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10. Pathology and Oncology MCQs

Practice Set 42 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 821

Topic: 10. Pathology and Oncology

A 50-year-old female undergoes surgical excision of a subungual glomus tumor via a transungual approach. During the procedure, the surgeon carefully removes the nail plate and makes an incision in the sterile matrix. Which of the following statements regarding the matrix incision and subsequent repair is most consistent with the principles outlined in the case to prevent postoperative complications?

. A. A transverse incision in the sterile matrix is preferred to allow for wider exposure and easier tumor excision.
. B. The sterile matrix should be elevated using fine skin hooks, and the tumor meticulously shelled out, ensuring complete excision.
. C. The matrix should be reapproximated using non-absorbable sutures (e.g., nylon) to ensure strong repair.
. D. The native nail plate should be discarded after removal to prevent infection and replaced with a synthetic stent.
. E. If a bony crater is present, it should be left untouched to avoid further damage to the phalanx.

Correct Answer & Explanation

. B. The sterile matrix should be elevated using fine skin hooks, and the tumor meticulously shelled out, ensuring complete excision.

Explanation

Correct Answer: BThe case provides detailed guidance on the transungual approach for subungual lesions. It explicitly states: "Under loupe magnification, the sterile matrix is inspected... A longitudinal incision is made directly over the mass.Transverse incisions are strictly avoided as they disrupt the longitudinal growth pattern of the nail and significantly increase the risk of postoperative split-nail deformity." It further details: "The sterile matrix is elevated using fine skin hooks. Glomus tumors are typically encapsulated and gelatinous. Using tenotomy scissors or a fine scalpel... the tumor is meticulously shelled out of its bed. Care must be taken to ensure complete excision, as retained microscopic satellites are the primary cause of recurrence." This directly supports Option B.Option A is incorrect because transverse incisions are strictly avoided due to the risk of nail dystrophy. Option C is incorrect; the case specifies 7-0 or 8-0absorbablesutures for matrix repair. Option D is incorrect; the native nail plate is preserved and used as a biologic stent. Option E is incorrect; the case states that if a bony crater is present, it is gently curetted.

Question 822

Topic: 10. Pathology and Oncology

A 48-year-old female undergoes surgical excision of a subungual glomus tumor. Two months postoperatively, she develops a split-nail deformity and persistent nail plate irregularity. Based on the information provided, which of the following is the most likely iatrogenic cause of this complication?

. A. Incomplete excision of the glomus tumor leading to recurrence.
. B. Failure to replace the native nail plate as a stent.
. C. A transverse incision made in the sterile matrix during tumor excision.
. D. Inadequate postoperative pain control leading to CRPS.
. E. Contamination of the subungual hematoma during the early postoperative phase.

Correct Answer & Explanation

. C. A transverse incision made in the sterile matrix during tumor excision.

Explanation

Correct Answer: CThe case explicitly addresses complications, particularly nail dystrophy. Under 'Complications and Management', it states: "Nail Dystrophy (10 to 20 percent) - Etiology: Iatrogenic injury to the germinal matrix;non-anatomic repair of the sterile matrix; transverse matrix incisions." Furthermore, in the 'Detailed Surgical Approach and Technique' section for the transungual approach, it warns: "A longitudinal incision is made directly over the mass.Transverse incisions are strictly avoided as they disrupt the longitudinal growth pattern of the nail and significantly increase the risk of postoperative split-nail deformity." Therefore, a transverse incision in the sterile matrix is the most likely iatrogenic cause of a split-nail deformity.Option A (incomplete excision) would lead to tumor recurrence, not primarily nail dystrophy. Option B (failure to replace the nail plate) could lead to adherence issues or infection, but not specifically a split-nail deformity. Option D (CRPS) is a systemic pain syndrome, not a direct cause of nail structural deformity. Option E (infection) could cause nail changes but is less specific to a split-nail deformity than a transverse matrix incision.

Question 823

Topic: 10. Pathology and Oncology

A 38-year-old male presents with mysterious fingertip pain. High-resolution MRI of the digit is performed, revealing a well-demarcated mass in the subungual region. The report describes the mass as hypointense on T1-weighted imaging, markedly hyperintense on T2-weighted imaging, and exhibiting avid, homogeneous enhancement following gadolinium administration. Based on these findings, what is the most likely diagnosis?

. A. Digital neuroma
. B. Osteoid osteoma
. C. Glomus tumor
. D. Subungual exostosis
. E. Epidermoid inclusion cyst

Correct Answer & Explanation

. C. Glomus tumor

Explanation

Correct Answer: CThe case specifically details the advanced imaging protocols for glomus tumors. Under 'Pre Operative Planning and Patient Positioning', it states: "For glomus tumors, a dedicated fingertip protocol using a surface coil is required.Glomus tumors typically appear as well-demarcated masses that are hypointense on T1-weighted imaging, markedly hyperintense on T2-weighted imaging, and exhibit avid, homogeneous enhancement following gadolinium administration." The MRI findings described in the question perfectly match the characteristic appearance of a glomus tumor.Digital neuromas (A) are typically disorganized masses of nerve fibers, often identified by HRUS. Osteoid osteomas (B) are bony lesions with a lucent nidus and sclerosis, best seen on radiographs or CT. Subungual exostoses (D) are bony outgrowths. Epidermoid inclusion cysts (E) would have different signal characteristics on MRI, typically fluid-filled and not showing avid enhancement in the same manner as a highly vascular glomus tumor.

Question 824

Topic: 10. Pathology and Oncology

A 30-year-old female is diagnosed with a subungual glomus tumor and undergoes surgical excision. Postoperatively, she is instructed on a rehabilitation protocol. Which of the following is a critical component of Phase Two (2-week mark) rehabilitation for this patient?

. A. Strict immobilization of the digit in a dorsal splint for 6 weeks.
. B. Aggressive strengthening exercises using putty and hand grippers.
. C. Initiation of a formal desensitization program with varying textures and fluidotherapy.
. D. Removal of the stenting nail plate and immediate return to full activities.
. E. Stellate ganglion blocks to manage persistent pain and swelling.

Correct Answer & Explanation

. C. Initiation of a formal desensitization program with varying textures and fluidotherapy.

Explanation

Correct Answer: CThe case outlines the postoperative rehabilitation protocols. Under 'Phase Two Suture Removal and Desensitization', it states: "At the two-week mark, non-absorbable sutures securing the nail plate are removed... Gentle, active range of motion (ROM) of the DIP, PIP, and MCP joints is initiated.A formal desensitization program is critical at this stage, involving tactile stimulation with varying textures, fluidotherapy, and gentle massage to normalize sensory input and prevent hypersensitivity."Option A (strict immobilization for 6 weeks) is incorrect; early gentle ROM is initiated at 2 weeks. Option B (aggressive strengthening) is typically introduced later, in Phase Three (4-6 weeks). Option D is incorrect; the stenting nail plate is left in situ for 3-6 months, and immediate return to full activities is not advised. Option E (stellate ganglion blocks) is a treatment for CRPS, not a routine part of Phase Two rehabilitation for an uncomplicated glomus tumor excision.

Question 825

Topic: 10. Pathology and Oncology

A 40-year-old female presents with a 7-year history of severe, intermittent pain in her ring finger, exacerbated by cold. She reports that the pain is often described as a throbbing or burning sensation. On examination, a small bluish discoloration is noted under the nail plate, and she has exquisite tenderness to pinpoint pressure. The average diagnostic delay for this condition, as described in the case, underscores its 'mysterious' nature. What is the estimated average diagnostic delay for this condition?

. A. 1 to 2 years
. B. 2 to 3 years
. C. 3 to 4 years
. D. 5 to 7 years
. E. 8 to 10 years

Correct Answer & Explanation

. D. 5 to 7 years

Explanation

Correct Answer: DThe patient's symptoms (severe, intermittent pain, cold exacerbation, throbbing/burning, subungual bluish discoloration, pinpoint tenderness) are classic for a glomus tumor. The 'Introduction and Epidemiology' section of the case specifically highlights the diagnostic delay for glomus tumors: "Misdiagnosis or delayed diagnosis is common, with anaverage diagnostic delay of 5 to 7 years, underscoring their 'mysterious' nature."Therefore, an average diagnostic delay of 5 to 7 years (Option D) is the correct answer, directly from the provided text.

Question 826

Topic: 10. Pathology and Oncology

A 33-year-old male is scheduled for surgical excision of a glomus tumor located in the volar pulp of his middle finger. During preoperative planning, the surgeon considers the optimal incision approach. Which of the following incision types is contraindicated for a lesion in the volar pulp, and why?

. A. Mid-lateral incision, to avoid neurovascular structures.
. B. Volar Bruner (zigzag) incision, to prevent contracture.
. C. Transungual approach, as it is reserved for subungual lesions.
. D. Direct longitudinal incision over the tactile surface, due to the risk of painful scar formation.
. E. Lateral periungual approach, to spare the central sterile matrix.

Correct Answer & Explanation

. D. Direct longitudinal incision over the tactile surface, due to the risk of painful scar formation.

Explanation

Correct Answer: DThe case details surgical approaches based on lesion location. Under 'Volar Approach for Pulp Lesions', it explicitly states: "For neuromas or glomus tumors located in the volar pulp, a mid-lateral incision or a volar Bruner (zigzag) incision is utilized.Direct longitudinal incisions over the tactile surface of the volar pad are contraindicated due to the risk of painful scar formation in the primary pinch zone."Options A and B are described as appropriate approaches for volar pulp lesions. Option C (transungual approach) is for subungual lesions, not pulp lesions, making it inappropriate but not 'contraindicated' in the sense of causing harm if used for a pulp lesion (it simply wouldn't expose it). Option E (lateral periungual approach) is for lateral nail unit lesions. The direct longitudinal incision over the tactile surface (D) is specifically highlighted as contraindicated due to the risk of painful scar formation in a critical functional area.

Question 827

Topic: 10. Pathology and Oncology

A 55-year-old male presents with a 3 cm, firm, non-tender mass on the volar aspect of his right wrist. He has a history of osteoarthritis. The mass does not transilluminate. Given the diagnostic uncertainty and the patient's history, which imaging modality is most appropriate to definitively characterize the mass and its relationship to surrounding structures, and why?

. Plain radiographs; to rule out underlying carpal instability.
. High-resolution ultrasound; to confirm cystic nature and delineate neurovascular relationships.
. CT scan; to assess bone involvement and soft tissue density.
. MRI; due to diagnostic uncertainty and superior soft tissue contrast.
. Arteriogram; to assess for vascular compression or aneurysm.

Correct Answer & Explanation

. MRI; due to diagnostic uncertainty and superior soft tissue contrast.

Explanation

Correct Answer: DThe case states, 'Magnetic Resonance Imaging (MRI): Generally reserved for cases presenting with diagnostic uncertainty, very large or deeply seated ganglions, or when there is suspicion of intraosseous pathology, complex intra-articular involvement, or alternative soft tissue tumors. MRI offers superior soft tissue contrast, allowing for precise definition of the lesion's extent and its relationship to osseous structures, tendons, nerves, and vessels.' The patient's mass does not transilluminate, which is atypical for a simple ganglion, and his history of osteoarthritis could suggest other pathologies, leading to diagnostic uncertainty.Option A is incorrect. Plain radiographs are useful to exclude osseous pathology but do not characterize soft tissue masses well.Option B is incorrect. While high-resolution ultrasound is often the first-line and most valuable imaging modality for confirming the cystic nature and delineating neurovascular relationships, the lack of transillumination and diagnostic uncertainty in this case suggest a need for superior soft tissue contrast to rule out other tumors, making MRI more appropriate.Option C, CT scan, is excellent for bone detail but less so for soft tissue characterization compared to MRI, especially for differentiating fluid-filled cysts from other soft tissue tumors.Option E, arteriogram, is invasive and specifically for vascular assessment, not for general mass characterization unless vascular compromise is strongly suspected as the primary pathology.

Question 828

Topic: 10. Pathology and Oncology

In adult oncology, which of the following primary bone tumors most commonly metastasizes to the lungs?

. Osteosarcoma
. Chondrosarcoma
. Giant cell tumor of bone
. Enchondroma
. Osteoid osteoma

Correct Answer & Explanation

. Osteosarcoma

Explanation

Correct Answer: AOsteosarcoma is the most common primary malignant bone tumor in children and young adults, and it has a high propensity for pulmonary metastasis, often presenting as 'cannonball' lesions. Chondrosarcoma can metastasize, but less frequently and typically later than osteosarcoma. Giant cell tumor of bone, while locally aggressive, rarely metastasizes, and when it does, it's typically a 'benign' metastasis to the lungs. Enchondroma and osteoid osteoma are benign bone tumors and do not metastasize.

Question 829

Topic: 10. Pathology and Oncology

During an open reduction and internal fixation of a humerus fracture, the anesthesiologist notes a sudden rise in end-tidal CO2, severe masseter muscle rigidity, and tachycardia. What is the definitive pharmacological treatment for this acute complication?

. Propofol
. Succinylcholine
. Dantrolene
. Epinephrine
. Calcium gluconate

Correct Answer & Explanation

. Dantrolene

Explanation

The patient is experiencing malignant hyperthermia, an autosomal dominant pharmacogenetic disorder triggered by volatile anesthetics or succinylcholine. Dantrolene, a ryanodine receptor antagonist, is the definitive treatment to halt abnormal calcium release from the sarcoplasmic reticulum.

Question 830

Topic: Bone Tumors

A 15-year-old boy presents with progressive distal thigh pain. Radiographs reveal a metaphyseal, poorly marginated, bone-forming lesion in the distal femur with a periosteal "sunburst" reaction and Codman's triangle. What is the standard of care for treating this primary malignancy?

. Wide surgical resection alone
. Neoadjuvant chemotherapy followed by wide resection and adjuvant chemotherapy
. Radiation therapy alone
. Wide resection followed by adjuvant radiation therapy
. Amputation as the sole treatment modality

Correct Answer & Explanation

. Neoadjuvant chemotherapy followed by wide resection and adjuvant chemotherapy

Explanation

The clinical and radiographic findings describe an osteosarcoma. The standard, most effective treatment protocol involves neoadjuvant chemotherapy, surgical resection with wide margins, and post-operative adjuvant chemotherapy.

Question 831

Topic: 10. Pathology and Oncology

A 12-year-old girl presents with a destructive, permeative lytic lesion in the diaphysis of her femur with an associated large soft tissue mass. Biopsy reveals uniform small, round, blue cells. Which chromosomal translocation is pathognomonic for this primary bone 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 an aggressive small, round, blue cell tumor typically arising in the diaphysis of long bones in children. It is pathognomonically associated with the t(11;22) chromosomal translocation, resulting in the EWS-FLI1 fusion protein.

Question 832

Topic: 10. Pathology and Oncology

A 15-year-old male presents with a painful mass in the distal femur. Biopsy reveals high-grade malignant spindle cells producing osteoid. Staging workup is negative for metastasis. What is the most appropriate initial step in definitive management?

. Primary above-knee amputation
. Radiation therapy
. Neoadjuvant chemotherapy
. Intralesional curettage and cementation
. Wide local excision without systemic therapy

Correct Answer & Explanation

. Neoadjuvant chemotherapy

Explanation

The standard of care for high-grade, non-metastatic osteosarcoma includes neoadjuvant chemotherapy, followed by surgical resection with wide margins, and subsequently adjuvant chemotherapy.

Question 833

Topic: 10. Pathology and Oncology

A 45-year-old male presents with a painful enlarging mass in his proximal humerus. Radiographs show a lytic, destructive lesion. MRI confirms a large lesion with soft tissue extension. The primary diagnostic procedure of choice to confirm the nature of this lesion, keeping in mind definitive treatment, should optimally be:

. Fine Needle Aspiration (FNA) biopsy
. Open incisional biopsy
. CT-guided core needle biopsy
. Excisional biopsy
. Direct aspiration of fluid for cytology

Correct Answer & Explanation

. CT-guided core needle biopsy

Explanation

Correct Answer: CFor most primary bone tumors, a core needle biopsy, preferably image-guided (CT or ultrasound), is the preferred initial diagnostic procedure. It provides adequate tissue for histological diagnosis, immunohistochemistry, and molecular studies, while minimizing contamination of surrounding tissues and allowing for planned limb-salvage surgery. FNA often provides insufficient tissue for comprehensive diagnosis of complex bone tumors. Open incisional biopsy carries a higher risk of tumor cell seeding and potential compromise of future surgical margins, making it a second-line option. Excisional biopsy is generally reserved for small, benign-appearing lesions or superficial soft tissue masses where diagnosis and treatment can be achieved simultaneously. Direct aspiration is primarily for cystic lesions or abscesses and typically does not yield sufficient cellular material for definitive diagnosis of solid tumors.

Question 834

Topic: 10. Pathology and Oncology

When planning a biopsy for a suspected high-grade sarcoma of the distal femur, which of the following is the MOST critical principle to ensure limb salvage is not jeopardized?

. Ensuring the incision is as small as possible.
. Placing the incision transversely across the thigh.
. Performing the biopsy under local anesthesia to minimize systemic effects.
. Maintaining a single fascial compartment violation and placing the incision directly in line with a potential definitive surgical approach.
. Avoiding any penetration of the joint capsule during the biopsy.

Correct Answer & Explanation

. Maintaining a single fascial compartment violation and placing the incision directly in line with a potential definitive surgical approach.

Explanation

Correct Answer: DThe most critical principle for biopsy planning in high-grade sarcomas, especially in potential limb-salvage candidates, is to place the biopsy tract strategically. This involves making a small, longitudinal incision, violating only one fascial compartment, and ensuring the entire biopsy tract can be resected en bloc with the definitive tumor specimen. A transverse incision contaminates a broader area and makes definitive resection of the contaminated tissue difficult. While small incisions are good, the placement is paramount. Local anesthesia is often insufficient or inappropriate for bone biopsies. Avoiding joint capsule penetration is important, but less critical than the overall tract placement and fascial compartment violation.

Question 835

Topic: 10. Pathology and Oncology

A 12-year-old male presents with right distal femoral pain. Imaging reveals a metaphyseal lesion consistent with osteosarcoma. A CT-guided core needle biopsy is planned. Which of the following is the most appropriate approach for specimen handling after obtaining the biopsy core?

. Place all cores in formalin for routine histology.
. Place one core in formalin, one in glutaraldehyde for electron microscopy, and send another for bacterial culture.
. Divide cores into fresh tissue for cytogenetics/molecular studies, some for formalin fixation, and some for frozen section analysis if indicated.
. Immediately send all cores for frozen section analysis to get an urgent diagnosis.
. Place all cores in sterile saline for transport to pathology.

Correct Answer & Explanation

. Divide cores into fresh tissue for cytogenetics/molecular studies, some for formalin fixation, and some for frozen section analysis if indicated.

Explanation

Correct Answer: COptimal handling of biopsy specimens for suspected primary bone tumors requires a multi-pronged approach to maximize diagnostic yield. Cores should be divided to allow for routine histology (formalin fixation), cytogenetics and molecular studies (fresh tissue, often snap-frozen), and potentially microbiological studies if infection is in the differential. Frozen section analysis can be useful intra-operatively for confirming tissue adequacy but is not sufficient for definitive diagnosis. Glutaraldehyde is rarely needed for initial diagnosis. Placing all cores in formalin or saline alone limits the range of advanced diagnostic tests that might be required.

Question 836

Topic: 10. Pathology and Oncology

A biopsy is performed on a suspected aggressive lesion in the proximal tibia. The pathologist reports 'inadequate specimen for diagnosis'. Which of the following is the most common reason for an 'inadequate specimen' in bone tumor biopsies?

. Technical error during biopsy causing crush artifact.
. Sampling error due to necrosis or cystic degeneration within the tumor.
. Insufficient quantity of tissue obtained.
. Lack of expertise by the performing surgeon.
. Inappropriate fixation of the tissue specimen.

Correct Answer & Explanation

. Sampling error due to necrosis or cystic degeneration within the tumor.

Explanation

Correct Answer: BSampling error is a very common reason for an inadequate or non-diagnostic bone biopsy. Tumors, especially large or aggressive ones, can have heterogeneous areas including necrosis, hemorrhage, or cystic degeneration. If the biopsy needle only samples these non-diagnostic areas, the pathologist will not be able to provide a definitive diagnosis. While crush artifact, insufficient quantity, and inappropriate fixation can occur, sampling error remains the most frequent challenge, even for experienced operators.

Question 837

Topic: 10. Pathology and Oncology

Which of the following scenarios MOST strongly contraindicates an immediate biopsy of a bone lesion?

. A solitary lytic lesion in a known cancer patient with extensive metastatic disease.
. A rapidly expanding lesion causing significant pain and impending pathological fracture.
. A lesion with imaging characteristics highly suggestive of a simple bone cyst (SBC) in an asymptomatic child.
. A lesion with extensive soft tissue involvement and proximity to major neurovascular structures.
. A small, well-defined cortical lesion with characteristic features of a non-ossifying fibroma (NOF) on radiographs.

Correct Answer & Explanation

. A small, well-defined cortical lesion with characteristic features of a non-ossifying fibroma (NOF) on radiographs.

Explanation

Correct Answer: EA small, well-defined cortical lesion with classic features of a Non-Ossifying Fibroma (NOF) on radiographs, especially in an asymptomatic patient, typically does not require a biopsy. NOFs are benign lesions with pathognomonic imaging findings. Observation is usually sufficient. In contrast, lesions in a known cancer patient with metastatic disease often require biopsy to confirm the primary origin or rule out a new primary. Rapidly expanding lesions with impending fracture and lesions with soft tissue involvement near neurovascular structures necessitate careful planning but are not absolute contraindications to biopsy; rather, they demand skilled execution.

Question 838

Topic: 10. Pathology and Oncology

A 70-year-old male with a history of prostate cancer presents with a new lytic lesion in his iliac wing. A CT-guided core needle biopsy is planned. What is the MOST important consideration regarding the biopsy approach for this lesion?

. Ensuring the biopsy needle does not penetrate the peritoneum.
. Selecting the largest possible core needle for adequate tissue.
. Placing the incision directly over the center of the lesion.
. Avoiding entry through bowel or bladder.
. Performing the biopsy under general anesthesia.

Correct Answer & Explanation

. Avoiding entry through bowel or bladder.

Explanation

Correct Answer: DWhen performing a biopsy of the iliac wing, avoiding entry through vital structures like the bowel or bladder is paramount. Penetrating these structures carries a high risk of infection and fistula formation. While avoiding the peritoneum is also important, the bowel and bladder are frequently in closer proximity to common iliac biopsy corridors. Selecting the largest needle is not the 'most' important consideration, and placing the incision over the center is not always the safest approach if vital structures are in the way. General anesthesia is not always required for iliac crest biopsies.

Question 839

Topic: 10. Pathology and Oncology

A biopsy specimen from a bone lesion shows 'spindle cell neoplasm'. The pathologist requests additional studies. Which of the following is MOST likely to be helpful in differentiating between different types of spindle cell sarcomas (e.g., osteosarcoma, leiomyosarcoma, fibrosarcoma)?

. Hematoxylin and Eosin (H&E) staining only
. Gram stain and bacterial culture
. Electron microscopy
. Immunohistochemical (IHC) staining
. Cytogenetic analysis

Correct Answer & Explanation

. Immunohistochemical (IHC) staining

Explanation

Correct Answer: DWhen H&E staining reveals a 'spindle cell neoplasm', immunohistochemical (IHC) staining is typically the most helpful next step for differentiation. IHC uses antibodies to detect specific antigens expressed by different tumor types (e.g., desmin for muscle differentiation, S-100 for neural/chondroid differentiation, CD34 for vascular differentiation). This can help categorize the tumor. Electron microscopy can provide ultrastructural details but is less commonly used as a primary diagnostic tool than IHC. Cytogenetic analysis looks for chromosomal abnormalities and is crucial for some specific sarcomas (e.g., Ewing sarcoma translocation), but IHC is often the first-line for broad differentiation of spindle cell tumors. Gram stain and culture are for infection.

Question 840

Topic: 10. Pathology and Oncology

Which of the following is considered a potential major complication unique to biopsy of bone lesions, particularly in weight-bearing bones?

. Infection of the biopsy site
. Hematoma formation
. Pathological fracture
. Neurovascular injury
. Tumor seeding along the needle tract

Correct Answer & Explanation

. Pathological fracture

Explanation

Correct Answer: CPathological fracture is a significant and unique complication associated with biopsy of bone lesions, especially in weight-bearing bones like the femur or tibia, or in weakened vertebrae. The biopsy procedure itself can further compromise the structural integrity of an already weakened bone, leading to a fracture. While infection, hematoma, neurovascular injury, and tumor seeding are all potential complications of any biopsy, pathological fracture is specifically related to the biomechanical insult of bone biopsy.

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