10. Pathology and Oncology MCQs

A 14-year-old boy presents with progressive knee pain. Radiographs show a mixed lytic and sclerotic lesion in the distal femoral metaphysis with a Codman triangle. Biopsy confirms high-grade osteosarcoma. What is the most significant prognostic factor for long-term survival in this patient?

A 16-year-old male presents with distal femur pain and a periosteal "sunburst" reaction on plain radiographs. Biopsy confirms high-grade intramedullary osteosarcoma. What is the most significant prognostic factor for long-term survival in this patient?

A 15-year-old boy presents with knee pain. Radiographs reveal a mixed lytic and sclerotic lesion in the distal femoral metaphysis with a Codman triangle. A biopsy confirms conventional high-grade osteosarcoma. Which of the following is the most important prognostic factor for this patient?

A biopsy of a destructive diaphyseal bone lesion in an 8-year-old boy shows sheets of small round blue cells. Cytogenetic analysis reveals a t(11;22)(q24;q12) translocation. Which fusion gene product is most likely responsible for the pathogenesis of this tumor?

A 25-year-old male presents with a slow-growing, painful mass in the plantar aspect of his foot. Biopsy reveals a biphasic spindle cell neoplasm. Which of the following chromosomal translocations is most characteristic of this tumor?

A 55-year-old male presents with a transverse fracture of the tibial shaft after a minor fall. Laboratory results show normal serum calcium, normal phosphorus, and markedly elevated alkaline phosphatase. Which of the following is the most likely underlying condition?

A 14-year-old male presents with knee pain. Imaging reveals a permeative, destructive metaphyseal lesion in the distal femur with a classic 'sunburst' periosteal reaction. Genetic analysis of this patient's tumor cells is most likely to reveal an inactivating mutation in which of the following tumor suppressor genes?

A 15-year-old boy presents with a destructive diaphyseal lesion of the femur and a large soft tissue mass. Biopsy reveals small round blue cells. Cytogenetic analysis is most likely to reveal which of the following translocations?

A 25-year-old male presents with a deep, slow-growing soft tissue mass in his foot. Biopsy reveals a biphasic pattern of spindle and epithelial cells. Which of the following chromosomal translocations is most strongly associated with this diagnosis?

A 16-year-old male is diagnosed with high-grade osteosarcoma of the distal femur. Staging CT chest reveals multiple small pulmonary nodules consistent with metastatic disease. Biopsy confirms classic osteosarcoma histology. What is the most appropriate initial management approach?

A 15-year-old boy presents with a painful mass in his distal femur. Biopsy reveals small round blue cells with positive CD99 staining. Which of the following chromosomal translocations is most characteristic of this diagnosis?

A 72-year-old man with a known history of Paget's disease of the bone presents with new-onset, severe, and unrelenting pain in his right humerus. Radiographs demonstrate a destructive, lytic lesion with cortical breakthrough. What is the most likely pathological diagnosis?

A 14-year-old boy presents with severe night pain in his right mid-thigh. Radiographs reveal a diaphyseal destructive lesion with an 'onion-skin' periosteal reaction. A biopsy is performed. Which of the following chromosomal translocations is most characteristic of this tumor?

A 65-year-old male presents with severe back pain, fatigue, and recent onset of renal insufficiency. Radiographs show multiple 'punched-out' lytic lesions in the skull and pelvis. Which laboratory test is most diagnostic for his underlying condition?

A 15-year-old boy presents with worsening knee pain. Radiographs demonstrate a destructive, bone-forming lesion in the distal femoral metaphysis with a 'sunburst' periosteal reaction. Genetic analysis of this tumor is most likely to reveal a mutation in which of the following?

A 12-year-old boy presents with a painful, swollen thigh. Radiographs show a permeative diaphyseal lesion in the femur with an 'onion-skin' periosteal reaction. Biopsy reveals uniform small round blue cells. Cytogenetic analysis is most likely to demonstrate which of the following translocations?

A 62-year-old male presents with persistent mid-back pain, worsening fatigue, and laboratory evidence of hypercalcemia and anemia. Radiographs demonstrate a 'punched-out' lytic lesion in the L3 vertebral body. Serum protein electrophoresis shows a monoclonal M-spike. This primary bone lesion represents a malignant proliferation of which cell type?

A 15-year-old boy presents with knee pain. Radiographs reveal a mixed lytic and sclerotic lesion in the distal femoral metaphysis with periosteal elevation forming a Codman triangle. A biopsy shows pleomorphic spindle cells producing immature osteoid. Which of the following genetic alterations is most highly associated with this pathology?

A 14-year-old boy presents with a painful mass in the mid-diaphysis of his femur. Radiographs show a permeative, destructive lesion with an 'onion-skin' periosteal reaction. A biopsy confirms a small round blue cell tumor. Which of the following chromosomal translocations is most characteristic of this diagnosis?

A 32-year-old female presents with knee pain. Radiographs reveal an eccentric, lytic, epiphyseal lesion extending to the subchondral bone of the distal femur. Biopsy shows mononuclear cells and multinucleated giant cells. What is the most appropriate initial treatment for a localized, non-metastatic lesion without impending fracture?