10. Pathology and Oncology MCQs

A 6-year-old boy complains of localized back pain. Lateral radiographs show complete collapse of the T8 vertebral body (vertebra plana) with preservation of the adjacent disc spaces. The most likely diagnosis is:

A 58-year-old man presents with bowel and bladder dysfunction and sacral pain. Imaging shows a large, destructive midline sacral mass. Biopsy reveals physaliferous cells in a myxoid background. Which of the following is the most appropriate surgical treatment?

A 40-year-old man presents with radicular pain. MRI reveals an intradural, extramedullary mass extending through the neural foramen into the extraspinal space, creating a "dumbbell" shape. Histology shows Antoni A and Antoni B tissue patterns. The correct diagnosis is:

A 22-year-old woman presents with severe back pain. MRI shows an expansile, multiloculated lytic lesion in the posterior elements of L3 with multiple fluid-fluid levels on T2-weighted sequences. The most likely diagnosis is:

A 60-year-old man with a history of renal cell carcinoma presents with acute paraparesis from a T10 metastatic lesion causing spinal cord compression. If surgical decompression is planned, which of the following should ideally precede surgery?

Which of the following represents the most common primary malignant bone tumor of the spine in the adult population?

A 28-year-old man presents with progressive lower extremity weakness. MRI identifies a myxopapillary ependymoma located in the conus medullaris and filum terminale. What is the most important factor in preventing local recurrence?

Which of the following tumor types is most characteristically associated with von Hippel-Lindau (VHL) syndrome when presenting in the spinal cord?

A 9-year-old child presents with progressive scoliosis and central nervous system signs. MRI reveals an extensive intramedullary cystic mass expanding the spinal cord from C3 to T2. What is the most likely diagnosis?

A 50-year-old woman with a history of breast cancer presents with thoracic back pain. MRI shows a single vertebral metastasis at T7 with epidural extension causing mild cord compression. Based on the Tokuhashi scoring system, a score of 12 (high score) suggests:

A 16-year-old male presents with fever and severe low back pain. Imaging shows a permeative, destructive lesion in the L4 vertebral body with a large associated soft-tissue mass. Biopsy reveals small round blue cells that are CD99 positive. The most likely diagnosis is:

A 45-year-old female presents with progressive spastic paraparesis and sensory loss. MRI reveals a well-circumscribed, centrally located, strongly enhancing intramedullary spinal cord lesion at T8 with an associated syrinx. What is the most likely diagnosis?

A 6-year-old child presents with torticollis and upper extremity weakness. MRI demonstrates an eccentrically located, ill-defined intramedullary lesion in the cervical spinal cord that expands the cord. What is the most likely diagnosis?

A 60-year-old woman presents with thoracic radicular pain. MRI reveals an intradural, extramedullary, homogeneously enhancing mass with a broad base on the dura and a "dural tail". What is the best initial surgical management strategy?

Which of the following histologic findings is most characteristic of a spinal schwannoma?

A 55-year-old man presents with bowel and bladder dysfunction and severe sacral pain. Radiographs reveal a large destructive, midline lytic lesion of the sacrum. Biopsy shows cords of large vacuolated cells (physaliferous cells) in a myxoid background. What is the optimal definitive treatment?

A 7-year-old boy complains of localized back pain. Radiographs of the thoracic spine show uniform collapse of the T7 vertebral body (vertebra plana) with preservation of the adjacent disc spaces. What is the most likely diagnosis?

A 16-year-old boy presents with severe thoracic back pain that is worse at night and completely relieved by ibuprofen. CT scan shows a 1 cm radiolucent nidus with surrounding sclerosis in the pedicle of T9. Which of the following is the most appropriate next step if conservative management fails?

An intradural, extramedullary spinal tumor is resected from the cervical spine of a 40-year-old patient. Pathology demonstrates an encapsulated mass containing spindle-shaped cells arranged in whorls and the presence of calcified concentric structures. What is the most likely diagnosis?

A 65-year-old man with prostate cancer presents with sudden onset lower extremity weakness and hyperreflexia. MRI shows a metastatic lesion at T10 causing severe ventral spinal cord compression. He has a life expectancy of 2 years and is an excellent surgical candidate. What is the best management?