Classification of Bone Tumors — MCQs
Epiphyseal tumor before fusion of epiphysis:
Soap bubble appearance on X-ray is seen in which bone tumor?
What is the most appropriate treatment for a soap bubble appearance at the lower end of the radius?
Which bone tumor involves the epiphysis?
On mammogram, all of the following are the features of a malignant tumor except:
Classification system of bone tumors is -
A 7-year-old child presents with a lesion in upper tibia. X-ray shows radiolucent area with Codman's triangle and sunray appearance. Diagnosis is
The image shows a wrist deformity and an X-ray of a bone lesion near the distal radius. Based on the clinical and radiological features, what is the most likely diagnosis?
Most common benign tumor of bone?
Most common site of adamantinoma of the long bones is -
Classification of Bone Tumors Indian Medical PG Practice Questions and MCQs
Question 1: Epiphyseal tumor before fusion of epiphysis:
- A. Chondrosarcoma
- B. Chondroblastoma (Correct Answer)
- C. Giant cell tumor
- D. Ewing's sarcoma
Explanation: ***Chondroblastoma*** - This is primarily an **epiphyseal tumor** that occurs predominantly in adolescents and young adults **before epiphyseal fusion**. - It is a **benign cartilaginous tumor** that typically presents with pain and swelling around the affected joint. *Chondrosarcoma* - This is a **malignant cartilaginous tumor** that typically occurs in older adults, usually after epiphyseal fusion. - While it can occur in various bones, it is generally found in the **metaphysis or diaphysis**, not primarily the epiphysis before fusion. *Giant cell tumor* - This tumor is typically found in the **epiphysis/metaphysis** but primarily occurs in skeletally mature individuals **after epiphyseal closure**. - It is characterized by its aggressive nature and high recurrence rate, but is less common before epiphyseal fusion. *Ewing's sarcoma* - This is a highly **malignant bone tumor** that primarily affects the **diaphysis** of long bones and flat bones. - It is common in children and young adults but is not characteristically an epiphyseal tumor before fusion.
Question 2: Soap bubble appearance on X-ray is seen in which bone tumor?
- A. Osteogenic sarcoma
- B. Multiple myeloma
- C. Chondroblastoma
- D. Giant cell tumor (Correct Answer)
Explanation: ***Giant cell tumor*** - The **soap bubble appearance** on X-ray is a classic radiographic finding for **giant cell tumors**, indicating areas of bone destruction and new bone formation. - These tumors are typically **benign but locally aggressive** and are commonly found in the **epiphyseal and metaphyseal regions** of long bones. *Osteogenic sarcoma* - Characterized by a more aggressive appearance on X-ray, often with a **sunburst pattern** or **Codman's triangle**, indicating periosteal reaction. - This is a **highly malignant tumor** of bone-forming tissue, not typically associated with a "soap bubble" appearance. *Multiple myeloma* - Presents on X-ray with characteristic **punched-out lytic lesions** in multiple bones, especially the skull, spine, and pelvis. - It does not usually form the multi-loculated, expansile lesions that create a "soap bubble" appearance. *Chondroblastoma* - Often appears as a **well-defined lytic lesion** with a thin sclerotic rim and is typically found in the **epiphysis** of long bones. - While it can be destructive, it usually doesn't produce the multi-loculated, expansile "soap bubble" pattern seen with giant cell tumors.
Question 3: What is the most appropriate treatment for a soap bubble appearance at the lower end of the radius?
- A. Local excision
- B. Excision and bone grafting (Correct Answer)
- C. Amputation
- D. Radiotherapy
Explanation: ***Excision and bone grafting*** - A **soap bubble appearance** at the lower end of the radius is highly suggestive of a **giant cell tumor (GCT)**, which is locally aggressive and has a high recurrence rate after simple curettage. - **Excision of the tumor and filling the defect with bone graft** is the preferred treatment to reduce recurrence and maintain skeletal integrity. *Local excision* - While local excision might remove the visible tumor, **GCTs are known to recur frequently** (up to 50%) after intralesional treatments like simple curettage. - It does not adequately address microscopic extensions or the risk of **local aggressive behavior**. *Amputation* - **Amputation is an overly aggressive and unnecessary treatment** for a GCT, as it is a benign but locally aggressive tumor. - It would be considered only in rare cases of extensive soft tissue invasion or intractable recurrence, which is not implied by a "soap bubble appearance." *Radiotherapy* - **Radiotherapy is generally not the first-line treatment for GCTs** due to concerns about **malignant transformation** (osteosarcoma) in a small percentage of cases, especially with high doses. - It may be considered for unresectable tumors or recurrent lesions in difficult anatomical locations, or as an adjuvant.
Question 4: Which bone tumor involves the epiphysis?
- A. Osteosarcoma
- B. Giant cell tumor (Correct Answer)
- C. Ewing's sarcoma
- D. Multiple myeloma
Explanation: ***Giant cell tumor*** - **Giant cell tumor (GCT)**, also known as osteoclastoma, characteristically arises in the **epiphysis** [1] or **metaphysis** of long bones in adults. - It is a benign but locally aggressive tumor that often presents with pain, swelling, and reduced range of motion in the affected joint [1]. *Osteosarcoma* - **Osteosarcoma** typically arises in the **metaphysis** of long bones, particularly around the knee (distal femur, proximal tibia). - It is a highly malignant primary bone tumor characterized by the production of **osteoid** by tumor cells [2]. *Ewing's sarcoma* - **Ewing's sarcoma** most commonly affects the **diaphysis** of long bones or flat bones (e.g., pelvis, scapula, ribs). - It is characterized by small, round, blue cells and often presents with pain, swelling, and systemic symptoms like fever. *Multiple myeloma* - **Multiple myeloma** is a malignancy of **plasma cells** that primarily affects the **bone marrow** and can cause widespread osteolytic lesions. - It typically presents in older adults and affects bones with active marrow, such as the vertebrae, ribs, skull, and pelvis, rather than being localized to the epiphysis as a primary bone tumor. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1205-1206. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 673-674.
Question 5: On mammogram, all of the following are the features of a malignant tumor except:
- A. Microcalcification
- B. Irregular mass
- C. Macrocalcification (Correct Answer)
- D. Spiculation
Explanation: ***Macrocalcification*** - **Macrocalcifications** are typically **benign** and are often associated with involutional changes in the breast, such as aging or fibroadenomas. - These are usually larger, coarser calcifications that are easily seen and rarely indicate malignancy. *Microcalcification* - **Microcalcifications**, especially when **pleomorphic**, **linear**, or grouped, are a significant indicator of potential malignancy, such as **ductal carcinoma in situ (DCIS)**. - They represent calcium deposits within the ducts or stromal tissue, which can be associated with rapidly proliferating cells. *Irregular mass* - An **irregularly shaped mass** with ill-defined margins is highly suspicious for malignancy because it suggests invasive growth into surrounding tissues. - Unlike benign lesions which tend to be round or oval with smooth borders, malignant tumors often grow in an uncontrolled, infiltrative manner. *Spiculation* - **Spiculation** refers to **radiating lines or projections** extending from the borders of a mass, indicating an infiltrative process highly suggestive of malignancy. - These spicules represent fibrous tissue reaction to an invading tumor and are a strong predictor of breast cancer.
Question 6: Classification system of bone tumors is -
- A. Enneking (Correct Answer)
- B. Edmonton
- C. TNM
- D. Manchester
Explanation: ***Enneking*** - The **Enneking staging system** is widely used for primary **bone tumors**, particularly sarcomas. - It classifies tumors based on their histological grade, local extension, and presence of metastases, which guides surgical planning and prognosis. *Edmonton* - The **Edmonton classification** is primarily used for **periprosthetic fractures** around hip and knee replacements. - It does not classify primary bone tumors but rather describes fracture patterns related to prosthetic implants. *TNM* - The **TNM (Tumor, Node, Metastasis)** classification is a general staging system used for many types of cancer, but it's not the primary system for bone tumors. - While applicable for some bone cancers, the **Enneking system** provides a more specific functional and anatomical assessment for limb-sparing surgery in bone sarcomas. *Manchester* - The **Manchester staging system** is primarily used for **lymphoma**, particularly Hodgkin lymphoma. - It describes the extent of lymph node involvement and extralymphatic disease, completely unrelated to bone tumors.
Question 7: A 7-year-old child presents with a lesion in upper tibia. X-ray shows radiolucent area with Codman's triangle and sunray appearance. Diagnosis is
- A. Osteosarcoma (Correct Answer)
- B. Osteoid Osteoma
- C. Ewing sarcoma
- D. Chondrosarcoma
Explanation: ***Osteosarcoma*** - The classic radiographic features of **Codman's triangle** (periosteal elevation) and **sunray appearance** (spiculated periosteal reaction) are highly characteristic of osteosarcoma. - This tumor commonly affects the **metaphysis of long bones** in children and young adults, with the distal femur and proximal tibia being frequent sites. *Osteoid Osteoma* - This is a **benign bone tumor** characterized radiographically by a small radiolucent **nidus** surrounded by a rim of dense sclerosis. - It does not present with Codman's triangle or sunray appearance and typically causes **nocturnal pain relieved by NSAIDs**. *Ewing sarcoma* - Ewing sarcoma often presents with an **"onion skin" periosteal reaction** (layers of new bone formation) due to its aggressive nature. - While it can be destructive and radiolucent, it typically does not classically exhibit the sunray appearance or a distinct Codman's triangle as prominently as osteosarcoma. *Chondrosarcoma* - Chondrosarcoma is a **malignant cartilaginous tumor** that usually affects older adults more commonly than children. - Radiographically, it often shows a **lobulated appearance** with **punctate or ring-and-arc calcifications** within the lesion, not the sunray or Codman's triangle findings.
Question 8: The image shows a wrist deformity and an X-ray of a bone lesion near the distal radius. Based on the clinical and radiological features, what is the most likely diagnosis?
- A. Ewings Sarcoma
- B. Osteochondroma
- C. Giant Cell Tumor (GCT) (Correct Answer)
- D. Osteoid Osteoma
Explanation: ***Giant Cell Tumor (GCT)*** * The image shows a **lytic (lucid) lesion** located in the **epiphysis/metaphysis of the distal radius**, which is a classic presentation site for GCT. * GCTs are typically seen in individuals aged 20-40, often present with **pain, swelling, and reduced range of motion**, and can show a **soap bubble appearance** on X-ray even with cortical erosion as seen in the image. *Ewing's Sarcoma* * Ewing's Sarcoma commonly affects the **diaphysis of long bones** and may present with an **onion skin periosteal reaction**, none of which are clearly depicted. * It primarily affects children and young adults (5-20 years old), which does not align with the assumed adult presentation given the fused epiphysis. *Osteochondroma* * Osteochondromas are **bony prominences covered by cartilage** and grow **outward from the bone surface**, often away from the joint, unlike the intraosseous lytic lesion seen. * They typically appear as **pedunculated or sessile exostoses** and are benign growth plate abnormalities, not lytic lesions of the marrow cavity. *Osteoid Osteoma* * Osteoid osteomas are characterized by a **small lucent nidus** (usually <1.5 cm) surrounded by a significant margin of **sclerotic bone**, which is not seen here. * They classically cause **nocturnal pain** relieved by NSAIDs and are typically smaller than the lesion depicted, which appears expansile.
Question 9: Most common benign tumor of bone?
- A. Osteoma
- B. Simple bone cyst
- C. Osteochondroma (Correct Answer)
- D. Osteoid osteoma
Explanation: ***Osteochondroma*** - This is the **most common benign bone tumor**, characterized by a bony spur with a cartilaginous cap. - It typically arises from the **metaphysis of long bones**, especially around the knee. *Osteoma* - Osteomas are **benign, slow-growing tumors** composed of mature compact or cancellous bone. - They are most commonly found in the **skull and facial bones**, not typically in long bones. *Simple bone cyst* - This is a **fluid-filled lesion** of bone, not a true neoplasm, frequently found in the metaphysis of long bones in children. - It is often discovered incidentally or after a **pathological fracture**. *Osteoid osteoma* - Characterized by a **small, benign bone tumor** with a central nidus of osteoid and trabecular bone, surrounded by reactive sclerotic bone. - It classically causes **nocturnal pain** that is relieved by NSAIDs.
Question 10: Most common site of adamantinoma of the long bones is -
- A. Tibia (Correct Answer)
- B. Ulna
- C. Fibula
- D. Femur
Explanation: ***Tibia*** - Adamantinoma is a rare, malignant bone tumor that has a strong predilection for the **tibia**, accounting for approximately 85-90% of cases in long bones. - It most commonly occurs in the **diaphysis of the tibia** but can also be found in the metaphysis. *Ulna* - While adamantinoma can rarely affect other long bones, the **ulna is not a common site** for its occurrence. - The incidence of adamantinoma in the upper extremities, including the ulna, is significantly lower compared to the tibia. *Fibula* - The **fibula is an uncommon site** for adamantinoma, with only a small percentage of cases reported in this bone. - When it does occur in the fibula, it usually involves the mid-diaphysis. *Femur* - The **femur is also a rare location** for adamantinoma, with only a handful of cases documented in medical literature. - The vast majority of adamantinomas consistently originate in the lower leg, particularly the tibia.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free