10. Pathology and Oncology MCQs

A 55-year-old male presents with a progressively enlarging, painful mass in his proximal femur. Biopsy confirms conventional high-grade chondrosarcoma. Which of the following best describes the optimal treatment strategy for this patient?

A 14-year-old boy is diagnosed with Ewing sarcoma of the diaphysis of the femur. Cytogenetic analysis reveals the classic t(11;22) translocation. The resulting EWS-FLI1 fusion gene produces which of the following?

A 60-year-old male presents with back pain, anemia, renal insufficiency, and hypercalcemia. Radiographs demonstrate multiple 'punched-out' lytic lesions in his skull and pelvis. Which of the following is the most common primary malignant bone tumor in this age group?

A 65-year-old male presents with a massive, purely lytic lesion in the proximal humerus. Biopsy reveals nests of clear cells with a rich capillary network. Preoperative selective arterial embolization is highly recommended before any prophylactic stabilization. What is the most likely primary malignancy?

A 65-year-old man with a history of increasing hat size and hearing loss presents with new, severe pain in his right thigh. Radiographs of the femur show a new, destructive, lytic lesion with cortical breakthrough in an area of thickened, sclerotic bone. What is the most likely diagnosis of this new lesion?

A 10-year-old boy is evaluated for multiple bony bumps around his knees and ankles. Radiographs show multiple pedunculated and sessile osteochondromas pointing away from the joint spaces. He is diagnosed with Multiple Hereditary Exostoses (MHE). The mutated genes (EXT1 and EXT2) in this condition are normally responsible for the synthesis of:

During a routine scoliotic curve correction in a 13-year-old boy, the anesthesiologist notes a sudden rise in end-tidal CO2, tachycardia, and severe muscle rigidity. The patient's temperature is rapidly increasing. The underlying cellular defect involves an abnormal release of calcium from the:

A 16-year-old male presents with severe nocturnal thigh pain that is completely and rapidly relieved by ibuprofen. Imaging reveals a 1 cm radiolucent nidus surrounded by dense reactive sclerosis in the femoral cortex. The profound response to NSAIDs in this specific condition is directly attributed to the intralesional production of:

A 14-year-old boy presents with a diaphyseal femur lesion with an associated large soft tissue mass. Biopsy reveals small round blue cells. Which of the following chromosomal translocations is most characteristic of this pathology?

A 16-year-old boy is diagnosed with a conventional high-grade osteosarcoma of the distal femur. A mutation in the Rb1 gene is identified. The normal wild-type retinoblastoma (Rb) protein functions primarily to regulate the cell cycle by binding and inhibiting which of the following transcription factors?

What is the most significant prognostic factor for overall survival in a 14-year-old patient diagnosed with a high-grade intramedullary osteosarcoma of the distal femur?

A 10-year-old boy presents with a painful, swollen mid-thigh. Radiographs show a permeative diaphyseal lesion with an 'onion-skin' periosteal reaction. Biopsy reveals small round blue cells. Which chromosomal translocation is classically associated with this tumor?

A 25-year-old male presents with a slow-growing, painful mass in his left foot. A biopsy reveals a biphasic tumor with both spindle cells and epithelial cells. Molecular analysis of this tissue is most likely to reveal which of the following chromosomal translocations?

An 18-year-old male presents with persistent night pain in his proximal thigh that is dramatically relieved by oral ibuprofen. CT scan shows a 7 mm radiolucent nidus surrounded by reactive sclerosis. The dramatic pain relief with NSAIDs is due to high intralesional concentrations of which of the following?

A 12-year-old boy presents with a painful, permeative diaphyseal lesion in his femur with an 'onion skin' periosteal reaction. Molecular analysis confirms Ewing sarcoma. The specific fusion protein (EWS-FLI1) associated with this tumor involves a transcription factor belonging to which family?

Multiple Hereditary Exostoses (MHE) is an autosomal dominant skeletal dysplasia characterized by multiple osteochondromas. This condition is most commonly caused by loss-of-function mutations in which pair of genes?

A 10-year-old boy presents with a diaphyseal destructive bone lesion of the femur with a prominent "onion skin" periosteal reaction. Biopsy reveals small round blue cells. Cytogenetic analysis is most likely to demonstrate which of the following translocations?

A 65-year-old male is diagnosed with a conventional grade II chondrosarcoma of the proximal humerus. What is the most appropriate definitive management strategy for this lesion?

A 10-year-old boy presents with an aggressive diaphyseal lesion of the femur demonstrating an "onion skin" periosteal reaction. Cytogenetics reveal a t(11;22) translocation. What is the most likely fusion protein resulting from this translocation?

A 12-year-old boy presents with a diaphyseal femur lesion exhibiting an "onion-skin" periosteal reaction. Biopsy shows small round blue cells. Which of the following chromosomal translocations is most characteristic of this diagnosis?