10. Pathology and Oncology MCQs

A 40-year-old patient presents with pain in the proximal humerus. MRI shows a cartilaginous lesion. Which of the following MRI findings most strongly supports a diagnosis of low-grade chondrosarcoma rather than a benign enchondroma?

A 30-year-old female presents with dull aching in her distal femur. Imaging shows an ill-defined, sclerotic, intramedullary lesion. Biopsy reveals woven bone stroma lacking osteoblastic rimming, forming a permeative pattern. Which of the following is an absolute contraindication for limb-salvage surgery in this disease?

A 12-year-old boy presents with a permeative, diaphyseal lesion in his femur with a periosteal 'onion-skin' reaction. A biopsy is performed. Which specific chromosomal translocation is most strongly associated with this tumor?

A 15-year-old male is diagnosed with conventional high-grade osteosarcoma of the distal femur. He undergoes 10 weeks of neoadjuvant chemotherapy followed by wide surgical resection. Pathologic analysis of the resected tumor is performed. Which of the following is the most significant prognostic factor for long-term survival?

A 55-year-old male presents with a proximal humerus lesion displaying characteristic 'rings and arcs' of calcification on radiographs. Biopsy confirms a grade 2 chondrosarcoma. What is the most appropriate definitive management?

An 18-year-old male complains of deep, aching pain in his proximal femur that is worse at night and dramatically relieved by ibuprofen. Imaging shows a 1 cm radiolucent nidus surrounded by dense reactive sclerosis. The pain is primarily mediated by high local concentrations of which of the following?

When evaluating a cartilaginous lesion in the distal femur of a 45-year-old patient, which radiographic feature most strongly suggests a low-grade chondrosarcoma rather than a benign enchondroma?

A 58-year-old male presents with a painful, destructive osteolytic lesion in the distal phalanx of his right thumb. Biopsy confirms metastatic adenocarcinoma. What is the most common primary malignancy to metastasize to locations distal to the knee or elbow (acrometastasis)?

A 16-year-old boy presents with progressive right thigh pain that is noticeably worse at night and dramatically relieved by taking ibuprofen. Radiographs demonstrate a diaphyseal cortical thickening with a central radiolucent nidus measuring 8 mm. Which of the following is the most likely diagnosis?

A 14-year-old boy is diagnosed with a permeative diaphyseal lesion of the femur with an 'onion-skin' periosteal reaction. Biopsy confirms small round blue cells. Which of the following chromosomal translocations is most characteristic of this tumor?

A 55-year-old male presents with a painful, enlarging mass in his proximal femur. Radiographs show a destructive lytic lesion with 'popcorn' intralesional calcifications. Biopsy confirms a grade II conventional chondrosarcoma. What is the most appropriate primary management?

A 28-year-old female presents with an expansile, purely lytic epiphyseal lesion of the distal femur extending to the subchondral bone. Biopsy confirms a Giant Cell Tumor. If the tumor is deemed surgically unresectable due to its size and location, which of the following pharmacological agents is most appropriate to downstage the tumor?

A 15-year-old male is suspected of having an osteosarcoma of the distal femur. A core needle biopsy is planned. Which of the following is a critical orthopedic oncology principle regarding the placement of the biopsy tract?

A 9-year-old boy sustains a minor fall and presents with arm pain. Radiographs reveal a central, purely radiolucent metaphyseal lesion in the proximal humerus with a cortical fragment resting at the bottom of the cyst. What is the most likely diagnosis?

A 65-year-old male presents with generalized bone pain, fatigue, and renal insufficiency. Radiographs of the skull and pelvis demonstrate numerous 'punched-out' purely lytic lesions without reactive sclerosis. What is the most common primary malignant bone tumor in this age group?

A 12-year-old girl presents with knee pain. MRI of the distal femur demonstrates an eccentric, expansile metaphyseal lesion containing multiple cystic spaces with distinct fluid-fluid levels. Histology shows blood-filled spaces separated by cellular septa. What is the most likely diagnosis?

A 22-year-old patient presents with multiple palpable, hard masses on his hands and severe deformities. Imaging reveals multiple enchondromas. Physical examination also reveals numerous bluish soft tissue nodules which are identified as hemangiomas. What is the diagnosis?

A 35-year-old male with a known long-standing asymptomatic distal femoral osteochondroma presents with new-onset, progressive pain and enlargement of the mass. An MRI is performed. Which of the following findings is most highly suspicious for secondary malignant transformation to a chondrosarcoma?

In the management of high-grade intramedullary osteosarcoma, which of the following factors is considered the most significant predictor of overall patient survival?

A 35-year-old female presents with knee pain. Radiographs show an eccentric, lytic lesion in the distal femur extending to the subchondral bone. Biopsy confirms Giant Cell Tumor (GCT). If medical management is considered prior to intralesional curettage to downstage the tumor, which agent is most appropriate?