10. Pathology and Oncology MCQs

A 22-year-old male with chronic hip pain and stiffness shows poor response to NSAIDs. Radiographs reveal a small radiolucency in the intracapsular femoral neck with very minimal surrounding sclerosis.

Why do intra-articular osteoid osteomas typically lack the extensive, dense reactive bone sclerosis seen in extra-articular diaphyseal lesions?

An 18-year-old male presents with persistent right anterior thigh pain that worsens at night. He reports significant relief of symptoms within 30 minutes of taking ibuprofen. Radiographs and a subsequent CT scan demonstrate a 1 cm radiolucent nidus surrounded by dense sclerotic bone in the femoral diaphysis.

If the patient cannot tolerate long-term NSAID therapy, what is the most appropriate first-line definitive intervention?

A 14-year-old boy presents with progressive knee pain and a palpable mass over the distal femur. Radiographs reveal a mixed lytic and sclerotic lesion with a sunburst periosteal reaction and a Codman's triangle. Core needle biopsy confirms a high-grade intramedullary osteosarcoma. Following neoadjuvant chemotherapy and wide surgical resection, which of the following is the single most important prognostic factor for long-term survival?

An 11-year-old boy presents with fever, weight loss, and severe thigh pain. Radiographs show a large destructive diaphyseal lesion in the femur with a multi-layered "onion-skin" periosteal reaction. Cytogenetic analysis of the biopsy specimen reveals a t(11;22)(q24;q12) chromosomal translocation. This translocation results in the formation of which of the following fusion genes?

A 62-year-old male complains of a dull, deep ache in his right pelvis for the past 6 months. Radiographs reveal a large, ill-defined destructive lytic lesion in the right ilium with internal "ring and arc" calcifications. Core biopsy confirms a Grade 2 conventional chondrosarcoma. What is the most appropriate management strategy?

An 18-year-old male with Multiple Hereditary Exostoses (MHE) reports a rapid increase in the size of a palpable mass on his proximal femur accompanied by new, resting pain. MRI shows an osteochondroma with a cartilage cap thickness of 3 cm. Malignant transformation in this syndrome most frequently results in which of the following histological entities?

A 22-year-old male undergoes surgical excision of a cortically based bone lesion in his tibia. He had a long history of night pain dramatically relieved by salicylates.

Histologic examination of the central nidus of this lesion is most likely to demonstrate which of the following?

A 15-year-old boy complains of diaphyseal tibial pain that is significantly worse at night and reliably relieved by ibuprofen. Imaging demonstrates a radiolucent nidus with dense surrounding sclerosis.

What is the primary chemical mediator responsible for the severe pain associated with this lesion?

A 14-year-old boy presents with a painful diaphyseal femur mass, low-grade fever, and an elevated ESR. Radiographs demonstrate an ill-defined permeative lesion with a prominent "onion skin" periosteal reaction. Cytogenetic analysis of the biopsy is most likely to identify which of the following?

A 16-year-old male presents with severe, painful, and rigid scoliosis. Advanced imaging reveals a small radiolucent nidus with dense surrounding sclerosis in the posterior elements of the T8 vertebra.

In relation to the scoliotic curve, where is this lesion almost universally located?

A 55-year-old male presents with a progressive, dull ache in his left pelvis. Radiographs show a large lytic lesion in the ilium with internal "popcorn-like" stippled calcifications. Biopsy confirms a grade II (intermediate) chondrosarcoma. What is the primary modality of treatment?

A 16-year-old male presents with severe nocturnal thigh pain that resolves with ibuprofen. Radiographs and CT reveal a cortically based lesion in the proximal femur with a central radiolucency.

If this lesion were excised, what classic histologic feature would confirm the diagnosis?

A 65-year-old man undergoes resection of a large pelvic mass showing popcorn calcifications on radiographs. Histology confirms a low-grade malignant cartilage-forming tumor. Which of the following genetic mutations is most frequently associated with the conventional form of this tumor?

A 12-year-old boy presents with fever, weight loss, and mid-shaft femur pain. Radiographs reveal a permeative diaphyseal lesion with an onion-skin periosteal reaction. A t(11;22) chromosomal translocation is identified. What is the most specific immunohistochemical marker for this neoplasm?

A 16-year-old female presents with pain in her proximal tibia. MRI reveals an expansile, multiloculated lesion with prominent fluid-fluid levels. Genetic analysis confirms a translocation involving t(16;17). Which gene is upregulated as a result of this translocation?

A 10-year-old boy with multiple painless bony bumps around his knees and shoulders is diagnosed with Multiple Hereditary Exostoses (MHE). What is the underlying molecular pathogenesis resulting from the most common genetic mutations in this disorder?

A 15-year-old boy completes neoadjuvant chemotherapy followed by wide surgical resection for a high-grade conventional osteosarcoma of the distal femur. Pathological evaluation of the resected specimen is performed. Which of the following findings is the most significant predictor of long-term survival?

A 14-year-old male presents with a painful spinal deformity that is worse at night. Imaging reveals an osteoid osteoma in the right T10 lamina. Which of the following best describes the typical curve pattern and natural history of his scoliosis following definitive radiofrequency ablation of the nidus?

A 45-year-old male presents with a slowly enlarging, painless mass on the volar aspect of his forearm. Excisional biopsy reveals a well-encapsulated tumor with alternating hypercellular and hypocellular regions. The hypercellular regions feature spindle cells with palisading nuclei. What is the classic name for these palisading nuclear arrangements?