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10. Pathology and Oncology MCQs

Practice Set 49 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 961

Topic: 10. Pathology and Oncology
A 16-year-old boy presents with a high-grade classic osteosarcoma of the distal femur. MRI reveals cortical destruction with a 4 cm soft tissue mass extending into the vastus intermedius. There are no pulmonary metastases. What is the correct Enneking stage?
. Stage IA
. Stage IB
. Stage IIA
. Stage IIB
. Stage III

Correct Answer & Explanation

. Stage IIB

Explanation

This is a high-grade (II) tumor that has breached the cortex and extended into the soft tissues, making it extracompartmental (B). Thus, the correct Enneking stage is IIB.

Question 962

Topic: 10. Pathology and Oncology
A 22-year-old man is diagnosed with a high-grade Ewing sarcoma of the femoral diaphysis. MRI demonstrates an aggressive marrow-replacing lesion, cortical permeation, and an adjacent soft tissue mass. An additional, discrete nodule of identical tumor is found in the proximal femoral metaphysis of the same bone. What is the Enneking stage?
. Stage IIA
. Stage IIB
. Stage IIIA
. Stage IIIB
. Stage III

Correct Answer & Explanation

. Stage III

Explanation

Skip metastases (discrete tumor nodules within the same bone or a second bone in the same extremity) are considered regional metastases. Any metastasis, regional or distant, automatically makes the lesion Stage III in the Enneking system.

Question 963

Topic: 10. Pathology and Oncology

Which of the following anatomic spaces is inherently considered 'extracompartmental' according to the Enneking staging system?

. Anterior compartment of the thigh
. Medullary canal of the tibia
. Popliteal space
. Posterior compartment of the leg
. Deltoid muscle

Correct Answer & Explanation

. Popliteal space

Explanation

The popliteal space is an extracompartmental zone because it lacks robust fascial boundaries and contains loose areolar tissue and major neurovascular structures. Tumors here can easily spread longitudinally.

Question 964

Topic: 10. Pathology and Oncology

A surgeon plans a resection for a Stage IIB osteosarcoma of the distal femur. To achieve a 'wide' surgical margin according to the Enneking system, the resection must:

. Remove the entire involved bone and all muscles originating or inserting on it.
. Pass through the tumor pseudocapsule to preserve neurovascular structures.
. Include the tumor, its pseudocapsule, and a continuous cuff of normal tissue in all directions.
. Shell out the tumor along the reactive tissue plane.
. Consist only of amputation proximal to the involved joint.

Correct Answer & Explanation

. Include the tumor, its pseudocapsule, and a continuous cuff of normal tissue in all directions.

Explanation

A wide margin requires removing the tumor, the pseudocapsule/reactive zone, and a continuous cuff of normal, unaffected tissue in all directions. It does not strictly require removing the entire anatomical compartment (which would be a radical margin).

Question 965

Topic: 10. Pathology and Oncology

A 22-year-old male presents with severe knee pain. Imaging reveals an expansile, lytic lesion in the proximal tibia with cortical destruction and extension into the surrounding soft tissue. Biopsy confirms an aneurysmal bone cyst. According to the Enneking staging system for benign musculoskeletal tumors, what is the correct stage for this lesion?

. Stage 1 (Latent)
. Stage 2 (Active)
. Stage 3 (Aggressive)
. Stage IA
. Stage IIA

Correct Answer & Explanation

. Stage 3 (Aggressive)

Explanation

Enneking Stage 3 benign tumors are aggressive lesions characterized by rapid growth, cortical destruction, and extension into surrounding soft tissues. Stage 1 is latent (asymptomatic, static), and Stage 2 is active (growing, expansile, but confined by an intact cortex).

Question 966

Topic: 10. Pathology and Oncology
A 45-year-old female undergoes a core needle biopsy of a distal femur lesion that is entirely contained within the medullary canal. The pathology returns as a low-grade chondrosarcoma. Staging scans of the chest, abdomen, and pelvis are negative for metastasis. What is the Enneking surgical stage of this tumor?
. Stage IA
. Stage IB
. Stage IIA
. Stage IIB
. Stage III

Correct Answer & Explanation

. Stage IA

Explanation

The Enneking system stages malignant tumors based on grade (G), site (T), and metastasis (M). This tumor is low-grade (G1), intracompartmental (T1), and has no metastasis (M0), classifying it as Stage IA.

Question 967

Topic: 10. Pathology and Oncology

A surgeon performs an excision of a soft tissue sarcoma in the thigh. The pathology report notes that the surgical resection plane passed through the reactive zone but remained entirely outside the tumor pseudocapsule. Which Enneking surgical margin was achieved?

. Intralesional
. Marginal
. Wide
. Radical
. Contaminated

Correct Answer & Explanation

. Marginal

Explanation

A marginal resection passes through the reactive zone (pseudocapsule) surrounding the tumor, leaving potential microscopic disease. A wide margin passes through normal healthy tissue outside the reactive zone, while intralesional passes directly through the tumor mass.

Question 968

Topic: 10. Pathology and Oncology
A 16-year-old girl is diagnosed with a high-grade osteosarcoma of the proximal humerus. MRI demonstrates that the tumor is completely confined within the bone cortex, with no soft tissue extension. Chest CT is negative for pulmonary nodules. What is the appropriate Enneking stage?
. Stage IA
. Stage IB
. Stage IIA
. Stage IIB
. Stage III

Correct Answer & Explanation

. Stage IIA

Explanation

This is a high-grade (G2) lesion that remains intracompartmental (T1) without metastases (M0). According to the Enneking system, G2, T1, M0 represents Stage IIA.

Question 969

Topic: 10. Pathology and Oncology
A 14-year-old boy presents with knee pain. MRI reveals a high-grade Ewing sarcoma of the distal femur that has breached the posterior cortex and extends significantly into the posterior thigh musculature. Staging scans show no evidence of distant metastasis. What is the Enneking stage of this tumor?
. Stage IA
. Stage IB
. Stage IIA
. Stage IIB
. Stage III

Correct Answer & Explanation

. Stage IIB

Explanation

The tumor is high-grade (G2) and has extended outside the bone into the soft tissue, making it extracompartmental (T2). With no metastasis (M0), this is classified as Enneking Stage IIB.

Question 970

Topic: 10. Pathology and Oncology
A 35-year-old male is diagnosed with a low-grade parosteal osteosarcoma of the posterior distal femur. Staging chest CT reveals a solitary 2 cm pulmonary nodule that is biopsy-proven to be metastatic osteosarcoma. What is the correct Enneking stage for this patient?
. Stage IA
. Stage IB
. Stage IIB
. Stage III
. Stage IV

Correct Answer & Explanation

. Stage III

Explanation

In the Enneking staging system, any bone or soft tissue sarcoma with regional or distant metastasis (M1) is automatically classified as Stage III, regardless of the tumor grade or compartmental status.

Question 971

Topic: 10. Pathology and Oncology

According to the Enneking staging system for musculoskeletal tumors, certain anatomic locations are inherently considered extracompartmental (T2) due to the lack of natural fascial boundaries to contain tumor spread. Which of the following is considered an extracompartmental space?

. Anterior compartment of the thigh
. Posterior compartment of the leg
. Popliteal fossa
. Medial compartment of the thigh
. Volar compartment of the forearm

Correct Answer & Explanation

. Popliteal fossa

Explanation

Extracompartmental spaces lack robust fascial boundaries and include the popliteal fossa, axilla, antecubital fossa, femoral triangle, and intrapelvic spaces. Tumors originating in these areas are automatically classified as T2.

Question 972

Topic: 10. Pathology and Oncology

A 12-year-old asymptomatic boy undergoes a radiograph after minor trauma, revealing an eccentric, cortically based, radiolucent lesion with a sclerotic rim in the distal femur without cortical expansion. It is diagnosed as a non-ossifying fibroma. What is the Enneking benign stage and the most appropriate management?

. Stage 1; observation
. Stage 2; intralesional curettage
. Stage 3; wide resection
. Stage 1; marginal excision
. Stage 2; observation

Correct Answer & Explanation

. Stage 1; observation

Explanation

This lesion is asymptomatic, non-expansile, and confined by bone, characterizing it as an Enneking Stage 1 (latent) benign tumor. The standard of care for latent, asymptomatic benign lesions like a non-ossifying fibroma is clinical and radiographic observation.

Question 973

Topic: 10. Pathology and Oncology
A 19-year-old female has a high-grade osteosarcoma of the distal femur. An MRI of the entire femur demonstrates the primary tumor along with a separate, non-contiguous focus of osteosarcoma in the proximal metaphysis of the same femur. Chest CT is negative. Under the Enneking staging system, how does this skip metastasis alter her stage?
. It makes the tumor extracompartmental (T2) and upstages it to IIB.
. It represents an intracompartmental spread and remains Stage IIA.
. It is considered a metastasis (M1) and upstages it to Stage III.
. It has no effect on Enneking staging but alters the AJCC stage.
. It upstages the tumor to Stage IB due to multifocality.

Correct Answer & Explanation

. It is considered a metastasis (M1) and upstages it to Stage III.

Explanation

In the Enneking staging system, skip metastases (non-contiguous tumor foci within the same bone) or regional lymph node involvement are categorized as M1 (metastatic disease). This automatically upstages the tumor to Stage III.

Question 974

Topic: 10. Pathology and Oncology

A 60-year-old male undergoes surgical excision of a high-grade undifferentiated pleomorphic sarcoma in the anterior thigh. The pathologist notes that the entire specimen is surrounded by a cuff of normal, healthy muscle tissue external to the tumor's reactive zone, but the entire anterior compartment was NOT removed. Which Enneking surgical margin describes this resection?

. Intralesional
. Marginal
. Wide
. Radical
. Extended

Correct Answer & Explanation

. Wide

Explanation

A wide margin is achieved when the resection plane passes entirely through normal, healthy tissue outside the tumor's reactive zone/pseudocapsule. A radical margin would require the en bloc removal of the entire anatomical compartment containing the tumor.

Question 975

Topic: 10. Pathology and Oncology

A 55-year-old female presents with a 4-month history of progressive radiating pain in her right leg and mild foot drop. MRI of the lumbar spine reveals an intradural-extramedullary tumor at L4-L5, which is T1 isointense, T2 hyperintense, and shows strong, homogeneous enhancement with gadolinium. Erosion of the adjacent pedicle is noted. Which of the following is the most likely diagnosis?

. Meningioma
. Ependymoma
. Schwannoma
. Astrocytoma
. Neurofibroma

Correct Answer & Explanation

. Schwannoma

Explanation

Correct Answer: CThe classic presentation of a slowly progressive radiculopathy combined with an intradural-extramedullary tumor that shows strong, homogeneous enhancement and associated bony erosion (enlarged neural foramen) is highly suggestive of a schwannoma. Meningiomas are also intradural-extramedullary but often show a dural tail sign and are more common in the thoracic spine in older females. Ependymomas and astrocytomas are intramedullary tumors. Neurofibromas are closely related to schwannomas but are more often associated with neurofibromatosis and can be plexiform.

Question 976

Topic: 10. Pathology and Oncology

Which of the following spinal tumor types is typically intramedullary and often associated with syringomyelia or cyst formation, particularly in the cervical spine?

. Meningioma
. Schwannoma
. Ependymoma
. Chordoma
. Osteosarcoma

Correct Answer & Explanation

. Ependymoma

Explanation

Correct Answer: CEpendymomas are the most common intramedullary spinal cord tumors in adults, frequently found in the cervical and cervicothoracic regions. They are well-known for their association with intratumoral hemorrhage and the formation of syrinx cavities, or cysts, both rostral and caudal to the tumor, due to altered CSF flow dynamics. Meningiomas and schwannomas are typically intradural-extramedullary. Chordomas and osteosarcomas are extradural, bone-forming tumors.

Question 977

Topic: 10. Pathology and Oncology

Regarding the surgical management of metastatic spinal tumors, the Spine Instability Neoplastic Score (SINS) is used to guide treatment. Which score range typically indicates overt instability requiring surgical stabilization?

. 0-6
. 7-12
. 13-18
. Above 12
. Above 7

Correct Answer & Explanation

. Above 7

Explanation

Correct Answer: EThe SINS score is a validated tool to assess spinal stability in patients with neoplastic disease. A score of 0-6 indicates stability, 7-12 indicates indeterminate stability, and 13-18 indicates overt instability. Therefore, a score above 7 (i.e., 8 or higher) typically suggests a need for surgical stabilization, although scores in the indeterminate range often warrant careful consideration and surgical consultation. A score above 12 definitely indicates overt instability, but the cutoff for considering intervention starts earlier.

Question 978

Topic: 10. Pathology and Oncology

Which primary bone tumor of the spine is most commonly found in the sacrum and clivus, and is characterized by its local aggressiveness and high recurrence rates despite appearing histologically benign?

. Osteosarcoma
. Chondrosarcoma
. Ewing's Sarcoma
. Chordoma
. Giant Cell Tumor

Correct Answer & Explanation

. Chordoma

Explanation

Correct Answer: DChordomas are rare, slow-growing malignant tumors derived from notochordal remnants. They have a predilection for the axial skeleton, particularly the sacrum (50-60%) and the clivus (30-35%), but can occur anywhere along the spine. They are known for their local aggressiveness, high local recurrence rates, and challenging surgical resection due to their location, despite often appearing histologically benign. Osteosarcoma, chondrosarcoma, and Ewing's sarcoma can affect the spine but have different epidemiological and anatomical distributions. Giant cell tumors are benign but locally aggressive, typically affecting long bones, and less commonly the spine.

Question 979

Topic: 10. Pathology and Oncology

A 45-year-old male presents with chronic back pain. Imaging reveals a lytic lesion in a vertebral body. A biopsy confirms metastatic renal cell carcinoma. The patient has no neurological deficits. Given the high vascularity of renal cell metastases, which pre-operative measure is often considered to reduce surgical blood loss?

. Pre-operative systemic chemotherapy
. High-dose corticosteroid administration
. Pre-operative embolization of the tumor feeders
. Immediate surgical stabilization without delay
. Radiation therapy prior to surgery

Correct Answer & Explanation

. Pre-operative embolization of the tumor feeders

Explanation

Correct Answer: CMetastases from renal cell carcinoma, thyroid carcinoma, and pheochromocytoma are notoriously hypervascular. Pre-operative embolization of the tumor's feeding arteries, typically performed by interventional radiology 24-72 hours before surgery, can significantly reduce intraoperative blood loss and improve the safety and feasibility of resection. Chemotherapy, corticosteroids (unless cord compression), or radiation therapy do not directly address intraoperative bleeding from hypervascular lesions. Immediate surgery without embolization carries a high risk of catastrophic hemorrhage.

Question 980

Topic: 10. Pathology and Oncology
According to the Enneking staging system, modified for spinal tumors, an Enneking stage III tumor (intracapsular benign) would be managed differently from a stage IA tumor (low-grade malignant, intracompartmental). Which of the following best describes the goal of surgical treatment for an Enneking Stage II (benign, extracompartmental) lesion?
. Intralesional curettage
. Marginal excision
. Wide en bloc resection
. Radical resection
. Palliative decompression

Correct Answer & Explanation

. Marginal excision

Explanation

The Enneking staging system guides surgical margins. For Stage II (active benign/extracompartmental), the goal is a marginal excision, where the tumor is removed en bloc with a minimal rim of surrounding normal tissue. This aims to remove the tumor completely while preserving vital structures.

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