoma

Back 51

benign cartilaginous tumor
-chicken wire calcification

Front 52

What is chondromyxoid fibroma?

Back 52

benign lesion that is chondroid, myxoid, and fibroma like

Front 53

Fibrous dysplasia on histology... what does it look like?

Back 53

chinese writing characters

Front 54

What is Ewing sarcoma?

Back 54

-small round blue cell tumor

Front 55

What is the clinical presentation of Ewing sarcoma?

Back 55

-pain
-mass (warm, tender)
-fracture
-systemic findings: fever, elev ESR, anemia, leukocytosis
-it 'mimics infection'!!
-sheets of uniform, small, round blue cells

Front 56

What tumors metastasize to bone in adults?

Back 56

prostate, breast, lung, kidney (mostly!)