Oncology 2014 Flashcards
Question 4
A 62-year-old otherwise healthy man underwent resection of a mass in his anterior thigh. The 8-cm superficial mass was a high-grade pleomorphic sarcoma, but no margins could be determined. The surgeon thought the mass was a lipoma, but stated taht adequate margins were identified intrasurgically. He did not send frozen section margins. Which treatment would best improve local control?
- Observation
- Radiation to the surgical bed
- Wide re-resection of the surgical bed and radiation
- Chemotherapy and re-resection of the surgical bed
- Wide re-resection of the surgical bed
- Wide re-resection of the surgical bed
RECOMMENDED READINGS
Venkatesan M, Richards CJ, McCulloch TA, Perks AG, Raurell A, Ashford RU; East Midlands Sarcoma Service. Inadvertent surgical resection of soft tissue sarcomas. Eur J Surg Oncol. 2012 Apr;38(4):346-51. doi: 10.1016/j.ejso.2011.12.011. Epub 2012 Jan 20. PubMed PMID: 22264775.
Noria S, Davis A, Kandel R, Levesque J, O’Sullivan B, Wunder J, Bell R. Residual disease following unplanned excision of soft-tissue sarcoma of an extremity. J Bone Joint Surg Am. 1996 May;78(5):650-5. PubMed PMID: 8642020.
Question 17
Figures 17a through 17d are the anteroposterior and lateral radiographs and low- and high-power biopsy specimens of a 67-year-old woman who has progressive left hip pain. She describes pain at rest that is exacerbated with weight bearing. What is the best next step?
- Observation
- Wide resection
- Internal fixation
- Chemotherapy
- Radiation therapy
- Internal fixation
RECOMMENDED READINGS
Peabody T. The rodded metastasis is a sarcoma: strategies to preventinadvertent surgical procedures on primary bone malignancies. Instr Course Lect. 2004;53:657-61. Review. PubMed PMID: 15116656.
Quinn RH, Randall RL, Benevenia J, Berven SH, Raskin KA. Contemporary management of metastatic bone disease: tips and tools of the trade for general practitioners. J Bone Joint Surg Am. 2013 Oct 16;95(20):1887-95. Review. PubMed PMID: 24288805.
Question 25
Figures 25a through 25d are the radiographs and biopsy specimens of a 20-year-old man who has ambulatory pain in his right heel. What is the most likely diagnosis?
- Chondroblastoma
- Intraosseous lipoma
- Unicameral bone cyst
- Aneurysmal bone cyst
- Giant-cell tumor of bone
- Unicameral bone cyst
RECOMMENDED READINGS
Kilgore WB, Parrish WM. Calcaneal tumors and tumor-like conditions. Foot Ankle Clin. 2005 Sep;10(3):541-65, vii. Review. PubMed PMID: 16081020.
Weber KL, Heck RK: Cystic and benign bone lesions. In: Schwartz HS, ed. Orthopaedic Knowledge Update: Musculoskeletal Tumors 2. Rosemont, IL: American Academy of Orthopaedic Surgeons;2007:87-102.
Question 37
Figures 37a through 37f are the plain radiographs, coronal and axial postcontrast MR images, and biopsy specimens of a 14-year-old boy who has progressive knee pain and swelling after falling from a bicycle several months ago. He now notes constant pain and has a limp. Examination reveals a deep, nonmobile distal thigh mass. What is the best next step?
- Curettage
- Embolization
- Wide resection
- Chemotherapy
- Radiation therapy
- Chemotherapy
Luetke A, Meyers PA, Lewis I, Juergens H. Osteosarcoma treatment - where do we stand? A state of the art review. Cancer Treat Rev. 2014 May;40(4):523-32. doi: 10.1016/j.ctrv.2013.11.006. Epub 2013 Nov 27. Review. PubMed PMID: 24345772.
Hornicek FJ. Osteosarcoma of bone. In: Schwartz HS, ed. Orthopaedic Knowledge Update: Musculoskeletal Tumors 2. Rosemont, IL. American Academy of Orthopaedic Surgeons;2007. 163-174.
Question 47
Figures 47a through 47c are the radiographs of a 65-year-old man with a history of lung adenocarcinoma. He has thigh pain with weight bearing. His bone scan findings reveal no other osseus lesion. What is the most appropriate next step?
- Biopsy
- Radiotherapy
- Total femur replacement
- Intramedullary nail and radiotherapy
- Wide resection and intercalary reconstruction
- Biopsy
RECOMMENDED READINGS
Weber KL, Randall RL, Grossman S, Parvizi J. Management of lower-extremity bone metastasis. J Bone Joint Surg Am. 2006 Dec;88 Suppl 4:11-9. PubMed PMID:17142431.
Bickels J, Dadia S, Lidar Z. Surgical management of metastatic bone disease. J Bone Joint Surg Am. 2009 Jun;91(6):1503-16. doi: 10.2106/JBJS.H.00175. Review. PubMed PMID: 19487532.
Question 60
Figures 60a through 60c are the axial T1, T2, and postcontrast MR images of a 57-year-old man who has a painless enlarging anterior thigh mass. What is the next appropriate step?
- Biopsy
- Chest CT
- Resection
- Observation
- Radiation therapy
- Biopsy
RECOMMENDED READINGS
Scarborough MT. The biopsy. Instr Course Lect. 2004;53:639-44. Review. PubMed PMID: 15116653.
Damron TA, Beauchamp CP, Rougraff BT, Ward WG Sr. Soft-tissue lumps and bumps. Instr Course Lect. 2004;53:625-37. Review. PubMed PMID: 15116652.
Question 71
Figures 71a and 71b are the T2-weighted MR image and histology of a 27-year-old man who had a painful lump in his right ankle for several months. Marginal resection was performed. Further treatment should include
- amputation.
- observation.
- chemotherapy and wide re-resection
- wide re-resection, radiation, and chemotherapy.
- wide re-resection of the area and radiation.
- observation.
RECOMMENDED READINGS
Lai CS, Chen IC, Lan HC, Lu CT, Yen JH, Song DY, Tang YW. Management of extremity neurilemmomas: clinical series and literature review. Ann Plast Surg. 2013 Dec;71 Suppl 1:S37-42. doi: 10.1097/SAP.0000000000000042. PubMed PMID: 24284739.
Question 79
Figures 79a through 79d are the plain radiographs and biopsy specimens of a 14-year-old boy who has sudden-onset calf pain after stepping awkwardly off a curb. His family notes that he has sustained fractures in the past. What is the most likely diagnosis?
- Adamantimona
- Fibrous dysplasia
- Nonossifying fibroma
- Osteofibrous dysplasia
- Osteogenesis imperfecta
- Adamantimona
Question 90
Figures 90a through 90c are the radiographs and pathology of a 20-year-old man who has knee pain and swelling 1 year after undergoing curetting of a benign bone tumor of the proximal tibia. What is the most likely diagnosis?
- Osteomyelitis
- Chondroblastoma
- Aneurysmal bone cyst
- Giant-cell tumor of bone
- Malignant giant-cell tumor
- Giant-cell tumor of bone
Question 109
Figures 109a and 109b are the radiographs of a 66-year-old woman with metastatic breast cancer who has a 3- to 4-week history of progressively worsening pain in her left leg and an inability to bear weight on her left lower extremity. Her estimated survival time is longer than 6 months. What is the appropriate next step?
- Biopsy of the area
- Intramedullary nail fixation
- Consultation with hospice care
- Consultation with a radiation oncologist
- Consultation with a chemotherapy oncologist
- Intramedullary nail fixation
RECOMMENDED READINGS
Biermann JS, Holt GE, Lewis VO, Schwartz HS, Yaszemski MJ. Metastatic bone disease: diagnosis, evaluation, and treatment. J Bone Joint Surg Am. 2009 Jun;91(6):1518-30. Review. PubMed PMID: 19487533.
Coleman RE. Skeletal complications of malignancy. Cancer. 1997 Oct 15;80(8 Suppl):1588-94. Review. PubMed PMID: 9362426.
Question 127
Figures 127a through 127c are the axial T1, coronal short tau inversion recovery, and axial postcontrast MR images of a 49-year-old woman who has an enlarging, increasingly symptomatic posterior arm mass. She is not sure how long the mass has been present. What is the most likely diagnosis?
- Lipoma
- Myxoma
- Hemangioma
- Atypical lipoma
- Soft-tissue sarcoma
- Lipoma
RECOMMENDED READINGS
Damron TA, Beauchamp CP, Rougraff BT, Ward WG Sr. Soft-tissue lumps and bumps. Instr Course Lect. 2004;53:625-37. Review. PubMed PMID: 15116652.
Gaskin CM, Helms CA. Lipomas, lipoma variants, and well-differentiated liposarcomas (atypical lipomas): results of MRI evaluations of 126 consecutive fatty masses. AJR Am J Roentgenol. 2004 Mar;182(3):733-9. PubMed PMID: 14975977.
Question 156
Figures 156a and 156b are the plain radiograph and biopsy specimen of a 14-year-old boy who has a 6-week history of right leg pain. The most appropriate next diagnostic steps should include
- a bone scan, MR of the femur, and CT of the chest.
- a bone scan; MR of the femur; and CT of the chest, abdomen, and pelvis.
- a bone marrow aspirate; CT of the chest, abdomen, and pelvis; and a bone scan.
- a bone marrow biopsy; CT of the chest, abdomen, and pelvis; MR of the femur; and a bone scan.
- nothing further; a biopsy should be adequate to stage this disease.
- a bone scan, MR of the femur, and CT of the chest.
RECOMMENDED READINGS
Kaste SC. Imaging pediatric bone sarcomas. Radiol Clin North Am. 2011 Jul;49(4):749-65, vi-vii. Doi: 10.1016/j.rcl.2011.05.006. Epub 2011 Jun 16. Review. PubMed PMID: 21807172.
Question 172
Figures 172a and 172b are the left humerus radiographs of a 78-year-old woman with multiple myeloma and multifocal osseous disease who has progressive left arm pain at rest and with activity. Comprehensive care of this patient’s osseous disease should include
- radiation to the left humerus and bisphosphonates.
- surgical stabilization and radiation to the left humerus.
- surgical stabilization and radiation to the left humerus and bisphosphonates.
- surgical stabilization and radiation to the left humerus, bisphosphonates, and hormone therapy.
- surgical stabilization and bisphosphonates.
- surgical stabilization and radiation to the left humerus and bisphosphonates.
RECOMMENDED READINGS
Scharschmidt TJ, Lindsey JD, Becker PS, Conrad EU. Multiple myeloma: diagnosis and orthopaedic implications. J Am Acad Orthop Surg. 2011 Jul;19(7):410-9. Review. PubMed PMID: 21724920.
Yeh HS, Berenson JR. Treatment for myeloma bone disease. Clin Cancer Res. 2006 Oct 15;12(20 Pt 2):6279s-6284s. Review. PubMed PMID: 17062714.
Question 187
Figures 187a through 187f are the plain radiographs, coronal short tau inversion recovery and axial T1 MR images, and biopsy specimens of a 9-year-old boy who has had a limp for 4 months. He has intermittent right hip pain and mild irritability around the hip. What is the most likely diagnosis?
- Fibrous dysplasia
- Osteofibrous dysplasia
- Unicameral bone cyst
- Aneurysmal bone cyst
- Eosinophilic granuloma
- Unicameral bone cyst
RECOMMENDED READINGS
Weber KL, Heck RK Jr. Cystic and benign bone lesions. In: Schwartz HS, ed. Orthopaedic Knowledge Update: Musculoskeletal Tumors 2. Rosemont, IL: American Academy of Orthopaedic Surgeons;2007:89-92.
Question 217
Figures 217a through 217e are the plain radiographs, coronal and axial T2-weighted MR images, and biopsy specimen of a 16-year-old boy who has severe activity-related knee pain. He has a firm, fixed, deep distal thigh mass. What is the most likely diagnosis?
- Osteosarcoma
- Osteoblastoma
- Chondrosarcoma
- Osteochondroma
- Nonossifying fibroma
- Osteochondroma
RECOMMENDED READINGS
Stieber JR, Dormans JP. Manifestations of hereditary multiple exostoses. J Am Acad Orthop Surg. 2005 Mar-Apr;13(2):110-20. Review. PubMed PMID: 15850368.