Bone Tumors Practice Questions

Q: Which of the following is an epiphyseal tumor?

Chondroblastoma. ***Chondroblastoma*** - **Chondroblastoma** is a rare, benign cartilaginous tumor that typically originates in the **epiphysis** of long bones before the closure of growth plates. - It is histologically characterized by chondroblast-like cells, multinucleated giant cells, and chondroid matrix, and radiographically appears as a lytic lesion with a sclerotic rim in the epiphysis. *Osteosarcoma* - **Osteosarcoma** is the most common primary malignant bone tumor and typically originates in the **metaphysis** of long bones, particularly around the knee. - It invades the surrounding bone and soft tissues, often presenting with a **Codman triangle** or **sunburst pattern** on imaging studies. *Osteoid osteoma* - **Osteoid osteoma** is a benign bone-forming tumor primarily found in the **cortex** of long bones, although it can occur in other locations, presenting with nocturnal pain relieved by NSAIDs. - It is characterized by a central radiolucent nidus surrounded by reactive sclerotic bone. *Adamantinoma* - **Adamantinoma** is an extremely rare, low-grade malignant tumor that almost exclusively occurs in the **tibia diaphysis**. - It is thought to originate from epithelial cells and presents as a lytic lesion within the cortical bone, often with a polycystic appearance.

Q: All of the following are true about Ewing's sarcoma, EXCEPT

Common in 4th decade. ***Common in 4th decade*** - Ewing's sarcoma is most common in **children and adolescents**, typically presenting between 10 and 20 years of age, making it rare in the fourth decade. - It is the **second most common primary bone tumor** in children, after osteosarcoma. *Responds well to radiotherapy* - Ewing's sarcoma cells are highly **radiosensitive**, making radiotherapy a crucial component of its multimodal treatment. - Both **local control** and **palliation** can often be achieved with radiation therapy, even in metastatic disease. *Grows in diaphysis of long bones* - Ewing's sarcoma characteristically arises in the **diaphysis (shaft)** or metadiaphysis of long bones, such as the femur and tibia. - The tumor's origin in the diaphysis is a key distinguishing feature from other bone tumors that often originate in the metaphysis. *Has onion peel appearance on radiograph* - The classic radiographic sign of Ewing's sarcoma is a **multilaminated periosteal reaction**, which creates a characteristic **"onion peel" appearance** due to new bone formation. - This appearance reflects the aggressive nature of the tumor, as it repeatedly breaches the cortex, stimulating new layers of periosteal bone.

Q: A 28-year-old lady presented with wrist pain. X-ray of the wrist shows a lytic eccentric lesion in the lower end of the radius with a soap bubble appearance. What is the next plan of management?

Biopsy of the lesion. ***Biopsy of the lesion*** - A definitive **diagnosis is crucial** before any surgical intervention for a bone lesion, especially one with a characteristic appearance like "soap bubble." Biopsy will confirm the nature of the lesion, ruling out malignancy and guiding treatment. - The presented lesion, with its **lytic, eccentric, soap-bubble appearance** in the lower radius of a young adult, is highly suggestive of a **giant cell tumor (GCT)**. However, other diagnoses like chondroblastoma or aneurysmal bone cyst (ABC) can also mimic this appearance. *Extended curettage with phenol* - This is a treatment option for certain benign aggressive bone tumors like **giant cell tumors** after diagnosis, not the initial diagnostic step. - Performing this procedure without a **histological diagnosis** could lead to inappropriate treatment for other possible lesions. *Bone curettage and bone grafting* - This is a surgical treatment method typically used for **benign bone tumors** to remove the lesion and fill the defect, but it is performed after a definitive diagnosis. - **Performing it blindly** without knowing the exact pathology carries the risk of inadequate treatment or unnecessary surgery for a lesion that might require different management. *Extended curettage with phenol and bone grafting* - This comprehensive treatment often follows a **confirmed diagnosis** of an aggressive but benign bone tumor like GCT to minimize recurrence. - It is not the **initial diagnostic step** and carries risks if the underlying pathology is not accurately identified.

Q: A 19-year-old male has a small circumscribed sclerotic swelling over the diaphysis of femur, likely diagnosis is:

Osteoid osteoma. ***Osteoid osteoma*** - A **small, circumscribed sclerotic swelling** on the diaphysis of the femur in a young male is highly classic for an **osteoid osteoma**. - This benign bone tumor is characterized by a small, radiolucent nidus surrounded by dense sclerotic bone, often causing nocturnal pain relieved by NSAIDs. *Giant cell tumor* - Typically found in the **epiphyseal-metaphyseal regions** of long bones, particularly around the knee, in individuals aged 20-40 years. - Presents as an **osteolytic (radiolucent)** lesion, not slerotic, and can be locally aggressive. *Osteosarcoma* - A highly malignant tumor that typically arises in the **metaphysis** of long bones, especially around the knee, in adolescents and young adults. - Radiographically, it often shows a mixture of **sclerotic and lytic lesions**, with characteristic features like a **sunburst pattern** or **Codman's triangle**. *Ewing sarcoma* - Most commonly affects the **diaphysis of long bones** and flat bones in children and young adults. - Radiographically, it often presents with an **"onion-skin" periosteal reaction** due to layers of new bone formation, and it is typically an aggressive, lytic lesion.

Q: True statements about hemangioma of bone: a) Mostly symptomatic b) Peak incidence in 5th decade c) Constitute 1-1.5% of total bone tumors d) Overgrowth of bone occurs

bd. ***bd*** - **Overgrowth of bone** can occur in response to the presence of a hemangioma, particularly in vertebral bodies. - The peak incidence of bone hemangiomas is indeed in the **5th decade**, though they can be found at any age. *ac* - Hemangiomas of bone are generally **asymptomatic** and are often incidental findings. - While they are benign tumors, they constitute a relatively **small percentage** of bone tumors, with 1-1.5% being a reasonable estimate. *ab* - As mentioned, bone hemangiomas are typically **asymptomatic**, not mostly symptomatic. - The **peak incidence in the 5th decade** is correct. *ad* - Hemangiomas of bone are usually **asymptomatic**, not mostly symptomatic. - **Overgrowth of bone** is a recognized feature, especially in vertebrae. *c* - While hemangiomas do constitute a small percentage of total bone tumors, this option is incomplete as **overgrowth of bone** and **peak incidence in the 5th decade** are also true statements.

Q: Osteomyelitis can mimic which of the following tumor?

Ewing sarcoma. ***Ewing sarcoma*** - Both osteomyelitis and Ewing sarcoma can present with **fever**, **pain**, **swelling**, and **elevated inflammatory markers**. - Radiographically, both conditions can show **periosteal reactions**, **bone destruction**, and **soft tissue masses**, making differentiation challenging without biopsy. *Chondroma* - Chondromas are **benign cartilage tumors** typically presenting as asymptomatic lesions or with mild pain if large. - They lack the inflammatory signs and rapid progression seen in osteomyelitis. *Osteoclastoma* - Osteoclastomas (also known as giant cell tumors of bone) are typically **lucent, aggressive lesions** found in the epiphysis of long bones, often presenting with pain and swelling. - While they can be aggressive, they generally do not present with the systemic inflammatory response or infectious signs characteristic of osteomyelitis. *None of the options* - This option is incorrect because Ewing sarcoma shares significant clinical and radiological features with osteomyelitis, making it a well-known mimic.

Q: Most common site of osteogenic sarcoma is:

Femur, lower end. ***Femur, lower end*** - The **distal femur** is the most common site for osteogenic sarcoma, accounting for approximately **40% of all cases** [1]. - This region, along with the **proximal tibia**, are the most frequent locations for this primary bone tumor [1]. *Tibia, lower end* - While osteogenic sarcoma can occur in the **tibia**, the **proximal end** is more commonly affected than the distal end. - The distal tibia is a less frequent site compared to the distal femur or proximal tibia. *Femur, upper end* - The **proximal femur** is a recognized site for osteogenic sarcoma, but it is less common than the **distal femur**. - Tumors in the proximal femur account for a smaller percentage of overall osteosarcoma cases. *Tibia, upper end* - The **proximal tibia** is the **second most common site** for osteogenic sarcoma, frequently affected after the distal femur [1]. - However, the question asks for the *most* common site, which remains the distal femur.

Q: A patient with GCT, which of the following is false?

Chemotherapy is the mainstay of treatment. ***Chemotherapy is the mainstay of treatment*** - This statement is **false** because **Giant Cell Tumor of Bone (GCT)** therapy primarily involves **surgical resection**, with or without adjuvant therapies like **denosumab**. - **Chemotherapy** is generally *not* the first-line treatment for GCT, as these tumors respond poorly to it; it's usually reserved for cases of **metastatic GCT** or when other treatments fail. *Defined margins* - GCTs often present radiographically with **well-defined, non-sclerotic margins**, which indicates a lytic lesion that is often locally aggressive but typically doesn't invade widely. - While they are locally destructive, their borders are usually visible, helping distinguish them from other bone tumors. *Epiphyseo-metaphyseal location* - GCTs commonly originate in the **metaphysis** of long bones and **extend into the epiphysis** after the growth plate has closed. - This characteristic location near a joint is a classic diagnostic feature of GCT, especially in adults. *Eccentric* - GCTs typically arise **eccentrically** within the bone, meaning they originate off-center in the bone marrow cavity before expanding and thinning the cortex. - This eccentric growth pattern is a distinguishing feature, particularly in contrast to other bone tumors which might be centrally located.

Q: A 35-year-old woman presents with a painless mass on her hand. An X-ray shows a well-defined, non-sclerotic lytic lesion. What is the most likely diagnosis?

Enchondroma. ***Enchondroma*** - A **painless mass on the hand** with a **well-defined, non-sclerotic lytic lesion** on X-ray is highly characteristic of an enchondroma. These are benign cartilaginous tumors common in the small bones of the hands and feet. - Enchondromas typically present in **young adults** and are often discovered incidentally or due to a pathological fracture, given their asymptomatic nature. *Giant Cell Tumor* - Giant cell tumors are typically found in the **epiphysis and metaphysis of long bones** (e.g., distal femur, proximal tibia), not as commonly in the small bones of the hand. - While they can be lytic, they often present with more aggressive features, potentially causing **pain and joint dysfunction**, and have a higher recurrence rate. *Chondroblastoma* - Chondroblastomas are rare cartilaginous tumors usually found in the **epiphysis of long bones** in teenagers and young adults, such as the humerus or femur. - They tend to cause **pain and swelling** around the affected joint, which differs from the painless presentation here. *Osteochondroma* - Osteochondromas are **exostoses**, meaning they are bone outgrowths covered by cartilage, presenting as a palpable bony lump. - X-rays would show a **bony projection** continuous with the cortex of the underlying bone, not a lytic lesion within the bone.

Question 1

Which of the following is an epiphyseal tumor?

Accepted Answer

Chondroblastoma

Answer

Osteosarcoma

Answer

Osteoid osteoma

Answer

Adamantinoma

Question 2

All of the following are true about Ewing's sarcoma, EXCEPT

Accepted Answer

Common in 4th decade

Answer

Responds well to radiotherapy

Answer

Grows in diaphysis of long bones

Answer

Has onion peel appearance on radiograph

Question 3

A 28-year-old lady presented with wrist pain. X-ray of the wrist shows a lytic eccentric lesion in the lower end of the radius with a soap bubble appearance. What is the next plan of management?

Accepted Answer

Biopsy of the lesion

Answer

Extended curettage with phenol

Answer

Bone curettage and bone grafting

Answer

Extended curettage with phenol and bone grafting

Question 4

A patient with known hemophilia presented with pain in his ankle. X-ray showed an osteolytic lesion with a sclerotic rim. What is your diagnosis?

Accepted Answer

PVNS

Answer

Hemophilic pseudotumor

Answer

Giant Cell Tumor

Answer

Ochronosis

Question 5

A 19-year-old male has a small circumscribed sclerotic swelling over the diaphysis of femur, likely diagnosis is:

Accepted Answer

Osteoid osteoma

Answer

Giant cell tumor

Answer

Osteosarcoma

Answer

Ewing sarcoma

Question 6

True statements about hemangioma of bone: a) Mostly symptomatic b) Peak incidence in 5th decade c) Constitute 1-1.5% of total bone tumors d) Overgrowth of bone occurs

Accepted Answer

bd

Answer

ac

Answer

ab

Answer

ad

Answer

c

Question 7

Osteomyelitis can mimic which of the following tumor?

Accepted Answer

Ewing sarcoma

Answer

Chondroma

Answer

Osteoclastoma

Answer

None of the options

Question 8

Most common site of osteogenic sarcoma is:

Accepted Answer

Femur, lower end

Answer

Tibia, lower end

Answer

Femur, upper end

Answer

Tibia, upper end

Question 9

A patient with GCT, which of the following is false?

Accepted Answer

Chemotherapy is the mainstay of treatment

Answer

Defined margins

Answer

Epiphyseo-metaphyseal location

Answer

Eccentric

Question 10

A 35-year-old woman presents with a painless mass on her hand. An X-ray shows a well-defined, non-sclerotic lytic lesion. What is the most likely diagnosis?

Accepted Answer

Enchondroma

Answer

Giant Cell Tumor

Answer

Chondroblastoma

Answer

Osteochondroma

Bone Tumors — MCQs

Bone Tumors — MCQs

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