10. Pathology and Oncology MCQs

A 40-year-old male undergoes a core needle biopsy for a suspected soft tissue sarcoma in the anterior compartment of the thigh. To minimize the risk of tumor seeding and optimize definitive oncologic resection, which of the following biopsy techniques is strictly required?

Molecular analysis of a typical epiphyseal chondroblastoma from a 14-year-old patient is most likely to reveal a somatic mutation in which of the following histone genes?

A 32-year-old female presents with a progressively enlarging, painful desmoid tumor of the shoulder girdle that is not amenable to function-preserving surgery. She has failed initial observation. What novel, FDA-approved gamma-secretase inhibitor represents a targeted systemic treatment option for this patient?

A 23-year-old female presents with a highly vascular, slow-growing mass in her right gluteal region. Staging imaging unexpectedly reveals multiple pulmonary nodules and a solitary brain metastasis. Biopsy of the primary tumor shows large cells with eosinophilic granular cytoplasm arranged in a pseudoalveolar pattern. What is the most likely diagnosis?

Which of the following soft tissue sarcomas has the highest propensity for regional lymph node metastasis?

A 65-year-old female presents with an enlarging, hard mass in her right axilla and chest wall. She underwent a lumpectomy and local radiation therapy for breast cancer 12 years ago. Core biopsy reveals a high-grade spindle cell proliferation with marked pleomorphism. What is the most common histologic subtype of post-radiation sarcoma in this setting?

A patient with a high-grade soft tissue sarcoma of the extremity is deciding between preoperative and postoperative radiation therapy. According to randomized clinical trials (e.g., O'Sullivan et al.), what complication is significantly more common with postoperative radiation therapy compared to preoperative radiation?

When evaluating the necessity of surgical margins for the treatment of extra-abdominal desmoid fibromatosis, current evidence indicates that:

A 72-year-old female presents with chronic, severe lymphedema of her left arm secondary to radical mastectomy and axillary node dissection 15 years prior. She recently developed multiple raised, purplish, ulcerating nodules on the affected arm. What is the most likely diagnosis?

In adult soft tissue sarcomas of the extremities, which of the following is considered the single most important prognostic factor for distant metastasis and overall survival?

A 34-year-old female presents with progressive pain and a slowly enlarging mass in the deep posterior thigh. MRI reveals an infiltrative, poorly marginated soft tissue mass encasing the sciatic nerve. A core needle biopsy is performed, and histologic examination demonstrates a uniform proliferation of spindle cells lacking atypia in a dense collagenous stroma. Active observation is initially selected, but 6 months later, serial MRI shows 30% enlargement of the mass and the patient reports worsening neuropathic pain. Given the anticipated high functional morbidity of surgical resection, systemic medical therapy is planned. Based on phase III randomized trial data, which of the following agents is most appropriate to improve progression-free survival in this specific condition?

A 9-year-old boy presents with chronic ankle pain and stiffness. The MRI and CT scans of his hindfoot are provided below. Based on the imaging findings demonstrating a lesion arising from the epiphysis, what is the most likely histological diagnosis of this mass?

Dysplasia epiphysealis hemimelica (DEH) shares identical histological features with which of the following benign bone tumors, and how is it primarily distinguished from it clinically and radiographically?

A 5-year-old boy is being evaluated for a hard, asymmetrical mass around his knee. Radiographs are obtained. Which of the following radiographic findings is most characteristic of Dysplasia Epiphysealis Hemimelica?

A 7-year-old boy presents with the clinical finding shown below. Radiographs reveal an underlying epiphyseal lesion. Histological examination of this mass would most likely reveal features identical to which of the following conditions?

Review the provided MRI and CT images of a pediatric patient's ankle. What is the primary anatomical feature that distinguishes this specific pathology from a solitary osteochondroma?

The sagittal MRI provided demonstrates a mass protruding from the distal femoral epiphysis into the popliteal fossa. In the context of Dysplasia Epiphysealis Hemimelica, what is the fundamental etiology of this condition?

A 7-year-old boy presents with the clinical finding shown below. Palpation reveals a painless, bone-hard swelling. Based on the most likely diagnosis, what is the histological appearance of this lesion most similar to?

A 10-year-old male presents with aching pain and limited knee range of motion. The lateral radiograph and sagittal MRI are shown below. The mass protrudes into the popliteal fossa. From which specific anatomical region does this pathology primarily arise?

When evaluating a child with suspected Dysplasia Epiphysealis Hemimelica (DEH), what is the classic radiographic hallmark observed in the affected joint?