This practice set contains high-yield board review questions covering key concepts in Soft Tissue Tumors & Metastasis. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.
Question 101
Topic: Soft Tissue Tumors & Metastasis
A 45-year-old male is diagnosed with a 12 cm deep myxoid liposarcoma of the thigh. As part of his systemic staging workup, which of the following imaging modalities is uniquely indicated for this specific histologic subtype?
Correct Answer & Explanation
. MRI of the total spine
Explanation
Myxoid liposarcoma has a unique propensity to metastasize to extrapulmonary locations, particularly the spine and other bones. Total spine MRI is standard in the staging workup for this specific subtype.
Question 102
Topic: Soft Tissue Tumors & Metastasis
A 45-year-old woman with a history of progressive proximal muscle weakness and a heliotrope rash is diagnosed with adult-onset dermatomyositis. What is the most critical screening evaluation required for this adult patient that is not routinely indicated for juvenile dermatomyositis?
Correct Answer & Explanation
. Malignancy screening
Explanation
Adult-onset dermatomyositis has a strong association with underlying malignancies, particularly ovarian, lung, gastrointestinal, and breast cancers. Comprehensive malignancy screening is mandatory in adult patients.
Question 103
Topic: Soft Tissue Tumors & Metastasis
On a standard radiograph, the presence of multiple, uniform-sized, spherical calcified loose bodies within the joint capsule of the knee strongly suggests which of the following diagnoses?
Correct Answer & Explanation
. Primary synovial chondromatosis
Explanation
Primary synovial chondromatosis is characterized by the metaplasia of synovium leading to multiple intra-articular cartilaginous nodules that calcify. A key distinguishing feature from secondary synovial chondromatosis (due to osteoarthritis) is that the loose bodies in the primary form are numerous and uniform in size.
Question 104
Topic: Soft Tissue Tumors & Metastasis
Deep lipomas of the extremities are classified as intramuscular or intermuscular. Which of the following statements regarding intramuscular lipomas is true compared to their subcutaneous counterparts?
Correct Answer & Explanation
. They have a higher rate of local recurrence after marginal excision
Explanation
Intramuscular lipomas frequently infiltrate between muscle fibers, making complete enucleation more difficult. This leads to a higher local recurrence rate (up to 15%) compared to well-encapsulated subcutaneous lipomas.
Question 105
Topic: Soft Tissue Tumors & Metastasis
A 40-year-old male notes a slowly enlarging mass in his trapezius muscle. MRI reveals a well-defined mass with signal intensity identical to subcutaneous fat, interspersed with distinct, thick striations of skeletal muscle fibers. What is the most likely diagnosis?
Correct Answer & Explanation
. Intramuscular lipoma
Explanation
An intramuscular lipoma characteristically infiltrates between skeletal muscle bundles. On MRI, this appears as a predominately fatty mass with traversing linear striations representing entrapped muscle fibers, distinct from the thick septations seen in liposarcomas.
Question 106
Topic: Soft Tissue Tumors & Metastasis
A 22-year-old male undergoes a pelvic radiograph following a minor sports injury. The radiograph incidentally reveals numerous small, well-defined, symmetric sclerotic foci clustered around the periarticular regions of the pelvis and proximal femurs. He is completely asymptomatic. If this patient were to exhibit associated cutaneous manifestations, what would be the most likely finding?
The incidental radiographic finding of multiple small, symmetric sclerotic foci in periarticular regions is characteristic of Osteopoikilosis ('spotted bone disease'). It is an autosomal dominant condition often caused by mutations in the LEMD3 gene. When osteopoikilosis is associated with cutaneous lesions, specifically connective tissue nevi (dermatofibrosis lenticularis disseminata), the condition is known as Buschke-Ollendorff syndrome. Café-au-lait spots with smooth borders are seen in Neurofibromatosis type 1. Hemangiomas are seen in Maffucci syndrome. Sclerodermatous changes are seen in Melorheostosis.
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