10. Pathology and Oncology MCQs

A 15-year-old boy presents with knee pain. Radiographs reveal a well-circumscribed, eccentrically located lytic lesion with sclerotic margins in the epiphysis of the distal femur. Histology shows polygonal mononuclear cells with longitudinal nuclear grooves and scattered multinucleated giant cells. What is the most likely diagnosis?

Which specific chromosomal translocation is pathognomonic for synovial sarcoma?

Which of the following genetic mutations is most frequently identified in patients with central chondrosarcoma and is also considered a hallmark of multiple enchondromatosis (Ollier disease and Maffucci syndrome)?

An 11-year-old boy presents with a painful mass in the diaphysis of the femur. Biopsy reveals small round blue cells. Cytogenetic analysis is pending. Which of the following chromosomal translocations is most characteristic of this tumor and what is the corresponding fusion gene product?

A 68-year-old male presents with severe back pain. Radiographs reveal multiple punched-out lytic lesions in the skull and a compression fracture of L2. Laboratory tests show hypercalcemia and elevated total protein. Which of the following tests is most definitive for confirming the underlying diagnosis?

A 12-year-old boy presents with a permeative lytic lesion in the diaphysis of the femur with an associated 'onion-skin' periosteal reaction. Biopsy reveals small round blue cells. The most likely diagnosis is associated with a fusion gene resulting from which of the following chromosomal translocations?

Which of the following bone tumors is characterized as a low-grade, surface-originating malignancy that is heavily ossified, commonly arises on the posterior aspect of the distal femur, and frequently exhibits amplification of MDM2 and CDK4?

A 25-year-old female presents with a painless, slow-growing mass on the posterior aspect of her distal thigh. Radiographs demonstrate a dense, lobulated, ossified mass attached to the posterior cortex of the distal femur with a 'string sign' visible at its base. Histology reveals low-grade spindle cells with well-formed bony trabeculae. Which of the following cytogenetic abnormalities is most characteristic of this lesion?

A 35-year-old male presents with chronic hip pain. Radiographs reveal a radiolucent lesion strictly contained within the epiphysis of the proximal femur with subtle intralesional calcifications. Histology shows cells with abundant clear cytoplasm, well-defined borders, and interspersed areas of mature bone formation. Which of the following is the most likely diagnosis?

A 14-year-old boy presents with right knee pain. Radiographs reveal a well-circumscribed, eccentrically located lytic lesion with a sclerotic rim in the proximal tibial epiphysis. Biopsy demonstrates mononuclear cells with longitudinal nuclear grooves and pericellular 'chicken-wire' calcifications. What is the most likely diagnosis?

A 25-year-old male presents with a slow-growing, painful mass adjacent to his left knee joint, clearly outside the joint capsule on MRI. Histological evaluation of a biopsy reveals a biphasic tumor comprised of spindle cells and epithelial cells. Molecular testing demonstrates a t(X;18)(p11;q11) translocation. What is the most accurate diagnosis?

A 14-year-old male presents with a painful, swollen thigh. Radiographs show a permeative, diaphyseal lesion with an 'onion skin' periosteal reaction. A biopsy is performed. Which of the following cytogenetic abnormalities is most characteristic of this patient's likely diagnosis?

A 14-year-old boy presents with severe bone pain in his right thigh. Radiographs reveal a diaphyseal lytic lesion with an 'onion skin' periosteal reaction. Biopsy confirms Ewing sarcoma. Which of the following chromosomal translocations is the classic genetic hallmark of this tumor?

A 62-year-old woman with a history of breast cancer presents with moderate thigh pain. Radiographs reveal a purely lytic lesion in the femoral diaphysis that occupies approximately half (1/2) of the bone diameter. Using Mirels' criteria, what is her score, and what is the recommended management?

A 28-year-old male presents with a slowly enlarging, painful mass near his knee joint. MRI shows a soft tissue mass adjacent to, but not within, the joint space. Biopsy reveals a biphasic pattern of epithelial and spindle cells. Which chromosomal translocation is highly diagnostic for this tumor?

Which of the following benign conditions carries the highest risk of undergoing malignant transformation into a secondary chondrosarcoma?

A 14-year-old boy presents with an aggressive, permeative diaphyseal lesion of the right femur with an 'onion-skin' periosteal reaction. A core needle biopsy confirms Ewing sarcoma. Which of the following specific chromosomal translocations is most frequently associated with this diagnosis?

A 28-year-old female presents with a palpable, painless mass behind her right knee. Radiographs demonstrate a heavily ossified, dense mass arising from the posterior cortex of the distal femur. A distinct radiolucent cleft is seen between portions of the mass and the underlying cortex ('string sign'). Histological evaluation reveals low-grade fibroblastic spindle cells with well-formed woven bone trabeculae. What is the most common genetic molecular abnormality associated with this tumor?

Which of the following radiographic and advanced imaging features is the hallmark 'classic' presentation of a dedifferentiated chondrosarcoma?

A 14-year-old boy presents with a permeative lytic lesion in the femoral diaphysis with an associated soft tissue mass. Biopsy reveals small round blue cells. Cytogenetic analysis is most likely to show which of the following translocations?