Bone Tumours

Topics in this chapter

• Benign Bone Tumors
• Cystic Bone Lesions
• Giant Cell Tumor
• Primary Malignant Bone Tumors
• Bone Metastases and Myeloma
• Bone Tumor Cytogenetics
• Metabolic Bone Lesions
• Bone Tumor Surgical Management

Practice questions

1. Question 1Q-9B32EF

   A 16-year-old male presents with pain and swelling around the right knee for 3 months. Radiographs of the distal femur reveal a destructive, mixed lytic and sclerotic lesion in the metaphysis with periosteal reaction showing 'Codman triangle' and 'sunburst' appearance. Which of the following is the most characteristic histological feature of this tumor?

   1. A.Cartilaginous matrix with atypical chondrocytes
   2. B.Malignant osteoid production directly by tumor cells
   3. C.Sheets of uniform round blue cells with glycogen granules
   4. D.Multinucleated giant cells evenly distributed among mononuclear stromal cells
   See the answer and solution
2. Question 2Q-EBFA8F

   An 18-year-old male presents with pain in the proximal right humerus and low-grade fever. Radiography shows a permeative lytic lesion in the diaphysis with an 'onion-skin' type of periosteal reaction. Biopsy reveals small round blue cells that are glycogen-positive and PAS-positive. Which of the following chromosomal translocations is most commonly associated with this tumor?

   1. A.t(11;22)(q24;q12)
   2. B.t(X;18)(p11.2;q11.2)
   3. C.t(9;22)(q34;q11)
   4. D.t(12;16)(q13;p11)
   See the answer and solution
3. Question 3Q-559647

   A 25-year-old female presents with dull aching pain in the right proximal tibia for 6 months, which worsens at night and is dramatically relieved by small doses of aspirin. Radiography shows a small, well-demarcated radiolucent nidus surrounded by a zone of reactive cortical bone sclerosis. What is the diagnosis?

   1. A.Osteoid osteoma
   2. B.Osteoblastoma
   3. C.Brodie abscess
   4. D.Osteosarcoma
   See the answer and solution
4. Question 4Q-28F28A

   A 30-year-old female presents with an eccentric, expansile lytic lesion in the subchondral region of the distal radius extending to the articular surface. Histopathology shows numerous uniformly distributed multinucleated giant cells set in a background of mononuclear round-to-oval stromal cells. What is the preferred surgical treatment for an aggressive (Campanacci grade III) lesion at this site?

   1. A.Intralesional curettage alone without adjuvants
   2. B.Wide en bloc resection and reconstruction
   3. C.Primary radiation therapy
   4. D.Amputation of the forearm
   See the answer and solution
5. Question 5Q-5FDB15

   A 65-year-old male presents with generalized bone pain and fatigue. Laboratory investigations reveal hypercalcemia, normocytic normochromic anemia, elevated erythrocyte sedimentation rate (ESR), and reversed albumin-globulin ratio. Serum protein electrophoresis shows an M-spike, and radiographs of the skull show multiple 'punched-out' lytic lesions. Which of the following cells is responsible for the bone destruction in this condition?

   1. A.Malignant plasma cells directly lysing bone
   2. B.Osteoclasts activated by myeloma cell-derived RANKL
   3. C.Reactive fibroblasts forming a fibrous capsule
   4. D.Chondrocytes undergoing premature hypertrophy
   See the answer and solution