10. Pathology and Oncology MCQs

A 12-year-old boy with conventional osteosarcoma of the distal femur completes a 10-week course of neoadjuvant chemotherapy. He then undergoes wide surgical resection. Which of the following histologic parameters evaluated in the resected specimen is the most important prognostic factor for his long-term survival?

A 28-year-old female presents with a slowly enlarging, painless mass on the posterior aspect of her thigh. Radiographs reveal a dense, heavily ossified mass attached to the posterior cortex of the distal femur with a broad base, but lacking medullary involvement. Which of the following is the most likely genetic amplification associated with this lesion?

A 15-year-old male presents with severe pain in his proximal humerus. Radiographs show an aggressive, expansile, completely lytic lesion. MRI reveals multiple fluid-fluid levels. Biopsy shows blood-filled spaces lined by highly atypical, pleomorphic cells producing small amounts of osteoid. What is the most likely diagnosis?

A 17-year-old male is undergoing multi-agent neoadjuvant chemotherapy for conventional osteosarcoma. His regimen includes Methotrexate, Doxorubicin, and Cisplatin. Routine monitoring for an irreversible side effect of Doxorubicin requires which of the following surveillance studies?

A 72-year-old male presents with a rapid increase in deep thigh pain. He has a longstanding history of a benign polyostotic bone disorder. Radiographs show cortical thickening and trabecular coarsening of the femur, with a new, superimposed destructive lytic lesion breaking through the cortex. Biopsy confirms osteosarcoma. Which of the following underlying conditions did this patient most likely have?

A 16-year-old male with a history of high-grade osteosarcoma of the distal femur treated with limb-salvage and chemotherapy presents for his 1-year follow-up. He is asymptomatic, but a routine surveillance scan reveals a new finding. Which of the following organs is the most common site of metastasis for this disease?

A 15-year-old girl presents with progressively worsening right knee pain. Radiographs reveal a destructive metaphyseal lesion of the distal femur with a sunburst periosteal reaction.

Biopsy confirms high-grade spindle cells producing osteoid. A biallelic germline mutation in which of the following tumor suppressor genes is most directly associated with a familial syndrome causing both this bone tumor and bilateral leukocoria in infancy?

An 18-year-old male is undergoing treatment for conventional osteosarcoma of the proximal tibia. He receives a standard regimen of neoadjuvant chemotherapy prior to surgical wide resection. Which of the following histologic findings on the definitive resection specimen is the most important prognostic factor for long-term survival?

A 20-year-old male presents with a purely lytic, destructive lesion in the distal femur. MRI reveals multiple fluid-fluid levels within the lesion.

A core needle biopsy demonstrates blood-filled spaces separated by septations containing highly atypical malignant spindle cells that are producing osteoid. What is the most likely diagnosis?

A 30-year-old female presents with a painless, slow-growing mass on the posterior aspect of her distal femur. Radiographs show a heavily ossified, lobulated mass arising from the cortex with a radiolucent "string sign" cleft between the tumor and the underlying bone.

Which of the following molecular alterations is most characteristic of this specific bone tumor?

What is the most common primary malignant bone tumor in children and young adults?

A 14-year-old boy presents with a painful mass in his distal femur. Biopsy reveals small round blue cells. Cytogenetic analysis demonstrates a t(11;22)(q24;q12) translocation. Which of the following fusion proteins is highly characteristic of this tumor?

A 16-year-old boy complains of progressive right thigh pain that is distinctly worse at night and dramatically relieved by ibuprofen. Radiographs reveal a cortical thickening with a small 8mm radiolucent nidus. What is the most appropriate definitive minimally invasive treatment?

A 15-year-old male is diagnosed with high-grade conventional osteosarcoma of the distal femur. Following neoadjuvant chemotherapy, what histological finding in the resected specimen is the most important independent prognostic factor for long-term survival?

A 14-year-old boy presents with progressive knee pain. Radiographs reveal a sunburst periosteal reaction and Codman's triangle in the distal femoral metaphysis. A biopsy confirms high-grade osteosarcoma. What is the standard sequence of treatment?

A 14-year-old boy presents with severe, aching pain in his right thigh that is worse at night and rapidly relieved by ibuprofen. Radiographs demonstrate diaphyseal cortical thickening with a 1-centimeter radiolucent nidus. What is the primary biochemical mediator responsible for this patient's pain?

A 15-year-old male presents with persistent knee pain. Radiographs reveal a destructive metaphyseal lesion in the distal femur with a "sunburst" periosteal reaction. Biopsy confirms malignant spindle cells producing unmineralized osteoid. What is the standard of care for this condition?

A 35-year-old mechanic presents 2 hours after accidentally discharging a high-pressure grease gun into his non-dominant index finger. The entry wound is only 2 mm with mild swelling, and capillary refill is intact. What is the most appropriate management?

A 35-year-old male presents with chronic, insidious nocturnal pain in his long finger, which is partially relieved by over-the-counter NSAIDs. Initial radiographs of the hand were reported as normal. Due to persistent symptoms, a dedicated high-resolution imaging study of the digit is performed. If the suspected diagnosis is an osteoid osteoma of the phalanx, which of the following imaging findings would be most characteristic?