Tumor/Pathology

Question 1

Multiple hereditary exostosis has increased risk of which malignancy?

Answer 1

Secondary Chondrosarcoma in area of prior exostosis

Question 2

Mafucci’s syndrome is associated with what?

Answer 2

Hemangiomas

Question 3

Ollier’s disease pts have what

Answer 3

Multiple enchondromas

Question 4

Gardner’s syndrome is associated with what?

Answer 4

Extra-abdominal desmoid tumors

Question 5

Von Recklinghausen’s disease is associated with what?

Answer 5

Plexiform neurofibromas

Question 6

Tumors that metastasize to lymph nodes

Answer 6

ESARC

• epithelioid sarcoma
• synovial sarcoma
• angiosarcoma
• rhabdomyosarcoma
• clear cell sarcoma

Question 7

Multiple myeloma histology

Answer 7

• sheets of plasma cells w/ eccentric nuclei (small round blue cells)
• coarsely clumped nuclear chromatin
• perinuclear halo

Question 8

Carcinoma metastasis histology

Answer 8

-nests of epithelial cells in fibrous background

Question 9

Fibrous dysplasia histology

Answer 9

-irregular bony trabecula without rimming osteoblasts

Question 10

Chondrosarcoma

Answer 10

• On radiograph, chondrosarcoma is a fusiform, lucent defect with scalloping of the inner cortex (endosteal scalloping) and periosteal reaction. Extension into the soft tissue may be present, as well as punctate or stippled calcification of the cartilage matrix.
• Histologically, chondrosarcoma is differentiated from benign cartilage tumors by enlarged plump nuclei, multiple cells per lacunae, binucleated cells, and hyperchromic nuclear pleomorphism.
• Treatment of most chondrosarcomas is surgery only because adjuvant treatments are not effective.

Question 11

Fibrous dysplasia

Answer 11

Fibrous dysplasia is a common benign skeletal lesion that may involve 1 bone (monostotic) or multiple bones (polyostotic) and occurs throughout the skeleton with a predilection for the long bones. The radiographic features of fibrous dysplasia typically illustrate a grayish “ground-glass” pattern that is similar to the density of cancellous bone. The key histologic features of fibrous dysplasia are trabeculae of immature bone, with no osteoblastic rimming, contained within a bland fibrous stroma of dysplastic spindle-shaped cells without any cellular features of malignancy. The etiology of fibrous dysplasia has been linked to an activating mutation in the gene that encodes the α subunit of stimulatory G protein located at 20q13.2-13.3. This leads to a constitutive activation of adenylate cyclase and increased cyclic adenosine monophosphate formation.

Question 12

FGFR3 mutation

Answer 12

Achondroplasia

Question 13

COMP mutation

Answer 13

• pseudo achondroplasia

- multiple epiphyseal dysplasia

Question 14

EXT-1 mutation

Answer 14

-multiple hereditary exostosis

Question 15

Biopsy of the proximal humerus

Answer 15

A biopsy of the proximal humerus should be performed through the anterior third of the deltoid. A biopsy should be performed through a single compartment and be incorporated with an extensile approach because the biopsy tract will be resected with the tumor if it is a sarcoma. Performing a biopsy through the deltopectoral interval will contaminate more than 1 compartment.

Question 16

Staging of sarcomas

Answer 16

-Staging of sarcomas is important to help predict prognosis. Not all sarcomas are reliably positive on a PET scan, so the preferred staging studies are CT scan of the chest and whole-body bone scan. Hematogenous spread of sarcomas is the most common route of metastatic disease, which speaks to the value of chest CT scans. Clear-cell sarcomas (in addition to synovial sarcoma, angiosarcoma, epithelioid sarcoma, and rhabdomyosarcoma) tend to involve lymphatic nodal metastatic disease, so sentinel node biopsy is considered when assessing these tumors. Evidence supports efficacy of sentinel node biopsy for clear-cell sarcomas in particular.

Question 17

Features concerning for soft-tissue sarcoma

Answer 17

-For patients with rapidly enlarging painless masses, particularly those that are either large or deep, the diagnosis of a soft-tissue sarcoma should be entertained. Masses exceeding 5 cm in largest dimension that are subfascial and heterogenous on MRI are concerning. MRI with and without contrast is the preferred imaging modality for evaluation of soft-tissue sarcomas because it can delineate location of the lesion, involvement of neurovascular structures, intra-articular involvement, and underlying signal alteration in the osseous structures. Most patients can relate the onset of their symptoms to a traumatic event, and the interpretation of an MRI may include a hematoma.

Question 18

Typical tx for giant cell tumor of bone?

Answer 18

Intralesional curettage w/ adjuvants

Question 19

Adjuvant therapy for recurrent giant cell tumor of bone?

Answer 19

-Denosumab

Question 20

Aggressive fibromatosis/Desmoid tumor has been associated with Gardner syndrome and familial adenomatous polyposis. This patient is at high risk for colon cancer. Gardner syndrome is associated with osteomas, epidermal cysts, periampullary carcinomas, lipomas, and dental abnormalities in addition to desmoid tumors.

Answer 20

.

Question 21

extra-abdominal fibromatosis/desmoid tumor

Answer 21

Aggressive fibromatosis has been associated with Gardner syndrome and familial adenomatous polyposis. This patient is at high risk for colon cancer. Gardner syndrome is associated with osteomas, epidermal cysts, periampullary carcinomas, lipomas, and dental abnormalities in addition to desmoid tumors.

Question 22

Ringed chromosomes and expression of MDM2, but do NOT have 12;16 translocation are typical of what?

Answer 22

Atypical lipomatous tumor (well-differentiated Liposarcoma)

Question 23

12;16 translocation in lipomatous mass is consistent w/ what diagnosis?

Answer 23

Myxoid Liposarcoma

Question 24

Achondroplasia

Answer 24

Achondroplasia is caused by the arginine-to-glycine amino acid substitution in the FGF-3 receptor gene and is characterized by rhizomelic limb shortening with normal trunk length attributable to inhibition of chondrocyte proliferation in the physis. Associated findings include macrocephaly, midface hypoplasia, trident hands, genu varum, and early gross motor delays that usually normalize with time. People with achondroplasia also can have foramen magnum stenosis with cervicomedullary spinal cord compression and diminished respiratory drive; the incidence of sudden infant death in this population is 2% to 5% and is thought to be attributable to the combination of central sleep apnea, tonsillar hypertrophy, and midface hypoplasia. Other signs of foramen magnum stenosis include swallowing difficulties and hyperreflexia. The American Academy of Pediatrics recommends neuroimaging of the craniocervical junction and polysomnography for infants with achondroplasia and suspected foramen magnum stenosis. Achondroplasia is not directly associated with neonatal cardiac abnormalities.

Question 25

Translocation associated w/ Ewing’s sarcoma

Answer 25

T(11;22)

Question 26

Synovial sarcoma associated gene

Answer 26

SYT

Question 27

Multiple hereditary exostosis associated gene

Answer 27

EXT1

Question 28

Ewing sarcoma associated gene

Answer 28

EWS

Question 29

Osteogenesis imperfecta associated gene

Answer 29

COL1A

Question 30

tenosynovial giant cell tumor

Answer 30

aka PVNS - characterized by an overexpression of CSF1. CSF1R activation leads to recruitment of CSF1R-expressing cells of the mononuclear phagocyte lineage.

Question 31

The characteristic histologic finding in synovial chondromatosis is what?

Answer 31

SYNOVIAL METAPLASIA (the cartilaginous change of the synovial membrane)

Question 32

chondrocyte cloning is found in what?

Answer 32

chondrosarcoma

Question 33

Cords of eosinophilic cell in myxoid stroma are characteristic for what?

Answer 33

extraskeletal chondrosarcoma

Question 34

Atraumatic vertebra plana in a young child is most commonly the result of a pathologic compression fracture through a lesion of what?

Answer 34

Langerhans cell histiocytosis (LCH).

Question 35

Ewing's sarcoma is treated by what?

Answer 35

Radiotherapy, Chemotherapy, and wide resection

Question 36

how is adamantinoma treated?

Answer 36

surgery alone

Question 37

Paget's disease of bone

Answer 37

osteoclastic abnormality marked by focally increased skeletal remodeling within the axial or appendicular skeleton. There is an initial wave of osteoclast-mediated bone resorption, followed by the second phase of disorganized skeletal repair. This process leads to excessively disorganized woven bone and lamellar bone, characterized by osteosclerosis and hyperostosis, respectively, and results in the characteristic findings of cement lines seen histologically. The disorganized bone is weaker and prone to fractures. The final phase of the disease is the quiescent phase in which there is little bone turnover. Because of the increased bone remodeling, there is usually an associated increased vascularity which should be taken in account when surgery is performed. There is no bony replacement of the bone marrow.

Question 38

Myxoid liposarcoma

Answer 38

- translocation t(12;16) - In addition to posing risk for pulmonary metastases, myxoid liposarcomas have an unusual predilection for extrapulmonary metastases. Most notable are bone metastases, particularly involving the spine. Sarcoma metastases to the brain or liver are relatively uncommon and typically are late findings. Lymph node metastases have been reported in about 2.6% of soft-tissue sarcomas, but they are more common in histologic subtypes including angiosarcoma, rhabdomyosarcoma, clear-cell sarcoma, epithelioid sarcoma, and synovial sarcoma. However, for myxoid liposarcoma, nodal metastases remain uncommon.

Question 39

osteoblastoma

Answer 39

The combination of immature woven bone with osteoblastic rimming surrounded by a vascular fibrous bland stroma seen in Figure 9 and scattered giant cells within the lesion seen in Figure 8 should arouse suspicion for osteoblastoma. Osteoblastoma most often is diagnosed in adolescents and young adults, with 75% of patients younger than 25 years of age at diagnosis. Within tubular bones, osteoblastoma most often arises in the metadiaphyseal region, but it is more commonly seen in the spine within the posterior elements and flat bones. The lesion is well defined on radiographs, with lucent to mixed-lucent and blastic areas. MR imaging findings reveal low to intermediate–signal intensity on T1-weighted images and intermediate to high–signal intensity on T2-weighted images.

Question 40

characteristic translocation of synovial sarcoma?

Answer 40

t(X;18)

Question 41

Clear cell chondrosarcoma

Answer 41

Clear-cell chondrosarcoma is a rare, slow-growing, low-grade malignancy that typically involves the epiphysis of long bones. The tumor is lytic, and the proximal femur is the most common location. Chemotherapy and radiation are not used because the tumor is low grade. Placement of a nail would result in an intralesional resection and pose risk for both local recurrence and metastatic disease. When treated appropriately with a wide resection, surgery alone usually is curative.

Question 42

Tx of lipomatous tumors

Answer 42

- Intramuscular lipomas and atypical lipomatous tumors are treated with marginal resection alone. - Surgical treatment of a high-grade sarcoma involves wide surgical resection. Radiation decreases local recurrence but does not clearly influence overall survival. The role of chemotherapy in high-grade soft-tissue sarcomas remains investigational; there is a modest (8%-15%) associated improvement in overall survival. - Radiation therapy for soft-tissue sarcomas may be given before or after surgery. When administered before surgery, patients have a higher wound complication rate but better long-term function attributable to lower rates of lymphedema, fibrosis, and contractures (lower dose given compared to post-op radiation).

Question 43

Synovial sarcoma associated translocation and staining?

Answer 43

T(X;18) | Keratin +

Question 44

Hemangioma

Answer 44

A phlebolith is identified on the radiograph. MR imaging demonstrates a heterogeneous mass with signal dropout of the phlebolith and evidence of fat within the tumor. The history of a chronic mass that changes in size helps confirm the diagnosis. A biopsy is not necessary considering the clinical and radiographic findings. Marginal resection is likely to result in recurrence. Chest CT findings likely will be normal, and a CT would be considered only in a scenario involving a soft-tissue sarcoma diagnosis

Question 45

High grade undifferentiated pleomorphic sarcoma

Answer 45

Histologically, UPS is characterized by high cellularity, marked nuclear pleomorphism, abundant mitotic activity (including atypical mitoses), and a spindle cell morphology. Necrosis is common and characteristic of high-grade lesions. Treatment consists of wide surgical excision and, in almost all cases, radiation. Radiation eliminates the need for limb amputation, and there is level I evidence to show that it leads to equivalent rates of survival. Radiation may be delivered either before or after surgery depending on the surgeon’s and multidisciplinary tumor board’s recommendations. There may be a role for presurgical embolization in some cases of high-grade soft-tissue sarcoma, but this is not appropriate as a standalone treatment. Chemotherapy provides limited survival improvement in adults with high-grade soft-tissue sarcomas.

Question 46

translocation associated w/ myxoid liposarcoma

Answer 46

t(12;16)

Question 47

translocation associated w/ alveolar soft tissue sarcoma

Answer 47

t(x;17)

Question 48

translocation associated w/ Ewing sarcoma

Answer 48

t(11;22)

Question 49

translocation associated w/ alveolar rhabdomyosarcoma

Answer 49

t(2;13)

Question 50

t(9;22) translocation is associated w/ what?

Answer 50

The t(9;22) translocation occurs in extraskeletal myxoid chondrosarcoma

Question 51

Low-grade cartilage lesions are among the few diagnoses for which proceeding to definitive surgical treatment without a definitive histologic diagnosis is appropriate. Extended curettage with adjuvants is an acceptable treatment option for both enchondroma and low-grade chondrosarcoma of the extremities; as such, it is appropriate to proceed to definitive treatment when these are the only diagnoses in the differential. There is no consensus regarding the number and type of adjuvants used in intralesional curettage. There is also lack of consensus regarding how to reconstruct the resultant defect, with some favoring cement and others favoring bone grafting. A wide resection with intercalary resection is not indicated. Most commonly, serial radiologic studies are recommended to ensure no change occurs over time when the lesion is found incidentally, as in this patient.

Answer 51

.

Question 52

Chromosome translocation for Ewing sarcoma

Answer 52

11;22

Question 53

Chromosome translocation for synovial cell sarcoma

Answer 53

X;18

Question 54

Chromosome translocation for myxoid Liposarcoma

Answer 54

12;16

Question 55

Chromosome translocation for extra-skeletal myxoid chondrosarcoma

Answer 55

9;22

Question 56

biopsy principles

Answer 56

Biopsy principles dictate that a biopsy should be performed in line with an extensile approach through one compartment and that contamination should be minimized. Performing the biopsy through the knee joint has caused the entire joint to be considered contaminated. It will have to be resected by an extra-articular resection or amputation at the time of definitive surgery. This substantially increases the morbidity of the procedure, in which a standard distal femoral replacement or distal femoral osteoarticular allograft could have been used for reconstruction.

Question 57

Treatment of chondrosarcoma

Answer 57

Surgical resection and reconstruction | -There is no known benefit of radiation or chemotherapy in the treatment of high-grade chondrosarcoma.

Question 58

treatment of low-grade chondrosarcomas

Answer 58

curettage

Question 59

Myxoid liposarcoma chromosomal translocation

Answer 59

12;16

Question 60

Synovial cell sarcoma chromosomal translocation

Answer 60

X;18

Question 61

Alveolar soft-part sarcoma chromosomal translocation

Answer 61

X;17

Question 62

Ewing sarcoma chromosomal translocation

Answer 62

11;22

Question 63

Alveolar rhabdomyosarcoma chromosomal translocation

Answer 63

2;13

Question 64

Synovial hemangioma

Answer 64

Histologically, vascular lakes within fine capillaries with a synovium on the surface of the lesion are characteristic of this condition. Many patients with synovial hemangioma have pain, swelling, stiffness, or mechanical symptoms. - As with PVNS, the disease can be localized or diffuse. Surgical excision, either open or arthroscopic, is the recommended treatment. PVNS is the most common intra-articular tumor, but hypointensity in either the diffuse or localized type is characteristic in both T1- and T2-weighted images.

Question 65

MRI appearance of PVNS?

Answer 65

PVNS is the most common intra-articular tumor, but hypointensity in either the diffuse or localized type is characteristic in both T1- and T2-weighted images.

Question 66

Langerhans cell histiocytosis

Answer 66

Also called eosinophilic granuloma, histiocytosis X, Langerhans cell granulomatosis Rare disorder of Langerhans cells Variable clinical picture with single or multiple lesions or disseminated disease Nodal involvement may be sole manifestation of disease or associated with systemic disease May also have nodal involvement by lymphoma Rarely have frankly malignant cells (Langerhans cell sarcoma) associated with more aggressive clinical behavior -Partial effacement of lymph node with preservation of follicular centers but distension of nodal sinuses by Langerhans cells, which are 12 - 15 microns in diameter with abundant, pale eosinophilic cytoplasm, irregular and elongated nuclei with prominent nuclear grooves and folds, fine chromatin and indistinct nucleoli Occasionally multinucleated Sinuses commonly have foci of necrosis, often surrounded by rim of eosinophils Rarely eosinophilic abscess incite a granulomatous response (J Clin Pathol 2006;59:548) Variable mitotic activity

Question 67

hematological conditions associated with multiple bone infarcts

Answer 67

Polycythemia, sickle-cell disease, hemophilia, aplastic anemia, thalassemia, and acute lymphoblastic leukemia

Question 68

bisphosphonate-induced stress fracture

Answer 68

- typically lateral cortical beaking (tension side of femur) | - Tx is immediate IMN without further work-up

Question 69

Biopsy principles around the knee

Answer 69

The biopsy should cross only 1 compartment if possible and proceed as directly as possible to the tumor. The lateral parapatellar and medial parapatellar approaches cross the knee joint, potentially visualizing tumor into the knee. A direct anterior approach will contaminate an extensive portion of the quadriceps muscle and potentially complicate limb salvage. Biopsy should be performed at the institution at which definitive resection is planned.

Question 70

Although postsurgical radiation is associated with lower rates of wound complication, radiation that is administered after surgery necessitates higher radiation doses and a larger tissue field than radiation administered before surgery. Risk for radiation-associated fracture increases with larger fields and higher doses. Retrospective studies have demonstrated increased fracture risk with postsurgical radiation doses of at least 60 Gy compared with presurgical radiation doses of 50 Gy.

Answer 70

.

Question 71

How do you treat renal cell carcinoma mets to proximal femur?

Answer 71

Proximal femur resection would be a reasonable choice in isolated renal cell carcinoma metastasis, which tends to be radioresistant and for which resection has been shown to have an oncologic benefit.

Question 72

Renal cell carcinoma

Answer 72

Renal cell carcinoma typically is radioresistant. With improvements in chemotherapy treatments, survival is increasing and fixation failure is more likely to occur. A curettage resection is likely to leave disease behind and puts patients at risk for progression of disease and hardware failure. Wide resection can improve implant survival, and complete resection of metastatic disease in renal cell carcinoma results in improved overall survival. Embolization should be performed with renal cell carcinoma prior to any surgical intervention because substantial blood loss can occur with placement of an intramedullary nail.

Question 73

Role of chemotherapy in high-grade soft tissue sarcomas?

Answer 73

Surgical treatment of a high-grade sarcoma involves wide surgical resection. Radiation decreases local recurrence but does not clearly influence overall survival. The role of chemotherapy in high-grade soft-tissue sarcomas remains investigational; there is a modest (8%-15%) associated improvement in overall survival.

Question 74

Tx for intramuscular lipomas and atypical lipomatous tumors?

Answer 74

marginal resection alone

Question 75

Enchondroma

Answer 75

well-mineralized lesion within the intramedullary canal with punctate calcifications. This by itself suggests an enchondroma or low-grade chondrosarcoma. It is important to note that enchondromas in the long bones rarely cause pathologic fractures. This is not the case when they are present in the hands and feet, where enchondromas frequently have a more aggressive radiologic appearance and pose higher risk. Radiographic findings concerning for malignant dedifferentiation of an enchondroma include cortical thinning or breach, a soft-tissue mass, or periosteal elevation.

Question 76

Is renal cell carcinoma typically radioopaque or radiolucent?

Answer 76

radiolucent

Question 77

Dedifferentiated chondrosarcoma

Answer 77

highly aggressive malignancy, with average 5-year survivals of less than 50%. As with most sarcomas, the most likely site of metastatic dissemination of chondrosarcoma is pulmonary. As with other bone sarcomas, staging entails a CT scan of the chest and a bone scan

Question 78

staging study for multiple myeloma

Answer 78

skeletal survey (NOT bone scan)

Question 79

Treatment of chondrosarcoma?

Answer 79

Wide surgical resection (NOT chemo or radiotherapy)

Question 80

Telangiectatic osteosarcoma

Answer 80

variant of high-grade osteosarcoma. The second decade of life is usually the most common age for this condition. The most common sites of metastasis are the lungs and other bones. Typical radiographic characteristics include an expansile destructive metaphyseal lesion with very little to no new bone formation. It is similar in appearance to an aneurysmal bone cyst. MR imaging demonstrates a low-signal intensity lesion on T1-weighted images, and fluid-fluid levels and high signal intensity may be present on T2-weighted images. Low-power histology resembles an aneurysmal bone cyst with cavernous blood-filled spaces. However, on high power, the septa have pleomorphic cells. Histology usually shows blood-filled cystic cavities with areas of hemorrhagic necrosis, giant cells, pleomorphic cells, and minimal osteoid. Typical treatment includes neoadjuvant chemotherapy followed by wide resection and postsurgical chemotherapy

Question 81

what should pelvic incidence/lumbar lordosis mismatch be to be within normal range?

Answer 81

within 10 degrees

Question 82

If an open biopsy of a musculoskeletal neoplasm is to be performed, the incision should be placed?

Answer 82

If an open biopsy is to be performed, the incision should fall along any line of future tumor resection. This line is NOT longitudinal about the shoulder or pelvic girdles, nor is it often in the place of a "standard" orthopaedic approach, which may contaminate surrounding structures.

Question 83

renal cell carcinoma histology

Answer 83

malignant cells with cytoplasmic inclusions

Question 84

chondrosarcoma

Answer 84

speckled calcifications on plain film and chondroid matrix on histology

Question 85

Multiple hereditary exostoses (MHE) has what genetic abnormality?

Answer 85

EXT1 or EXT2 genes

Question 86

Treatment for Ewing sarcoma

Answer 86

Chemotherapy plus wide surgical resection

Question 87

Imaging study of choice to diagnose osteoid osteoma?

Answer 87

thin cut CT scan

Question 88

when an osteoid osteoma occurs in the spine

Answer 88

located in posterior elements, and paraspinal pain and scoliosis often are present

Question 89

adductor insertion avulsion syndrome, also known as thigh splints

Answer 89

This is a painful condition that worsens with resisted hip adduction. Treatment consists of activity cessation with use of crutches and nonsteroidal anti-inflammatory drugs. Repeat imaging and monitoring for resolution of the symptoms should be performed to confirm the diagnosis.

Question 90

Staging of osteosarcoma of bone

Answer 90

includes local imaging of the affected extremity with radiographs,MR imaging, chest imaging with a CT scan, and a whole-body bone scan. Because the treatment of osteosarcoma begins with neoadjuvant chemotherapy, immediate referral to a pediatric oncologist is critical.A CT scan of the abdomen and pelvis is not indicated in primary bone sarcomas, but it may have a role in the staging of some soft-tissue sarcomas. Bone marrow biopsy is not a component of osteosarcoma staging but is used in the staging of Ewing sarcoma of bone. Radiation is not used in the standard treatment of osteosarcoma of bone.

Question 91

Nests of polyhedral cells

Answer 91

Squamous cell carcinoma

Question 92

fat embolism syndrome (FES)

Answer 92

- Classic findings of FES are mental status changes, hypoxemia, and petechial rash developing after intramedullary instrumentation procedures. FES is more common after closed femoral nailing for cancer treatment than after traumatic fractures. Patients with preexisting cardiopulmonary dysfunction are at increased risk. FES remains a clinical diagnosis, although a high-resolution CT scan may distinguish fat emboli from thrombi, and diffusion-weighted brain MRI may demonstrate fat emboli. Aggressive supportive care including as-needed mechanical ventilation and fluid resuscitation remains the primary treatment. - FES prophylaxis generally consists of intraoperative hydration and oxygenation. Some authors suggest that distal femoral venting is beneficial to decrease intramedullary pressure and subsequent fat embolism. Broad-spectrum antibiotics would be an appropriate treatment for aspiration pneumonia. This patient has diffuse bilateral infiltrates as opposed to a focal infiltrate. Furthermore, the mental status changes are more consistent with FES than pneumonia. Anticoagulation would be the treatment of choice for pulmonary embolism. The timing after surgery is more consistent with FES, as are the changes in mental status.

Question 93

treatment for giant cell tumors of tendon sheath

Answer 93

marginal excision

Question 94

treatment of parosteal osteosarcoma

Answer 94

wide resection alone (same with chondrosarcoma)

Question 95

Denosumab, the human monoclonal antibody that specifically binds and inactivates receptor activator of nuclear factor-kB ligand (RANKL), is commonly used in the setting of metastatic disease. Its cell surface receptor is expressed by

Answer 95

Both osteoclast precursors and mature osteoclasts

Question 96

Osteoblasts produce osteoprotegerin, which stimulates osteoclasts to induce apoptosis by acting as a decoy for RANKL, preventing the binding of RANKL to RANK.

Answer 96

.

Question 97

When evaluating postmenopausal women who are taking osteoporosis medication, history should include use of

Answer 97

antiepileptics

Question 98

Treatment for Ewing sarcoma

Answer 98

Radiotherapy and chemotherapy and surgery

Question 99

treatment of adamantinoma

Answer 99

surgery alone

Question 100

Chromosomal translocation associated with Synovial Sarcoma?

Answer 100

t(x;18)

Question 101

Synovial sarcoma

Answer 101

- soft-tissue sarcoma that usually occurs in young adults. - often causes pain, unlike most soft-tissue sarcomas, which generally do not cause pain - Imaging characteristics include soft-tissue calcifications on plain radiographs and a heterogeneous mass that is generally isointense to muscle on T1-weighted images and hyperintense to muscle on T2-weighted images - There are biphasic and monophasic types of synovial sarcoma. The biphasic type has both spindle cell and epithelial components and will stain for both vimentin and cytokeratin - More than 90% of patients with synovial sarcoma have a characteristic genetic translocation of t(X;18), which results in the fusion protein SS18-SSX

Question 102

t(11;12)

Answer 102

Ewing sarcoma

Question 103

t(9;22)

Answer 103

Extraskeletal myxoid chondrosarcoma

Question 104

t(12;16)

Answer 104

Myxoid Liposarcoma

Question 105

MSTS staging system

Answer 105

-assigns progressively higher degrees of risk to neoplasms based on their surgical grade, anatomic location, and presence or absence of metastases. Lesions that are low grade are assigned a score of I, while high-grade lesions are assigned a score of II. Lesions contained in the bone or those that are intracompartmental are designated as A, and extracompartmental lesions are designated as B. Metastases elevates the score to III