*MOVED*Advanced Neoplasia Flashcards
In opposition to osteoid osteoma, osteoblastoma is most commonly found in which location? A. tubular bones B. flat bones C. vertebrae D. cranium E. two of the above
E. two of the above
Which of the following statements describe ossifying fibromas? A. It is a lesion closely related to fibrous dysplasia. B. They most commonly affect the maxilla and mandible. C. They predominate in women who are in there second, third, and fourth decades of life. D. The tibia and fibula are the most common sites of tubular bone involvement. E. All of the above
E. All of the above
Because the histologic differentiation between a low grade, well-differentiated chondrosarcoma and an enchondroma is often difficult, what is the best way to differentiate these two tumors? A. Calcification visualized on the radiograph B. Anatomic location of the tumor C. Age of the patient D. Degree of endosteal scalloping
C. Age of the patient
Classically, neurilemomas are composed of compact cellular areas in combination with loosely arranged hypocellular regions, this biphasic pattern is most commonly seen in the soft tissue tumors and less clearly present in the intraosseous type. What is the term used to name these distinct areas? A. Bartoni A and B B. Antoni A and B C. Neuroni A and B D. Verocay A and B
B. Antoni A and B
Hemangiomas are benign tumors of vascular origin. These tumors are most commonly seen in vertebrae and skull. Estimations of 10% of spines that are examined at time of autopsy have hemangiomas. What type of vascular channels composes this tumor seen within the spine? A. Corduroy cloth B. Capillary C. Venous D. Cavernous
B. Capillary
Which of the following imaging techniques is best utilized for the diagnosis of an osteoid osteoma? A. Conventional radiographs B. Scintigraphy C. Ultrasound D. Magnetic resonance imaging
A. Conventional radiographs
Which one of the following represents an osteosarcoma that features large cystic cavities filled with fresh and clotted blood? A. Conventional osteosarcoma B. Gnathic osteosarcoma C. Small cell osteosarcoma D. Telangiectatic osteosarcoma
D. Telangiectatic osteosarcoma
Which of the following statements describe primary bone involvement from non-Hodgkins lymphoma? A. It affects males more that females of any age. B. It has a propensity for the appendicular skeleton. C. It presents with a pathalogical fracture and a soft tissue mass. D. A sequestrum is evident in 10% of cases. E. All of the above.
E. All of the above.
Microscopically, synovial sarcomas usually have a biphasic histiologic appearance. Occasionally, one cell type will predominate giving the tumor a monophasic appearance. Which of the cell types,when dominant, results in a worse prognosis? A. Pseudoglandular B. Fibrosarcoma C. Endothelioid D. Lipomatous
C. Endothelioid
In decreasing frequency, what is the most common site for conventional osteosarcoma of long bones? A. Epiphysis > Diaphysis > Metaphysis B. Diaphysis > Metaphysis > Epiphysis C. Metaphysis > Diaphysis > Epiphysis D. They are affected equally.
C. Metaphysis > Diaphysis > Epiphysis
What is the percentage of osteosarcomas that contain areas of tumor that are separate from the main neoplasm, or “skip” lesions? A. 2% B. 25% C. 75% D. 90%
B. 25%
The most common location of an ossifying fibroma is where? A. Facial bones B. Long tubular bones C. Spine D. Pelvis
A. Facial bones
Which of the following is the least reasonable differential diagnosis for malignant fibrous histiocytoma? A. metastasis B. plasmacytoma C. lymphoma D. lytic osteosarcoma E. fibrosarcoma
D. lytic osteosarcoma
How many types of chondosarcoma are there? A. 10 B. 13 C. 2 D. 6
D. 6
Giant cell reparative granulomas are both radiographically and histologically indistinguishable from which lesion? A. giant cell tumor B. aneurysmal bone cyst C. brown tumor D. fibrous dysplasia
C. brown tumor
Which of the following processes are thought to represent an ossifying, subperiosteal hematoma? A. subungual exostosis B. turret exostosis C. reactive bone excrescence D. Nora’s lesion
B. turret exostosis
Which of the following benign bone lesions would be included as a differential diagnosis for an intraosseous low grade osteosarcoma? A. Fibrous dysplasia B. Non-ossifying fibroma C. Chondromyxoid fibroma D. All of these shoud be considered
D. All of these shoud be considered
Which one of the following disorders does Ewing’s sarcoma histologically resemble? A. Neuroblastoma B. Osteogenic sarcoma C. Clear cell chondroblastoma D. Chordoma
A. Neuroblastoma
Which of the following is not associated with myelofibrosis? A. Extramedullary hematopoiesis B. Bone marrow fibrosis C. Anemia D. Splenomegaly E. All are associated with myelofibrosis
E. All are associated with myelofibrosis
Which of the following statements best represents a gnathic osteosarcoma? A. The mean age of onset is approximately 30 years old. B. They present with greater affinity to the mandible versus the maxilla. C. Radiographic appearance is that of a small radiodense lesion with permetion of the cortex, periostitis, and a soft tissue mass. D. They are less like to metastasize, therefore 40% of patients have a 5yr survival rate. E. All of the above describe gnathic osteosarcomas.
E. All of the above describe gnathic osteosarcomas.
Which of the following statements is true about the imaging findings for a telangiectatic osteosarcoma. A. Radiography demonstrates a large, multiloculated and expansile lesion of osteolysis with extensive periosteal reaction. B. A homogenous increase of radionuclide uptake on scintigraphy. C. Areas of increase signal intensity on TIWI, fluid-fluid levels, and hetergenous enhancement of gadolinium on MRI. D. All of the above
C. Areas of increase signal intensity on TIWI, fluid-fluid levels, and hetergenous enhancement of gadolinium on MRI.
The ten-year survival rate for most chondrosarcomas is 30 to 70%. Which one of the following represents a factor that is an exception to this survival rate? A. Spinal chondrosarcomas B. Peripheral chondrosarcomas C. Arcal chondrosarcomas D. Pelvic chondrosarcomas
A. Spinal chondrosarcomas
A 13 year old male patient fracures his tibia. Upon radiographic examination, you discover a lesion in the diaphysis demonstrating a permeative to moth-eaten pattern of bone destruction, onion skined periostitis, and saucerization of the external cortex. Which of the following primary tumors of bone is the least likely differential. A. Adamantinoma B. Lymphoma C. Infection D. Osteosarcoma E. Ewing’s sarcoma
A. Adamantinoma
Which one of the following is false regarding the radiographic presentation of osteofibrous dysplasia involving the long tubular bones? A. Lesions may be purely blastic B. A ground glass matrix calcification is common C. Osseous deformity may be accentuated by pathologic fractures D. Involvement of the distal segment of the humerus is typical
D. Involvement of the distal segment of the humerus is typical
In what region of the spine do osteoid osteomas most commonly occur? A. Cervical spine B. Thoracic spine C. Lumbar spine D. Sacrum
C. Lumbar spine
What percent of Multiple Myeloma patients are under the age of 40 years? A. >5% B. >12% C. >30% D. 50%
A. >5%
Which one of the following is the least common benign neoplasm of cartilage? A. Chondroblastoma B. Enchondroma C. Chondromyxoid fibroma D. Desmoplastic fibroma
C. Chondromyxoid fibroma
Which of the following best describes hemangiopericytoma? A. Benign B. Malignant C. Locally aggressive D. All of the above
D. All of the above
What percentage of multiple myeloma cases present with generalized osteopenia being the only radiographic finding? A. 15% B. 35% C. 55% D. 75%
A. 15%
Which of the following metastatic tumors most closely resemble liposarcoma? A. breast B. lung C. renal cell D. thyroid
C. renal cell
Chondromyxoid fibroma is found most commonly in which of the following locations? A. innominate bone B. small bones of the feet C. tibia and femur D. radius
C. tibia and femur
Which of the following statements is NOT true about Burkitt’s lymphoma? A. It is the most common malignant disease of children in tropical Africa. B. It is a stem cell lymphoma in children. C. It has a high association with the Epstein-Barr virus. D. It has a propensity for the facial bones. E. It is common in the long bones.
E. It is common in the long bones.
Which two bones are affected in almost 70% of cases of periosteal chondroma? A. humerus and tibia B. humerus and femur C. tibia and femur D. tibia and fibula
B. humerus and femur
Systemic mastocytosis has recognized clinical manifestation resembling lymphoma or leukemia. However, it is the cutaneous involvement that is most common and characteristic. Which of the following disorders most closely resembles the cutaneous manifestations seen in mastocytosis? A. Neurofibromatosis B. Fibrous Dysplasia C. Urticaria Pigmentosa D. Gaucher’s Disease
C. Urticaria Pigmentosa
Which of the following lesions is defined as originating withing the outer layer of periosteum? A. Periosteal B. Parosteal C. Subperiosteal D. Juxtacortical E. Paraosseous
B. Parosteal
Neurogenic Sarcoma (Malignant Schwannoma) is an unusual lesion that has a variable histiologic appearance (perhaps related to the versatility of the Schwann cell.. Through metaplasia what tissue types can this tumor produce? A. Cartilage B. Bone C. Fat D. Muscle E. All of the above F. None of the above
E. All of the above
A 30-year-old male presents with a painful mass within the posterior aspect of his knee. Radiographs demonstrate a large radiodense and irregular mass at the posterior aspect of the distal femur. This mass is attached in a sessile fashion to the external cortex and a thin radiolucent line separates the remaining portion of the mass from the underlying bone. Which one of the following is the most likely diagnosis? A. Parosteal osteosarcoma B. Periosteal osteosarcoma C. Surface high grade osteosarcoma D. Conventional osteosarcoma
A. Parosteal osteosarcoma
What percentage of Ewing’s sarcoma represents a large cell (atypical) type? A. <5% B. 5-15% C. 20-30% D. 35-45% E. > 50%
B. 5-15%
An ossifying fibroma is closely related radiographically and pathologically to what other disorder? A. Fibrogenesis imperfecta ossium B. Desmoplastic fibroma C. Cementoma D. Fibrous dysplasia
D. Fibrous dysplasia
A 20 YOM presents with pain, soft tissue swelling, joint effusion, and restricted ROM of the left elbow. Radiographs reveal a positive sail sign, osteopenia, and uniform narrowing of the elbow joint space. Which one of the following is not a reasonable diagnosis? A. Rheumatoid arthritis B. Intracapsular desmoplasitic fibroma C. Osteoid osteoma D. Idiopathic synovitis
B. Intracapsular desmoplasitic fibroma
A 55-year-old female presents with a painful knee after a fall. The patient states that the knee has been swollen for some time, but because it wasn’t painful she didn’t seek attention for it. Radiographs of the distal femur to include the knee demonstrate a large lytic area within the distal femur accompanied by a periosteal reaction and a pathologic fracture. Further physical examination reveals several enlarged lymph nodes within the inguinal area that are painful on palpation and have a “rubbery’ feel. What is the most likely diagnosis? A. Goltz syndrome B. Non-Hodgkin’s lymphoma of bone C. Mycosis fungoides D. HOOD syndrome
B. Non-Hodgkin’s lymphoma of bone
Which one of the following is NOT a factor in estimating the risk of malignant transformation of an osteochondroma? A. Size of the cartilaginous cap B. Pain C. Solitary lesions versus multiple lesions D. Location
D. Location
A 15-year-old male presents with a painless mass occurring in the proximal humerus. Plain film radiographs of the area reveals an osseous protuberance arising from the external surface of the humerus. The spongiosa and cortex of this protuberance is continuous with the parent bone. Which one of the following is true about the MRI of this lesion? A. The cartilaginous tissue in the cap of this lesion is of low signal intensity on T2-weighted sequences B. The use of gadolinium compounds allows differentiation from this lesion and a peripheral chondrosarcoma C. The cartilaginous cap enhances with gadolinium D. MRI is not useful in measuring the size of the cartilaginous cap
B. The use of gadolinium compounds allows differentiation from this lesion and a peripheral chondrosarcoma
Which of the following lesions commonly affect the great toe? Mark all that apply. A. subungual exostosis B. reactive bone excrescence C. turret exostosis D. Nora’s lesion
A. subungual exostosis B. reactive bone excrescence
Which of the following statements is NOT true regarding an osteoid osteoma when found in the spine? A. Pain associated with an osteoid osteoma is commonly radicular. B. Scoliosis is commonly seen with the lesion on the concave aspect of the curve. C. It is commonly seen as an osteosclerotic lesion of a pedicle. D. All of the above are true.
D. All of the above are true.
Excluding osteoma cutis, what is the most common location for a soft tissue osteoma? A. Plantar fascia B. Posterior wall of the oral pharynx C. Soft palate D. Posterior portion of the tongue
D. Posterior portion of the tongue
Which of the following is not a reasonable differential diagnosis for a desmoplastic fibroma? A. non-ossifying fibroma B. chondromyxoid fibroma C. giant cell tumor D. simple bone cyst E. fibrous dysplasia
D. simple bone cyst
According to Resnick which of the following is an AKA for Hemangioendothelioma? A. Hemangiopericytoma B. Lymphangiomatosis C. Angiosacroma D. Cystic Angiomatosis
C. Angiosacroma
Which of the following conditions presents with multiple enchondromas and soft tissue vascular lesions? A. Fong’s syndrome B. Multiple hereditary exostosis C. Maffucci’s syndrome D. Ollier’s disease E. Osteopoikilosis
C. Maffucci’s syndrome
What percentage of aggressive osteoblastomas reoccur? A. 10% B. 50% C. 75% D. 90%
B. 50%
Which one of the following is false regarding Ewings sarcoma? A. Rare in blacks B. Demonstrates a large soft tissue mass C. Flat bones represent the most common site of involvement D. Demonstrates a positive PAS reaction for glycogen
C. Flat bones represent the most common site of involvement
Which of the following features best distinguishes ossifying fibroma of the facial bones from fibrous dysplasia? A. ossifying fibromas are painful lesions of the tooth-bearing portion of the mandible B. ossifying fibromas exapand the bone in the AP dimension C. ossifying fibromas usually smaller than 1 cm in diameter D. ossifying fibromas are ill-defined, unilocular lesions with very little calcification
B. ossifying fibromas exapand the bone in the AP dimension
Which of the following is false regarding juxtacortical desmoid tumors? A. almost exclusively found in the posteromedial cortex of the distal femur B. represents a fibroblastic proliferation of the periosteum C. the cause is most likely idiopathic D. the cortex develops a saucer-like defect with adjacent sclerosis and periostitis and soft tissue swelling
C. the cause is most likely idiopathic
Originating from cranial, peripheral and sympathetic nerves, a solitary neurofibroma is exceedingly uncommon. However when seen these tumors are found most commonly (approximately 66% of the time) in what bone? A. Maxilla B. Mandible C. Tibia D. Fibula E. Humerus
B. Mandible
What is the most common age of onset of patients with primary lymphoma of bone? A. <5 B. 10 C. 20 D. 30 E. > 40
E. > 40
According to Resnick, what is considered the “gold standard” for the diagnosis of conventional osteosarcoma? A. Radiography B. Scintigraphy C. Angiography D. Computed tomography E. Magnetic resonance imaging
A. Radiography
What is the most likely region of a long to be affected by Ewing’s sarcoma? A. Epiphysis B. Metaphysis C. Metadiaphysis D. Diaphysis E. Physis
C. Metadiaphysis
Ewing’s sarcoma is regarded as a highly aggressive tumor most commonly affecting persons between the ages of 5 and 30 years. Immunohistochemical and cytogenic studies as well as clinical and radiographic features are suggestive of this tumor origin. Although there is no definitive proof what is thought to be the cellular origin of this tumor? A. Neuroectodermal B. Sarcosanguinous C. Lymphatic D. Fibrohistocytic
A. Neuroectodermal
One theory for the origin of an intraosseous leiomyosarcoma is that the point of neoplastic departure is from the media of an intraosseous blood vessel. What is the cellular origin of the media of an intraosseous blood vessel? A. Leiomyoma cells B. Smooth muscle cells C. Lymphatic cells D. Epidermal cells
B. Smooth muscle cells
Regarding dysplasia ephysialis hemimelica, the term “hemimelica” refers to … A. involvement of one side of an epiphysis B. involvement of one side of an extremity C. involvement of one side of the body D. None of the above
B. involvement of one side of an extremity
Which one of the following represents an osteosarcoma whose component cells resemble those of Ewings sarcoma? A. Fibrohistiocytic conventional osteosarcoma B. Intraosseous low grade osteosarcoma C. Small cell osteosarcoma D. Telangiectatic osteosarcoma
C. Small cell osteosarcoma
Which of following primary tumors of bone carries the poorest prognosis with < 1yr survival rate? A. Conventional osteosarcoma B. Gnathic osteosarcoma C. Telangiectatic osteosarcoma D. Small cell osteosaroma E. Intraosseous low-grade osteosarcoma
D. Small cell osteosaroma
Which of the following types of osteosarcomas is the least common? A. Conventional B. Telangiectatic C. Gnathic D. Small cell E. Intracortical
E. Intracortical
What percentages of chondrosarcomas dedifferentiate? A. 10% B. 25% C. 50% D. 75%
A. 10%
Which of following radiographic findings for Hodgkins lymphoma carries the poorest prognosis? A. Pure osteolytic lesions. B. Mixed osteolytic and osteosclerotic lesions. C. Pure osteosclerotic lesions. D. All of the above carry the same prognosis.
A. Pure osteolytic lesions.
Which one of the following statements is FALSE? A. MRI is less useful than CT in the evaluation of osteoid osteomas B. Angiography is the imaging gold standard for identifying the osteoid osteoma nidus. C. The “double density” sign is an abnormality may be seen in bone scintigraphy of osteoid osteomas. D. Ultrasonography may be used successfully for the detection of osteoid osteomas in the femoral neck.
B. Angiography is the imaging gold standard for identifying the osteoid osteoma nidus.
In what percentage of fibrosarcoma cases is a pathologic fracture present at the initial work-up? A. 10% B. 30% C. 50% D. 70%
B. 30%
Osteolytic lesions are encountered in 30-50% of cases of acute childhood leukemia. Which of the following is characteristic of an osteolytic lesion for this disease? A. Destruction of the proximal clavicle at the sternoclavicular joint. B. Destruction of the posterior elements of the spine. C. Destruction of the occipital bone near the foramen magnum. D. Destruction of the medial cortex of the proximal humerus. E. Destrutcion of the lateral cortex of the proximal femur.
D. Destruction of the medial cortex of the proximal humerus.
A 44-year-old male presents with a painful knee. Radiographs reveal a solitary geographic radiolucency within the distal femoral epiphysis. No periosteal reaction is present. Which one of the following represents the most likely diagnosis? A. Chondroblastoma B. Osteoid osteoma C. Clear cell chondrosarcoma D. Metastatic desmoplastic fibroma
C. Clear cell chondrosarcoma
First described by Starker in 1918, Hemophilic Pseudotumors of bone and soft tissue occurs at what frequency in patients with hemophilia? A. < 2% B. 20% C. 60% D. > 90%
A. < 2%
What percentage of patients with conventional osteosarcoma present with primary lesions of the femur? A. 20% B. 40% C. 60% D. 80% E. 100%
B. 40%
What is the most common location for the locally aggressive (or malignant), angioblastoma (AKA. Adamantinoma)? A. Femur B. Pelvis C. Tibia D. Fibula
C. Tibia
The prognosis for small cell osteosarcoma is… A. much better than for any other variety of osteosarcoma B. similar to conventional osteosarcoma C. poor, most patients die within a year of diagnosis D. the poorest of all bone tumors overall
C. poor, most patients die within a year of diagnosis
Where is the most common location for a gnathic osteosarcoma to occur? A. Mandible B. Maxilla C. Zygoma D. Hard palate
A. Mandible
Which of the following statements is TRUE regarding Hodgkin’s lymphoma? A. Only 15-25% cases demonstrate radiographic findings. B. Bone involvement is greater in adults than in children. C. The spine, pelvis, ribs, femur, and sternum are the most common sites of involvement. D. Hematogenous spread carries a poor prognosis. E. All of the above are true
E. All of the above are true
Which of the following statements is false in reference to chondromyxoid fibromas? A. It is the most common benign cartilage forming tumors. B. Onset is generally less than 30 years of age. C. It has an affinity for the tibial tuberosity. D. Excision is the treatment of choice with a good prognosis. E. All of the above are false.
A. It is the most common benign cartilage forming tumors.
Which one of the following disorders is not associated with giant cell tumors? A. Paget’s disease B. Goltz syndrome C. Oncogenic osteomalcia D. Neurofibromatosis
D. Neurofibromatosis
Which of the following lesions is defined as originating withing the inner layer of periosteum? A. Periosteal B. Parosteal C. Subperiosteal D. Juxtacortical E. Paraosseous
A. Periosteal
Which of the following is NOT a common radiographic appearance for secondary bone involvement of non-Hodgkins lymphoma? A. Multiple osteolytic lesions with a moth eaten to permeative pattern of bone destruction. B. Endosteal scalloping. C. Cortical destruction adjacent soft tissue involvement. D. Periostitis. E. Osteosclerotic lesions.
E. Osteosclerotic lesions.
Which of the following statements is false in reference to the radiographic appearance of chondromxoid fibromas? A. It is primarily an metaphyseal lesion. B. It is primarily eccentrically located and osteolytic. C. Extensive calcific foci are visible within its matrix. D. The lesion may range from 2-10 cm. E. Endosteal sclerosis is common.
C. Extensive calcific foci are visible within its matrix.
Which one of the five major histologic types of ameloblastoma is most capable of metastasizing? A. Follicular B. Plexiform C. Basal Cell D. Acanthomatous E. Granular Cell
E. Granular Cell
Which one of the following is another term for Brown Tumor of Hyperparathyroid. A. Pseudotumor B. Osteoclastoma C. Osteitis Fibrosa Cystica D. Endothelioma
B. Osteoclastoma
What is the “gold standard” imaging technique for the specific diagnosis of a conventional osteosarcoma? A. Plain film B. MRI C. ст D. Bone scan
A. Plain film
Which of the following is NOT a common radiographic finding for primary bone involvement of non-Hodgkins lymphoma in the appendicular skeleton? A. Long bones of the lower extremity are most commonly involved. B. Has a predilection for the posterior elements of vertebrae C. Has a predilection for the metaphysis of long bones. D. Osteolytic lesions with a poor zone of transition. E. All of the above are common radiographic findings.
B. Has a predilection for the posterior elements of vertebrae
Which of the following lesions has a classic radiographic appearance of a centrally located, round radiolucency of cortical bone measuring less than a centimeter surrounded by a zone of uniform bone sclerosis? A. Enostoma B. Osteoma C. Osteoblastoma D. Osteoid osteoma E. Osteosarcoma
D. Osteoid osteoma
Which of the following conditions presents with assymetric and unilateral multiple enchondromas with shortening of the affected extremity and a palpable mass? A. Fong’s syndrome B. Multiple hereditary exostosis C. Maffucci’s syndrome D. Ollier’s disease E. Osteopoikilosis
D. Ollier’s disease
The most common presentation of telangiectatic osteosarcoma is what? A. Purely lytic B. Purely blastic C. Mixed D. Soft tissue mass only
A. Purely lytic
Which of the following osteosclerotic lesions is a result of direct invasion from Hodgkins lymphoma of breast lymph nodes? A. Sternum B. Ribs C. Vertebrae D. Sacrum
A. Sternum
A patient presents to your office with complaints of frequent nosebleeds and blood in their stool. Labs reveal an increase in iron binding capacity but are otherwise negative. On physical examination, you notice small red and violet lesions on the face, lips, oral and nasal mucosa, and the tips of the fingers and toes. Which of the following is associated with this patient’s condition? A. Ulcerative Colitis B. Gorham’s disease C. Hemangiomatosis D. Hemangioma
C. Hemangiomatosis
What is the most likely diagnosis of a lesion involving the distal metaphysis of the femur that is purely osteolytic, multilocular, and expansile with little or no evidence or periosteal reaction? A. Conventional osteosarcoma B. Gnathic osteosarcoma C. Telangiectatic osteosarcoma D. Small cell osteosarcoma E. Surface high-grade osteosarcoma
C. Telangiectatic osteosarcoma
What percent of primary malignant osseous tumors does primary lymphoma of bone account? A. 5% B. 15% C. 25% D. 35% E. 45%
A. 5%
What percentage of patients with Ewings sarcoma also has metastatic disease at presentation? A. 30% B. 60% C. 80% D. 100%
A. 30%
