10. Pathology and Oncology MCQs

Which of the following cell types is not typically found in giant cell tumors of tendon sheath:

A 19-year-old male presents with severe, aching pain in his mid-tibia that classically worsens at night. He reports complete relief of symptoms within 30 minutes of taking aspirin. Radiographs reveal a cortical lucency surrounded by sclerosis. The central nidus of this lesion predominantly secretes high levels of which biochemical mediator?

A 14-year-old boy presents with a destructive metaphyseal lesion of the distal femur with a sunburst periosteal reaction. Biopsy confirms conventional osteosarcoma. Following neoadjuvant chemotherapy, what is the most significant prognostic factor for long-term survival?

A 32-year-old woman presents with knee pain. Radiographs show an eccentric, lytic epiphyseal lesion in the distal femur. Biopsy reveals mononuclear cells and multinucleated giant cells.

What is the most appropriate definitive management?

A 12-year-old boy presents with progressive knee pain and swelling. Radiographs show a destructive, permeative metaphyseal lesion in the distal femur with a "sunburst" periosteal reaction and Codman's triangle. Histological examination reveals malignant spindle cells producing osteoid matrix. What is the most likely diagnosis?

A 60-year-old man presents with progressive deep pelvic pain. Radiographs reveal a large, lobulated lytic lesion in the ilium with "popcorn" stippled calcifications. Biopsy demonstrates a hyaline cartilage matrix with atypical chondrocytes. What is the mainstay of treatment for conventional low-grade chondrosarcoma of the pelvis?

The most common bone tumor of the upper extremity is:

The most common benign bone tumor of the hand is:

Osteochondromas are benign but can have a malignant transformation in which of the following cases:

The risk of malignant transformation in patients with multiple hereditary exostoses is:

Recurrence of osteochondroma is likely if:

Malignant transformation of osteochondroma commonly occurs to:

All of the following suggest a possibility of malignant transformation in multiple hereditary exostoses except:

A 12-year-old boy is brought to the clinic by his concerned parents. The boy's forearm is bowed, and his parents are confused as to the possible diagnosis and treatment options. You notice that the right forearm of the child is bowed ulnarwards and is shorter compared to the left forearm. The pronosupination is markedly decreased on the right side but is also limited on the left side. The patient has a good grip, pinch, and grasp. He is neurologically intact as well. The parents say that they first noticed the deformity around 6 or 7 years ago, and the mother informs you that she had noticed a hard bump on the forearm. She has recently noticed another bump on his right leg. The child does not complain of pain and is using both of his hands quite well. The parents were informed by a previous physician that the child has Madelung's deformity and are concerned that the disease is now involving other areas of his body. You order a radiograph of the forearm. The anteroposterior radiograph is shown (Slide 1). The child's skeletal radiograph survey is also presented (Slide 2 and Slide 3). Which of the following areas is unlikely to be involved:

A 12-year-old boy is brought to the clinic by his concerned parents. The boy's forearm is bowed, and his parents are confused as to the possible diagnosis and treatment options. You notice that the right forearm of the child is bowed ulnarwards and is shorter compared to the left forearm. The pronosupination is markedly decreased on the right side but is also limited on the left side. The patient has a good grip, pinch, and grasp. He is neurologically intact as well. The parents say that they first noticed the deformity around 6 or 7 years ago, and the mother informs you that she had noticed a hard bump on the forearm. She has recently noticed another bump on his right leg. The child does not complain of pain and is using both of his hands quite well. The parents were informed by a previous physician that the child has Madelung's deformity and are concerned that the disease is now involving other areas of his body. You order a radiograph of the forearm. The anteroposterior radiograph is shown (Slide 1). The child's skeletal radiograph survey is also presented (Slide 2 and Slide 3). The most likely complication in this child is:

A 12-year-old boy is brought to the clinic by his concerned parents. The boy's forearm is bowed, and his parents are confused as to the possible diagnosis and treatment options. You notice that the right forearm of the child is bowed ulnarwards and is shorter compared to the left forearm. The pronosupination is markedly decreased on the right side but is also limited on the left side. The patient has a good grip, pinch, and grasp. He is neurologically intact as well. The parents say that they first noticed the deformity around 6 or 7 years ago, and the mother informs you that she had noticed a hard bump on the forearm. She has recently noticed another bump on his right leg. The child does not complain of pain and is using both of his hands quite well. The parents were informed by a previous physician that the child has Madelung's deformity and are concerned that the disease is now involving other areas of his body. You order a radiograph of the forearm. The anteroposterior radiograph is shown (Slide 1). The child's skeletal radiograph survey is also presented (Slide 2 and Slide 3). Which of the following is not true regarding the possibility of malignant degeneration in this child:

A 25-year-old male presents with knee pain. Radiographs show an eccentric, expansile, purely lytic lesion in the distal femoral epiphysis. Biopsy reveals multinucleated giant cells. Which genetic mutation is highly sensitive and specific for this tumor?

Which of the following clinical or pathologic findings represents the most significant adverse prognostic factor for overall survival in a 16-year-old patient diagnosed with high-grade intramedullary osteosarcoma of the distal femur?

Which of the following bone tumors is characterized histologically by a proliferation of mononuclear cells and multinucleated giant cells, frequently harboring an H3F3A gene mutation?

A 30-year-old black woman presents with complaints of pain in the tip of her right index finger. The pain started approximately 6 months ago and becomes intense in cold weather. She also states that her nail on the index finger does not look as good as the others despite regular manicures. You notice a bluish discoloration and ridging of the nail. The nail is not split, but it appears clubbed. The patient does not have a history of respiratory or hemodynamic disease and appears healthy. The nail is exquisitely tender on pressure, but no mass is palpable. Two-point discrimination is intact and capillary refill is good. Radiographs do not reveal bony destruction, but you notice pressure indentation over the distal phalanx. The joint space is preserved, and the patient has full range of motion. The most likely diagnosis is: