10. Pathology and Oncology MCQs

A 10-year-old boy with a history of DEH of the ankle develops worsening pain. Serial radiographs are obtained. Which of the following is true regarding the risk of malignant transformation in DEH?

A 6-year-old child presents with a painless, restricted range of motion in the right ankle. An MRI is ordered to evaluate a suspected Dysplasia Epiphysealis Hemimelica (DEH) lesion of the talus. Which of the following MRI findings is most characteristic of this pathology?

A 9-year-old male with known Dysplasia Epiphysealis Hemimelica (DEH) of the distal femur presents for a routine follow-up. The parents inquire about the long-term growth behavior of the lesion. Which of the following best describes the natural history of the mass in DEH?

A 5-year-old boy undergoes an excisional biopsy of an irregular, hard mass protruding from the medial distal tibial epiphysis. The histopathology report indicates mature trabecular bone covered by a hyaline cartilage cap undergoing endochondral ossification. Based on these findings, how does the histology of Dysplasia Epiphysealis Hemimelica (DEH) compare to an osteochondroma?

During a resident teaching round, the attending asks for the defining anatomical distinction between Multiple Hereditary Exostoses (MHE) and Dysplasia Epiphysealis Hemimelica (DEH). While both present with osteochondroma-like lesions, DEH is uniquely characterized by its origin from which specific region of the developing bone?

A muscle biopsy is performed on a patient suspected of having dermatomyositis. Which of the following histopathological findings is classically associated with this condition?

In adult patients presenting with new-onset dermatomyositis, the treating physician must have a high index of suspicion and screen for which of the following associated conditions?

A 12-year-old girl with a known autoimmune disorder presents with severe joint contractures and hard palpable masses. Radiographs are shown:

Surgical excision of these lesions is generally indicated for which of the following reasons?

In juvenile dermatomyositis, a muscle biopsy classically demonstrates which of the following histological findings?

An orthopedic oncologist is consulted for an aggressive thigh mass in a 60-year-old male. During evaluation, the patient is noted to have a classic heliotrope rash and proximal muscle weakness. What underlying relationship must be considered?

A patient undergoing workup for suspected dermatomyositis has a muscle biopsy performed by an orthopedic surgeon. What is the characteristic histopathological finding that differentiates dermatomyositis from polymyositis?

A 7-year-old girl is evaluated for worsening proximal muscle weakness and a distinctive violaceous rash over her knuckles and eyelids.

If a muscle biopsy were to be performed to confirm the underlying diagnosis, what is the pathognomonic histologic finding?

A 55-year-old woman presents to the clinic with profound proximal muscle weakness, an erythematous rash on her face and knuckles, and difficulty climbing stairs. She is diagnosed with adult-onset dermatomyositis. What mandatory screening must be performed in this patient?

A 9-year-old girl is diagnosed with juvenile dermatomyositis. She presents with characteristic violaceous papules over her metacarpophalangeal joints.

Which of the following histopathological findings on muscle biopsy is most characteristic of this condition?

A 45-year-old woman with a history of progressive proximal muscle weakness and a heliotrope rash is diagnosed with adult-onset dermatomyositis. What is the most critical screening evaluation required for this adult patient that is not routinely indicated for juvenile dermatomyositis?

A 13-year-old boy presents with knee pain and is diagnosed with conventional osteosarcoma of the distal femur. Genetic testing reveals a germline mutation in the RB1 gene. This patient is at the highest risk for having a history of, or developing, which of the following secondary malignancies?

A 65-year-old man presents with worsening back pain and fatigue. Laboratory studies show hypercalcemia, anemia, and elevated creatinine. Radiographs show multiple "punched-out" lytic lesions in the skull and vertebral bodies.

Which of the following is required to establish the definitive diagnosis of this patient's most likely condition?

A 65-year-old man presents with severe back pain and fatigue. Radiographs show multiple punched-out lytic lesions in the skull and spine.

Serum protein electrophoresis demonstrates a prominent M-spike. Which of the following is the most likely histological finding upon bone marrow biopsy?

A 70-year-old female is diagnosed with multiple myeloma after presenting with hypercalcemia and a pathologic femur fracture.

Which of the following imaging modalities is most appropriate for staging her overall skeletal tumor burden?

A 14-year-old boy presents with right thigh pain and swelling. Radiographs reveal a destructive diaphyseal lesion in the femur with a prominent "onion-skin" periosteal reaction. Biopsy shows small round blue cells. Which chromosomal translocation is most characteristic of this tumor?