bone tumors, pathology
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Question 1
A 45-year-old female presents to the clinic with persistent pain and swelling over the left knee for six months. Radiographs reveal a well-defined, radiolucent lesion near the metaphysis. Upon biopsy, the histology shows a cartilaginous component. Given her age and clinical presentation, what is the most likely diagnosis? What would be the next best step in management?
Explanation
Given the patient's age and the presence of a cartilaginous lesion, chondrosarcoma is the most likely diagnosis, particularly if it has aggressive features. The correct management involves a wide local excision due to the potential for malignancy, whereas the other options either misdiagnose or do not adequately address the potential severity.
Question 2
A 16-year-old male volleyball player undergoes evaluation for recurrent knee pain and swelling, which decreases with aspirin use. An MRI shows a small, well-defined cortical lesion on the anterior aspect of the femur. What is the most likely diagnosis, and what initial management option should be considered?
Explanation
The characteristics described align with an osteoid osteoma, which typically presents with nocturnal pain alleviated by aspirin. Initial management often involves radiofrequency ablation, while the alternatives either misinterpret the clinical features or suggest more invasive solutions.
Question 3
A 70-year-old male presents with unexplained hip pain and localized swelling. His history reveals prior radiation treatment for prostate cancer. X-rays reveal a destructive bone lesion at the femoral neck. What is the most likely diagnosis based on this presentation, and what follow-up test is most immediately warranted?
Explanation
Considering the patient's age, radiation history, and presentation, secondary bone metastasis is the most likely diagnosis. Biopsy is warranted to determine the exact nature, whereas other options do not comprehensively address the risk of metastatic disease.
Question 4
A 25-year-old female with a history of multiple fractures presents with progressive anterior knee pain. Imaging shows a lytic lesion in the femur, and a biopsy reveals the presence of bland spindle cells amidst a fibrous stroma. Given the clinical information, how should the results be interpreted?
Explanation
The combination of lytic lesions and bland spindle cells suggests fibrous dysplasia, often requiring surgical intervention if symptomatic. The other options misidentify the lesion's characteristics or fail to account for the underlying pathology.
Question 5
A 12-year-old boy presents with a painful right shoulder and swelling. Imaging studies indicate a lytic lesion in the proximal humerus. Biopsy points to the presence of malignant small round blue cells. Which condition is most likely, and what is the best management strategy?
Explanation
The clinical presentation and histological findings strongly suggest Ewing sarcoma. The recommended treatment approach includes a multi-agent chemotherapy regime before any potential surgical intervention, distinguishing it from the misinterpretations of other possible conditions.
Question 6
An elderly patient reports increasing weakness and bone pain. Radiological evaluation uncovers multiple lytic lesions throughout the skeleton alongside high serum calcium levels. What is the most definitive diagnosis based on these findings, and what should be the immediate next step in managing this patient?
Explanation
The presence of lytic bone lesions combined with hypercalcemia raises suspicion for metastatic disease. Conducting a PET scan is key for evaluating the source of the metastases. Bisphosphonate therapy is applicable in the context of myeloma, which is less likely considering the immediate evidence.
Question 7
A 30-year-old male undergoes elective surgery and is found to have asymptomatic lesions in the femur characterized by ground-glass opacities on X-ray. What is the best approach in managing these findings given their benign appearance?
Explanation
The ground-glass appearance is characteristic of fibrous dysplasia, and due to its benign nature, observation is the recommended course of action, while the alternatives suggest aggressive actions that are unwarranted.
Question 8
An adolescent male presents with pain in his left leg and notices a lump that has increased in size over a month. Radiographs show a mixed lytic and blastic lesion around the knee joint. What is the most appropriate diagnostic test to confirm the suspected diagnosis?
Explanation
Given the suspicion of an aggressive bone lesion, a biopsy is crucial for definitive histological diagnosis. While imaging studies provide valuable information, they cannot confirm malignancy like a biopsy can.
Question 9
A 52-year-old female presents with recurrent abdominal pain and weight loss. Imaging reveals soft tissue mass in the retroperitoneum. Upon histological evaluation, spindle cells are observed. What potential diagnosis should the clinician be concerned about, and what is the critical factor influencing treatment decisions?
Explanation
The spindle cell morphology suggests liposarcoma, a soft tissue sarcoma. The histological subtype and grade are critical in determining prognosis and treatment strategy, as they influence the expected response to therapy.
Question 10
An active 27-year-old male has a palpable lump on the anterior aspect of his knee. The lesion is firm, well-circumscribed, and found to be benign. Surgical removal shows no evidence of malignancy. What is the best classification for this lesion, and what should be recommended for follow-up?
Explanation
The findings align with osteochondroma, a benign bone tumor that typically does not require aggressive follow-up beyond periodic clinical evaluation unless symptomatic changes arise.
Question 11
A 60-year-old man presents with severe hip pain, and radiological findings suggest a primary tumor at the iliac crest with associated cortical thinning. What could be the potential recommendation for management in this case?
Explanation
The findings suggest plasma cell myeloma, which often presents with bone pain and can mimic primary malignant lesions. Systemic therapy aimed at managing the underlying condition is critical, while other treatments do not address the probable cause.
Question 12
After receiving a diagnosis of a soft tissue sarcoma in a 35-year-old woman, you are tasked with determining the surgical approach prior to adjuvant therapy administration. What is the most critical aspect to consider in surgical planning?
Explanation
The tumor grade is pivotal as it impacts the likelihood of complete excision and the required surgical margins to reduce recurrence risk, guiding the surgical approach. Other factors are less critical in the planning process.
Question 13
A 15-year-old girl arrives with swelling at the knee that has increased in size over the past three months. Imaging shows a subperiosteal mass with reactive bone formation. What is the likely condition, and what initial action should be taken?
Explanation
The presence of a subperiosteal mass with associated bone formation strongly indicates osteochondroma. Regular follow-up assessments are adequate unless significant changes occur, contrasting with the other suggested aggressive alternatives.
Question 14
An adult male patient presents with a large and painful mass in the thigh that is diagnosed as well-differentiated liposarcoma. What is the most essential factor to determine prior to planning treatment?
Explanation
The tumor grade is critical for influencing the treatment strategy and expected prognosis, guiding both surgical and medical interventions. The other factors are less central in deciding the immediate management.
Question 15
A 15-year-old girl presents with persistent pain in her knee, particularly at night. Imaging reveals a well-defined radiolucency in the distal femur, and the histological examination shows prominent osteoblasts surrounding woven bone. Considering her age and tumor characteristics, what is the most likely diagnosis?. What management strategy would be most appropriate for this case?
Explanation
The correct approach is to perform curettage and bone grafting, as osteoid osteomas are benign and typically treated this way. Monitoring is not advisable due to the nature of growth expected in these cases. Chemotherapy is unnecessary for benign tumors, and amputation is overly aggressive in this scenario.
Question 16
A 65-year-old man with a history of Paget disease presents with a new onset of pain in his left upper leg. Imaging studies indicate an aggressive bone mass in the femur with periosteal lifting. Which of the following diagnoses is most concerning and requires immediate further evaluation?
Explanation
The correct answer is osteosarcoma, as the patient's age and history of Paget disease significantly increase the risk of malignant transformation. Osteochondroma is common but usually benign, and simple bone cyst and fibrous dysplasia are not associated with such aggressive presentation.
Question 17
A 40-year-old woman with a genetic predisposition to osteosarcoma undergoes routine imaging, which shows a Codman triangle on her left humerus. Considering her familial history and clinical findings, how should her case be managed?
Explanation
The most appropriate management is to conduct a biopsy followed by surgical resection, as the presence of a Codman triangle highly suggests malignant bone activity. Radiotherapy is not the first-line treatment for osteosarcomas, monitoring is inappropriate given her risk factors, and conservative management is inadequate for a likely malignant tumor.
Question 18
A young adult male is diagnosed with multiple hereditary osteochondromas. His family history reveals similar conditions affecting his relatives. What is the appropriate initial step in managing these tumors, especially concerning future malignancy risks?
Explanation
The correct approach is to educate the patient and monitor for symptomatic changes, as not all lesions need surgical intervention. Immediate excision is unnecessary unless symptomatic. Yearly imaging can be part of the monitoring strategy, but intervention may be required only if the tumors become problematic.
Question 19
An 8-year-old boy presents with nodular subcutaneous lesions on his torso and extremities. Biopsy reveals spindle-shaped cells with the presence of neurofibromas. After establishing a diagnosis of Neurofibromatosis type 1 (NF1), which long-term management strategy should be prioritized?
Explanation
The most prudent long-term management strategy is to monitor for malignant transformation and associated complications due to NF1. Surgery may not always be warranted, and chemotherapy is not indicated for benign neurofibromas. Cosmetic management is too narrow a focus given the potential risks.
Question 20
A 12-year-old girl complaining of hip pain is found to have a central lesion in the femoral neck revealed by MRI. The biopsy shows a well-circumscribed lesion consistent with a chondroma. What factors must be evaluated to determine the appropriate treatment plan?
Explanation
Correctly, the size, symptoms, and potential for malignant transformation are critical in developing a treatment plan. The patient's age alone does not dictate management options, and pain alone does not necessitate surgery without evaluation of other factors. Histological grading remains important even in benign tumors due to its implications for management.