Soft Tissue Tumors — MCQs
Fibrous histiocytoma is classified as which type of tumor?
Which of the following is a differential of giant cell tumor?
All of the following are small round blue cell tumours except
A 26-year-old male presents to the outpatient department with a discrete thyroid swelling. On neck ultrasound, an isolated cystic swelling of the gland is seen. What is the risk of malignancy associated with this finding?
Most common tumor associated with neurofibromatosis type 1?
Which of the following stages of lip carcinoma does not have nodal involvement?
The most chemoresistant tumor amongst the following:
Malignant peripheral nerve sheath tumour showing which of the following differentiation is termed as 'Triton tumour'?
Match the following: A) Caplan syndrome- 1) Found first in coal worker B) Asbestosis- 2) Upper lobe predominance C) Mesothelioma- 3) Involves lower lobe D) Sarcoidosis- 4) Pleural effusion is seen
A 15-year-old boy is injured while playing cricket. X-rays of the leg rule out a possible fracture. The radiologist reports the boy has evidence of aggressive bone tumor with both bone destruction and soft tissue mass. The bone biopsy reveals a bone cancer with neural differentiation. Which of the following is the most likely diagnosis?
Soft Tissue Tumors Indian Medical PG Practice Questions and MCQs
Question 1: Fibrous histiocytoma is classified as which type of tumor?
- A. Epithelial tumor
- B. Soft tissue tumor (Correct Answer)
- C. Germ cell tumor
- D. Lymphoid tumor
Explanation: ***Soft tissue tumor*** - Fibrous histiocytoma is a type of **soft tissue tumor** arising from fibroblasts and histiocytes [1]. - It typically presents as a **nodular mass** and can be mistaken for other spindle cell tumors. *Hemangiopericytoma* - This is a vascular tumor arising from **pericytes**, often presenting as a deep-seated mass rather than a fibrous nodule. - Hemangiopericytoma has a distinct morphology and is associated with **hemorrhagic pathology**, unlike fibrous histiocytoma. *Angiomyolipomas* - Composed of **blood vessels, smooth muscle, and fat**, angiomyolipomas typically occur in the kidneys, not resembling fibrous histiocytoma. - These tumors are often associated with **tuberous sclerosis**, which is not the case for fibrous histiocytoma. *Angiomyosarcoma* - This malignant tumor consists of malignant **vascular and smooth muscle** components, distinct from the benign nature of fibrous histiocytoma. - Angiomyosarcoma has a poor prognosis and is characterized by **aggressive behavior**, unlike the benign fibrous histiocytoma. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, p. 1222.
Question 2: Which of the following is a differential of giant cell tumor?
- A. Chondroblastoma (Correct Answer)
- B. Osteogenic sarcoma
- C. Ossifying fibroma
- D. Non-ossifying fibroma
Explanation: **Chondroblastoma** - Both **Chondroblastoma** and **giant cell tumor (GCT)** are epiphyseal lesions that can occur in a similar age group and have some overlapping radiographic features, making them a differential. - Histologically, chondroblastoma can contain **multinucleated giant cells**, which may be confused with those found in GCT. *Osteogenic sarcoma* - **Osteogenic sarcoma (osteosarcoma)** is a malignant bone tumor primarily affecting the metaphysis of long bones, in contrast to GCT's epiphyseal location [1]. - Radiographically, osteosarcoma often presents with an aggressive, destructive pattern including **periosteal reaction** (e.g., sunburst, Codman's triangle), which is less typical for GCT [1]. *Ossifying fibroma* - **Ossifying fibroma** is a benign fibro-osseous lesion most commonly found in the jaws, distinctly different from GCT's predilection for epiphyses of long bones. - Histologically, it's characterized by the presence of **mineralized material** resembling bone or cementum within a fibrous stroma, unlike the abundant multinucleated giant cells of GCT [1]. *Non-ossifying fibroma* - A **non-ossifying fibroma (NOF)**, also known as a fibrous cortical defect, is typically a benign, asymptomatic, and self-limiting lesion found in the metaphysis of long bones, usually in children and adolescents. - It is characterized by **fibrous tissue** and foam cells but lacks the prominent multinucleated giant cells and epiphyseal location characteristic of GCT [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1205-1206. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, p. 1208.
Question 3: All of the following are small round blue cell tumours except
- A. Ewing's sarcoma
- B. Rhabdomyosarcoma
- C. Retinoblastoma
- D. Wilms tumour (Correct Answer)
Explanation: ***Wilms tumour*** - **Wilms tumour** (nephroblastoma) is a **triphasic tumor** composed of blastemal, stromal, and epithelial elements [1], leading to a more varied histological appearance than mere small round blue cells. - While it can contain small, undifferentiated cells, its characteristic histology with **immature tubules** and mesenchymal elements differentiates it from classic small round blue cell tumors [1]. *Ewing's sarcoma* - **Ewing's sarcoma** is a classic example of a **small round blue cell tumor**, characterized by uniform, primitive cells with scant cytoplasm [2]. - It is classically associated with specific **chromosomal translocations**, particularly t(11;22). *Rhabdomyosarcoma* - **Rhabdomyosarcoma** is the most common soft tissue sarcoma in children and is also considered a **small round blue cell tumor** due to its primitive, undifferentiated cells [3]. - These tumors show evidence of **skeletal muscle differentiation**, which can be identified through immunohistochemistry (e.g., desmin, myogenin) [3]. *Retinoblastoma* - **Retinoblastoma** is a malignant tumor of the retina composed of primitive **neuroectodermal cells** that appear small, round, and blue [1]. - It classically forms characteristic **rosettes** (Flexner-Wintersteiner rosettes), which are a histological hallmark within its small round blue cell morphology [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 211-212. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 671-672. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1224-1225.
Question 4: A 26-year-old male presents to the outpatient department with a discrete thyroid swelling. On neck ultrasound, an isolated cystic swelling of the gland is seen. What is the risk of malignancy associated with this finding?
- A. 48%
- B. 12%
- C. 24%
- D. 3% (Correct Answer)
Explanation: ***3%*** - **Purely cystic thyroid nodules** (as described in this case with "isolated cystic swelling") have a **very low risk of malignancy**, typically **2-3%** or less. - According to **ATA guidelines** and **TIRADS classification**, purely cystic nodules are considered **low suspicion** lesions. - The cystic nature suggests a **benign process** such as a degenerated adenoma, colloid cyst, or simple cyst. - **Fine needle aspiration (FNA)** may still be considered if the nodule is >2 cm or has any suspicious solid components, but is often not required for purely cystic lesions. *48%* - This percentage is **significantly higher** than the actual malignancy risk for a purely cystic thyroid swelling. - Such a **high risk** would typically be associated with **solid nodules** exhibiting highly suspicious ultrasound features such as: - Microcalcifications - Irregular or spiculated margins - Taller-than-wide shape - Marked hypoechogenicity - Extrathyroidal extension *24%* - This percentage represents a **moderate to high risk** of malignancy, which is **not characteristic** of an isolated purely cystic thyroid swelling. - A risk in this range might be seen with: - **Mixed solid-cystic nodules** with predominantly solid components - Solid nodules with **intermediate suspicious features** on ultrasound *12%* - While lower than 24% or 48%, 12% is still **considerably higher** than the generally accepted malignancy risk for purely cystic thyroid nodules. - This risk level could be plausible for: - **Predominantly cystic nodules** with some eccentric solid components - Solid nodules with **mildly suspicious** features on ultrasound
Question 5: Most common tumor associated with neurofibromatosis type 1?
- A. Neurofibromas (Correct Answer)
- B. Astrocytoma
- C. Bilateral acoustic neuroma
- D. Optic glioma
Explanation: ***Neurofibromas*** - **Neurofibromas** are pathognomonic benign peripheral nerve sheath tumors that occur in over 90% of individuals with **Neurofibromatosis type 1 (NF1)**, making them the most common associated tumor. - They can be cutaneous, subcutaneous, or plexiform, with plexiform neurofibromas having a potential for malignant transformation. *Optic glioma* - **Optic gliomas** (specifically pilocytic astrocytomas of the optic pathway) are commonly associated with NF1 and can cause visual impairment, but they are not the *most common* tumor overall. - While frequently seen, particularly in childhood NF1, the prevalence of optic gliomas is lower than that of neurofibromas. *Astrocytoma* - **Astrocytomas** are a type of glioma that can occur in NF1, including those that manifest as optic gliomas. However, astrocytoma is a broad category, and non-optic pathway astrocytomas are less common than neurofibromas. - Other forms of astrocytoma, such as high-grade gliomas, are rare but can occur in NF1 patients. *Bilateral acoustic neuroma* - **Bilateral acoustic neuromas (vestibular schwannomas)** are the hallmark tumor of **Neurofibromatosis type 2 (NF2)**, not NF1 [1]. - Their presence strongly indicates a diagnosis of NF2, which is genetically and clinically distinct from NF1.
Question 6: Which of the following stages of lip carcinoma does not have nodal involvement?
- A. T2N1
- B. T3N0 (Correct Answer)
- C. T2N2
- D. T1N1
Explanation: ***T3N0*** - The **'N' classification** in the TNM staging system refers to **nodal involvement**. A stage with **'N0' indicates no regional lymph node metastasis**. - A **T3 lesion** signifies a large primary tumor, but if it's accompanied by **N0**, it means there's no evidence of spread to the lymph nodes. *T2N1* - The **'N1' classification** indicates the presence of **regional lymph node metastasis**, specifically in a **single ipsilateral lymph node** that is 3 cm or less in its greatest dimension. - This stage therefore **does have nodal involvement**, contradicting the premise of the question. *T2N2* - The **'N2' classification** signifies more advanced regional lymph node metastasis, such as a **single ipsilateral lymph node** greater than 3 cm but not more than 6 cm. - It could also refer to **multiple ipsilateral lymph nodes**, none greater than 6 cm, or bilateral/contralateral lymph nodes, none greater than 6 cm. In all these cases, **nodal involvement is present**. *T1N1* - Similar to T2N1, the **'N1' component** in T1N1 indicates the presence of **regional lymph node metastasis** in a single ipsilateral lymph node of 3 cm or less. - Therefore, this stage **does involve nodal spread**, despite having a smaller primary tumor (T1).
Question 7: The most chemoresistant tumor amongst the following:
- A. Osteosarcoma
- B. Clear cell sarcoma
- C. Undifferentiated pleomorphic sarcoma (Correct Answer)
- D. Synovial sarcoma
Explanation: ***Undifferentiated pleomorphic sarcoma*** - **Undifferentiated pleomorphic sarcoma (UPS)** is known for its aggressive nature and inherent resistance to conventional chemotherapy. - Its **heterogeneous genetic profile** and lack of specific therapeutic targets contribute to its poor response to systemic treatments. *Osteosarcoma* - While osteosarcoma is a highly aggressive bone tumor, it is generally considered **chemosensitive**, particularly to agents like **methotrexate, doxorubicin, and cisplatin**. - **Neoadjuvant chemotherapy** is a standard part of treatment, often leading to significant tumor necrosis and improved outcomes. *Clear cell sarcoma* - **Clear cell sarcoma** is a rare soft tissue sarcoma with a distinct genetic translocation, t(12;22), involving the **EWSR1 gene**. - Although it can be challenging to treat, it is not consistently ranked as the most chemoresistant among sarcomas; specific targeted therapies are being investigated. *Synovial sarcoma* - **Synovial sarcoma** is often sensitive to chemotherapy, particularly regimens containing **ifosfamide and doxorubicin**. - Its response to chemotherapy can be variable, but it is generally *more chemosensitive* than undifferentiated pleomorphic sarcoma.
Question 8: Malignant peripheral nerve sheath tumour showing which of the following differentiation is termed as 'Triton tumour'?
- A. Cartilaginous
- B. Rhabdomyoblastic (Correct Answer)
- C. Glandular
- D. Osseous
Explanation: ***Rhabdomyoblastic*** - A **Triton tumour** is a specific subtype of **malignant peripheral nerve sheath tumour (MPNST)** characterized by the presence of **rhabdomyosarcomatous differentiation** [1]. - This differentiation means that the tumour cells express features of **skeletal muscle differentiation**, making it a challenging diagnosis due to its aggressive nature and mixed histological features [1], [2]. *Cartilaginous* - The presence of **cartilaginous differentiation** in an MPNST would lead to a diagnosis of an **MPNST with heterologous chondrosarcomatous differentiation**, not a Triton tumour. - While MPNSTs can show heterologous elements, cartilage is not the characteristic feature of a Triton tumour [1]. *Glandular* - If an MPNST exhibits **glandular differentiation**, it would be termed an **MPNST with heterologous glandular differentiation** [1]. - This is a distinct subtype and does not correspond to the definition of a Triton tumour. *Osseous* - An MPNST with **osseous differentiation** (bone formation) would be classified as an **MPNST with heterologous osteosarcomatous differentiation** [1]. - This is another example of heterologous differentiation but is not what defines a Triton tumour. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Peripheral Nerves and Skeletal Muscles, pp. 1250-1251. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1224-1225.
Question 9: Match the following: A) Caplan syndrome- 1) Found first in coal worker B) Asbestosis- 2) Upper lobe predominance C) Mesothelioma- 3) Involves lower lobe D) Sarcoidosis- 4) Pleural effusion is seen
- A. A-3, B-4, C-2, D-1
- B. A-1, B-4, C-3, D-2 (Correct Answer)
- C. A-4, B-2, C-3, D-1
- D. A-2, B-4, C-3, D-1
Explanation: **A-1, B-4, C-3, D-2** - **Caplan syndrome** was first described in **coal workers** with **rheumatoid arthritis** and progressive massive fibrosis. - **Asbestosis** is often associated with **pleural effusion**, which can be benign or malignant. - **Mesothelioma** typically involves the **lower lobes** of the lungs, specifically the pleura, and is strongly linked to asbestos exposure. - **Sarcoidosis** is characterized by **non-caseating granulomas**, which have a predilection for the **upper lobes** of the lungs. *A-3, B-4, C-2, D-1* - This option incorrectly states that Caplan syndrome involves the lower lobe; **Caplan syndrome** is defined by the presence of large nodules in the lungs of coal workers with rheumatoid arthritis, and their specific lobar distribution is not a defining characteristic. - This option incorrectly states that Mesothelioma has an upper lobe predominance; **Mesothelioma** is a pleural malignancy and typically involves the **lower lobes**, extending along the pleura. *A-4, B-2, C-3, D-1* - This option incorrectly associates Caplan syndrome with pleural effusion; **Caplan syndrome** manifests as rheumatoid nodules in the lungs, not primarily pleural effusion. - This option incorrectly states that Asbestosis has an upper lobe predominance; **Asbestosis** predominantly affects the **lower lobes** of the lungs, causing interstitial fibrosis. *A-2, B-4, C-3, D-1* - This option incorrectly states that Caplan syndrome has an upper lobe predominance; the defining feature of **Caplan syndrome** is the combination of rheumatoid arthritis and pneumoconiosis, not specific lobar involvement. - This option correctly identifies pleural effusion with asbestosis and lower lobe involvement with mesothelioma, but **Caplan syndrome** is not characterized by upper lobe predominance.
Question 10: A 15-year-old boy is injured while playing cricket. X-rays of the leg rule out a possible fracture. The radiologist reports the boy has evidence of aggressive bone tumor with both bone destruction and soft tissue mass. The bone biopsy reveals a bone cancer with neural differentiation. Which of the following is the most likely diagnosis?
- A. Ewing's sarcoma (Correct Answer)
- B. Osteosarcoma
- C. Neuroblastoma
- D. Chondroblastoma
Explanation: ***Ewing's sarcoma*** - This is an aggressive bone tumor that commonly affects children and adolescents, characterized by **bone destruction** and a **soft tissue mass**. - A key diagnostic feature is its **neural differentiation**, often identified by the presence of a characteristic **t(11;22) translocation**. *Osteosarcoma* - While it is an aggressive bone tumor in adolescents, it primarily demonstrates **osteoid production** rather than neural differentiation [1]. [2] - X-rays typically show a **sunburst appearance** and **Codman's triangle**, which are not specified here [1]. *Neuroblastoma* - This is a pediatric malignancy of the **sympathetic nervous system** that can metastasize to bone, but it originates from neural crest cells and is not primarily a bone tumor. - While it shows neural differentiation, the primary tumor is usually in the **adrenal gland** or sympathetic ganglia, not directly arising from bone. *Chondroblastoma* - This is a rare, benign cartilaginous tumor typically found in the **epiphyses of long bones** in adolescents but is not generally aggressive or associated with neural differentiation. - It involves **cartilage formation**, which is distinct from the aggressive bone destruction and neural features described [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1200-1202. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 673-674.
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