Bone and Soft Tissue Tumors — MCQs
Soap bubble appearance on X-ray is seen in which bone tumor?
Commonest malignancy of bones is -
Which of the following is not true about osteosarcoma?
Which statement is incorrect about the pathology of the bone tumor?
Which bone tumor involves the epiphysis?
True about bone tumor is:
Osteomyelitis can mimic which of the following tumor?
Which of the following is an epiphyseal lesion?
Investigation of choice for lumbar prolapsed disc -
What is the best imaging modality for detecting early osteomyelitis?
Bone and Soft Tissue Tumors Indian Medical PG Practice Questions and MCQs
Question 1: Soap bubble appearance on X-ray is seen in which bone tumor?
- A. Osteogenic sarcoma
- B. Multiple myeloma
- C. Chondroblastoma
- D. Giant cell tumor (Correct Answer)
Explanation: ***Giant cell tumor*** - The **soap bubble appearance** on X-ray is a classic radiographic finding for **giant cell tumors**, indicating areas of bone destruction and new bone formation. - These tumors are typically **benign but locally aggressive** and are commonly found in the **epiphyseal and metaphyseal regions** of long bones. *Osteogenic sarcoma* - Characterized by a more aggressive appearance on X-ray, often with a **sunburst pattern** or **Codman's triangle**, indicating periosteal reaction. - This is a **highly malignant tumor** of bone-forming tissue, not typically associated with a "soap bubble" appearance. *Multiple myeloma* - Presents on X-ray with characteristic **punched-out lytic lesions** in multiple bones, especially the skull, spine, and pelvis. - It does not usually form the multi-loculated, expansile lesions that create a "soap bubble" appearance. *Chondroblastoma* - Often appears as a **well-defined lytic lesion** with a thin sclerotic rim and is typically found in the **epiphysis** of long bones. - While it can be destructive, it usually doesn't produce the multi-loculated, expansile "soap bubble" pattern seen with giant cell tumors.
Question 2: Commonest malignancy of bones is -
- A. Multiple myeloma
- B. Metastases (Correct Answer)
- C. Osteogenic sarcoma
- D. Ewing's sarcoma
Explanation: ***Metastases*** - **Metastatic tumors** are the most common malignancies found in bone, originating from primary cancers elsewhere in the body (e.g., breast, prostate, lung) [1], [3]. - While other options represent primary bone cancers, metastases significantly outnumber them due to the frequent spread of various carcinomas to bone [1], [3]. *Multiple myeloma* - This is a **primary bone marrow malignancy** involving plasma cells, but it is not a primary bone tumor in the strict sense. - While it causes extensive skeletal destruction, its overall incidence is less than that of metastatic bone disease from solid tumors [3]. *Ewing's sarcoma* - This is a **primary malignant bone tumor** that typically affects children and young adults [1]. - It is relatively rare compared to both metastatic disease and other primary bone tumors [1]. *Osteogenic sarcoma* - Also known as **osteosarcoma**, this is the most common primary malignant bone tumor, predominantly affecting adolescents and young adults [2]. - However, when considering all malignancies of bone, including metastatic disease, osteosarcoma's incidence is far lower than that of metastases [3]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 671-672. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, p. 1202. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1198-1200.
Question 3: Which of the following is not true about osteosarcoma?
- A. Seen in the metaphyseal region of the long bones
- B. Lung metastasis is common
- C. Secondary osteosarcoma is seen in older age groups
- D. Most commonly arises in the epiphyseal region (Correct Answer)
Explanation: ***Most commonly arises in the epiphyseal region*** - This statement is **FALSE** - osteosarcoma most commonly arises in the **metaphyseal region** of long bones, particularly around the knee (distal femur, proximal tibia) and proximal humerus [1]. - The metaphysis is the region where bone growth is most active, which explains why osteosarcoma preferentially occurs there. - The epiphysis (growth plate region) is **not** the typical location for osteosarcoma. *Seen in the metaphyseal region of the long bones* - This is **TRUE** - osteosarcoma characteristically arises in the **metaphyseal regions** of long bones, especially around the knee and proximal humerus where growth is most active [1]. *Lung metastasis is common* - This is **TRUE** - the lungs are the most common site of distant metastasis in osteosarcoma, occurring in up to 80% of patients who develop metastatic disease [1]. - Pulmonary metastasis significantly impacts prognosis and treatment [1]. *Secondary osteosarcoma is seen in older age groups* - This is **TRUE** - while primary osteosarcoma affects children and young adults (peak 10-20 years), **secondary osteosarcoma** occurs in older patients, typically arising in association with Paget's disease, prior radiation therapy, or bone infarcts [1]. **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.
Question 4: Which statement is incorrect about the pathology of the bone tumor?
- A. Tumor has distinct margin
- B. Tumor arises from epiphyseal to metaphyseal region
- C. Eccentric lesion
- D. Chemotherapy is the treatment of choice for all bone tumors. (Correct Answer)
Explanation: ***Tumor has distinct margin*** - A **distinct margin** often indicates a benign tumor, while malignant tumors typically show **infiltrative margins**. - In bone tumors, particularly malignant ones, the lack of clear demarcation is a key pathological feature. *Chemotherapy is the treatment of choice* - While chemotherapy may be used for certain **malignant bone tumors**, it is not the first-line treatment for most bone tumors [1]. - The primary treatment is often **surgical excision**, especially for localized lesions [1]. *Tumor arise from epiphyseal to metaphyseal region* - While some tumors can originate in these areas, many actually arise from the **diaphyseal** region in bone tumors like osteosarcoma. - This option misrepresents the common locations where various tumors develop, as osteochondromas tend to develop near the epiphyses of limb bones [2]. *Eccentric lesion* - Many bone tumors do indeed present as **eccentric lesions**, especially benign ones like **osteochondromas**. - However, this feature does not apply universally, as some malignant tumors can also be **central or infiltrative** in nature. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 673-674. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 672-673.
Question 5: Which bone tumor involves the epiphysis?
- A. Osteosarcoma
- B. Giant cell tumor (Correct Answer)
- C. Ewing's sarcoma
- D. Multiple myeloma
Explanation: ***Giant cell tumor*** - **Giant cell tumor (GCT)**, also known as osteoclastoma, characteristically arises in the **epiphysis** [1] or **metaphysis** of long bones in adults. - It is a benign but locally aggressive tumor that often presents with pain, swelling, and reduced range of motion in the affected joint [1]. *Osteosarcoma* - **Osteosarcoma** typically arises in the **metaphysis** of long bones, particularly around the knee (distal femur, proximal tibia). - It is a highly malignant primary bone tumor characterized by the production of **osteoid** by tumor cells [2]. *Ewing's sarcoma* - **Ewing's sarcoma** most commonly affects the **diaphysis** of long bones or flat bones (e.g., pelvis, scapula, ribs). - It is characterized by small, round, blue cells and often presents with pain, swelling, and systemic symptoms like fever. *Multiple myeloma* - **Multiple myeloma** is a malignancy of **plasma cells** that primarily affects the **bone marrow** and can cause widespread osteolytic lesions. - It typically presents in older adults and affects bones with active marrow, such as the vertebrae, ribs, skull, and pelvis, rather than being localized to the epiphysis as a primary bone tumor. **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] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 673-674.
Question 6: True about bone tumor is:
- A. Multiple myeloma is seen in more than 55 years of age and above (Correct Answer)
- B. Osteoclastoma- fifth decade
- C. Osteogenic sarcoma-fourth decade
- D. Chondrosarcoma -first decade
Explanation: ***Multiple myeloma is seen in more than 55 years of age and above*** - **Multiple myeloma** is a plasma cell malignancy that predominantly affects older adults, with the median age of diagnosis being around **69 years** [1] - Its incidence significantly increases with age, making it rare before the age of 40 and most prevalent in those **over 55 years** [1][2] - This statement is **medically accurate** and represents the correct answer *Osteoclastoma - fifth decade* - **Osteoclastoma** (giant cell tumor of bone) typically occurs in young adults, primarily in their **20s to 40s** (2nd to 4th decade) - Peak incidence is in the **3rd-4th decade**, not the fifth decade - This statement is **incorrect** as fifth decade is an atypical presentation *Osteogenic sarcoma - fourth decade* - **Osteogenic sarcoma** (osteosarcoma) has a **bimodal age distribution** with peaks in adolescence (10-20 years, 2nd decade) and a smaller peak in older adults over 60 years - It is **uncommon in the fourth decade** (30s), which falls outside its primary age groups - This statement is **incorrect** *Chondrosarcoma - first decade* - **Chondrosarcoma** is a malignant cartilaginous tumor that predominantly affects older adults, typically in their **50s and 60s** (5th-6th decade) - It is **exceedingly rare in the first decade** of life (0-9 years), and its incidence significantly increases with age - This statement is **incorrect** **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 616-618. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 606-607.
Question 7: Osteomyelitis can mimic which of the following tumor?
- A. Chondroma
- B. Osteoclastoma
- C. Ewing sarcoma (Correct Answer)
- D. None of the options
Explanation: ***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.
Question 8: Which of the following is an epiphyseal lesion?
- A. Fibrosarcoma
- B. Chondroblastoma (Correct Answer)
- C. Chondrosarcoma
- D. Non-ossifying fibroma
Explanation: **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**.
Question 9: Investigation of choice for lumbar prolapsed disc -
- A. CT Scan
- B. Myelogram
- C. X-ray
- D. MRI (Correct Answer)
Explanation: ***MRI*** - An **MRI** provides the best visualization of **soft tissues**, including the intervertebral discs, spinal cord, and nerve roots, making it the **gold standard** for diagnosing lumbar prolapsed disc. - It can accurately show the **degree of disc herniation**, its impact on neural structures, and associated edema, which are crucial for treatment planning. *CT Scan* - While a **CT scan** provides good bony detail and can show disc herniation, its ability to visualize soft tissues is inferior to MRI for this specific condition. - It involves **ionizing radiation** and may miss subtle nerve root compression or spinal cord abnormalities apparent on MRI. *Myelogram* - A **myelogram** involves injecting contrast dye into the spinal canal and then performing X-rays or CT scans to outline the spinal cord and nerve roots. - Though effective in showing **nerve compression**, it is an **invasive procedure** with potential complications and has largely been replaced by MRI as a first-line diagnostic investigation. *X-ray* - **X-rays** primarily visualize **bony structures** and are useful for detecting fractures, spinal alignment issues, or severe degenerative changes. - They **cannot directly visualize intervertebral discs** or nerve compression, making them unsuitable for diagnosing a prolapsed disc.
Question 10: What is the best imaging modality for detecting early osteomyelitis?
- A. CT scan
- B. X-ray
- C. MRI (Correct Answer)
- D. Bone scintigraphy
Explanation: ***MRI*** - **Magnetic Resonance Imaging (MRI)** is considered the **gold standard** for detecting early osteomyelitis due to its excellent soft tissue contrast and ability to visualize **bone marrow edema**, which is an early sign of infection. - It can identify changes within **3-5 days** of infection onset, much earlier than other modalities. *CT scan* - While useful for showing **bone destruction**, cortical integrity, and sequestra, **CT scans** are less sensitive than MRI for detecting early marrow edema. - Its ability to diagnose osteomyelitis is usually delayed until significant **bony changes** have occurred, typically around 1-2 weeks. *X-ray* - **Plain radiographs** are often the initial imaging study but are **insensitive** for early osteomyelitis, showing changes only after 10-14 days or more. - Early findings on X-rays can be subtle, such as **periosteal elevation** or **soft tissue swelling**, but frank bone destruction is a late finding. *Bone scintigraphy* - **Bone scintigraphy** (e.g., technetium-99m) is sensitive for detecting increased bone turnover associated with infection but lacks **specificity**, as it can be positive in other conditions like trauma or tumors. - While it can detect changes earlier than X-rays, typically within 2-3 days, it cannot clearly differentiate infection from other processes, and its spatial resolution is poor compared to MRI.
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