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A 51-year-old woman presents with a polyostotic condition resulting in the lesions shown in Figure A. If malignant transformation were to occur, histology would show which of the following (Figures B through E)?
Select Answer to see Preferred Response
A 59-year-old patient presents with increasing right hip pain of 8 months duration. The patient reports pain at night and during activities. The patient denies any weight loss or fevers. Figures A and B are the radiograph and MRI of the pelvis. Figure C is the biopsy of the lesion. What is the most likely diagnosis and next best step in treatment?
Malignant fibrous histiocytoma; chemotherapy
Fibrosarcoma; wide resection
Chondrosarcoma; wide resection
Chordoma; radiation and wide resection
An otherwise healthy 55-year-old male presents with right hip pain. The pain has progressively been worsening over the last six months. Radiographs are shown in Figures A and B. An MRI is shown in Figure C. A preoperative biopsy is obtained and shown in Figure D. What would be the most appropriate next step in management?
Observation and close follow up
Intramedullary nail stabilization with cement augmentation and post-operative whole-bone radiation therapy
Wide resection and surgical reconstruction
Marginal resection with currettage
A 65-year-old male patient presents with pain and swelling in his thigh for 1 year. Radiographs and biopsy findings are seen in Figures A through C. What is the most appropriate treatment?
Surgery and chemotherapy
Surgery, chemotherapy and radiotherapy
A 36-year-old female is in your office for a left-sided pelvic mass. An outside provider performed an excisional biopsy and a specimen from this is shown in Figure A. Her radiograph prior to this procedure is shown in Figure B. Which of the following risk factors is associated with a poorer prognosis for this type of tumor?
Negative resection margins
Younger patient age
Biopsy performed at a tumor center
A 52-year-old Asian male presents with pain in his right hip worse with activity. He is otherwise healthy and denies any history of trauma or constitutional symptoms. Radiographs, CT, and MRI are shown in Figure A, B, and C respectively. A CT guided biopsy is performed and low power and high power histology images are shown in Figure D and E respectively. A CT scan of the chest, abdomen, and pelvis is performed and there is no evidence of metastatic disease. Which of the following is the most appropriate treatment?
radiation followed by surgical excision followed by chemotherapy
chemotherapy followed by surgical excision followed by chemotherapy
neoadjuvant radiation followed by chemotherapy
wide surgical excision alone
radical resection and brachytherapy followed by reconstruction
A 38-year-old male complains of progressive right groin pain over the past year. Initially, the pain occurred only with weight-bearing, but is now beginning to bother him while sitting and has awoken him from sleep on a few occasions. A radiograph demonstrates a mixed lucent and sclerotic lesion within the femoral head just below the articular surface. An MRI is shown in figure A. A histology slide from an open biopsy is provided in figure B. Which of the following is the most likely diagnosis?
Clear cell chondrosarcoma
Giant cell tumor
A 60-year-old female complains of progressive right hip pain. A pelvis radiograph is shown in Figure A and a biopsy specimen is shown in Figure B. What is the most appropriate treatment?
Neoadjuvant radiation followed by surgical resection
Neoadjuvant chemotherapy followed by surgery followed by adjuvant chemotherapy
Wide surgical resection
Chemotherapy followed by radiation therapy
What is the preferred definitive treatment for biopsy proven grade-2 chondrosarcoma of the distal femur without evidence of metastases?
Chemotherapy then wide excision
Hip disarticulation amputation
A 65-year-old man undergoes a biopsy from his pelvis for a suspicious lesion. The biopsy is shown in Figures A and B. What is the preferred treatment for this condition?
Wide excision plus chemotherapy
A 72-year-old male presents with increasing thigh pain. Radiographs and high power biopsy are shown in Figures A and B. Staging studies demonstrate no further sites of disease. What is the next step in treatment?
Neoadjuvant radiation therapy
Wide surgical excision and reconstruction
Which of the following statements regarding dedifferentiated chondrosarcoma is CORRECT?
Survival rates of 10% at 10 years are common
These tumors arise de novo from an intramedullary location
Histologically these tumors consist of homogeneous intermediate grade chondroid tissue
Treatment involves intra-lesional curettage, cementation, and internal fixation
The most common age of presentation is the young adolescent
Patients with which of the following conditions have the highest incidence of malignant tumor?
Multiple hereditary exostosis
A 44-year-old male reports a mass at his right iliac crest that bothers him when he wears a belt. He denies constitutional symptoms and has no bowel function disturbance. His ESR and CRP are normal. His chest CT is normal. Pelvis radiograph, CT, and MRI images are shown in Figures A-D. A biopsy is performed with histology shown in Figure E. What is the next most appropriate step in management?
Repeat CT scan in 3 months
Neoadjuvant radiation followed by marginal surgical resection followed by adjuvant chemotherapy
Marginal surgical resection
Neoadjuvant chemotherapy followed by marginal surgical resection followed by adjuvant chemotherapy
Which of the following tumors is chemotherapy and radiation therapy resistant?
Classic intramedullary chondrosarcoma
A 79-year-old healthy male has 1 year of progressively worse left hip pain. He denies any significant weight loss but does complain of night pain. Radiograph and MRI are shown in Figures A & B. Bone scan and histology is shown in Figures C-E. What is the definitive treatment of this?
radiation therapy alone
wide resection and reconstruction
wide resection, reconstruction and chemotherapy
wide resection, reconstruction and local radiation therapy.