Bone and Soft Tissue Pathology Practice Questions

Q: Osteoblastic metastases are most commonly seen from which primary malignancy?

Prostate. **Explanation:** The nature of skeletal metastasis depends on the interaction between tumor cells and the bone microenvironment. Metastases are classified as **osteoblastic** (bone-forming), **osteolytic** (bone-destroying), or mixed. **Why Prostate is Correct:** Prostate adenocarcinoma is the classic example of a malignancy causing **purely osteoblastic** lesions [1]. Tumor cells secrete factors like **Bone Morphogenetic Proteins (BMPs)**, WNT proteins, and Endothelin-1, which directly stimulate osteoblast proliferation and activity. On imaging, these appear as dense, radio-opaque "sclerotic" spots [1]. **Analysis of Incorrect Options:** * **Lung (A):** Most primary lung cancers (especially Non-Small Cell Lung Cancer) produce **osteolytic** lesions due to the secretion of PTHrP (Parathyroid Hormone-related Protein), which activates osteoclasts. * **Adrenal (C):** Adrenal malignancies (like Neuroblastoma in children) typically cause aggressive **osteolytic** destruction rather than blastic changes. * **Breast (D):** Breast cancer is the most common cause of **mixed** (both blastic and lytic) lesions. While it can be blastic, it is not as characteristically or purely blastic as prostate cancer. **High-Yield Clinical Pearls for NEET-PG:** * **Mnemonic for Blastic Metastases:** "**P**rostate **B**rings **S**trong **B**ones" (**P**rostate, **B**reast (mixed), **S**mall cell lung cancer, **B**ladder). * **Mnemonic for Lytic Metastases:** "**L**ung, **K**idney, **T**hyroid" (Lead to "holes" in bone). * **Most common site for bone metastasis:** Thoracic spine (via Batson’s venous plexus). * **Biochemical Marker:** Osteoblastic lesions are associated with elevated **Serum Alkaline Phosphatase (ALP)** [1], while lytic lesions often show hypercalcemia. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 501-502.

Q: Herringbone pattern is seen in which of the following tumors?

Fibrosarcoma. ### Explanation **Correct Answer: B. Fibrosarcoma** **Why it is correct:** The **"Herringbone pattern"** is the classic histopathological hallmark of **Fibrosarcoma**. This pattern is characterized by highly cellular areas where malignant spindle-shaped fibroblasts are arranged in intersecting fascicles at acute angles, resembling the skeleton of a herring fish. These cells typically show scant cytoplasm and elongated, hyperchromatic nuclei with variable mitotic activity. **Analysis of Incorrect Options:** * **A. Rhabdomyosarcoma:** This skeletal muscle tumor is characterized by **"Rhabdomyoblasts"** (tadpole or strap cells) containing cross-striations. The alveolar subtype often shows a "cluster of grapes" (sarcoma botryoides) or a "partitioned" appearance, not herringbone. * **C. Fibrous Histiocytoma:** Benign or malignant fibrous histiocytomas (now often classified as Undifferentiated Pleomorphic Sarcoma) typically exhibit a **"Storiform pattern"** (cartwheel or whorled appearance), where spindle cells radiate from a central point. * **D. Liposarcoma:** This tumor is identified by the presence of **Lipoblasts**. Depending on the subtype, it may show a "chicken-wire" capillary pattern (Myxoid variant) or a pleomorphic, high-grade appearance, but not a herringbone pattern. **NEET-PG High-Yield Pearls:** * **Storiform Pattern:** Dermatofibrosarcoma Protuberans (DFSP) and Fibrous Histiocytoma. * **Chicken-wire Calcification:** Chondroblastoma. * **Chicken-wire Capillaries:** Myxoid Liposarcoma and Oligodendroglioma. * **Verocay Bodies:** Schwannoma (Antoni A areas). * **Biphasic Pattern:** Synovial Sarcoma (spindle cells + epithelial elements). * **Small Round Blue Cell Tumors:** Ewing’s Sarcoma, Neuroblastoma, and Rhabdomyosarcoma.

Question 1

A patient presented with fever, night sweats, and weight loss. Clinical examination revealed painless lymphadenopathy. Microscopy shows Reed Sternberg cells. Most likely condition is?

Accepted Answer

Hodgkin's lymphoma

Answer

HIV

Answer

Chronic lymphocytic leukemia

Answer

Secondary TB

Question 2

Conservative surgical excision would be appropriate treatment and probably curative for which of the following?

Accepted Answer

Nodular fasciitis

Answer

Fibromatosis

Answer

Fibrosarcoma

Answer

Rhabdomyosarcoma

Question 3

Which tumor shows a herringbone pattern on histology?

Accepted Answer

Fibrosarcoma

Answer

Lipoma

Answer

Carcinoma

Answer

Liposarcoma

Question 4

Generalised hypercementosis is seen in which of the following conditions?

Accepted Answer

Paget's disease

Answer

Hypophosphatasia

Answer

Fibrous dysplasia

Answer

Cherubism

Question 5

Osteoblastic metastases are most commonly seen from which primary malignancy?

Accepted Answer

Prostate

Answer

Lung

Answer

Adrenal

Answer

Breast

Question 6

Herringbone pattern is seen in which of the following tumors?

Accepted Answer

Fibrosarcoma

Answer

Rhabdomyosarcoma

Answer

Fibrocytic Histiocytoma

Answer

Liposarcoma

Question 7

What is the characteristic finding in muscular dystrophy?

Accepted Answer

Heterogeneity of fiber size

Answer

Inflammatory cell infiltrate

Answer

Nuclear proliferation beneath sarcolemma

Answer

All of the above

Question 8

A patient presents with complaints of sciatica. Radiological examination reveals sclerotic lesions on his skull. Which of the following is most likely to be elevated in this patient?

Accepted Answer

Prostate specific antigen (PSA)

Answer

Carcinogenic embryonic antigen (CEA)

Answer

Alkaline phosphatase

Answer

Alpha 1 antitrypsin

Question 9

A diabetic patient is undergoing dialysis. Aspiration done around the knee joint would show which of the following?

Accepted Answer

Beta-2 microglobulin

Answer

Amyloidosis-associated protein (AA)

Answer

Amyloid light chain (AL)

Answer

Lactoferrin

Question 10

A patient with multiple impacted supernumerary teeth, and inability to bring his shoulders together, is suffering from which of the following conditions?

Accepted Answer

Cleidocranial dysostosis

Answer

Klinefelter's syndrome

Answer

Trisomy 21

Answer

Down's syndrome

Bone and Soft Tissue Pathology — MCQs

Bone and Soft Tissue Pathology — MCQs

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