10. Pathology and Oncology MCQs

A 12-year-old boy presents with a painful, swollen thigh and low-grade fever. Radiographs show a permeative diaphyseal lesion with an 'onion skin' periosteal reaction. Which of the following cytogenetic abnormalities is most characteristic of this tumor?

A 16-year-old boy presents with nocturnal back pain relieved by NSAIDs. Imaging reveals a 7mm intracortical nidus in the lamina of L4, located 4 mm from the traversing L4 nerve root. Which of the following is the most appropriate definitive management?

An adult patient with a known solitary enchondroma of the proximal humerus presents with new-onset, progressive pain at rest. Imaging reveals endosteal scalloping greater than two-thirds of the cortical thickness and cortical breakthrough. What is the most likely diagnosis?

A 32-year-old female presents with knee pain. Radiographs show an eccentric, lytic epiphyseal lesion in the distal femur.

Biopsy confirms multinucleated giant cells interspersed among mononuclear cells. Which genetic mutation is highly specific and diagnostic for this neoplasm?

A 45-year-old asymptomatic male has an incidental finding on a knee radiograph obtained after minor trauma.

The lesion is centrally located in the metaphysis, demonstrating stippled calcification without cortical destruction or periosteal reaction. What is the most appropriate next step in management?

A 12-year-old boy presents with localized pain, fever, and weight loss. Radiographs reveal a permeative lesion in the femoral diaphysis with an "onion-skin" periosteal reaction. Cytogenetic testing reveals a t(11;22) translocation. Which fusion protein is most commonly produced by this genetic alteration?

A 16-year-old male complains of chronic hip pain. Radiographs reveal a 2 cm well-circumscribed, lytic lesion in the greater trochanter apophysis with fine matrix calcifications. Histology shows polygonal mononuclear cells with clefted nuclei and "chicken-wire" calcification. What is the standard treatment?

A 14-year-old male with multiple painless, bony bumps around his knees and shoulders is diagnosed with Multiple Hereditary Exostoses (MHE). He asks about his risk of malignant transformation. The highest risk is malignant transformation into which of the following?

A 19-year-old male presents with severe nocturnal pain in the proximal tibia that is completely relieved by oral ibuprofen. Imaging shows a 1.2 cm radiolucent nidus surrounded by thick cortical sclerosis. Which specific cell type is primarily responsible for the excessive prostaglandin E2 (PGE2) production in this lesion?

A 15-year-old female presents with a rapidly enlarging, painful mass in her distal radius. Radiographs show an eccentric, expansile lytic lesion with a thin "eggshell" cortex. MRI reveals multiple fluid-fluid levels. Which genetic rearrangement is highly characteristic of the primary form of this lesion?

A 16-year-old male is undergoing treatment for conventional high-grade osteosarcoma of the distal femur. After completing neoadjuvant chemotherapy, wide surgical resection is performed. Which of the following histologic findings in the resected specimen is the most important predictor of long-term survival?

A 45-year-old asymptomatic male undergoes a shoulder radiograph following mild trauma, revealing a well-defined intramedullary lesion with punctate calcifications in the proximal humerus.

There is no endosteal scalloping or cortical breakthrough. What is the most appropriate management?

A 60-year-old male presents with a painful, destructive lesion in his distal femur.

Biopsy confirms Primary Bone Lymphoma (Diffuse Large B-Cell type). Which of the following clinical factors portends the most favorable prognosis in this patient?

A 12-year-old male presents with a mixed lytic and sclerotic metaphyseal lesion of the distal femur with a 'sunburst' periosteal reaction. He has a history of poikiloderma, sparse hair, and bilateral cataracts. Which gene mutation is most likely responsible for his underlying syndrome?

A 14-year-old male presents with severe mid-thigh pain, swelling, and low-grade fever. Radiographs show a permeative diaphyseal lesion with an 'onion-skin' periosteal reaction. Molecular testing of the biopsy specimen is most likely to reveal which of the following translocations?

A 16-year-old male complains of chronic right knee pain. Radiographs show a 2 cm eccentric, purely lytic lesion in the proximal tibial epiphysis with a thin sclerotic rim. Histological examination shows mononuclear cells with grooved nuclei and areas of pericellular 'chicken-wire' calcification. What is the most likely diagnosis?

A 60-year-old male presents with worsening thigh pain over several months. Radiographs demonstrate a permeative, poorly marginated radiolucent lesion in the femoral diaphysis.

MRI reveals extensive soft tissue and marrow involvement that appears vastly out of proportion to the subtle cortical destruction. What is the most likely diagnosis?

A 50-year-old male presents with deep thigh pain. Radiographs demonstrate a poorly defined, permeative lytic lesion in the femoral diaphysis with minimal cortical destruction. MRI reveals extensive marrow replacement and a large surrounding soft tissue mass.

Which of the following statements best describes primary lymphoma of bone compared to other primary bone malignancies?

An 18-year-old male presents with rapid onset of pain and swelling over his distal thigh following minor trauma. Radiographs reveal a purely lytic, expansile metaphyseal lesion with cortical destruction. Biopsy shows blood-filled cystic spaces separated by septa containing highly pleomorphic spindle cells and fine, lace-like osteoid. What is the most likely diagnosis?