10. Pathology and Oncology MCQs

Which of the following primary carcinomas is most notorious for producing highly vascular, purely lytic osseous metastases that are largely resistant to radiation therapy, making wide resection or stabilization the preferred management?

A 24-year-old female presents with a painless, slow-growing mass on the posterior aspect of her distal femur. Radiographs reveal a heavily ossified, lobulated mass on the cortical surface with a radiolucent cleft separating the tumor from the underlying cortex. What is the most likely diagnosis?

A 14-year-old boy undergoes neoadjuvant chemotherapy followed by wide resection for a conventional high-grade osteosarcoma of the distal femur. Which of the following factors provides the most important prognostic information for his long-term survival?

A 12-year-old girl presents with a painful, swollen mid-thigh. Radiographs show a permeative diaphyseal lesion with an "onion-skin" periosteal reaction. A biopsy reveals sheets of uniform, small blue round cells. Which of the following genetic translocations is most characteristic of this diagnosis?

A 65-year-old man presents with deep, persistent pelvic pain. Radiographs reveal a large, ill-defined destructive lesion in the ilium with "ring and arc" calcifications. Core needle biopsy confirms a grade 2 conventional chondrosarcoma. What is the most appropriate primary treatment modality?

A 35-year-old man with a known history of Neurofibromatosis type 1 reports that a long-standing, palpable mass in his thigh has recently doubled in size and become exquisitely painful. MRI shows an enlarging, heterogeneous mass along the sciatic nerve. What is the most likely diagnosis?

When performing an incisional biopsy of a suspected primary malignant bone tumor in the distal femur, which of the following is an absolute surgical principle?

A 16-year-old boy presents with knee pain. Radiographs reveal a metaphyseal permeative lesion in the distal femur with a 'sunburst' periosteal reaction. What is the most important prognostic factor for his long-term survival following neoadjuvant chemotherapy and wide resection?

A 12-year-old boy presents with a diaphyseal femur mass, fever, and elevated ESR. Radiographs show an 'onion-skin' periosteal reaction. Cytogenetics reveal a t(11;22) translocation. Which fusion protein is characteristic of this tumor?

A 14-year-old boy complains of right thigh pain that is worse at night and dramatically relieved by ibuprofen. CT scan shows a 7 mm radiolucent nidus surrounded by dense sclerosis in the femoral diaphysis. What is the primary mediator responsible for his specific pain pattern?

A 55-year-old man presents with an enlarging, painful mass in his proximal femur. Radiographs show a lytic lesion with 'popcorn' calcifications and endosteal scalloping. What is the standard of care for a conventional high-grade chondrosarcoma?

A 12-year-old boy presents with thigh pain and fever. Radiographs show a permeative diaphyseal lesion with an 'onion skin' periosteal reaction. A core needle biopsy is performed. Which of the following cytogenetic abnormalities is most characteristic of this diagnosis?

A 35-year-old male with a known diagnosis of Neurofibromatosis Type 1 reports rapid enlargement and new onset of severe, rest pain in a pre-existing plexiform neurofibroma in his thigh.

What is the most appropriate next step to evaluate for malignant transformation?

A 55-year-old male presents with shoulder pain. Radiographs reveal a large, destructive lesion in the proximal humerus with intralesional 'popcorn' calcifications. Biopsy confirms a grade 2 conventional chondrosarcoma. What is the most appropriate definitive management?

A 22-year-old male presents with dull, aching pain in his mid-back that is not significantly relieved by ibuprofen. Imaging shows a 3.5 cm lytic lesion with central mineralization in the posterior elements of T8. Histology demonstrates interlacing trabeculae of woven bone lined by prominent osteoblasts. What is the most likely diagnosis?

Which of the following accurately describes the genetic etiology of Neurofibromatosis Type 1 (NF1)?

A 35-year-old male presents with a rapidly expanding, painful mass in his left thigh. He has a known history of NF1 and multiple plexiform neurofibromas. Biopsy reveals a high-grade spindle cell sarcoma. Which of the following is the most likely diagnosis?

In the evaluation of primary pediatric bone tumors, which of the following cytogenetic abnormalities is considered pathognomonic for Ewing Sarcoma?

A 28-year-old woman presents with a lytic lesion in the distal femoral epiphysis extending to the subchondral bone. Biopsy shows mononuclear stromal cells and multinucleated giant cells. Which targeted therapy is most appropriate for extensive, unresectable disease?