Bone Tumors Practice Questions

Q: A child presented in the OPD with multiple permeating lesions involving all the bones of the body. Which of the following is the most probable diagnosis?

Histiocytosis X. ***Histiocytosis X*** - **Histiocytosis X**, now known as **Langerhans cell histiocytosis (LCH)**, can present with lytic bone lesions, which may be widespread and "permeating" throughout the skeletal system in children. - The disease involves the proliferation of **Langerhans cells**, and bone involvement is a common manifestation, leading to multiple osteolytic lesions. *Neuroblastoma* - **Neuroblastoma** is a common childhood cancer that frequently metastasizes to bone, leading to lytic lesions; however, it often presents with other symptoms like an abdominal mass, opsoclonus-myoclonus syndrome, or proptosis due to orbital involvement. - While bone metastases can be extensive, the primary tumor is typically extraosseous, originating from neural crest cells. *Metastasis from Wilm's tumour* - **Wilms' tumor** primarily affects the kidney and typically metastasizes to the lungs, liver, and occasionally bone marrow. - While bone metastasis can occur, it's less common than in neuroblastoma and less likely to present as widespread "permeating" osseous lesions throughout all bones, as described. *Metastasis from osteosarcoma* - **Osteosarcoma** is a primary malignant bone tumor, and its metastases usually occur in the lungs. - While it can metastasize to other bones, it generally presents as new, discrete osteoblastic or mixed lesions rather than a widespread permeating pattern across the entire skeletal system.

Q: All of the following are the causes of sudden increase in pain in osteochondroma, except:

Degenerative changes. ***Degenerative changes*** - While other conditions listed can cause acute pain in an osteochondroma, **degenerative changes** typically manifest as a slow, progressive increase in pain rather than a sudden exacerbation. - This option is the least likely cause of a **sudden** increase in pain among the choices provided. *Bursitis* - An osteochondroma can irritate adjacent soft tissues, leading to the formation of a **bursa** overlying the lesion, which can become inflamed (**bursitis**) and cause sudden pain. - The inflammation of the bursa can cause acute, localized pain due to pressure and friction. *Sarcomatous change* - The malignant transformation of an osteochondroma into a **chondrosarcoma** or osteosarcoma can cause a rapid increase in pain, size, and in some cases, lead to pathological fracture. - This is a serious complication and a significant cause of sudden pain. *Fracture* - The bony stalk or the cartilaginous cap of an osteochondroma can fracture, especially with trauma or repetitive stress. - A **fracture** of the lesion will typically result in a sudden onset of severe pain.

Q: Following X-ray shows the most probable diagnosis as?

Giant cell Tumor. ***Giant cell Tumor*** - The X-ray likely demonstrates a **lytic lesion** with an **epiphyseal location** and a **soap-bubble appearance**, characteristic of giant cell tumor. - This tumor typically occurs in **young adults (20-40 years old)** and is often found at the **ends of long bones**, such as the distal femur or proximal tibia, as suggested by the image. *Osteosarcoma* - Osteosarcoma usually presents with a **sclerotic** or **mixed sclerotic/lytic** lesion, often with periosteal reaction like a **Codman triangle** or **sunburst appearance**, which is not clearly depicted. - It most commonly affects the **metaphyseal region** of long bones and is prevalent in adolescents and young adults. *Ewing sarcoma* - Ewing sarcoma typically manifests as a **diaphyseal** or **metadiaphyseal lytic lesion** with an **onion-skin periosteal reaction**, particularly in children and young adults. - While it is a lytic lesion, its characteristic periosteal changes and location differ from the X-ray findings. *Aneurysmal Bone cyst* - Aneurysmal bone cysts are typically **expansile, multi-loculated lytic lesions** that can appear in any bone, often with a fluid-fluid level on MRI. - While they can be epiphyseal, their aggressive expansion and internal septations might not perfectly match the specific "soap-bubble" appearance often seen in GCTs.

Q: Most common benign tumor of bone?

Osteochondroma. ***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.

Q: Commonest site of the simple bone cyst is

Upper end of humerus. ***Upper end of humerus*** - The **proximal metaphysis of the humerus** is the most common location for a **simple bone cyst (SBC)**, also known as a unicameral bone cyst. - These are typically found in **children and adolescents**, often discovered incidentally or after a pathological fracture. *Lower end of femur* - While other bone lesions can occur here, the **distal femur** is not the most common site for simple bone cysts. - This region is more commonly associated with conditions like **osteosarcoma** or **osteochondroma**. *Lower end of tibia* - The **distal tibia** is a less common site for simple bone cysts. - This area is associated with various other bone pathologies but not typically the primary site for SBCs. *Lower end of humerus* - The **distal humerus** is a possible, though much less frequent, location for simple bone cysts compared to the proximal humerus. - It is not considered the most common site for this lesion.

Q: Most common benign tumor of bone:

Osteochondroma. ***Osteochondroma*** - **Osteochondroma** is the **most common benign bone tumor**, accounting for approximately 35-40% of all benign bone tumors [2]. - It arises from the growth plate and is characterized by a cartilage cap covering a bony stalk, typically affecting the **metaphysis** of long bones [1], [2]. *Bone cyst* - **Unicameral bone cysts** (simple bone cysts) and aneurysmal bone cysts are common benign bone lesions, but they are not true tumors. - They are typically fluid-filled lesions that can weaken the bone, predisposing to **pathological fractures**. *Osteoblastoma* - **Osteoblastoma** is a rare benign bone tumor, much less common than osteochondroma [3]. - It is characterized by the production of **osteoid** and **woven bone** and often causes pain due to its richly innervated nature [3]. *Chordoma* - **Chordoma** is a rare, malignant bone tumor, not benign. - It arises from remnants of the **notochord** and typically occurs at the sacrococcygeal region, skull base, or vertebral column. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 672-673. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, p. 1202. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, p. 1200.

Q: Which of the following is an epiphyseal lesion?

Chondroblastoma. **Chondroblastoma** - **Chondroblastoma** is a rare, benign bone tumor that typically arises in the **epiphysis** of long bones before epiphyseal fusion. - It specifically originates from **chondroblasts** within the epiphyseal growth plate region. *Fibrosarcoma* - **Fibrosarcoma** is a malignant tumor of fibrous connective tissue origin, typically found in the **metaphysis** or **diaphysis** of long bones. - It rarely affects the **epiphyseal** region and is characterized by aggressive local invasion and metastases. *Chondrosarcoma* - **Chondrosarcoma** is a malignant tumor of cartilage, commonly arising in the **metaphysis** or **diaphysis** of long bones, particularly the femur, humerus, and pelvis. - While it involves cartilage, its typical location is not primarily **epiphyseal** and it is characterized by malignant cartilaginous matrix. *Non-ossifying fibroma* - A **non-ossifying fibroma** (NOF), also known as a fibrous cortical defect, is a common benign fibrous lesion typically found in the **metaphysis** of long bones. - These lesions are usually asymptomatic and self-limiting, often resolving spontaneously, and do not originate in the **epiphysis**.

Q: A 45 yrs male presented with an expansile lesion in the centre of femoral metaphysis. The lesion shows Endosteal scalloping and punctuate calcifications. Most likely diagnosis is:

Chondrosarcoma. ***Chondrosarcoma*** - An **expansile lesion** within the **femoral metaphysis** with **endosteal scalloping** and **punctate calcifications** is highly characteristic of a chondrosarcoma. - The punctate/arc-and-ring calcifications are typical for cartilage matrix, which is the hallmark of chondrosarcoma, and the patient's age (45 years) fits the typical demographic. *Fibrous Dysplasia* - This condition presents as a **ground-glass matrix** on imaging, not punctate calcifications. - While it can be expansile, it typically does not show prominent endosteal scalloping with cartilage calcifications. *Simple bone cyst* - Simple bone cysts are typically **lytic lesions** that do not show punctate calcifications or aggressive endosteal scalloping. - They are often **fluid-filled** and common in children/adolescents, whereas this patient is 45 years old. *Osteosarcoma* - Osteosarcomas are characterized by **osteoid matrix formation** and often have a more aggressive appearance with a **sunburst or spiculated periosteal reaction** and bone formation, not punctate cartilage calcifications. - While it can be expansile, the calcification pattern described points away from osteosarcoma.

Q: Ewings sarcoma clinically mimics -

Osteomyelitis. ***Osteomyelitis*** - **Ewing's sarcoma** can clinically mimic **osteomyelitis** due to similar symptoms like **bone pain**, **swelling**, **fever**, and **leukocytosis**. - Both conditions can present with a periosteal reaction, such as an **onion-skin appearance** on X-ray, making differentiation challenging without further investigation. *Osteochondroses* - **Osteochondroses** are a group of disorders affecting **growth plates** or **epiphyseal centers**, commonly seen in children and adolescents, and are associated with repetitive trauma or vascular compromise. - While they can cause pain, they typically lack systemic symptoms like fever and do not show rapid destructive changes or soft tissue masses commonly associated with Ewing's sarcoma. *Heterotopic ossification* - **Heterotopic ossification** involves the formation of new bone in soft tissues where it normally does not exist, often following trauma, surgery, or neurological injury. - It is typically a localized process of abnormal bone growth and does not commonly present with systemic symptoms like fever or aggressive destructive lesions characteristic of Ewing's sarcoma. *Osteosclerosis* - **Osteosclerosis** refers to an abnormal increase in bone density, which can be localized or generalized, and is often a sign of various metabolic, genetic, or neoplastic conditions. - While some bone tumors can cause osteosclerotic changes, Ewing's sarcoma is typically an **osteolytic** or mixed lesion, and osteosclerosis itself does not mimic the aggressive clinical presentation of Ewing's sarcoma.

Question 1

A child presented in the OPD with multiple permeating lesions involving all the bones of the body. Which of the following is the most probable diagnosis?

Accepted Answer

Histiocytosis X

Answer

Neuroblastoma

Answer

Metastasis from Wilm's tumour

Answer

Metastasis from osteosarcoma

Question 2

All of the following are the causes of sudden increase in pain in osteochondroma, except:

Accepted Answer

Degenerative changes

Answer

Bursitis

Answer

Sarcomatous change

Answer

Fracture

Question 3

Following X-ray shows the most probable diagnosis as?

Accepted Answer

Giant cell Tumor

Answer

Osteosarcoma

Answer

Ewing sarcoma

Answer

Aneurysmal Bone cyst

Question 4

Most common benign tumor of bone?

Accepted Answer

Osteochondroma

Answer

Osteoma

Answer

Simple bone cyst

Answer

Osteoid osteoma

Question 5

Commonest site of the simple bone cyst is

Accepted Answer

Upper end of humerus

Answer

Lower end of femur

Answer

Lower end of tibia

Answer

Lower end of humerus

Question 6

Most common benign tumor of bone:

Accepted Answer

Osteochondroma

Answer

Bone cyst

Answer

Osteoblastoma

Answer

Chordoma

Question 7

Not true about enchondroma

Accepted Answer

Associated with maffucci syndrome

Answer

Treated with extended currettage

Answer

Painful condition

Answer

Malignant transformation to chondrosarcoma

Question 8

Which of the following is an epiphyseal lesion?

Accepted Answer

Chondroblastoma

Answer

Fibrosarcoma

Answer

Chondrosarcoma

Answer

Non-ossifying fibroma

Question 9

A 45 yrs male presented with an expansile lesion in the centre of femoral metaphysis. The lesion shows Endosteal scalloping and punctuate calcifications. Most likely diagnosis is:

Accepted Answer

Chondrosarcoma

Answer

Fibrous Dysplasia

Answer

Simple bone cyst

Answer

Osteosarcoma

Question 10

Ewings sarcoma clinically mimics -

Accepted Answer

Osteomyelitis

Answer

Osteochondroses

Answer

Heterotopic ossification

Answer

Osteosclerosis

Bone Tumors — MCQs

Bone Tumors — MCQs

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