Menu

10. Pathology and Oncology MCQs

Practice Set 48 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 941

Topic: 10. Pathology and Oncology

A 35-year-old male has an asymptomatic, heavily calcified lesion in the proximal humerus discovered incidentally on a radiograph following a minor fall. MRI shows a lobulated intramedullary lesion with no endosteal scalloping or soft tissue extension. Biopsy confirms a low-grade enchondroma. How is this lesion classified according to the Enneking system for benign bone tumors?

. Stage 1
. Stage 2
. Stage 3
. Stage IA
. Stage IB

Correct Answer & Explanation

. Stage 1

Explanation

Enneking Stage 1 benign tumors are 'latent', asymptomatic, and well-marginated without progressive growth. They typically require only observation.

Question 942

Topic: 10. Pathology and Oncology
A 22-year-old male undergoes resection of a high-grade distal femur osteosarcoma. The pathology report describes a separate tumor nodule within the vastus lateralis muscle, proximal to the main tumor block but not contiguous with it, and confined to the same limb. According to the Enneking staging system, what is the stage?
. Stage IIA
. Stage IIB
. Stage III
. Stage IVA
. Stage IVB

Correct Answer & Explanation

. Stage III

Explanation

Skip metastases are defined as noncontiguous tumor nodules within the same bone or transarticular space. In the Enneking system, skip metastases are considered regional metastases (M1), classifying the tumor as Stage III.

Question 943

Topic: 10. Pathology and Oncology
A 40-year-old woman is diagnosed with an atypical lipomatous tumor (low-grade liposarcoma) deep within the quadriceps muscle. It does not invade the fascia, bone, or neurovascular structures. There are no distant metastases. What is the Enneking stage?
. Stage IA
. Stage IB
. Stage IIA
. Stage IIB
. Stage III

Correct Answer & Explanation

. Stage IA

Explanation

While typically applied to bone, Enneking staging for soft tissue follows similar principles. A low-grade (G1), intracompartmental (T1) tumor with no metastases (M0) is Stage IA.

Question 944

Topic: 10. Pathology and Oncology

A 28-year-old man presents with a painful, expansile lesion in the proximal tibia. Radiographs show a lytic, eccentrically placed epiphyseal lesion. MRI confirms an intact but thinned cortex with no soft tissue mass. Biopsy confirms Giant Cell Tumor of bone. What is the appropriate Enneking benign stage?

. Stage 1
. Stage 2
. Stage 3
. Stage IA
. Stage IIA

Correct Answer & Explanation

. Stage 2

Explanation

Enneking Stage 2 benign tumors are 'active' lesions that cause pain and expand the cortex, but remain contained within the bone (intact periosteum/cortex). Giant cell tumors are classically Stage 2 or 3.

Question 945

Topic: 10. Pathology and Oncology

A surgeon plans an excision for an Enneking Stage IIB osteosarcoma of the proximal tibia. The goal is a 'wide margin'. Which of the following best defines a wide surgical margin?

. Removal of the tumor by shelling it out through the pseudocapsule
. Excision through the reactive zone
. Excision of the tumor with a continuous cuff of normal healthy tissue
. Removal of the entire anatomic compartment containing the tumor
. Amputation through the joint proximal to the tumor

Correct Answer & Explanation

. Excision of the tumor with a continuous cuff of normal healthy tissue

Explanation

A wide margin involves resecting the tumor entirely outside its reactive zone, enveloped by a continuous cuff of normal, healthy tissue. This is the standard surgical requirement for high-grade sarcomas.

Question 946

Topic: 10. Pathology and Oncology
A 60-year-old male is diagnosed with a conventional chondrosarcoma of the proximal femur. Biopsy reveals a Grade 1 (low-grade) tumor. Imaging shows the tumor filling the medullary canal and breaking through the lateral cortex into the abductor musculature. No metastases are present. What is the Enneking stage?
. Stage IA
. Stage IB
. Stage IIA
. Stage IIB
. Stage III

Correct Answer & Explanation

. Stage IB

Explanation

The tumor is low-grade (G1) and extracompartmental (T2) due to the cortical breach into the adjacent muscle compartment. G1, T2, M0 strictly corresponds to Enneking Stage IB.

Question 947

Topic: 10. Pathology and Oncology

Which of the following descriptions best identifies an Enneking Stage 3 benign bone tumor?

. Asymptomatic, self-healing lesion
. Symptomatic lesion with an intact, expanded cortex
. Aggressive lesion with cortical destruction and soft tissue extension
. Low-grade malignancy contained within the medullary canal
. High-grade malignancy with skip metastases

Correct Answer & Explanation

. Aggressive lesion with cortical destruction and soft tissue extension

Explanation

Enneking Stage 3 (Aggressive) benign tumors exhibit rapid growth, cortical destruction, and soft tissue extension. Examples include aggressive giant cell tumors or expanding aneurysmal bone cysts breaching the cortex.

Question 948

Topic: 10. Pathology and Oncology

A 10-year-old boy presents with severe night pain in his tibia that is completely relieved by NSAIDs. Imaging reveals a 1 cm radiolucent nidus surrounded by intense sclerosis. What is the Enneking stage of this lesion?

. Stage 1
. Stage 2
. Stage 3
. Stage IA
. Stage IIA

Correct Answer & Explanation

. Stage 2

Explanation

Osteoid osteoma is an 'active' benign tumor, typically classified as Enneking Stage 2. It is highly symptomatic and evokes a strong reactive bone response, but it does not aggressively destroy the cortex or soft tissue.

Question 949

Topic: 10. Pathology and Oncology
A 16-year-old boy has a high-grade Ewing sarcoma of the femoral diaphysis. MRI demonstrates the tumor is entirely confined within the medullary canal with no cortical breakthrough or soft tissue mass. A PET-CT scan is negative for metastases. What is the Enneking stage?
. Stage IA
. Stage IB
. Stage IIA
. Stage IIB
. Stage III

Correct Answer & Explanation

. Stage IIA

Explanation

Ewing sarcoma is inherently a high-grade malignancy (G2). Because it is entirely intracompartmental (T1) without metastases (M0), it is classified as Enneking Stage IIA.

Question 950

Topic: 10. Pathology and Oncology

In the Enneking surgical staging system for malignant bone tumors, what parameter differentiates a Stage IIA tumor from a Stage IIB tumor?

. Histologic grade
. Presence of pulmonary metastases
. Presence of skip metastases
. Anatomic compartmentalization
. Sensitivity to neoadjuvant chemotherapy

Correct Answer & Explanation

. Anatomic compartmentalization

Explanation

Stage IIA is intracompartmental (T1), whereas Stage IIB is extracompartmental (T2). Both stages represent high-grade (G2) tumors without distant metastases (M0).

Question 951

Topic: 10. Pathology and Oncology
A 45-year-old female undergoes en bloc resection of a distal radius lesion. Histology reveals an adamantinoma. The tumor was strictly confined to the medullary canal of the radius, with no cortical breach. No metastases are noted. What is the most likely Enneking stage?
. Stage IA
. Stage IB
. Stage IIA
. Stage IIB
. Stage III

Correct Answer & Explanation

. Stage IA

Explanation

Adamantinoma is a low-grade malignancy (G1). Being confined to the bone makes it intracompartmental (T1). The combination of G1, T1, M0 represents Enneking Stage IA.

Question 952

Topic: 10. Pathology and Oncology

A patient with an Enneking Stage 3 benign tumor of the proximal fibula is being scheduled for surgery. To minimize the risk of local recurrence, which of the following surgical margins is considered most appropriate?

. Intralesional curettage alone
. Marginal excision
. Wide excision
. Radical resection
. Amputation

Correct Answer & Explanation

. Wide excision

Explanation

Enneking Stage 3 (aggressive) benign tumors typically require a wide excision to minimize recurrence. Simple intralesional or marginal margins have unacceptably high local failure rates for aggressive benign disease.

Question 953

Topic: 10. Pathology and Oncology

Which of the following scenarios best defines a 'radical margin' according to the Enneking system?

. Resection through the tumor pseudocapsule
. Resection of the tumor with 2 cm of normal tissue in all directions
. Removal of the entire bone and surrounding muscle compartment from origin to insertion
. Excision of the tumor with negative microscopic margins
. Amputation through the adjacent joint proximal to the tumor

Correct Answer & Explanation

. Removal of the entire bone and surrounding muscle compartment from origin to insertion

Explanation

A radical margin involves the en bloc removal of the entire anatomic compartment containing the tumor, extending from joint to joint or origin to insertion.

Question 954

Topic: 10. Pathology and Oncology
A 19-year-old presents with a high-grade telangiectatic osteosarcoma of the humerus. MRI shows tumor extending into the anterior compartment of the arm and axilla. CT chest reveals bilateral 5mm pulmonary nodules, confirmed by biopsy as metastatic osteosarcoma. What is the Enneking stage?
. Stage IIB
. Stage III
. Stage IVA
. Stage IVB
. Stage V

Correct Answer & Explanation

. Stage III

Explanation

Any malignant bone tumor with regional or distant metastases (M1) is classified as Enneking Stage III. This applies regardless of the tumor's histologic grade or intracompartmental status.

Question 955

Topic: 10. Pathology and Oncology

An asymptomatic 14-year-old boy is found to have an incidental well-circumscribed, eccentrically located, sclerotic-rimmed lesion in the distal tibial metaphysis on plain radiographs. There is no cortical expansion or soft tissue mass. Bone scan shows mild uptake strictly confined to the lesion. According to the Enneking classification for benign tumors, what stage does this lesion represent?

. Stage 1
. Stage 2
. Stage 3
. Stage IA
. Stage IB

Correct Answer & Explanation

. Stage 1

Explanation

This describes a latent benign tumor (Stage 1), such as a non-ossifying fibroma. Stage 1 benign lesions are asymptomatic, inactive, and do not grow or expand the cortex.

Question 956

Topic: 10. Pathology and Oncology

A 12-year-old girl presents with mild thigh pain. Radiographs reveal a centrally located, lytic lesion in the proximal femur with cortical thinning and mild expansion, but no cortical breach. MRI confirms a fluid-filled cavity with intact surrounding bone. According to the Enneking benign staging system, how is this categorized?

. Stage 1
. Stage 2
. Stage 3
. Stage IA
. Stage IIA

Correct Answer & Explanation

. Stage 2

Explanation

This lesion demonstrates active growth with cortical expansion but no breach, characteristic of a Stage 2 (active) benign tumor like a unicameral bone cyst. They grow slowly and expand the cortex but remain entirely contained within the bone.

Question 957

Topic: 10. Pathology and Oncology
A 35-year-old woman presents with severe knee pain and swelling. Imaging shows a large, lytic epiphyseal lesion in the proximal tibia with extensive cortical destruction and a soft tissue mass. Biopsy confirms a benign giant cell tumor of bone. What is the appropriate Enneking stage for this lesion?
. Stage 1
. Stage 2
. Stage 3
. Stage IIB
. Stage III

Correct Answer & Explanation

. Stage 3

Explanation

This is a Stage 3 (aggressive) benign tumor. Aggressive benign lesions are locally destructive, frequently breach the cortex to form a soft tissue mass, and have a high rate of local recurrence.

Question 958

Topic: 10. Pathology and Oncology

A 45-year-old man undergoes curettage for a benign bone tumor. The surgeon uses a high-speed burr to remove the reactive bone surrounding the lesion and applies phenol to the cavity. According to Enneking's surgical margins, what type of margin was achieved?

. Intralesional
. Marginal
. Wide
. Radical
. Extracompartmental

Correct Answer & Explanation

. Intralesional

Explanation

Despite the use of adjuvants (burr, phenol) to extend the zone of necrosis, the physical surgical plane passed through the tumor and reactive zone. This is classified as an extended intralesional margin.

Question 959

Topic: 10. Pathology and Oncology

During the excision of a soft tissue sarcoma, the surgeon dissects meticulously along the tumor's pseudocapsule, ensuring the mass is removed in one piece without visually entering the tumor. Which of the following describes this surgical margin and its expected outcome for a high-grade sarcoma?

. Wide margin; low local recurrence
. Marginal margin; high local recurrence
. Radical margin; low local recurrence
. Intralesional margin; moderate local recurrence
. Marginal margin; low local recurrence

Correct Answer & Explanation

. Marginal margin; high local recurrence

Explanation

Dissection along the pseudocapsule (reactive zone) yields a marginal margin. For high-grade sarcomas, the reactive zone contains microscopic satellite tumor cells, resulting in a high local recurrence rate if no adjuvants are used.

Question 960

Topic: 10. Pathology and Oncology
A 50-year-old male is diagnosed with a low-grade central chondrosarcoma of the proximal humerus. Imaging demonstrates the tumor is entirely confined within the medullary canal without any cortical breakthrough. Staging scans are negative for metastasis. What is the Enneking surgical stage?
. Stage 1
. Stage IA
. Stage IB
. Stage IIA
. Stage IIB

Correct Answer & Explanation

. Stage IA

Explanation

The Enneking system stages malignant tumors using Grade (I=low, II=high), Compartment (A=intra, B=extra), and Metastasis (III). A low-grade (I) tumor confined within the bone (A) is Stage IA.

Test Yourself

Switch to an interactive, timed exam simulation to truly master this topic.

On this Page