10. Pathology and Oncology MCQs

A 60-year-old male presents with dull right hip pain. Radiographs show a large lytic lesion with 'popcorn' calcifications in the right ilium. Biopsy confirms a grade II chondrosarcoma. What is the mainstay of treatment for this condition?

A 16-year-old male complains of severe, aching thigh pain that is worse at night and dramatically relieved by NSAIDs. Radiographs demonstrate a 1-cm radiolucent nidus surrounded by dense sclerotic bone in the femoral diaphysis. What is the preferred definitive treatment if medical management fails?

A 65-year-old woman presents with severe back pain. Radiographs reveal multiple punched-out lytic lesions in the skull and a compression fracture of L2. Laboratory workup shows hypercalcemia and a monoclonal spike. What is the most common primary bone malignancy in this age group?

A 14-year-old boy is diagnosed with conventional high-grade osteosarcoma of the distal femur. Genetic testing reveals a mutation in the TP53 gene. Which of the following syndromes is most closely associated with this patient's diagnosis?

A 12-year-old girl presents with a destructive diaphyseal lesion of her tibia with an associated "onion-skin" periosteal reaction. A biopsy is performed, and molecular analysis demonstrates a t(11;22) chromosomal translocation. Which of the following fusion proteins is highly specific to this tumor?

A 15-year-old male is suspected of having an osteosarcoma of the proximal tibia. A core needle biopsy is planned. To adhere to standard orthopedic oncology principles and avoid compromising definitive limb-salvage surgery, which of the following is an absolute requirement for the biopsy tract?

A 25-year-old male presents with a slow-growing, deep mass near his knee. Biopsy reveals a biphasic pattern of epithelial and spindle cells. Which of the following cytogenetic abnormalities is pathognomonic for this tumor?

A 45-year-old male complains of knee pain, swelling, and mechanical locking. Radiographs show multiple intra-articular radiopaque bodies of uniform size.

What is the primary underlying pathophysiology of this condition?

A 35-year-old female undergoes marginal excision of a large intramuscular mass in her anterior thigh. Pathology reveals myxoid stroma, a prominent capillary network, and lipoblasts. Which genetic abnormality is most likely present in this tumor?

A 22-year-old male presents with a painless, ulcerating nodule on his volar forearm that has been enlarging over several months. It was initially excised under the presumed diagnosis of a ganglion cyst but rapidly recurred. Immunohistochemistry of the lesion is expected to show loss of expression of which of the following markers?

While most soft tissue sarcomas metastasize hematogenously to the lungs, a specific subset has a higher propensity for regional lymph node metastasis. Which of the following soft tissue tumors requires the most vigilant clinical examination of regional lymph nodes?

In the multidisciplinary management of a high-grade soft tissue sarcoma of the extremity, a decision is made to utilize preoperative rather than postoperative radiation therapy.

What is the primary disadvantage of this specific approach?

A 28-year-old female presents with a slow-growing right thigh mass and new-onset focal seizures. Brain MRI demonstrates multiple contrast-enhancing lesions. Which soft tissue sarcoma is notoriously associated with early brain metastases despite a relatively small primary tumor?

A 32-year-old female notes a deep palpable mass in her abdominal wall. Biopsy reveals uniform spindle cells in a collagenous stroma without nuclear atypia, and immunohistochemistry is strongly positive for nuclear beta-catenin. What is the most appropriate initial systemic therapy if the mass is symptomatic and progressively enlarging?

A 50-year-old patient undergoes a diagnostic core needle biopsy for a suspicious 8 cm deep mass in the vastus lateralis.

Which of the following principles MUST be adhered to during the biopsy?

A 60-year-old male undergoes excision of a large, deep fatty mass in his thigh. The pathologist must differentiate between a deep lipoma and an atypical lipomatous tumor. Amplification of which of the following genes confirms the diagnosis of an atypical lipomatous tumor?

A 6-year-old boy presents with a rapidly expanding mass in his forearm. Biopsy confirms an alveolar rhabdomyosarcoma. Which of the following best describes the typical fusion gene associated with this specific histologic subtype?

A patient with a 10-year history of known stable primary synovial chondromatosis of the hip presents with rapid onset of severe resting pain and cortical bone erosion on radiographs. What is the most likely complication driving these new symptoms?

A 65-year-old woman presents with a rapidly growing mass in her left axilla. She had breast-conserving surgery and localized radiation therapy for breast cancer 12 years ago. Biopsy reveals a high-grade undifferentiated pleomorphic sarcoma. According to Cahan's criteria, which of the following is essential for diagnosing a radiation-induced sarcoma?