Oncology 2016 Flashcards
- Figures 4a and 4b are the radiograph and biopsy specimen of a 62-year-old man who notes progressive left shoulder pain without antecedent trauma. He underwent arthroscopic debridement 10 years ago. What is the most likely diagnosis?
- Lymphoma
- Osteomyelitis
- Ewing sarcoma
- Multiple myeloma
- Metastatic carcinoma
- Multiple Myeloma
Röllig C, Knop S, Bornhäuser M. Multiple myeloma. Lancet. 2015 May 30;385(9983):2197-208. doi: 10.1016/S0140-6736(14)60493-1. Epub 2014 Dec 23. Review. PubMed PMID: 25540889.
- Figures 17a and 17b are the MR image and biopsy specimen of a 67-year-old woman who has a slowly enlarging buttock mass. She is otherwise healthy. She first noticed this change a couple of years ago and now is reporting mild pain over the mass. What is the most likely diagnosis?
- Well-differentiated liposarcoma
- Intramuscular myxoma
- Myxoid liposarcoma
- Round-cell liposarcoma
- Lipoma
- Intramuscular Myxoma
RECOMMENDED READINGS
Prado MA, Miró RL, Leal IM, Vargas J, Dorrego EJ. Intramuscular myxoma: differential diagnosis and review of the literature. Orthopedics. 2002 Nov;25(11):1297-9. Review. PubMed PMID: 12452352.
Petscavage-Thomas JM, Walker EA, Logie CI, Clarke LE, Duryea DM, Murphey MD. Soft-tissue myxomatous lesions: review of salient imaging features with pathologic comparison. Radiographics. 2014 Jul-Aug;34(4):964-80. doi: 10.1148/rg.344130110. PubMed PMID: 25019435.
- Figures 25a and 25b are the hip radiographs of an independent 57-year-old man who has had moderate hip pain for the past 2 months. He walks unaided with an antalgic gait and has a history of lung cancer. A biopsy of the lesion reveals metastatic lung adenocarcinoma. He has no other active areas of metastatic disease. What is the best next step?
- Protected weight bearing and an oncology referral
- Placement of a cephalomedullary nail
- Proximal femoral replacement with a cemented long-stem prosthesis
- External beam irradiation to the affected bone.
- Open curettage, cementation, and placement of a proximal femoral locking plate
- Placement of a cephalomedullary nail.
RECOMMENDED READINGS
Mirels H. Metastatic disease in long bones: A proposed scoring system for diagnosing impending pathologic fractures. 1989. Clin Orthop Relat Res. 2003 Oct;(415 Suppl):S4-13. PubMed PMID: 14600587.
Quinn RH, Randall RL, Benevenia J, Berven SH, Raskin KA. Contemporary management of metastatic bone disease: tips and tools of the trade for general practitioners. Instr Course Lect. 2014;63:431-41. PubMed PMID: 24720328.
Scolaro JA, Lackman RD. Surgical management of metastatic long bone fractures: principles and techniques. J Am Acad Orthop Surg. 2014 Feb;22(2):90-100. doi: 10.5435/JAAOS-22-02-90. Review. PubMed PMID: 24486755.
- Figures 37a through 37d are the radiographs, MR image, and biopsy specimen of a 60-year-old man who had progressive shoulder pain for 3 months. He has pain with activity and at rest. An examination reveals midhumeral tenderness. A workup shows no other areas of active disease. What is the best next step?
- Observation
- Internal fixation
- Radiation therapy
- Corticosteroid injection
- Radiofrequency ablation
- Internal Fixation
Evans AR, Bottros J, Grant W, Chen BY, Damron TA. Mirels’ rating for humerus lesions is both reproducible and valid. Clin Orthop Relat Res. 2008 Jun;466(6):1279-84. doi: 10.1007/s11999-008-0200- 0. Epub 2008 Mar 21. PubMed PMID: 18357496.
Peabody T. The rodded metastasis is a sarcoma: strategies to prevent inadvertent surgical procedures on primary bone malignancies. Instr Course Lect. 2004;53:657-61. Review. PubMed PMID: 15116656.
- A 37-year-old man is experiencing the atraumatic onset of a painless soft-tissue mass in his buttock. After discussion, the patient opts for an incisional biopsy. How should this biopsy be performed?
- Transverse incision in an extensile line with drain placement
- Transverse incision in an extensile line, frozen section, and drain placement after the diagnosis confirmation
- Transverse incision in an internervous plane
- Longitudinal incision through an intramuscular plane
- Longitudinal incision through an internervous plane
- Longitudinal incision through an intramuscular plane.
- Figures 60a through 60d are the radiographs, coronal MR image, and bone scan of a 63-year-old woman who noted the progressive onset of right shoulder pain. She has had physical therapy and has taken nonsteroidal anti-inflammatory drugs, experiencing minimal relief. The pain began insidiously, is associated with overhead activities, and is mild. What is the best next step?
- Biopsy
- Curettage
- Observation
- CT scan of the chest
- Subacromial steroid injection
- Subacromial Steroid Injection
RECOMMENDED READINGS
Douis H, Saifuddin A. The imaging of cartilaginous bone tumours. I. Benign lesions. Skeletal Radiol. 2012 Sep;41(10):1195-212. doi: 10.1007/s00256-012-1427-0. Epub 2012 Jun 17. Review. PubMed PMID: 22707094.
Levy JC, Temple HT, Mollabashy A, Sanders J, Kransdorf M. The causes of pain in benign solitary enchondromas of the proximal humerus. Clin Orthop Relat Res. 2005 Feb;(431):181-6. PubMed PMID: 15685073.
- Osteoid osteoma can most effectively be differentiated from a stress fracture with which diagnostic modality?
- MR image
- Bone scan
- Biopsy only
- Plain radiograph
- High-resolution CT scan
- High-resolution CT Scan
RECOMMENDED READINGS
Henshaw RM, Carmody Soni EE. Benign bone-forming tumors. In: Biermann JS, ed. Orthopaedic Knowledge Update 3: Musculoskeletal Tumors. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2014:107-121.
Bilchik T, Heyman S, Siegel A, Alavi A. Osteoid osteoma: the role of radionuclide bone imaging, conventional radiography and computed tomography in its management. J Nucl Med. 1992 Feb;33(2):269- 71. PubMed PMID: 1732454.
- A 24-year-old man underwent a transhumeral amputation 2 years ago for a high-grade sarcoma that encased the neurovascular bundle. He now has a focally tender mass consistent with a neuroma. Prosthetic revisions have not relieved the discomfort. What is the most reasonable next step?
- Targeted muscle reinnervation
- Neuroma resection
- Muscle transfer
- Nerve transposition
- Further humeral resection
- Targeted Muscle Reinnervation
RECOMMENDED READINGS
Souza JM, Cheesborough JE, Ko JH, Cho MS, Kuiken TA, Dumanian GA. Targeted muscle reinnervation: a novel approach to postamputation neuroma pain. Clin Orthop Relat Res. 2014 Oct;472(10):2984-90. doi: 10.1007/s11999-014-3528-7. PubMed PMID: 24562875.
Gart MS, Souza JM, Dumanian GA. Targeted Muscle Reinnervation in the Upper Extremity Amputee: A Technical Roadmap. J Hand Surg Am. 2015 Sep;40(9):1877-88. doi: 10.1016/j.jhsa.2015.06.119. Review. PubMed PMID: 26314220.
Fitzgibbons P, Medvedev G. Functional and Clinical Outcomes of Upper Extremity Amputation. J Am Acad Orthop Surg. 2015 Dec;23(12):751-60. doi: 10.5435/JAAOS-D-14-00302. Epub 2015 Nov 2. Review. PubMed PMID: 26527583.
A 24-year-old woman has a painless mass in her thigh that has been increasing in size. A biopsy is planned. Which approach pictured in Figure 90 should be used to perform the biopsy?
- A
- B
- C
- D
- E
- C
- A 24-year-old woman with a history of a soft-tissue sarcoma of her left thigh is being monitored for recurrence. An MR image performed 2 years after her resection is shown in Figure 109a. Bone scan, positron emission tomography CT, and radiograph findings are all normal. A biopsy of the right femur is shown in Figure 109b. Which chromosomal translocation is associated with this pathology?
- X;18
- 12;16
- X;17
- 11;22
- 2;13
- 12;16
RECOMMENDED READINGS
Xiang H1, Wang J, Hisaoka M, Zhu X. Characteristic sequence motifs located at the genomic breakpoints of the translocation t(12;16) and t(12;22) in myxoid liposarcoma. Pathology. 2008 Oct;40(6):547-52. doi: 10.1080/00313020802320424. PubMed PMID: 18752119.
Noble JL1, Moskovic E, Fisher C, Judson I. Imaging of skeletal metastases in myxoid liposarcoma. Sarcoma. 2010;2010:262361. doi: 10.1155/2010/262361. Epub 2010 Mar 30. PubMed PMID: 20369068.
Schwab JH1, Boland PJ, Antonescu C, Bilsky MH, Healey JH. Spinal metastases from myxoid liposarcoma warrant screening with magnetic resonance imaging. Cancer. 2007 Oct 15;110(8):1815-22. PubMed PMID: 17724681.
- Figure 119a is the initial radiograph of a 12-year-old girl who plays competitive soccer. She has a 3-week history of right thigh pain and a limp, and the radiograph was performed 3 weeks ago. Current radiographs and MR images are shown in Figures 119b through 119d. She has remained afebrile; a white blood cell count, erythrocyte sedimentation rate, and C-reactive protein level are within defined limits. She has pain with resisted adduction of her hip, but otherwise her examination findings are benign. Initial treatment should consist of
- activity cessation and observation.
- biopsy.
- prophylactic fixation with an intramedullary nail.
- empiric intravenous antibiotics.
- irrigation and debridement.
- Activity cessation and observation
RECOMMENDED READINGS
Nishio J, Hara M, Naito M. Adductor insertion avulsion syndrome mimicking neoplastic processes in a 14-year-old long-distance runner. Orthopedics. 2012 Sep;35(9):e1442-5. doi: 10.3928/01477447- 20120822-37. PubMed PMID: 22955417.
Anderson MW, Kaplan PA, Dussault RG. Adductor insertion avulsion syndrome (thigh splints): spectrum of MR imaging features. AJR Am J Roentgenol. 2001 Sep;177(3):673-5. PubMed PMID: 11517070.
Mahajan MS. Bone scanning in the adductor insertion avulsion syndrome. World J Nucl Med. 2013 May;12(2):73-5. doi: 10.4103/1450-1147.136698. PubMed PMID: 25126001.
- Figure 151a is a radiograph of a 40-year-old man with a history of a giant-cell tumor of the femur that was resected 7 years ago. He has had increasing pain and swelling that is worse with activity for 3 months. He is afebrile, and his white blood cell count, erythrocyte sedimentation rate, and C-reactive protein level are all within defined limits. A CT scan of the chest, abdomen, and pelvis demonstrates no evidence of other disease. He previously had allograft bone placed into the defect. Low- and high-power pathologic specimens are shown in Figures 151b and 151c. Further treatment should consist of
- subcutaneous denosumab injections.
- repeat curettage resection with a local adjuvant, placement of autograft bone, and prophylactic fixation.
- repeat curettage resection with a local adjuvant, placement of methylmethacrylate, and prophylactic fixation.
- irrigation and debridement, placement of an antibiotic spacer, and intravenous antibiotics.
- wide resection with reconstruction with a distal femoral replacement.
- wide resection with reconstruction with a distal femoral replacement.
RECOMMENDED READINGS
Li J, Zhu Y, Wei Y. Fibrosarcoma development 15 years after curettage and bone grafting of giant cell tumor of bone. Orthopedics. 2014 May;37(5):e512-6. doi: 10.3928/01477447-20140430-66. PubMed PMID: 24810832.
Saito T, Mitomi H, Izumi H, Suehara Y, Okubo T, Torigoe T, Takagi T, Kaneko K, Sato K, Matsumoto T, Yao T. A case of secondary malignant giant-cell tumor of bone with p53 mutation after long-term follow-up. Hum Pathol. 2011 May;42(5):727-33. doi: 10.1016/j.humpath.2010.08.008. Epub 2011 Jan 14. PubMed PMID: 21237496.
- Figures 156a through 156c are the radiograph, MR image, and biopsy specimen of a 47-year-old woman who underwent total knee arthroplasty and continues to have left groin pain. What is the most appropriate treatment?
- Surgical resection and reconstruction
- Radiation therapy and surgical resection
- Curettage, adjuvant treatment, and internal fixation
- Curettage and reconstruction
- Presurgical chemotherapy, surgical resection, and radiation
- Surgical resection and reconstruction
RECOMMENDED READINGS
Mermerkaya MU, Bekmez S, Karaaslan F, Danisman M, Kosemehmetoglu K, Gedikoglu G, Ayvaz M, Tokgozoglu AM. Intralesional curettage and cementation for low-grade chondrosarcoma of long bones: retrospective study and literature review. World J Surg Oncol. 2014 Nov 10;12:336. doi: 10.1186/1477- 7819-12-336. Review. PubMed PMID: 25382793.
Angelini A, Calabrò T, Pala E, Trovarelli G, Maraldi M, Ruggieri P. Resection and reconstruction of pelvic bone tumors. Orthopedics. 2015 Feb;38(2):87-93. doi: 10.3928/01477447-20150204-51. PubMed PMID: 25665107.
- Figures 172a and 172b are the MR image and biopsy specimen of a 37-year-old runner who injured his calf 2 weeks ago while training for a marathon. He describes a plantar flexion eversion position of his ankle and now has pain and swelling on his calf. What is the most likely diagnosis?
- Lipoma
- Synovial sarcoma
- Hematoma
- Intramuscular arteriovenous malformation (AVM)
- Medial gastrocnemius avulsion injury
- Synovial Sarcoma
RECOMMENDED READINGS
Deshmukh R, Mankin HJ, Singer S. Synovial sarcoma: the importance of size and location for survival. Clin Orthop Relat Res. 2004 Feb;(419):155-61. PubMed PMID: 15021147.
Karakousis G. Update for ASCO 2015 sarcoma sessions. Surg Oncol. 2015 Dec;24(4):369-70. doi: 10.1016/j.suronc.2015.08.006. Epub 2015 Aug 14. PubMed PMID: 26298199.
- A 58-year-old woman with a history of nonmetastatic breast cancer sustains a pathologic displaced humeral fracture. An intraoperative biopsy and frozen section is completed; after a pathology review, you determine that proceeding with intramedullary fixation of the fracture is appropriate. Which pathology specimen (Figures 187a through 187e) helps to confirm that it is safe to proceed with intramedullary fixation?
- 187a
- 187b
- 187c
- 187d
- 187e
- 187e
- Figures 217a through 217e are the plain radiographs, T1- and T2-weighted MR images, and biopsy specimen of an 18-year-old woman who has noticed a painless posterior thigh mass for several months. She believes the mass may have increased in size, but cannot describe any symptoms in the area. What is the most likely diagnosis?
- Desmoid
- Lipoma
- Hemangioma
- Clear-cell sarcoma
- Alveolar soft-part sarcoma
- Alveolar Soft-Part Sarcoma
RECOMMENDED READINGS
Zarrin-Khameh N, Kaye KS. Alveolar soft part sarcoma. Arch Patho-l Lab Med. 2007 Mar;131(3):488-91. Review. PubMed PMID: 17516754.
Stacy GS, Nair L. Magnetic resonance imaging features of extremity sarcomas of uncertain differentiation. Clin Radiol. 2007 Oct;62(10):950-8. Epub 2007 May 15. Review. PubMed PMID: 17765459.
- Figures 241a and 241b are arthroscopic views of a 36-year-old woman who undergoes a knee arthroscopy for pain and recurrent effusions. Which figure depicts the pathology specimen that correlates with the surgical findings?
- 241c
- 241d
- 241e
- 241f
- 241g
- 241d
RECOMMENDED READINGS
Aurégan JC, Bohu Y, Lefevre N, Klouche S, Naouri JF, Herman S, Hardy P. Primary arthroscopic synovectomy for pigmented villo-nodular synovitis of the knee: recurrence rate and functional outcomes after a mean follow-up of seven years. Orthop Traumatol Surg Res. 2013 Dec;99(8):937-43. doi: 10.1016/j.otsr.2013.08.004. Epub 2013 Oct 23. PubMed PMID: 24161841.
Murphey MD, Rhee JH, Lewis RB, Fanburg-Smith JC, Flemming DJ, Walker EA. Pigmented villonodular synovitis: radiologic-pathologic correlation. Radiographics. 2008 Sep-Oct;28(5):1493-518. doi: 10.1148/ rg.285085134. PubMed PMID: 18794322.
- Figure 257a is an MR image of a 73-year-old woman who has hip pain and no known history of cancer. Staging studies demonstrate a mass in her kidney with no other lesions noted. A biopsy specimen is shown in Figure 257b. In regard to her femur, which intervention will provide the best long-term outcome and lowest risk for revision surgery?
- Presurgical radiation
- Presurgical embolization
- Intralesional resection of the tumor with placement of methylmethacrylate and a long
cephalomedullary nail
- Intralesional resection of the tumor with placement of methylmethacrylate and a dynamic hip screw
- Resection of the tumor and placement of an endoprosthesis
- Resection of the tumor and placement of an endoprosthesis
RECOMMENDED READINGS
Laitinen M, Parry M, Ratasvuori M, Wedin R, Albergo JI, Jeys L, Abudu A, Carter S, Gaston L, Tillman R, Grimer R. Survival and complications of skeletal reconstructions after surgical treatment of bony metastatic renal cell carcinoma. Eur J Surg Oncol. 2015 Jul;41(7):886-92. doi: 10.1016/j.ejso.2015.04.008. Epub 2015 Apr 29. PubMed PMID: 25964050.
Hwang N, Nandra R, Grimer RJ, Carter SR, Tillman RM, Abudu A, Jeys LM. Massive endoprosthetic replacement for bone metastases resulting from renal cell carcinoma: factors influencing patient survival. Eur J Surg Oncol. 2014 Apr;40(4):429-34. doi: 10.1016/j.ejso.2013.08.001. Epub 2013 Sep 21. PubMed PMID: 24063967.
Miller BJ, Soni EE, Gibbs CP, Scarborough MT. Intramedullary nails for long bone metastases: why do they fail? Orthopedics. 2011 Apr 11;34(4). doi: 10.3928/01477447-20110228-12. PubMed PMID: 21469628.
- Figure 262 is the radiograph of a 46-year-old healthy woman with a 3-week history of vague thigh pain that began when she sustained an injury while stepping out of the shower. Laboratory study findings are normal, and a positron emission tomography (PET)/CT body scan shows activity isolated only to the fracture site. What is the best next step?
- Closed reduction and internal fixation with a locked intramedullary rod
- Above-knee amputation
- Open biopsy and splint application
- Open reduction and internal fixation with a locked intramedullary rod
- Placement of skeletal traction and an MRI
- Open biopsy and splint application
- Figures 270a through 270e are the radiograph, CT scans, and low- and high-power biopsy specimens of a 9-year-old girl who has progressive pain and swelling over her medial clavicle. An examination reveals a swollen, tender left medial clavicle. What is the most likely diagnosis?
- Lymphoma
- Osteomyelitis
- Ewing sarcoma
- Fibrous dysplasia
- Aneurysmal bone cyst
- Osteomyeitis
RECOMMENDED READINGS
Ceroni D, Belaieff W, Cherkaoui A, Lascombes P, Schrenzel J, de Coulon G, Dubois-Ferrière V, Dayer R. Primary epiphyseal or apophyseal subacute osteomyelitis in the pediatric population: a report of fourteen cases and a systematic review of the literature. J Bone Joint Surg Am. 2014 Sep 17;96(18):1570-5. doi: 10.2106/JBJS.M.00791. Review. PubMed PMID: 25232082.
Street M, Puna R, Huang M, Crawford H. Pediatric Acute Hematogenous Osteomyelitis. J Pediatr Orthop. 2015 Sep;35(6):634-9. doi: 10.1097/BPO.0000000000000332. PubMed PMID: 25333907.
