Exam Corner

Pathology

Prepared by Mohamed Sukeik
SICOT Associate Member & SICOT Newsletter Associate Editor - London, United Kingdom

 

Questions

  1. The Musculoskeletal Tumour Society staging system is also called:

    1. The American Joint Commission on Cancer (AJCC) system

    2. The British Joint Commission on Cancer system

    3. The Enneking system

    4. The National Cancer Institute system

    5. The Dukes system
       

  2. In The American Joint Commission on Cancer (AJCC) system a stage III is characterized by: 

    1. Grade 2 moderately differentiated tumours

    2. Grade 3 poorly differentiated tumours

    3. Metastasis to the lung

    4. Metastasis to other distant sites

    5. Discontinuous tumours in the primary bone
       

  3. The 3 stages of The Musculoskeletal Tumour Society system are sub classified into A and B according to which of the following?

    1. Location being intra or extra-compartmental

    2. Grade being high or low

    3. Lymph node involvement

    4. Presence of metastasis to the lung

    5. Presence of metastasis to other distant sites
       

  4. All of the following bone tumours are typically high grade tumours except?

    1. Intramedullary osteosarcoma

    2. Post irradiation sarcoma

    3. Fibrosarcoma

    4. Parosteal osteosarcoma

    5. Paget sarcoma
       

  5. All of the following bone tumours are typically low grade tumours except?

    1. Primary chondrosarcoma

    2. Secondary chondrosarcoma

    3. Hemagioendothelioma

    4. Chordoma

    5. Malignant fibrous histiocytoma
       

  6. All of the following soft tissue tumours are typically high grade tumours except?

    1. Malignant fibrous histiocytoma

    2. Pleomorphic liposarcoma

    3. Rhabdomyosarcoma

    4. Synovial sarcoma

    5. Alveolar cell sarcoma
       

  7. The most common musculoskeletal soft tissue malignant tumour in children is:

    1. Rhabdomyosarcoma

    2. Malignant fibrous histiocytoma

    3. Liposarcoma

    4. Angiosarcoma

    5. Synovial sarcoma
       

  8. The most common musculoskeletal soft tissue malignant tumour in adults is:

    1. Rhabdomyosarcoma

    2. Malignant fibrous histiocytoma

    3. Liposarcoma

    4. Angiosarcoma

    5. Synovial sarcoma
       

  9. The most common primary benign bone tumour is:

    1. Enchondroma

    2. Osteoblastoma

    3. Osteoid osteoma

    4. Osteochondroma

    5. Chondroblastoma
       

  10. The most common sarcoma of the hand and wrist is:

    1. Synovial sarcoma

    2. Chondrosarcoma

    3. Epithelioid sarcoma

    4. Fibrosarcoma

    5. Malignant fibrous histiocytoma
       

  11. The most common sarcoma of the foot and ankle is:

    1. Synovial sarcoma

    2. Chondrosarcoma

    3. Epithelioid sarcoma

    4. Fibrosarcoma

    5. Malignant fibrous histiocytoma
       

  12. The most common phalangeal tumour is:

    1. Aneurysmal bone cyst

    2. Giant cell tumour

    3. Fibrosarcoma

    4. Chondrosarcoma

    5. Enchondroma
       

  13. The most common primary malignant bone tumour is:

    1. Chondrosarcoma

    2. Osteosarcoma

    3. Synovial sarcoma

    4. Epithelioid sarcoma

    5. Fibrosarcoma
       

  14. Which of the following lesions typically occur in children younger than 5 years of age?

    1. Osteofibrous dysplasia

    2. Enchondroma

    3. Mastocytosis

    4. Chondrosarcoma

    5. Eosinophilic granuloma
       

  15. Surgical principles of performing an open biopsy include all of the following except:

    1. All biopsy samples should be submitted for bacteriologic analysis

    2. Biopsy incisions are made through muscles

    3. Neurovascular structures should be avoided

    4. Transverse incisions are recommended

    5. If a drain is necessary, it should be placed at the corner of the wound
       

  16. A marginal margin excision of a tumour means:

    1. The plane of direction goes through the tumour

    2. Removal of the tumour and its compartment

    3. Resection goes through the reactive zone of the tumour

    4. The entire tumour is removed with a cuff of normal tissue

    5. When malignant mesenchymal tumours are resected, a local recurrence rate of less than 5% is always achieved
       

  17. External beam irradiation is used in all of the following tumours except:

    1. Ewing sarcoma

    2. Lymphoma

    3. Myeloma

    4. Chondrosarcoma

    5. Metastatic bone disease
       

  18. The genetic translocation t(X;18) is associated with which of the following?

    1. Myxoid liposarcoma

    2. Ewing sarcoma

    3. Synovial sarcoma

    4. Myxoid chondrosarcoma

    5. Rhabdomyosarcoma
       

  19. A CT abdomen and pelvis is indicated whilst staging which of the following?

    1. Rhabdomyosarcoma

    2. Liposarcoma

    3. Osteosarcoma

    4. Ewing sarcoma

    5. Chondrosarcoma
       

  20. Tumours which commonly metastasize via the lymphatic vessels include all of the following except:

    1. Rhabdomyosarcoma

    2. Clear cell sarcoma

    3. Epithelioid sarcoma

    4. Synovial sarcoma

    5. Chondrosarcoma

Answers

  1. c
    The Musculoskeletal Tumour Society (also called the Enneking system) and the American Joint Commission on Cancer are the most commonly used systems for staging musculoskeletal lesions
    Reference: Review of Orthopaedics, Miller

  2. e
    An AJCC stage III is characterized by discontinuous tumours in the primary bone regardless of the grade of the tumour
    Reference: Review of Orthopaedics, Miller

  3. a
    The 3 stages of The Musculoskeletal Tumour Society system are sub classified into A and B according to location being intra or extra-compartmental
    Reference: Review of Orthopaedics, Miller

  4. d
    All except parosteal osteosarcomas are typically high grade tumours
    Reference: Review of Orthopaedics, Miller

  5. e
    All except malignant fibrous histiocytoma are typically low grade tumours
    Reference: Review of Orthopaedics, Miller

  6. c
    All except rhabdomyosarcoma are typically high grade soft tissue tumours
    Reference: Review of Orthopaedics, Miller

  7. a
    The most common musculoskeletal soft tissue malignant tumour in children is rhabdomyosarcoma
    Reference: Review of Orthopaedics, Miller

  8. b
    The most common musculoskeletal soft tissue malignant tumour in adults is malignant fibrous histiocytoma
    Reference: Review of Orthopaedics, Miller

  9. d
    The most common primary benign bone tumour is osteochondroma
    Reference: Review of Orthopaedics, Miller

  10. c
    The most common sarcoma of the hand and wrist is epithelioid sarcoma
    Reference: Review of Orthopaedics, Miller

  11. a
    The most common sarcoma of the foot and ankle is synovial sarcoma
    Reference: Review of Orthopaedics, Miller

  12. e
    The most common phalangeal tumour is enchondroma
    Reference: Review of Orthopaedics, Miller

  13. b
    The most common primary malignant bone tumour is osteosarcoma
    Reference: Review of Orthopaedics, Miller

  14. a
    Osteofibrous dysplasia typically occurs in children younger than 5 years of age. Other lesions seen in this age group include leukemia, neuroblastoma, rhabdomyosarcoma and osteomyelitis. Eosinophilic granuloma occurs in 10-25 years age group. The others typically occur in patients over 40 years of age.
    Reference: Review of Orthopaedics, Miller

  15. d
    If the lesion proves to be malignant, the entire biopsy tract should be removed with the entire lesion. Hence, transverse incisions should be avoided.
    Reference: Review of Orthopaedics, Miller

  16. c
    The plane of direction goes through the tumour – Intralesional margin
    Removal of the tumour and its compartment – Radical margin
    Resection goes through the reactive zone of the tumour
    The entire tumour is removed with a cuff of normal tissue – Wide margin
    When mesenchymal malignant tumours are resected, a local recurrence rate of 25-50% is expected. If response to preoperative chemotherapy has been excellent with 95-100% tumour necrosis, a marginal margin may be safe and effective.
    Reference: Review of Orthopaedics, Miller

  17. d
    External beam irradiation is used in all tumours listed except for chondrosarcoma which is resistant to both radiotherapy and chemotherapy
    Reference: Review of Orthopaedics, Miller

  18. c
    The genetic translocation t(X;18) is associated with synovial sarcoma.
    Myxoid liposarcoma t(12;16)
    Ewing sarcoma t(11;22)
    Synovial sarcoma - t(X;18)
    Myxoid chondrosarcoma t(9;22)
    Rhabdomyosarcoma t(1;13) or t(2;13)
    Reference: Review of Orthopaedics, Miller

  19. b
    A CT abdomen and pelvis is indicated whilst staging for liposarcomas because of synchronous retroperitoneal liposarcomas.
    Reference: Review of Orthopaedics, Miller

  20. e
    Tumours which commonly metastasize via the lymphatic vessels include all listed except chondrosarcoma.
    Reference: Review of Orthopaedics, Miller