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Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC.
A 64-year-old man presents with forearm swelling. A gadolinium-enhanced MRI of his forearm is shown in Figure A and a CT scan of his chest is shown in Figure B. The lesion is resected and its gross and cellular histological appearance is shown in Figure C and D respectively. Fluorescence-in-situ-hybridization is negative for t(X:18) and t(12:16). Immunohistochemistry is negative for desmin, myogenin and CD34. What is the most likely pathologic diagnosis?
High-grade pleomorphic undifferentiated sarcoma
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A 24-year-old male presents to your office with ecchymosis and a mass in the posterolateral aspect of his thigh. He states he noticed the mass approximately 6-months ago and that it has slowly been growing. He denies constitutional symptoms, is otherwise healthy, and denies any associated trauma. MRI report suggests the mass may be an organizing hematoma. Core needle biopsy in the office yields only blood. What is the next appropriate treatment option?
Conservative treatment - rest, ice, compression, elevation
Repeat core needle biopsy
Consult interventional radiography to place a drain under image guidance
Irrigation and debridement with initiation of postoperative antibiotics
Open surgical biopsy
A 52-year-old male presents with 6 months of swelling and pain in his leg. He states the lesion has not changed in size for several months and doesn't bother him. He is otherwise healthy and has no other complaints. Representative photograph and MRI are shown in Figures A through C. What is the best initial step in his management?
Follow-up in 6 months with repeat radiographs
Neoadjuvant chemotherapy and wide excision
Sixty Gy is a typical radiation dose for which of the following indications?
Prevention of post-operative heterotopic ossification
Neoadjuvant radiation therapy for a high-grade chondrosarcoma
Adjuvant radiation therapy for a high-grade osteosarcoma
Adjuvant radiation therapy for a soft-tissue sarcoma
Palliative therapy for a painful adenocarcinoma metastasis in the thoracic spine
What is the correct treatment for an incompletely excised high grade superficial sarcoma on the volar aspect of the forearm?
Marginal resection of the tumor bed to spare the neurovascular bundles
Wide resection of the tumor bed and coverage as necessary
A 58-year-old man presents to your clinic with a 4-cm deep mass in his left thigh. It has been slowly expanding over the last 6 months. Radiographs show no evidence of bony involvement or soft tissue calcifications within the lesion. Which of the following is most appropriate at this time?
Repeat clinical examination and radiographs in 6 months
Contrast-enhanced MRI scan
Fine needle aspiration
Which treatment factor has been shown to be most important for five-year disease-free survival in patients with subcutaneous sarcomas?
Dose of chemotherapy
Addition of adjuvant radiation
Size of operative margin
Length of chemotherapy course
Addition of radiofrequency ablation
A surgeon resects a small, superficial, mobile lesion from the thigh. Pathological review of the specimen suggests it is a low-grade soft tissue sarcoma with positive surgical margins. After staging the patient, no other sites of disease are identified. What is the next most appropriate treatment for this patient?
Tumor bed re-excision
A 56-year-old male undergoes resection of a mass that was suspected to be a simple lipoma. The mass was contained within his sartorius muscle and shown in Figure A. The final pathology came back as a high grade soft tissue sarcoma. The treating surgeon operated completely within the sartorius compartment and did not violate any other compartments, however the final pathology showed positive margins. Staging studies show isolated disease in his right thigh. What is the most appropriate treatment for this patient?
Wide excision of the tumor bed
Wide excision of the tumor bed followed by radiation therapy
A 39-year-old male is diagnosed with myxoid liposarcoma of the thigh. Radiation therapy is being considered in adjunct to surgical excision. Which of the following is true regarding radiation therapy in soft tissue sarcoma?
Compared to post-operative radiation, pre-operative radiation is associated with a reduced rate of wound dehiscence
Radiation therapy reduces the risk of local recurrence
Radiation therapy improves overall survival
Compared to post-operative radiation, pre-operative radiation is associated with increased rates of radiation induced morbidity such as post-radiation fibrosis
Radiation therapy decreases the chances of successful limb-salvage