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10. Pathology and Oncology MCQs

Practice Set 30 of 351

This practice set contains high-yield board review questions covering key concepts in 10. Pathology and Oncology. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 581

Topic: 10. Pathology and Oncology

A 40-year-old patient is diagnosed with a 9 cm well-differentiated liposarcoma (atypical lipomatous tumor) located in the subcutaneous tissue of the anterior abdominal wall. The tumor is completely resected with wide, negative margins. What is the most likely long-term outcome for this patient?

. High risk of distant metastasis to the lungs and bone.
. Significant risk of dedifferentiation into a high-grade sarcoma.
. Excellent prognosis with a very low risk of local recurrence and no metastatic potential.
. Requires long-term adjuvant chemotherapy due to high metastatic risk.
. High risk of local recurrence if not followed by adjuvant radiotherapy.

Correct Answer & Explanation

. Excellent prognosis with a very low risk of local recurrence and no metastatic potential.

Explanation

Correct Answer: CAcademic Rationale:Well-differentiated liposarcomas (ALT)located in the extremities or trunk wall (like the anterior abdominal wall in this case), when adequately excised with wide negative margins, have an excellent prognosis. These tumors are locally aggressive but do not metastasize unless they dedifferentiate, which is a rare event in extremity/trunk wall ALTs compared to retroperitoneal lesions. The primary risk is local recurrence if margins are inadequate, but with wide negative margins, this risk is significantly minimized. Therefore, the patient has a very good prognosis with a low risk of local recurrence and no metastatic potential. Adjuvant chemotherapy is not indicated, and while radiotherapy can be considered for close margins, it's not universally required for wide negative margins in this specific location and grade.

Question 582

Topic: 10. Pathology and Oncology

A 30-year-old female presents with a slowly growing, tender mass on her forearm. MRI confirms a fatty lesion with a prominent vascular component. Histology reveals mature adipocytes intermixed with numerous capillary-sized vessels. Which benign fatty tumor is most consistent with this presentation?

. Conventional lipoma
. Hibernoma
. Spindle cell lipoma
. Angiolipoma
. Pleomorphic lipoma

Correct Answer & Explanation

. Angiolipoma

Explanation

Correct Answer: DAcademic Rationale:Angiolipomasare benign lipomatous tumors characterized by a prominent vascular component (mature capillary-sized vessels) within the adipose tissue. A distinguishing clinical feature of angiolipomas, unlike conventional lipomas, is that they frequently present as painful or tender nodules. Conventional lipomas are typically painless. Hibernomas arise from brown fat. Spindle cell lipomas contain mature adipocytes and uniform spindle cells. Pleomorphic lipomas contain characteristic floret-type giant cells. The combination of a fatty lesion, prominent vascularity, and tenderness strongly points to angiolipoma.

Question 583

Topic: 10. Pathology and Oncology

For a newly diagnosed high-grade pleomorphic liposarcoma of the thigh, which imaging modality is most crucial for detecting distant metastases?

. Plain radiography of the affected limb
. Ultrasound of regional lymph nodes
. Magnetic Resonance Imaging (MRI) of the surgical bed
. Computed Tomography (CT) scan of the chest, abdomen, and pelvis
. Bone scan

Correct Answer & Explanation

. Computed Tomography (CT) scan of the chest, abdomen, and pelvis

Explanation

Correct Answer: DAcademic Rationale:High-grade soft tissue sarcomas, including pleomorphic liposarcoma, have a significant risk of distant metastasis. The most common site of distant metastasis for these tumors is the lungs. Therefore, aComputed Tomography (CT) scan of the chestis crucial for detecting pulmonary metastases. Depending on the primary site and specific metastatic patterns, a CT of the abdomen and pelvis may also be included to screen for other common metastatic sites. MRI of the surgical bed is essential for local staging and detecting local recurrence, but not for distant metastasis screening. Plain radiography and ultrasound of lymph nodes are generally not sufficient for comprehensive distant staging of high-grade sarcomas. Bone scans are reserved for suspected bone involvement.

Question 584

Topic: Soft Tissue Tumors & Metastasis

Which subtype of liposarcoma is particularly known for its high radiosensitivity, making radiation therapy a crucial component of its multidisciplinary management?

. Well-differentiated liposarcoma
. Dedifferentiated liposarcoma
. Myxoid liposarcoma
. Pleomorphic liposarcoma
. Spindle cell lipoma

Correct Answer & Explanation

. Myxoid liposarcoma

Explanation

Correct Answer: CAcademic Rationale:Myxoid liposarcomais uniquely recognized among soft tissue sarcomas for its relative sensitivity to both chemotherapy and, more notably, radiation therapy. This characteristic makes radiotherapy a crucial component of its management, often utilized in neoadjuvant (pre-operative) or adjuvant (post-operative) settings to improve local control and facilitate limb salvage. While radiation therapy is used for other high-grade sarcomas, myxoid liposarcoma shows a particularly favorable response. Well-differentiated liposarcoma is less radiosensitive, and while dedifferentiated and pleomorphic liposarcomas are high-grade, myxoid liposarcoma stands out for its specific radiosensitivity.

Question 585

Topic: 10. Pathology and Oncology
A patient presents with multiple subcutaneous lipomas, epidermoid cysts, osteomas of the mandible, and a history of desmoid tumors. This constellation of findings is most suggestive of which genetic syndrome?
. Neurofibromatosis Type 1
. Li-Fraumeni Syndrome
. Gardner Syndrome
. Multiple Endocrine Neoplasia Type 2A
. Von Hippel-Lindau Disease

Correct Answer & Explanation

. Gardner Syndrome

Explanation

Gardner Syndrome is an autosomal dominant disorder, a variant of Familial Adenomatous Polyposis (FAP), characterized by intestinal polyps with a high risk of malignant transformation to colorectal cancer. Its extracolonic manifestations are key to its diagnosis and include multiple osteomas (especially of the mandible and skull), epidermoid cysts, desmoid tumors (aggressive fibromatosis), and various soft tissue tumors, including lipomas and fibromas. Neurofibromatosis Type 1 is associated with neurofibromas and café-au-lait spots. Li-Fraumeni Syndrome is a cancer predisposition syndrome. Multiple Endocrine Neoplasia Type 2A involves endocrine tumors. Von Hippel-Lindau Disease is associated with hemangioblastomas and renal cell carcinoma.

Question 586

Topic: 10. Pathology and Oncology

A 12-year-old boy presents with a 2-month history of worsening left thigh pain. Radiographs show a permeative, diaphyseal lytic lesion of the femur with a laminated periosteal reaction. Biopsy reveals small round blue cells. Which chromosomal translocation is most characteristically associated with this patient's diagnosis?

. t(11;22)
. t(9;22)
. t(12;16)
. t(X;18)
. t(2;13)

Correct Answer & Explanation

. t(11;22)

Explanation

The clinical presentation and histology are classic for Ewing sarcoma. The t(11;22) translocation, resulting in the EWS-FLI1 fusion protein, is present in over 85% of Ewing sarcoma cases.

Question 587

Topic: 10. Pathology and Oncology

A 15-year-old girl is diagnosed with a conventional intramedullary osteosarcoma of the distal femur. She completes a 10-week course of neoadjuvant chemotherapy followed by wide surgical resection. Which of the following is the most important prognostic factor for her long-term survival?

. Tumor size at initial presentation
. Specific histologic subtype of conventional osteosarcoma
. Percentage of tumor necrosis following neoadjuvant chemotherapy
. Baseline alkaline phosphatase level
. Patient age at diagnosis

Correct Answer & Explanation

. Percentage of tumor necrosis following neoadjuvant chemotherapy

Explanation

The most significant prognostic factor in conventional high-grade osteosarcoma is the histologic response to neoadjuvant chemotherapy. Greater than 90% tumor necrosis is considered a good response and correlates with improved long-term survival.

Question 588

Topic: 10. Pathology and Oncology

A 55-year-old male presents with persistent right shoulder pain. Radiographs show a lytic lesion in the proximal humerus with intralesional stippled calcifications. Biopsy confirms high-grade conventional chondrosarcoma. What is the most appropriate definitive treatment?

. Radiation therapy alone
. Systemic chemotherapy followed by radiation
. Neoadjuvant chemotherapy and intralesional curettage
. Wide surgical resection
. Intralesional curettage with cementation

Correct Answer & Explanation

. Wide surgical resection

Explanation

Conventional chondrosarcoma is notably resistant to both chemotherapy and radiation therapy. The mainstay of treatment for intermediate to high-grade lesions is wide surgical resection with negative margins.

Question 589

Topic: 10. Pathology and Oncology

A 62-year-old female with a history of breast cancer presents with a metastatic lesion in her proximal femur. When applying Mirels' criteria to determine the need for prophylactic internal fixation, which of the following characteristics scores the maximum 3 points?

. Upper extremity location
. Blastic nature of the lesion
. Size less than 1/3 of the cortical diameter
. Peritrochanteric location
. Mild functional pain

Correct Answer & Explanation

. Peritrochanteric location

Explanation

Mirels' scoring system evaluates Site, Nature, Size, and Pain on a 1 to 3 scale. A peritrochanteric location is considered the highest risk for fracture in the Site category and is awarded 3 points.

Question 590

Topic: 10. Pathology and Oncology

A 68-year-old male complains of severe back pain and fatigue. Labs show hypercalcemia, renal insufficiency, and anemia. Radiographs show multiple punched-out lytic lesions in his skull and vertebral bodies. A bone marrow biopsy is expected to show an abnormal proliferation of which cell type?

. Osteoclasts
. Plasma cells
. Chondrocytes
. Langerhans cells
. Lymphoblasts

Correct Answer & Explanation

. Plasma cells

Explanation

The clinical picture describes Multiple Myeloma, which is characterized by the CRAB criteria (Calcium elevation, Renal failure, Anemia, Bone lesions). The underlying pathology is a malignant proliferation of monoclonal plasma cells in the bone marrow.

Question 591

Topic: Bone Tumors

An 18-year-old male reports persistent deep shin pain that is significantly worse at night and rapidly relieved by ibuprofen. Imaging shows a 1.2 cm radiolucent nidus surrounded by dense sclerotic bone in the proximal tibial diaphysis. What is the most common minimally invasive treatment if conservative management fails?

. Cryotherapy
. En bloc surgical resection
. Radiofrequency ablation
. Intralesional corticosteroid injection
. External beam radiation

Correct Answer & Explanation

. Radiofrequency ablation

Explanation

The presentation is classic for an osteoid osteoma (nidus <1.5 cm, nocturnal pain relieved by NSAIDs). If medical management fails or the patient prefers definitive treatment, CT-guided radiofrequency ablation is the gold standard minimally invasive treatment.

Question 592

Topic: Bone Tumors

A 9-year-old boy presents with a pathologic fracture of the proximal humerus after a minor fall. Radiographs show a centrally located, lytic, expansile metaphyseal lesion with a dependent cortical fragment visible within the cavity. Which fluid is most likely to be obtained upon aspiration of this lesion?

. Purulent material
. Gross, unclotting blood
. Clear or serosanguinous fluid
. Chylous fluid
. Thick, viscous synovial fluid

Correct Answer & Explanation

. Clear or serosanguinous fluid

Explanation

The dependent cortical fragment is the fallen leaf sign, pathognomonic for a Unicameral Bone Cyst (UBC). Aspiration of a UBC typically yields clear or slightly serosanguinous fluid, distinguishing it from an aneurysmal bone cyst (ABC) which yields unclotting blood.

Question 593

Topic: 10. Pathology and Oncology

A 25-year-old male presents with a slowly enlarging, deep soft tissue mass near his knee joint. MRI shows a heterogeneous mass adjacent to the joint capsule, and biopsy confirms synovial sarcoma. Which cytogenetic abnormality is diagnostic for this tumor?

. t(11;22)
. t(X;18)
. t(12;16)
. t(9;22)
. t(2;13)

Correct Answer & Explanation

. t(X;18)

Explanation

Synovial sarcoma is characterized by the t(X;18)(p11;q11) chromosomal translocation. This creates the pathognomonic SYT-SSX fusion gene. Despite its name, it rarely arises directly from within the intra-articular synovium.

Question 594

Topic: 10. Pathology and Oncology

A 14-year-old boy presents with progressive, deep knee pain. Radiographs show a sunburst periosteal reaction in the distal femur. Biopsy confirms high-grade osteosarcoma. What is the most appropriate initial treatment?

. Neoadjuvant chemotherapy followed by wide surgical resection
. Immediate wide surgical resection followed by adjuvant chemotherapy
. Definitive radiation therapy
. Amputation followed by radiation
. Intralesional curettage and cementation

Correct Answer & Explanation

. Neoadjuvant chemotherapy followed by wide surgical resection

Explanation

High-grade osteosarcoma is treated with neoadjuvant chemotherapy, followed by wide surgical resection and adjuvant chemotherapy. This approach allows for the assessment of tumor necrosis, which is a critical prognostic indicator.

Question 595

Topic: 10. Pathology and Oncology

A 55-year-old man complains of progressive shoulder pain. Radiographs reveal a lytic lesion in the proximal humerus with intralesional "popcorn" calcifications and endosteal scalloping. Biopsy confirms a grade II chondrosarcoma. What is the most appropriate management?

. Neoadjuvant chemotherapy and wide resection
. Intralesional curettage with phenol and cement
. Wide surgical resection alone
. Radiation therapy alone
. Observation with serial imaging

Correct Answer & Explanation

. Wide surgical resection alone

Explanation

Intermediate to high-grade chondrosarcomas are relatively chemoresistant and radioresistant. The treatment of choice is wide surgical resection to minimize local recurrence.

Question 596

Topic: 10. Pathology and Oncology

A 9-year-old boy presents with a diaphyseal femur lesion showing an "onion skin" periosteal reaction. Biopsy confirms small blue round cells. Which of the following translocations is most characteristic of this tumor?

. t(11;22)
. t(9;22)
. t(X;18)
. t(12;16)
. t(2;13)

Correct Answer & Explanation

. t(11;22)

Explanation

Ewing sarcoma is classically characterized by the t(11;22)(q24;q12) translocation. This translocation results in the EWS-FLI1 fusion protein, a key molecular diagnostic marker.

Question 597

Topic: 10. Pathology and Oncology

A 70-year-old man with advanced prostate cancer presents with severe mid-back pain. Radiographs reveal a blastic lesion at T8. Laboratory evaluation is most likely to show an elevation of which of the following?

. Serum calcium
. Prostate-specific antigen and alkaline phosphatase
. Parathyroid hormone
. Serum protein electrophoresis M-spike
. Alpha-fetoprotein

Correct Answer & Explanation

. Prostate-specific antigen and alkaline phosphatase

Explanation

Metastatic prostate cancer typically produces osteoblastic bone lesions, which lead to an elevation in alkaline phosphatase. Prostate-specific antigen (PSA) will also be elevated given his primary diagnosis.

Question 598

Topic: Bone Tumors

A 20-year-old male reports right thigh pain worse at night and relieved by NSAIDs. CT scan shows a 7 mm radiolucent nidus surrounded by dense sclerosis in the proximal femur. Which of the following is the most appropriate definitive minimally invasive treatment?

. Observation alone
. Intralesional curettage and bone grafting
. Radiofrequency ablation
. Wide local excision
. External beam radiation

Correct Answer & Explanation

. Radiofrequency ablation

Explanation

The clinical and radiographic presentation is classic for an osteoid osteoma. Radiofrequency ablation is the gold standard minimally invasive definitive treatment, offering high success rates with low morbidity.

Question 599

Topic: Bone Tumors

A 62-year-old female presents with bone pain. Radiographs show multiple punched-out lytic lesions in her skull. Lab tests show hypercalcemia and anemia. Which diagnostic test is most specific for confirming the suspected underlying systemic diagnosis?

. Serum alkaline phosphatase level
. Bone scintigraphy (bone scan)
. Serum and urine protein electrophoresis
. Erythrocyte sedimentation rate
. C-reactive protein

Correct Answer & Explanation

. Serum and urine protein electrophoresis

Explanation

The presentation is classic for multiple myeloma (hypercalcemia, renal failure, anemia, and bone lesions). Serum and urine protein electrophoresis identifying a monoclonal spike (M-protein) is essential for diagnosis.

Question 600

Topic: 10. Pathology and Oncology

A 45-year-old man undergoes wide excision of a 10 cm high-grade pleomorphic sarcoma in his anterior thigh. Pathology reveals a 1 mm margin of normal tissue covered by intact deep fascia over the tumor. How is this margin classified oncologically?

. Intralesional
. Marginal
. Wide
. Radical
. Contaminated

Correct Answer & Explanation

. Wide

Explanation

A wide margin is defined by an intact cuff of normal tissue surrounding the entire tumor. When a robust anatomical barrier like intact deep fascia is present, even a physically narrow margin is considered oncologically wide.

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