Bone and Soft Tissue Pathology Practice Questions

Q: A patient presented with pain in his ankle. X-ray shows an osteolytic lesion with a sclerotic rim. Histopathological findings are available. What is your diagnosis?

Hemophilic pseudotumor. **Explanation:** **Hemophilic Pseudotumor** is a rare but serious complication of severe hemophilia (Factor VIII or IX deficiency). It results from repeated, chronic subperiosteal or intraosseous hemorrhages. The pressure from the expanding hematoma leads to pressure necrosis of the bone, appearing on X-ray as a well-defined **osteolytic lesion** often surrounded by a **sclerotic rim** (representing the bone's attempt at repair). Histologically, it reveals organized blood clots, hemosiderin-laden macrophages, and fibrous tissue. **Analysis of Incorrect Options:** * **Eumycosis (Madura foot):** Typically presents with soft tissue swelling, multiple draining sinuses, and "sulfur granules." X-rays show "moth-eaten" bone destruction rather than a clean sclerotic rim. * **Ochronosis (Alkaptonuria):** Characterized by the deposition of homogentisic acid in connective tissues. It typically involves the spine (disc calcification) and large joints, presenting with joint space narrowing and subchondral sclerosis, not isolated lytic lesions. * **Pigmented Villonodular Synovitis (PVNS):** This is a proliferative lesion of the synovium. While it can cause "apple-core" erosions at the joint margins, it is primarily a soft tissue process characterized by brown, frond-like synovial projections and massive hemosiderin deposition on MRI (blooming effect). **NEET-PG High-Yield Pearls:** * **Location:** Most common in the femur, pelvis, and small bones of the hands/feet. * **Radiology:** Can mimic a malignant bone tumor (like Osteosarcoma) due to its size, but the sclerotic border and clinical history of a bleeding disorder are diagnostic clues. * **Management:** Factor replacement is the first line; surgery is high-risk due to potential uncontrollable hemorrhage.

Q: Which of the following is false regarding Cherubism?

Unilocular lesion. **Explanation:** **Cherubism** is a rare, autosomal dominant fibro-osseous disorder characterized by symmetrical, non-neoplastic enlargement of the jaws. It is caused by mutations in the **SH3BP2 gene** on chromosome 4p16. 1. **Why Option A is the Correct Answer (False Statement):** Radiographically, Cherubism presents as **multilocular**, expansive radiolucencies (often described as a "soap-bubble" appearance). These lesions are characteristically **bilateral** and involve the mandible (angle and ramus) and/or the maxilla. A unilocular presentation is inconsistent with the classic pathology of this condition. 2. **Analysis of Other Options:** * **Option B (Bilateral):** This is a hallmark feature. The symmetrical involvement of the lower face gives the child a characteristic "cherubic" (angel-like) appearance with upward-looking eyes due to maxillary involvement stretching the skin. * **Option C (Presence of Giant cells):** Histologically, the lesions consist of vascularized fibrous tissue containing numerous **multinucleated giant cells**, resembling a Central Giant Cell Granuloma (CGCG). * **Option D (Delayed eruption):** The massive expansion of the alveolar bone often leads to the displacement of tooth buds, failure of permanent teeth to erupt, or premature loss of primary teeth. **High-Yield Clinical Pearls for NEET-PG:** * **Inheritance:** Autosomal Dominant (High penetrance in males, lower in females). * **Age of Onset:** Typically appears between ages 2–5 years. * **Natural History:** The lesions usually undergo **spontaneous regression** or remodeling after puberty; hence, surgery is often delayed. * **Histology Tip:** Look for **perivascular collagen cuffing** (eosinophilic cuffing around small capillaries), which helps differentiate Cherubism from other giant cell lesions.

Q: Which of the following is the diagnostic characteristic of peripheral giant cell granuloma?

Multinuclear giant cells. **Explanation:** **Peripheral Giant Cell Granuloma (PGCG)** is a common reactive exophytic lesion of the oral cavity, specifically occurring on the gingiva or alveolar ridge. **Why Option B is Correct:** The hallmark histological feature of PGCG is the presence of numerous **multinucleated giant cells** (resembling osteoclasts) scattered within a highly vascularized fibrocellular stroma. These giant cells are considered the diagnostic signature of the lesion. They are often separated by spindle-shaped mesenchymal cells and extravasated red blood cells, which frequently lead to **hemosiderin deposition**, giving the lesion its characteristic reddish-blue clinical appearance. **Analysis of Incorrect Options:** * **Option A:** While PGCG is highly vascular, it is distinct from "granulation tissue" (which is the hallmark of a Pyogenic Granuloma). PGCG is a specific reactive hyperplasia, not simple inflammatory repair tissue. * **Option C:** Keloid-like enlargement refers to excessive collagen deposition (hypertrophic scarring), which is not a feature of PGCG. PGCG is cellular and vascular, not densely collagenous. * **Option D:** While the overlying epithelium may be ulcerated due to trauma, atrophic epithelium is not a diagnostic or defining characteristic of this pathology. **NEET-PG High-Yield Pearls:** * **Origin:** It arises from the **periosteum** or periodontal ligament. * **Clinical Site:** Exclusively found on the **gingiva** (unlike Central Giant Cell Granuloma, which is intraosseous). * **Radiology:** May show "cupping" resorption of the underlying alveolar bone. * **Differential Diagnosis:** Must be clinically differentiated from Pyogenic Granuloma and Peripheral Ossifying Fibroma. * **Association:** Always rule out **Hyperparathyroidism** (Brown tumor) if multiple giant cell lesions are present.

Question 1

Biphasic histopathology is seen in which of the following conditions?

Accepted Answer

Mesothelioma

Answer

Rhabdomyoma

Answer

Neurofibromatosis

Answer

Synovial sarcoma

Question 2

A patient presented with pain in his ankle. X-ray shows an osteolytic lesion with a sclerotic rim. Histopathological findings are available. What is your diagnosis?

Accepted Answer

Hemophilic pseudotumor

Answer

Eumycosis

Answer

Ochronosis

Answer

Pigmented Villonodular Synovitis (PVNS)

Question 3

All are congenital myopathies EXCEPT?

Accepted Answer

Z band myopathy

Answer

Central core myopathy

Answer

Nemaline myopathy

Answer

Centronuclear myopathy

Question 4

A 70-year-old male patient presents with a single, well-defined lytic lesion of the skull. The patient has no other complaints, and urine examination shows no abnormalities. What is the most likely diagnosis?

Accepted Answer

Langerhans cell histiocytosis (LCH)

Answer

Localized myeloproliferative disorder

Answer

Generalized myeloproliferative disorder

Answer

Tumor of osteoblasts

Question 5

A 50-year-old patient presents with a midline lesion involving the sacrum, which is found to be sclerotic. What is the most probable diagnosis?

Accepted Answer

Chordoma

Answer

Metastasis

Answer

Osteosarcoma

Answer

Chondrosarcoma

Question 6

A 70-year-old male has a pathologic fracture of the femur. X-rays show a lytic lesion with a circumscribed, punched-out appearance. Curettage from the fracture site is most likely to show which of the following?

Accepted Answer

Sheets of atypical plasma cells

Answer

Diminished and thinned trabecular bone fragments secondary to osteopenia

Answer

Metastatic prostatic adenocarcinoma

Answer

Malignant cells forming osteoid bone

Question 7

Which of the following is false regarding Cherubism?

Accepted Answer

Unilocular lesion

Answer

Bilateral

Answer

Presence of Giant cells

Answer

Delayed eruption of permanent teeth

Question 8

Precancerous potential in Plummer-Vinson syndrome may be due to which change in the epithelium?

Accepted Answer

Atrophy

Answer

Hypertrophy

Answer

Acanthosis

Answer

All the above

Question 9

All of the following are examples of round cell tumors except?

Accepted Answer

Osteosarcoma

Answer

Neuroblastoma

Answer

Non-Hodgkin's lymphoma

Answer

Ewing's sarcoma

Question 10

Which of the following is the diagnostic characteristic of peripheral giant cell granuloma?

Accepted Answer

Multinuclear giant cells

Answer

Mass of granulation tissue

Answer

Keloid-like enlargement

Answer

Epithelium is atrophic in some areas

Bone and Soft Tissue Pathology — MCQs

Bone and Soft Tissue Pathology — MCQs

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