Orthopedic Oncology — Staging, Chemotherapy and Limb Salvage MCQs

Orthopedics · 50 free questions with answers & explanations.

1. A 15-year-old boy presents with 3 months of knee pain and a destructive metaphyseal lesion of the distal femur with Codman's triangle and sunburst appearance on X-ray. Biopsy confirms osteosarcoma. Staging reveals no metastases. What is the current standard initial treatment strategy?
2. The Enneking staging system for musculoskeletal tumors classifies a high-grade malignant tumor confined within the cortical boundary of the bone (no extraosseous extension) and without distant metastases as:
3. In limb salvage surgery for distal femoral osteosarcoma in a skeletally immature child, an expandable/growing prosthesis is preferred. Which biological approach offers an alternative to a metal expandable prosthesis while preserving epiphyseal function?
4. A 22-year-old presents with a well-defined eccentric lytic lesion in the distal femoral epiphysis with a ground-glass matrix, soap-bubble appearance, and no periosteal reaction on plain radiography. Biopsy shows spindle cells with bizarre giant cells in a vascular stroma but no osteoid matrix. The most likely diagnosis is:
5. In the surgical management of giant cell tumor of bone (GCT), the preferred treatment for a Campanacci Grade III lesion with pathological fracture is:
6. A 17-year-old presents with a distal femoral tumor showing a sunburst pattern on X-ray and Codman's triangle. Biopsy reveals high-grade osteosarcoma. According to Enneking staging, a high-grade tumor confined within the cortex without lymph node or distant metastases is classified as:
7. The most important prognostic factor for survival in osteosarcoma following neoadjuvant chemotherapy and limb salvage surgery is:
8. Limb salvage surgery for osteosarcoma of the distal femur in a skeletally immature child preferably uses which reconstructive option to preserve limb length equality?
9. Which of the following statements correctly describes the WBB (Weinstein-Boriani-Biagini) staging system for spinal tumors?
10. A 17-year-old boy with osteosarcoma of the distal femur is being assessed for limb salvage surgery. According to the Enneking surgical staging system, a Stage IIB lesion is defined as:
11. A teenage patient with classical osteosarcoma receives neoadjuvant chemotherapy before limb salvage surgery. Histopathological examination of the resected specimen shows 95% tumour necrosis. What is the significance of this finding?
12. A 15-year-old girl undergoes limb salvage surgery for distal femoral osteosarcoma. An expandable endoprosthesis is implanted. The primary advantage of this implant type in a skeletally immature patient is:
13. Which chemotherapy drug combination constitutes the standard neoadjuvant and adjuvant regimen for classical osteosarcoma of bone?
14. A 16-year-old boy has a distal femoral osteosarcoma confirmed on biopsy. Pre-operative chemotherapy (neoadjuvant) is given for 10 weeks. The resected specimen shows 95% tumour necrosis. According to the Huvos grading system, this response is classified as:
15. According to the Enneking surgical staging system for musculoskeletal sarcomas, a Stage IIB lesion is characterised by:
16. A 14-year-old girl has Ewing's sarcoma of the proximal fibula with no detectable metastasis. The most appropriate definitive local treatment is:
17. The 'skip metastasis' in osteosarcoma refers to:
18. Which chemotherapy drug is most uniquely associated with the treatment of Ewing's sarcoma but NOT routinely used in osteosarcoma regimens?
19. A 16-year-old boy presents with a painful swelling around the distal femur for 2 months. MRI shows an intramedullary lesion with soft tissue extension breaching the cortex. Biopsy reveals high-grade spindle cells producing osteoid. According to the Enneking staging system, what stage is this tumor?
20. A 14-year-old girl with Ewing's sarcoma of the proximal fibula is being planned for limb salvage surgery. The criterion of a 'wide' surgical margin as defined by Enneking is:
21. A 13-year-old boy presents with a lytic lesion at the diaphysis of the femur with a permeative pattern and 'onion peel' periosteal reaction on X-ray. Biopsy shows small round blue cells. Preoperative neoadjuvant chemotherapy is planned. Which regimen is standard for this tumor?
22. A 40-year-old woman presents with a slowly growing, painless mass of the posterior thigh. MRI shows a well-defined lesion with signal characteristics of fat on T1 and T2. There is no septation or nodular enhancement. The most appropriate initial management is:
23. The 'sunburst' periosteal reaction on radiograph is MOST characteristically associated with which bone tumor?
24. During limb salvage for a distal femoral osteosarcoma, a rotating hinge megaprosthesis is used. The most important consideration when planning this surgery in a skeletally immature child is:
25. A 55-year-old woman with breast cancer presents with mid-shaft femoral metastasis causing impending pathological fracture (Mirels score 9). The best management is:
26. A 16-year-old male presents with a destructive lesion of the distal femur with Codman's triangle and a sunburst pattern on X-ray. MRI shows the tumor confined to bone without skip metastases. According to Enneking's staging system, this tumor is best classified as:
27. The MAP protocol used in the neo-adjuvant treatment of osteosarcoma consists of which combination?
28. A 14-year-old with Ewing's sarcoma of the fibula diaphysis has completed neo-adjuvant chemotherapy with an excellent response. Limb salvage surgery with wide excision is planned. The minimum oncologically safe surgical margin required is:
29. Giant cell tumor (GCT) of bone most commonly occurs at which site, and what is the defining histological feature?
30. A 17-year-old boy presents with a 3-month history of knee pain. MRI shows a 9 cm intramedullary lesion of the distal femoral metaphysis with periosteal elevation and a soft tissue mass. Biopsy confirms osteosarcoma. According to the Enneking (MSTS) staging system, this would be classified as Stage IIB if which criterion is met?
31. Neoadjuvant chemotherapy is administered before limb salvage surgery for osteosarcoma. The histological response to chemotherapy is assessed on the resected specimen. A 'good response' (Huvos Grade III/IV) is defined by what percentage of tumor necrosis?
32. In a 15-year-old with distal femoral osteosarcoma undergoing limb salvage, the surgical margin requires clearance of the neurovascular bundle. The reconstructive option that best preserves longitudinal growth potential in a skeletally immature patient is:
33. A 40-year-old woman presents with a slowly enlarging painless mass in the posterior thigh. MRI shows a 12 cm intramuscular mass with low signal on T1 and heterogeneous high signal on T2 with areas of hemorrhage. Biopsy reveals pleomorphic undifferentiated sarcoma (UPS). The standard of care for local control is:
34. A 16-year-old presents with a distal femoral osteosarcoma confined to the bone, crossing the physis, without satellite lesions or skip metastases, and with no distant metastasis. MRI shows adequate soft-tissue clearance from the neurovascular bundle. According to the Enneking staging system, this is:
35. Following neoadjuvant chemotherapy for osteosarcoma, the resected specimen shows > 90% tumour necrosis. This histological response is graded as Huvos Grade IV. What is the clinical significance of this finding?
36. In limb salvage surgery for osteosarcoma of the distal femur, which of the following represents an absolute contraindication to limb-sparing resection?
37. Ewing sarcoma of the diaphysis of the femur in a 12-year-old child is best managed with:
38. A 16-year-old boy presents with a 10-week history of knee pain and swelling. MRI shows a metaphyseal lesion of the distal femur with cortical destruction, soft tissue extension, and skip lesions in the mid-femoral diaphysis. Which staging system best evaluates the surgical margin requirements?
39. A teenage boy with confirmed osteosarcoma of the distal femur undergoes neoadjuvant chemotherapy followed by wide resection. Histological analysis of the resected specimen reveals 95% tumor necrosis. This finding indicates:
40. Limb salvage surgery for bone tumors is contraindicated in which of the following scenarios?
41. Giant cell tumor (GCT) of bone at the distal radius recurs locally 2 years after curettage and bone grafting. The Campanacci grade was III (cortical destruction with soft tissue extension). Which drug can be used as neoadjuvant/adjuvant therapy to reduce the size of the tumor and lower the risk of recurrence?
42. A 12-year-old presents with a mid-shaft femoral lesion showing 'onion-skin' periosteal reaction on plain radiograph. Biopsy reveals small round blue cells arranged in sheets. The chromosomal translocation characteristic of this diagnosis is:
43. A 16-year-old boy has an osteosarcoma of the distal femur confirmed on biopsy. Staging CT shows no distant metastases. According to the Musculoskeletal Tumor Society (MSTS) staging system, the lesion is stage IIB (high-grade extracompartmental). The preferred surgical margin for limb salvage surgery is:
44. Histological assessment of an osteosarcoma resection specimen after neoadjuvant chemotherapy shows 95% tumor necrosis. This Huvos grade response is classified as:
45. A 45-year-old woman has a chondrosarcoma of the proximal humerus (grade 2, extracompartmental, no metastases — MSTS stage IIB). The most important factor distinguishing whether limb salvage is feasible versus amputation is:
46. A young adult with an Ewing's sarcoma of the fibular diaphysis is being planned for surgical management. The biological reconstruction method that uses the patient's own vascularised cortical bone — harvested on a pedicled or free flap basis — to fill the resection defect is known as:
47. A 16-year-old boy with osteosarcoma of the distal femur undergoes staging with MRI, chest CT, and bone scan. MRI shows tumor confined to bone with a reactive zone but no skip lesions; chest CT is clear; bone scan shows no distant foci. According to the Enneking/MSTS surgical staging system, this is best staged as:
48. After 3 cycles of neoadjuvant MAP chemotherapy (methotrexate, adriamycin, cisplatin) for distal femoral osteosarcoma, resection specimen histology shows 98% necrosis. This necrosis response corresponds to Huvos grade and indicates:
49. A 14-year-old girl with Ewing's sarcoma of the proximal fibula, Stage IIA, is planned for limb-salvage surgery. The surgical margin achieved should be classified as 'wide' under the Enneking margin classification. What does a 'wide' margin mean?
50. A 19-year-old man with high-grade osteosarcoma of the distal femur has the popliteal neurovascular bundle free of tumor on MRI. He is planned for limb-salvage surgery with modular endoprosthetic reconstruction. A contraindication to limb salvage in osteosarcoma is: