10. Pathology and Oncology MCQs

A 55-year-old female presents with shoulder pain. Radiographs show a lytic lesion in the proximal humerus with intralesional popcorn calcification and endosteal scalloping greater than two-thirds of the cortical thickness. Biopsy confirms Grade 2 chondrosarcoma. What is the most appropriate surgical treatment?

A 22-year-old male complains of severe, aching pain in the posterior elements of his L4 vertebra, which is not completely relieved by NSAIDs. Imaging reveals a 2.5 cm expansile, radiolucent lesion with a sclerotic rim in the L4 lamina. What is the most likely diagnosis?

A 32-year-old male presents with a slow-growing mass in the popliteal fossa. Histology reveals a biphasic pattern of spindle cells and epithelial cells. Cytogenetic testing demonstrates a t(X;18)(p11;q11) translocation. What is the resulting fusion gene critical for this tumor's pathogenesis?

In the AJCC staging system for soft tissue sarcomas of the extremity, what finding automatically upgrades the tumor to at least Stage IV, regardless of tumor size or histologic grade?

A 48-year-old patient presents with a clean, well-vascularized full-thickness skin defect over the dorsal aspect of the metacarpophalangeal (MCP) joint of the middle finger, following excision of a benign lesion. The underlying extensor tendon's paratenon is intact and healthy. The primary goals for reconstruction are to minimize secondary contraction, maximize pliability for joint motion, and achieve good aesthetic outcome. Which of the following skin graft options is MOST appropriate?

A 10-year-old male presents with a painless, palpable mass on the medial aspect of his distal femur. Radiographs show a bony exostosis arising from the metaphyseal cortex, with the cortex and medullary cavity continuous with the parent bone. The lesion points away from the joint. What is the most likely diagnosis?

A 35-year-old man with a known solitary osteochondroma of the proximal tibia reports new onset of increasing pain, warmth, and a rapidly enlarging mass. Radiographs show a poorly defined lesion, and MRI reveals a cartilage cap thickness of 3.5 cm. What is the most appropriate next step in management?

Which of the following genetic mutations is most commonly associated with Hereditary Multiple Exostoses (HME)?

Which imaging modality is most effective for evaluating the cartilage cap thickness of an osteochondroma, especially when assessing for malignant transformation?

A 25-year-old male presents with acute, severe pain after a fall directly onto his knee. He has a known osteochondroma arising from the distal femur. Radiographs show a distinct lucent line across the base of the stalk of the exostosis. What is the most likely diagnosis?

A 6-year-old boy presents with a growing mass near his ankle. Clinical examination reveals an osteochondroma arising from the distal tibia. His parents are concerned about its impact on future growth. What is the most common growth disturbance associated with lower extremity osteochondromas in children?

A 35-year-old male with a history of multiple hereditary exostoses presents with a rapidly enlarging mass on his proximal femur and increasing pain. MRI demonstrates an osteochondroma with a cartilage cap thickness of 2.5 cm. What is the most likely diagnosis?

A 14-year-old boy has a known pedunculated osteochondroma on the distal medial femur. He recently started cross-country running and complains of new-onset localized pain over the lesion. Radiographs show no change in size or appearance. What is the most common cause of pain in this scenario?

A 13-year-old male has an asymptomatic, 2 cm osteochondroma on the proximal humerus. The parents request excision due to cosmetic concerns. What is the most appropriate recommendation regarding surgical excision?

A 35-year-old female with a known solitary osteochondroma of the proximal tibia reports new-onset localized pain and a recent increase in the size of the mass. An MRI is obtained. Which of the following MRI findings is the most reliable indicator of malignant transformation to secondary chondrosarcoma?

A 12-year-old child with Multiple Hereditary Exostoses (MHE) presents with increasing forearm deformity. Radiographs demonstrate the classic Masada Type I deformity. Which of the following is the hallmark radiographic feature of this specific forearm deformity?

A 19-year-old male with a solitary distal femur osteochondroma presents with a pulsatile mass in his popliteal fossa and diminished distal pulses. What is the most common etiology of this vascular complication?

A 16-year-old male presents with a painful, firm nodule beneath the nail bed of his great toe. Radiographs demonstrate an exophytic bony mass projecting from the dorsal aspect of the distal phalanx. Histology reveals a cartilage cap, but imaging shows no medullary continuity with the host bone. What is the diagnosis?

A 35-year-old male with known Hereditary Multiple Exostoses presents with rapidly increasing pain and swelling over a long-standing lesion on his proximal humerus. Magnetic resonance imaging (MRI) is obtained. Which of the following findings is most highly predictive of secondary malignant transformation to chondrosarcoma?

A 22-year-old male incidentally discovers a hard mass around his left knee. He has no pain, neurovascular symptoms, or mechanical blocks to motion. Radiographs reveal a sessile exostosis on the distal femur with medullary continuity.

What is the most appropriate management for this patient?