10. Pathology and Oncology MCQs

A 14-year-old boy presents with a destructive diaphyseal lesion in the femur with an associated large soft tissue mass. Biopsy reveals sheets of uniform small round blue cells. Which chromosomal translocation is most characteristically associated with this pathology?

A 60-year-old female presents with a destructive, highly vascular bone lesion in her proximal humerus. Biopsy confirms metastatic follicular thyroid carcinoma. Which of the following preoperative interventions is most critical to perform 24 to 48 hours prior to prophylactic internal fixation?

A 25-year-old male presents with a painless mass near his knee. Biopsy reveals a biphasic tumor with both epithelial and spindle cell components. Molecular testing is ordered. Which of the following chromosomal translocations is diagnostic for this malignancy?

In the Enneking surgical staging system for malignant musculoskeletal tumors, what specific parameter distinguishes a Stage IIB lesion from a Stage IIA lesion?

A 15-year-old boy presents with a destructive permeative diaphyseal lesion of the femur with an associated soft tissue mass. Biopsy reveals sheets of small round blue cells. Which chromosomal translocation is most characteristic of this tumor?

According to Enneking's staging system for benign musculoskeletal tumors, which of the following accurately describes a Stage 3 lesion?

A 10-year-old boy presents with thigh pain after a minor fall. Radiographs show a transverse fracture through a purely lytic, centrally located metadiaphyseal lesion of the femur with cortical thinning. What is the most likely underlying diagnosis?

A 10-year-old girl is brought in for a mild limp. Radiographs show a centrally located, lytic lesion in the proximal humerus metaphysis with a 'fallen leaf' sign. She has minimal pain after a minor fall. What is the most likely diagnosis?

A 14-year-old boy presents with knee pain. Radiographs demonstrate a mixed lytic and sclerotic lesion in the distal femur metaphysis with cortical destruction and a 'sunburst' periosteal reaction.

Biopsy confirms high-grade intramedullary osteosarcoma. Which of the following genetic alterations is most consistently associated with this condition?

A 14-year-old boy presents with a painful mass in the diaphysis of the femur. Radiographs show a destructive permeative lesion with a 'onion-skin' periosteal reaction. Biopsy reveals small round blue cells. Cytogenetic analysis demonstrates a t(11;22) translocation. Which of the following fusion proteins is primarily responsible for the pathogenesis of this tumor?

A 16-year-old boy presents with severe right thigh pain that is distinctly worse at night and dramatically relieved by taking ibuprofen. Radiographs reveal a cortical thickening with a small 8 mm radiolucent nidus in the diaphysis of the femur. If a trial of conservative medical management fails, what is the most appropriate definitive treatment?

A 22-year-old female presents with a painless, slow-growing soft tissue mass in her popliteal fossa. MRI reveals a well-circumscribed, multilobulated mass intimately associated with an adjacent tendon sheath. Core needle biopsy demonstrates a biphasic cellular pattern consisting of epithelial-like cells and spindle cells. Which of the following chromosomal translocations is diagnostic for this neoplasm?

A 16-year-old male presents with severe right thigh pain that is uniquely worse at night and dramatically relieved by ibuprofen. Radiographs demonstrate a radiolucent nidus surrounded by dense reactive sclerosis in the proximal femur. Which of the following inflammatory mediators is produced in high levels by this lesion and is responsible for the classic clinical presentation?

A 9-year-old girl presents with a painful mass in her proximal tibia. Radiographs show a destructive, permeative lytic lesion in the diaphysis with an "onion-skin" periosteal reaction. A biopsy is performed. Which of the following translocations is most characteristic of this tumor?

A 65-year-old man presents with back pain, fatigue, and renal insufficiency. Radiographs show a "punched-out" lytic lesion in his L4 vertebral body. Serum protein electrophoresis reveals an M-spike. Which of the following is the most appropriate next step in confirming the diagnosis?

A 15-year-old boy presents with severe, progressive night pain in his distal femur. Radiographs reveal a poorly marginated, destructive diaphyseal lesion with a lamellated 'onion-skin' periosteal reaction. Biopsy demonstrates uniform, small round blue cells. Cytogenetic analysis is most likely to demonstrate which of the following translocations?

A 12-year-old female is undergoing standard neo-adjuvant chemotherapy for a high-grade conventional osteosarcoma of the distal femur. Her multidisciplinary regimen includes high-dose Methotrexate, Doxorubicin, and Cisplatin (MAP protocol). Two months into treatment, she acutely develops bilateral sensorineural hearing loss and ringing in her ears. Which of the following chemotherapeutic agents is most likely directly responsible for this specific toxicity?

A 28-year-old male presents with a deep-seated, slowly enlarging mass in the soft tissues of his distal thigh. Core needle biopsy reveals a biphasic tumor consisting of spindle cells and epithelial glandular structures. Cytogenetic analysis is most likely to reveal which of the following translocations?

A 55-year-old male presents with a painful mass in his proximal humerus. Plain radiographs demonstrate an intramedullary lytic lesion with cortical destruction and an internal matrix mineralization pattern described as "rings and arcs" or "popcorn-like."

This matrix pattern is most characteristic of which type of tissue?