10. Pathology and Oncology MCQs

A 50-year-old female presents with recurrent kidney stones and bone pain. Radiographs show an expansile, multiloculated lytic lesion in her third metacarpal. Biopsy reveals multinucleated giant cells clustered in a highly vascular, fibroblastic stroma with extensive hemosiderin deposition. What is the most appropriate next step in management?

A 70-year-old man is newly diagnosed with multiple myeloma. Which of the following serum markers is considered the most significant independent prognostic factor for survival in this disease?

A 30-year-old male is evaluated for a minor knee sprain. Incidentally, plain radiographs reveal multiple small, symmetric, well-defined circular sclerotic foci clustered in the periarticular regions of the distal femur and proximal tibia. He has no prior medical history. Which genetic mutation is most commonly associated with this benign condition?

A 68-year-old man presents with severe lower back pain, fatigue, and recent onset of renal impairment. Radiographs demonstrate multiple sharply marginated "punched-out" lytic lesions in the skull and spine.

Which of the following is most commonly detected in the urine of patients with this condition?

A 55-year-old man undergoes a biopsy of a solitary lytic lesion in the T10 vertebral body, which confirms a solitary bone plasmacytoma. A bone marrow biopsy shows less than 5% plasma cells, and a skeletal survey is otherwise negative. What is the approximate probability that this condition will progress to multiple myeloma within 10 years?

A 15-year-old boy presents with shoulder pain after a minor fall. Radiographs show an expansile, eccentric lytic lesion in the proximal humeral metaphysis. Biopsy reveals blood-filled spaces lacking a true endothelial lining, interspersed with fibrous septa containing giant cells. Which genetic translocation is highly specific for this primary lesion?

A 25-year-old woman presents with a Shepherd's crook deformity of the proximal femur. Radiographs display a large intramedullary lesion with a "ground-glass" appearance. She is diagnosed with fibrous dysplasia, which is caused by a somatic activating mutation in the GNAS gene. What is the direct intracellular consequence of this mutation?

An 18-year-old male complains of deep, aching pain in his right thigh that is worse at night and dramatically relieved by ibuprofen. Radiographs reveal a 1 cm radiolucent nidus surrounded by intense reactive sclerosis in the femoral diaphysis. What is the most common anatomic location for this type of lesion?

A 15-year-old boy presents with progressive, worsening pain and swelling around his knee. Radiographs reveal a destructive lesion in the distal femoral metaphysis with a "sunburst" periosteal reaction and a Codman triangle. Biopsy confirms conventional high-grade osteosarcoma. What is the current standard of care for this patient?

A 12-year-old boy presents with fever, weight loss, and severe pain in his leg. Radiographs reveal a permeative, destructive lesion in the tibial diaphysis with a multi-layered "onion-skin" periosteal reaction. Cytogenetics demonstrate a t(11;22) translocation. Which immunohistochemical marker is characteristically strongly positive in this tumor?

A 10-year-old asymptomatic boy has a knee radiograph taken after a minor contusion. The imaging reveals an incidental eccentric, lobulated, bubbly radiolucent lesion with a well-defined sclerotic margin located in the distal femoral metaphysis, measuring 2 cm in length. What is the most appropriate management?

A 7-year-old boy presents with mid-back pain. Radiographs reveal the complete collapse of the T8 vertebral body, appearing as a thin dense line ("vertebra plana"), with adjacent discs maintained. Biopsy reveals cells containing tennis-racket-shaped Birbeck granules on electron microscopy. Which immunohistochemical stain is classically positive in this disease?

A 65-year-old woman presents with isolated right hip pain. Radiographs demonstrate a single 5 cm lytic lesion in the right ilium.

A biopsy confirms monoclonal plasma cells. Comprehensive staging, including a bone marrow biopsy, reveals less than 5% clonal plasma cells elsewhere, and no end-organ damage. What is the preferred primary treatment for this condition?

A 3-year-old boy presents with painless anterior bowing of the tibia. Radiographs demonstrate multiple intracortical osteolytic lesions in the anterior tibial diaphysis. Biopsy reveals a bland fibroblastic stroma with spicules of woven bone rimmed by active osteoblasts. This specific condition is closely related to, and can occasionally be a precursor for, which of the following malignant tumors?

A 60-year-old woman with a known history of multiple myeloma presents with progressive thigh pain with weight-bearing. Radiographs show a 3.5 cm lytic lesion in the peritrochanteric region of the femur involving greater than 50% of the cortical diameter.

What is her Mirels score, and what is the most appropriate management?

A 70-year-old male with new-onset back pain is diagnosed with multiple myeloma after radiographs demonstrate diffuse osteopenia and punched-out lytic lesions in his lumbar spine.

Which of the following laboratory values is considered the most significant independent prognostic indicator for overall survival in this patient?

A 62-year-old male presents with acute kidney injury, hypercalcemia, and a lytic lesion in his right humerus. Serum protein electrophoresis shows a monoclonal spike. A diagnosis of multiple myeloma is suspected.

What is the most common underlying mechanism for renal failure in this patient population?

A 50-year-old male presents with isolated back pain. Imaging demonstrates a single osteolytic lesion in the L3 vertebral body. Biopsy confirms a monoclonal proliferation of plasma cells, but bone marrow aspirate shows only 2% plasma cells. Whole-body MRI reveals no other skeletal lesions. What is the most appropriate initial treatment for this patient?

A 45-year-old female presents with persistent, deep right shoulder pain. Radiographs reveal a 5 cm radiolucent lesion with stippled calcifications in the proximal humerus. MRI shows endosteal scalloping involving 80% of the cortical thickness. What is the most likely diagnosis?