Bone Tumors MCQs

A 68-year-old man presents with severe lower back pain, fatigue, and recent onset of renal impairment. Radiographs demonstrate multiple sharply marginated "punched-out" lytic lesions in the skull and spine.

Which of the following is most commonly detected in the urine of patients with this condition?

A 25-year-old woman presents with a Shepherd's crook deformity of the proximal femur. Radiographs display a large intramedullary lesion with a "ground-glass" appearance. She is diagnosed with fibrous dysplasia, which is caused by a somatic activating mutation in the GNAS gene. What is the direct intracellular consequence of this mutation?

An 18-year-old male complains of deep, aching pain in his right thigh that is worse at night and dramatically relieved by ibuprofen. Radiographs reveal a 1 cm radiolucent nidus surrounded by intense reactive sclerosis in the femoral diaphysis. What is the most common anatomic location for this type of lesion?

A 45-year-old female presents with persistent, deep right shoulder pain. Radiographs reveal a 5 cm radiolucent lesion with stippled calcifications in the proximal humerus. MRI shows endosteal scalloping involving 80% of the cortical thickness. What is the most likely diagnosis?

A 16-year-old male is diagnosed with an osteoblastic osteosarcoma of the distal femur. What is the most sensitive imaging modality for detecting 'skip metastases' within the same bone?

Recent genomic profiling has identified specific somatic mutations that are highly prevalent in solitary enchondromas, central chondrosarcomas, and syndromic enchondromatosis. Which of the following mutations is most characteristically involved?

A 15-year-old male complains of chronic knee pain. Radiographs reveal an eccentric, lytic lesion in the distal femoral epiphysis that crosses an open physis. Histology shows polygonal cells with grooved nuclei and fine, pericellular calcifications. What is the diagnosis?

A 14-year-old girl is diagnosed with a conventional high-grade intramedullary osteosarcoma of the distal femur. What is the standard neoadjuvant chemotherapy regimen utilized to improve survival and prevent metastasis?

A 26-year-old woman is evaluated for a localized mass on the surface of her proximal tibia. Radiographs reveal saucerization of the underlying cortex and a sclerotic margin.

Which radiographic feature best differentiates this lesion from a periosteal osteosarcoma?

A 45-year-old asymptomatic woman undergoes knee radiography for mild osteoarthritis. An incidental 3-cm lobulated, calcified metaphyseal lesion is found in the distal femur. MRI demonstrates lobular hyperintensity on T2-weighted images without cortical breakthrough or soft tissue extension. Which genetic mutation is most commonly associated with this specific tumor's pathogenesis?

A 40-year-old female presents with shoulder pain. Radiographs reveal a purely lytic lesion confined to the epiphysis of the proximal humerus. Histology demonstrates cells with abundant clear cytoplasm, distinct borders, and scattered multinucleated giant cells within a cartilaginous background. What is the most likely diagnosis?

A 24-year-old male presents with a mildly painful palpable mass on the proximal humerus. Radiographs reveal a surface lesion with cortical saucerization and a sclerotic periosteal reaction at the proximal and distal margins.

What is the most likely diagnosis?

An asymptomatic 35-year-old woman has a hand radiograph taken after a minor sprain, revealing the lesion shown.

Recent molecular studies show that solitary lesions of this type are most strongly associated with somatic mutations in which of the following genes?

A 24-year-old male presents with a painless palpable mass on the proximal humerus. Radiographs show a surface-based radiolucent lesion with a well-defined sclerotic border and overhanging cortical edges. Which of the following radiographic features best differentiates this lesion from a juxtacortical (periosteal) chondrosarcoma?

A 42-year-old woman presents with persistent hip pain. Radiographs demonstrate an expansile, lytic epiphyseal lesion in the proximal femur with sharp margins. Histologic evaluation shows cells with abundant clear cytoplasm and distinct cell membranes intermixed with areas of reactive bone formation. What is the most likely diagnosis?

A 20-year-old male presents with chronic knee pain. Imaging reveals an eccentric, purely lytic lesion in the proximal tibial metaphysis with a well-demarcated sclerotic margin. Histology shows lobules of stellate and spindle-shaped cells in a myxoid background, with an increased concentration of cells at the periphery of the lobules. What is the diagnosis?

A 14-year-old boy completes neoadjuvant chemotherapy and wide resection for a distal femur osteosarcoma. Two years later, a surveillance chest CT reveals three new, unilateral peripheral lung nodules (largest 1.5 cm) with no other evidence of disease. What is the most appropriate next step in management?

A 16-year-old girl undergoes radiographic evaluation after a minor fall, revealing an incidental proximal femoral lesion (Figure A). A biopsy is performed (Figure B). The histologic presence of spicules of woven bone without osteoblastic rimming in a bland fibrous stroma is pathognomonic for which of the following conditions?

A 23-year-old man presents with right posterolateral knee pain that is worse at night and relieved by NSAIDs. Imaging and histology are shown. The histologic specimen demonstrates a nidus of vascular, cellular stroma with immature woven bone trabeculae. What is the currently preferred minimally invasive treatment for this lesion?