Bone Tumors MCQs

A 19-year-old male presents with persistent, dull aching back pain that is worse at night. The pain is not relieved by ibuprofen. CT imaging reveals a 2.5 cm radiolucent nidus with surrounding sclerosis in the posterior elements of L4. What is the most likely diagnosis?

A 24-year-old male presents with chronic axial back pain. He notes that the pain is dull, constant, and only mildly relieved by non-steroidal anti-inflammatory drugs (NSAIDs). Radiographs and a subsequent CT scan reveal a 3.0 cm expansile, lytic lesion in the posterior elements of L4. Histologically, the lesion shows a loose fibrovascular stroma with interlacing trabeculae of osteoid lined by prominent osteoblasts. What is the most likely diagnosis?

Which of the following histologic variants of osteosarcoma typically carries the most favorable prognosis following wide surgical resection without neoadjuvant chemotherapy?

A 9-year-old boy incidentally undergoes radiography for mild shoulder pain, revealing a centrally located, well-circumscribed, purely lytic lesion in the proximal humeral metaphysis. An MRI demonstrates a single fluid-filled cavity with no fluid-fluid levels. During a diagnostic aspiration, clear yellow fluid is obtained. Which of the following is true regarding the biochemical fluid contents of this specific lesion?

A 19-year-old male presents with chronic, dull back pain that profoundly worsens at night. He notes that naproxen provides significant, albeit temporary, relief. CT scan reveals a 3.0 cm lytic defect in the posterior elements of L3, surrounded by extensive sclerosis. Histologically, the lesion consists of interconnecting woven bone trabeculae lined by prominent single layers of osteoblasts with a vascular stroma. Based on the overall presentation and imaging, what is the most likely diagnosis?

A 9-year-old girl presents with a pathologic fracture of the proximal femur with a "shepherd's crook" deformity. She also has precocious puberty and cafe-au-lait spots with irregular borders. The underlying pathophysiology involves a post-zygotic activating mutation in which of the following?

A 68-year-old woman presents with generalized bone pain, anemia, and hypercalcemia. Skeletal survey reveals multiple punched-out lytic lesions in the skull and pelvis. Which of the following lab findings is most likely present?

A 20-year-old male complains of severe nocturnal back pain relieved by NSAIDs. Imaging reveals a 2.5 cm lytic lesion with surrounding sclerosis in the posterior elements of L4. What makes this lesion most likely an osteoblastoma rather than an osteoid osteoma?

A 22-year-old male presents with a 6-month history of a dull, aching pain in his posterior thoracic spine that is not relieved by aspirin. CT imaging reveals a 3.5 cm expansile, radiolucent lesion in the T8 posterior elements. What is the most likely diagnosis?

A 14-year-old girl presents with a rapidly enlarging, painful mass in her proximal humerus. Radiographs show an eccentric, expansile radiolucent lesion. MRI demonstrates multiple fluid-fluid levels. If a primary neoplastic process is confirmed, which gene rearrangement is characteristic of this lesion?

An 18-year-old boy complains of nocturnal lower back pain that is completely relieved by ibuprofen. A CT scan reveals a 1 cm sclerotic lesion with a central radiolucent nidus in the L4 pedicle. What is the most appropriate initial minimally invasive treatment?

A 9-year-old boy experiences acute right shoulder pain after a minor fall. X-rays show a central, purely lytic lesion in the proximal humerus metaphysis extending to the physis, with a small piece of cortical bone resting at the dependent portion of the cyst. What is the most likely diagnosis?

A 35-year-old woman with an unresectable giant cell tumor of the sacrum is initiated on denosumab therapy. Which of the following best describes the expected histologic and radiographic response to this medication?

Which characteristic typically distinguishes Ewing's Sarcoma from osteosarcoma on a plain radiograph?

Which age group is most commonly affected by Aneurysmal Bone Cysts?

Which imaging modality is most sensitive for demonstrating the characteristic 'fluid-fluid levels' within an Aneurysmal Bone Cyst?

When distinguishing a primary Aneurysmal Bone Cyst from a Unicameral Bone Cyst (UBC), which feature is more typical of a primary ABC?

Which of the following locations for an Aneurysmal Bone Cyst is most challenging to treat surgically and often requires consideration of alternative or multi-modal therapies?