Bone Tumors Practice Questions

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: 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.

Q: Ganga Ram, a 19-year-old male with a short history of pain in the right groin that worsens at night time and has a small circumscribed sclerotic swelling over diaphysis of femur. Likely diagnosis is:

Osteoid osteoma. ***Osteoid osteoma*** - This benign bone tumor classically presents with **nocturnal pain** that is relieved by **NSAIDs**, a key differentiating feature not mentioned but highly characteristic. - The description of a **small, circumscribed sclerotic swelling** over the femoral diaphysis is consistent with the typical radiographic appearance of an osteoid osteoma. *Osteosarcoma* - This is a highly malignant primary bone tumor that typically presents with **progressive, severe pain** and a rapidly growing mass, often in the metaphysis of long bones. - Radiographically, it often shows a **sunburst appearance** or **Codman's triangle**, and is not typically described as a small, circumscribed sclerotic lesion. *Ewing's sarcoma* - This aggressive bone tumor commonly affects children and young adults, presenting with severe pain, swelling, and systemic symptoms like fever. - Radiographically, it often exhibits an **onion-skin periosteal reaction** and lytic lesions, which differs from a small, sclerotic swelling. *Osteoclastoma* - Also known as a **giant cell tumor of bone**, this tumor typically affects the **epiphysis** of long bones in young adults, causing pain and swelling. - Radiographically, it appears as a **lytic, expansile lesion** without significant sclerosis, making it inconsistent with the described circumscribed sclerotic swelling.

Q: Epiphyseal tumor before fusion of epiphysis:

Chondroblastoma. ***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.

Q: Maffucci syndrome:

Multiple enchondromatosis with hemangiomas. ***Multiple enchondromatosis with hemangiomas*** - **Maffucci syndrome** is a rare, non-hereditary disorder characterized by the presence of multiple **enchondromas** (benign cartilaginous tumors) and **hemangiomas** (benign vascular tumors). - The enchondromas typically affect the long bones and can lead to skeletal deformities and fractures, while the hemangiomas can be soft tissue or visceral. *Multiple osteochondromas* - This description typically refers to **multiple hereditary exostoses** (MHE), a distinct genetic condition. - In MHE, the bone lesions are **osteochondromas**, which are bone spurs capped with cartilage, rather than enchondromas that form within the bone. *Multiple osteochondromatosis with hemangiomas* - This accurately describes the presence of **hemangiomas** but identifies the bone lesions as **osteochondromas** instead of enchondromas. - The presence of osteochondromas would point towards a different diagnosis like MHE, even with co-occurring hemangiomas. *Multiple Giant cell tumor* - **Giant cell tumors (GCTs)** are generally solitary, benign, but locally aggressive bone tumors, not typically seen as multiple lesions in the context of a syndrome like Maffucci. - They also differ histologically and clinically from enchondromas.

Q: Most common site of adamantinoma of the long bones is -

Tibia. ***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.

Q: What is the most common site of osteosarcoma:

Lower end of femur. ***Lower end of femur*** - The **distal femur** is the most common site for osteosarcoma, particularly in the **metaphyseal regions** where rapid growth occurs. - This area, along with the proximal tibia, accounts for a significant majority of all osteosarcoma cases. *Lower end of tibia* - While the **proximal tibia** is a common site, the **distal tibia** is less frequently affected by osteosarcoma compared to the distal femur. - The incidence in the distal tibia is notably lower than in the knee region. *Upper end of femur* - The **proximal femur** is a recognized site for osteosarcoma, but it is less common than the **distal femur**. - Tumors in this location can be challenging to manage due to their proximity to major neurovascular structures. *Upper end of humerus* - The **proximal humerus** is another common location for osteosarcoma, accounting for a notable percentage of cases. - However, its incidence is still lower than that of the **distal femur**.

Question 1

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 2

Not true about enchondroma

Accepted Answer

Associated with maffucci syndrome

Answer

Treated with extended currettage

Answer

Painful condition

Answer

Malignant transformation to chondrosarcoma

Question 3

Which of the following is an epiphyseal lesion?

Accepted Answer

Chondroblastoma

Answer

Fibrosarcoma

Answer

Chondrosarcoma

Answer

Non-ossifying fibroma

Question 4

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 5

Ewings sarcoma clinically mimics -

Accepted Answer

Osteomyelitis

Answer

Osteochondroses

Answer

Heterotopic ossification

Answer

Osteosclerosis

Question 6

Ganga Ram, a 19-year-old male with a short history of pain in the right groin that worsens at night time and has a small circumscribed sclerotic swelling over diaphysis of femur. Likely diagnosis is:

Accepted Answer

Osteoid osteoma

Answer

Osteosarcoma

Answer

Ewing's sarcoma

Answer

Osteoclastoma

Question 7

Epiphyseal tumor before fusion of epiphysis:

Accepted Answer

Chondroblastoma

Answer

Chondrosarcoma

Answer

Giant cell tumor

Answer

Ewing's sarcoma

Question 8

Maffucci syndrome:

Accepted Answer

Multiple enchondromatosis with hemangiomas

Answer

Multiple osteochondromas

Answer

Multiple osteochondromatosis with hemangiomas

Answer

Multiple Giant cell tumor

Question 9

Most common site of adamantinoma of the long bones is -

Accepted Answer

Tibia

Answer

Ulna

Answer

Fibula

Answer

Femur

Question 10

What is the most common site of osteosarcoma:

Accepted Answer

Lower end of femur

Answer

Lower end of tibia

Answer

Upper end of femur

Answer

Upper end of humerus

Bone Tumors — MCQs

Bone Tumors — MCQs

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