Soft tissue tumours and other diseases

10 Soft tissue tumours and other diseases



Co-written by Nigel Raby



SWELLINGS AND TUMOURS OF SOFT TISSUE


Soft tissue swellings are a common presentation to primary care physicians and a cause of great anxiety to patients when they discover a lump in their limb or trunk which they interpret as a cancer. In fact malignant tumours are very rare and benign tumours are much more common in a ratio of more than 100:1. These tumours frequently cause problems in diagnosis and treatment because of the difficulty in differentiating them from other, much commoner, causes of lumps and swellings in the limbs. These include cysts and ganglia around joints, normal muscle variants, muscle rupture, haematoma, vascular aneurysm, and myositis ossificans.









Myositis ossificans (heterotopic ossification)


This is an uncommon but troublesome lesion because of its apparent malignant behaviour. It presents as a painful and tender lump in a limb muscle, with or without a history of recent trauma to the site. Imaging is crucial to obtain the correct diagnosis and MRI and ultrasound are the most useful in the very early stages as they can detect the presence of calcification in the lesion which is the key to diagnosis (Fig. 10.3A). Later imaging with CT scanning will reveal a diagnostic rim of ossification at the periphery of the well-circumscribed lesion. Plain radiographs after several weeks will show some calcification in the muscle which should indicate the correct diagnosis (Fig. 10.3B). However, in some patients where the early changes are not recognised these appearances may be misinterpreted and may lead to a presumed diagnosis of soft tissue osteosarcoma. This assumption may be reinforced if a biopsy is performed, as this will show a very active lesion containing immature mesenchymal cells with atypical nuclei and osteoid formation. No active treatment is required, other than careful observation, as the lesion will resolve in 2–3 months.




TUMOURS OF SOFT TISSUE


The soft-tissue tumours that are met with in orthopaedic practice arise from the connective tissues or blood vessels of the limbs or trunk. They may be benign or malignant. They usually present clinically as painless soft-tissue lumps, and cause symptoms only when quite large.



BENIGN TUMOURS OF SOFT TISSUE



Benign peripheral nerve sheath tumours


Tumours arising from nerves are of two types: schwannomas and neurofibromas.



Jun 5, 2016 | Posted by in ORTHOPEDIC | Comments Off on Soft tissue tumours and other diseases

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