10. Pathology and Oncology MCQs

A 9-year-old boy sustains a pathologic fracture through a centrally located, lytic bone lesion in the proximal humerus. The lesion exhibits the 'fallen leaf sign' on radiographs. After the fracture heals, the lesion persists. What is the best initial surgical management?

A 60-year-old woman with a history of multiple myeloma presents with progressively worsening back pain and new-onset lower extremity weakness. MRI demonstrates a T8 vertebral body metastatic lesion with epidural spinal cord compression. She has no mechanical instability. According to the NOMS framework, what is the best initial treatment?

A 60-year-old man with metastatic renal cell carcinoma presents with mechanical back pain. MRI shows a solitary L2 vertebral metastasis with early epidural extension, but the epidural space is largely patent and there is no spinal cord compression. He is neurologically intact. According to the NOMS framework, how should this lesion best be managed?

A 58-year-old woman with a history of renal cell carcinoma presents with progressive paraparesis. MRI reveals a large metastatic lesion in the T8 vertebral body causing significant epidural spinal cord compression. What is the most appropriate management strategy?

A 62-year-old male presents with rapidly progressive paraparesis. Imaging reveals a solitary, large osteolytic metastatic lesion in the L2 vertebral body with severe epidural spinal cord compression. Biopsy confirms renal cell carcinoma. What is the most appropriate surgical management strategy?

A 60-year-old man with metastatic renal cell carcinoma to the T10 vertebra presents with intractable pain and early paraparesis. MRI shows epidural tumor with high-grade spinal cord compression. Given that renal cell carcinoma is radioresistant, what is the preferred treatment strategy prior to stereotactic body radiation therapy (SBRT)?

A 58-year-old man with a history of prostate cancer presents with severe, mechanically exacerbated back pain. Imaging reveals a lytic metastatic lesion in the L2 vertebral body involving the left pedicle and 60% of the vertebral body height, with a resulting 15-degree kyphosis. He is neurologically intact. According to the SINS criteria, this lesion is considered:

A 68-year-old man with a history of prostate cancer presents with progressively worsening back pain, which is worse at night. Thoracic spine MRI reveals an infiltrative lesion in the T8 vertebral body with posterior cortex destruction and mild epidural extension, but no cord compression. The neurological exam is intact. What is the most appropriate initial management?

A 60-year-old man with metastatic renal cell carcinoma presents with severe mechanical back pain and progressive lower extremity weakness. MRI demonstrates a T8 lytic lesion with high-grade epidural spinal cord compression. According to the NOMS framework, what is the most appropriate management?

A 60-year-old woman with breast cancer presents with progressive back pain and lower extremity weakness. MRI shows a metastatic lesion at T8 with high-grade epidural spinal cord compression. The tumor is historically highly radiosensitive. Based on the NOMS framework, what is the most appropriate initial management?

A 60-year-old male presents with a solitary lytic lesion in the L3 vertebral body, confirmed as metastatic renal cell carcinoma. Before proceeding with a palliative surgical decompression and stabilization, which adjunctive procedure is highly recommended?

A 60-year-old male presents with dull, aching lower back pain and bowel/bladder dysfunction. Imaging shows a destructive midline sacral mass with a large pre-sacral soft tissue component. Biopsy reveals physaliferous cells in a myxoid stroma. What is the most appropriate definitive surgical management?

Which of the following pathologic entities is classically associated with the "winking owl" sign on an anteroposterior (AP) plain radiograph of the thoracic spine?

A 45-year-old man presents with firm, painless, slow-growing nodules on the plantar aspect of his foot that cause discomfort only when walking in hard-soled shoes. Biopsy of a similar lesion previously showed benign fibroblastic proliferation. What is the most appropriate initial management?

A 40-year-old woman presents with burning pain in her forefoot radiating into the third and fourth toes. Squeezing the metatarsal heads together while applying plantar pressure reproduces the pain with a palpable click (Mulder's sign). Histological evaluation of the resected tissue in this condition most typically demonstrates:

A 45-year-old woman complains of burning pain in her forefoot that radiates into her third and fourth toes. Symptoms are exacerbated by wearing narrow, high-heeled shoes and relieved by removing the shoes and massaging the foot. Examination reveals a painful click when the forefoot is compressed laterally. Histologic evaluation of the excised lesion in this condition typically shows:

A 56-year-old poorly controlled diabetic patient presents with a red, hot, and swollen left foot. Radiographs show osteopenia but no frank fractures or dislocation. MRI reveals diffuse marrow edema in the cuboid and cuneiforms. Which of the following tests is considered the gold standard to differentiate acute Charcot arthropathy from osteomyelitis in this setting?

An 18-year-old male presents with a painful clunking and grating sensation beneath his right scapula with overhead movement. Physical therapy and injections have failed to provide relief. A CT scan of the chest and shoulder reveals a bony exostosis arising from the ventral surface of the scapula. What is the most likely underlying diagnosis?

A 32-year-old man presents with a slow-growing, painful mass in his left thigh. MRI shows a well-circumscribed soft tissue mass adjacent to the knee joint. Biopsy reveals a biphasic tumor with both epithelial and spindle cell components. Which of the following chromosomal translocations is diagnostic for this lesion?

A 40-year-old man presents with chronic shoulder pain. Radiographs reveal a lytic lesion with intralesional calcifications in the proximal humeral epiphysis. Biopsy shows malignant cells with abundant clear cytoplasm. Which of the following is true regarding this diagnosis?