Bone Tumors MCQs

A 13-year-old girl is diagnosed with high-grade intramedullary osteosarcoma of the distal femur. Which of the following is considered the most significant adverse prognostic factor at the time of initial diagnosis?

A 16-year-old male presents with localized cervical spine pain. Radiographs reveal a 3.5 cm expansile, radiolucent lesion in the posterior elements of C4.

Which of the following characteristics most reliably differentiates this lesion from an osteoid osteoma?

A 14-year-old boy presents with a painful, enlarging mass on his right thigh 3 weeks after sustaining a minor femur fracture. Radiographs demonstrate exuberant bone formation that mimics osteosarcoma. Physical examination also reveals limited forearm pronation and supination. What is the most likely genetic mutation responsible for his underlying condition?

A 14-year-old girl undergoes curettage of a 3.5 cm lytic bone lesion in the distal femur. The histology is shown.

Microscopy reveals loose fibrovascular connective tissue intermixed with irregular osteoid without atypical mitoses. Her pain was poorly relieved by NSAIDs. What is the diagnosis?

A 16-year-old girl undergoes intralesional curettage of an expansile 3.5 cm lytic lesion located in the posterior elements of C4. A photomicrograph of the specimen is shown.

What is the most likely diagnosis?

A 15-year-old boy presents with a rapidly expanding, destructive metaphyseal lesion of the distal femur. MRI reveals large fluid-fluid levels. Histology shows highly pleomorphic, atypical spindle cells producing fine, lace-like osteoid within the septa separating blood-filled spaces. What is the most likely diagnosis?

An 8-year-old boy sustains a minor twisting injury to his arm and complains of shoulder pain. Radiographs show a centrally located, completely radiolucent lesion in the proximal humeral metaphysis extending to the physis. A small fragment of bone is seen resting at the dependent portion of the cyst. What is the most likely diagnosis?

A 15-year-old male presents with chronic back pain, which is worse at night and incompletely relieved by NSAIDs. Radiographs reveal an expansile, lytic lesion in the posterior elements of L3.

Based on the clinical presentation and typical radiographic findings shown, what is the most likely diagnosis?

A 12-year-old boy presents with pain and swelling in his mid-thigh. Radiographs show a permeative diaphyseal lesion with an "onion skin" periosteal reaction. Genetic testing reveals a t(11;22) chromosomal translocation. What fusion protein is associated with this specific translocation?

A 5-year-old African American child with homozygous sickle cell disease presents with high fever and severe left arm pain. Radiographs show periosteal elevation of the radial diaphysis. While Staphylococcus aureus remains common, which of the following organisms is disproportionately frequent in this specific patient population?

An 11-year-old boy presents with night-time right thigh pain that dramatically improves within 30 minutes of taking ibuprofen. Radiographs demonstrate a dense sclerotic lesion in the proximal femur with a 1-cm central radiolucent nidus. What is the most common definitive treatment currently utilized for this condition?

A 6-year-old girl presents with a limp, precocious puberty, and large, irregular cafe-au-lait spots on her torso. Radiographs show ground-glass appearing expansile lesions in her proximal femur resulting in a "shepherd's crook" deformity. What is the underlying genetic mutation?

An 8-year-old boy presents to the emergency department after a minor fall onto his arm. Radiographs demonstrate a pathologic fracture through a centrally located, purely radiolucent lesion in the proximal humeral metaphysis. A radiopaque fragment is noted resting at the dependent portion of the cyst (the "fallen leaf" sign). What is the most appropriate initial management for this presentation?

A 68-year-old man complains of severe lower back pain and fatigue. Radiographs show multiple 'punched-out' lytic lesions in his skull and pelvis. Which of the following tests is the most appropriate next step to confirm the suspected diagnosis?

A 19-year-old male reports right thigh pain that is worse at night and dramatically relieved by ibuprofen. Imaging shows a 0.8 cm radiolucent nidus surrounded by dense sclerotic bone in the femoral diaphysis. What is the treatment of choice if he fails medical management?

An 18-year-old male complains of deep, aching pain in his proximal femur that is worse at night and dramatically relieved by ibuprofen. Imaging shows a 1 cm radiolucent nidus surrounded by dense reactive sclerosis. The pain is primarily mediated by high local concentrations of which of the following?

A 16-year-old boy presents with progressive right thigh pain that is noticeably worse at night and dramatically relieved by taking ibuprofen. Radiographs demonstrate a diaphyseal cortical thickening with a central radiolucent nidus measuring 8 mm. Which of the following is the most likely diagnosis?

A 9-year-old boy sustains a minor fall and presents with arm pain. Radiographs reveal a central, purely radiolucent metaphyseal lesion in the proximal humerus with a cortical fragment resting at the bottom of the cyst. What is the most likely diagnosis?

A 12-year-old girl presents with knee pain. MRI of the distal femur demonstrates an eccentric, expansile metaphyseal lesion containing multiple cystic spaces with distinct fluid-fluid levels. Histology shows blood-filled spaces separated by cellular septa. What is the most likely diagnosis?

A 60-year-old man presents with deep thigh pain. Radiographs reveal a large diaphyseal lesion in the femur with endosteal scalloping greater than two-thirds of the cortical thickness and \"popcorn\" calcifications. What is the mainstay of treatment for this lesion?