Bone and Soft Tissue Pathology Practice Questions

Q: An X-ray shows a lytic lesion in the calcaneus in a young adult. Biopsy shows the following diagnosis:

Pigmented villonodular synovitis. ***Pigmented villonodular synovitis*** - **PVNS** commonly affects young adults and can cause **lytic bone lesions** in locations like the calcaneus due to its aggressive synovial proliferation and bone erosion. - Biopsy shows characteristic **hemosiderin-laden macrophages**, **foam cells**, **multinucleated giant cells**, and **villous synovial proliferation** with brownish pigmentation. *Ochronosis* - Associated with **alkaptonuria** and deposition of **homogentisic acid**, causing dark cartilage and joint degeneration rather than lytic bone lesions. - Typically presents with **blue-black pigmentation** of cartilage and sclerae, not the cellular features seen in this biopsy. *Osteomyelitis* - Would show **inflammatory infiltrate** with neutrophils, bacteria, and necrotic tissue on biopsy, not the specialized cells described. - Usually presents with **systemic signs** like fever and elevated inflammatory markers, plus characteristic **sequestra** formation on imaging. *Eumycosis* - Refers to **fungal infections** that would demonstrate **fungal hyphae** and **spores** on biopsy with associated inflammatory response. - Typically shows **granulomatous inflammation** with epithelioid cells and Langhans giant cells, not the pigmented macrophages of PVNS.

Q: Angulated body cells are found in which of the following conditions?

Granular cell myoblastoma. ### Explanation **Correct Option: A. Granular cell myoblastoma (Granular Cell Tumor)** Granular cell myoblastoma (now commonly called Granular Cell Tumor) is a benign neoplasm of Schwann cell origin. Histologically, it is characterized by large, polygonal, or **angulated cells** with abundant, eosinophilic, granular cytoplasm. These granules represent an accumulation of lysosomes (PAS-positive and diastase-resistant). A high-yield diagnostic feature is the presence of **Pustulo-ovoid bodies of Milian**, which are large, round, acidophilic inclusions surrounded by a clear halo. **Incorrect Options:** * **B. Hodgkin’s Disease:** Characterized by the hallmark **Reed-Sternberg (RS) cells**, which are large, multinucleated cells with "owl-eye" nucleoli [1]. It does not feature angulated body cells. * **C. Pemphigus Vulgaris:** Characterized by **Tzanck cells** (acantholytic cells), which are rounded, detached keratinocytes found within intraepidermal vesicles. * **D. Hurler’s Syndrome:** A lysosomal storage disease (Mucopolysaccharidosis I) where cells (especially hepatocytes and fibroblasts) contain "clear vacuoles" or **Gargoyle cells**, but not angulated bodies. **High-Yield Clinical Pearls for NEET-PG:** * **Pseudoepitheliomatous Hyperplasia (PEH):** Granular cell tumors of the tongue often show PEH in the overlying epithelium, which can be mistaken for Squamous Cell Carcinoma. * **S-100 Positivity:** Since they arise from Schwann cells, these tumors are strongly S-100 positive. * **Most Common Site:** The **tongue** is the most frequent site of involvement. * **Pustulo-ovoid bodies:** These are pathognomonic and represent phagolysosomes. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, p. 616.

Q: Osteoblastic metastases are most commonly seen from which primary malignancy?

Prostate. **Explanation:** The nature of skeletal metastasis depends on the interaction between tumor cells and the bone microenvironment. Metastases are classified as **osteoblastic** (bone-forming), **osteolytic** (bone-destroying), or mixed. **Why Prostate is Correct:** Prostate adenocarcinoma is the classic example of a malignancy causing **purely osteoblastic** lesions [1]. Tumor cells secrete factors like **Bone Morphogenetic Proteins (BMPs)**, WNT proteins, and Endothelin-1, which directly stimulate osteoblast proliferation and activity. On imaging, these appear as dense, radio-opaque "sclerotic" spots [1]. **Analysis of Incorrect Options:** * **Lung (A):** Most primary lung cancers (especially Non-Small Cell Lung Cancer) produce **osteolytic** lesions due to the secretion of PTHrP (Parathyroid Hormone-related Protein), which activates osteoclasts. * **Adrenal (C):** Adrenal malignancies (like Neuroblastoma in children) typically cause aggressive **osteolytic** destruction rather than blastic changes. * **Breast (D):** Breast cancer is the most common cause of **mixed** (both blastic and lytic) lesions. While it can be blastic, it is not as characteristically or purely blastic as prostate cancer. **High-Yield Clinical Pearls for NEET-PG:** * **Mnemonic for Blastic Metastases:** "**P**rostate **B**rings **S**trong **B**ones" (**P**rostate, **B**reast (mixed), **S**mall cell lung cancer, **B**ladder). * **Mnemonic for Lytic Metastases:** "**L**ung, **K**idney, **T**hyroid" (Lead to "holes" in bone). * **Most common site for bone metastasis:** Thoracic spine (via Batson’s venous plexus). * **Biochemical Marker:** Osteoblastic lesions are associated with elevated **Serum Alkaline Phosphatase (ALP)** [1], while lytic lesions often show hypercalcemia. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 501-502.

Q: Herringbone pattern is seen in which of the following tumors?

Fibrosarcoma. ### Explanation **Correct Answer: B. Fibrosarcoma** **Why it is correct:** The **"Herringbone pattern"** is the classic histopathological hallmark of **Fibrosarcoma**. This pattern is characterized by highly cellular areas where malignant spindle-shaped fibroblasts are arranged in intersecting fascicles at acute angles, resembling the skeleton of a herring fish. These cells typically show scant cytoplasm and elongated, hyperchromatic nuclei with variable mitotic activity. **Analysis of Incorrect Options:** * **A. Rhabdomyosarcoma:** This skeletal muscle tumor is characterized by **"Rhabdomyoblasts"** (tadpole or strap cells) containing cross-striations. The alveolar subtype often shows a "cluster of grapes" (sarcoma botryoides) or a "partitioned" appearance, not herringbone. * **C. Fibrous Histiocytoma:** Benign or malignant fibrous histiocytomas (now often classified as Undifferentiated Pleomorphic Sarcoma) typically exhibit a **"Storiform pattern"** (cartwheel or whorled appearance), where spindle cells radiate from a central point. * **D. Liposarcoma:** This tumor is identified by the presence of **Lipoblasts**. Depending on the subtype, it may show a "chicken-wire" capillary pattern (Myxoid variant) or a pleomorphic, high-grade appearance, but not a herringbone pattern. **NEET-PG High-Yield Pearls:** * **Storiform Pattern:** Dermatofibrosarcoma Protuberans (DFSP) and Fibrous Histiocytoma. * **Chicken-wire Calcification:** Chondroblastoma. * **Chicken-wire Capillaries:** Myxoid Liposarcoma and Oligodendroglioma. * **Verocay Bodies:** Schwannoma (Antoni A areas). * **Biphasic Pattern:** Synovial Sarcoma (spindle cells + epithelial elements). * **Small Round Blue Cell Tumors:** Ewing’s Sarcoma, Neuroblastoma, and Rhabdomyosarcoma.

Question 1

A storiform pattern of fibrous tissue is characteristically seen in which of the following tumors?

Accepted Answer

Malignant fibrous histiocytoma

Answer

Fibrosarcoma

Answer

Neurofibroma

Answer

Ameloblastic fibroma

Question 2

What is the name of the granulomatous tissue responsible for the destruction of articular surfaces of the temporomandibular joint (TMJ) in rheumatoid arthritis?

Accepted Answer

Pannus

Answer

Pulse granuloma

Answer

Baker's cyst

Answer

Immune granuloma

Question 3

An X-ray shows a lytic lesion in the calcaneus in a young adult. Biopsy shows the following diagnosis:

Accepted Answer

Pigmented villonodular synovitis

Answer

Ochronosis

Answer

Osteomyelitis

Answer

Eumycosis

Question 4

Conservative surgical excision would be appropriate treatment and probably curative for which of the following?

Accepted Answer

Nodular fasciitis

Answer

Fibromatosis

Answer

Fibrosarcoma

Answer

Rhabdomyosarcoma

Question 5

Sarcoma Botryoides is also known as:

Accepted Answer

Embryonal rhabdomyosarcoma

Answer

Alveolar rhabdomyosarcoma

Answer

Leiomyosarcoma

Answer

Lipoblastomatosis

Question 6

Angulated body cells are found in which of the following conditions?

Accepted Answer

Granular cell myoblastoma

Answer

Hodgkin's disease

Answer

Pemphigus vulgaris

Answer

Hurler’s syndrome

Question 7

Osteoblastic metastases are most commonly seen from which primary malignancy?

Accepted Answer

Prostate

Answer

Lung

Answer

Adrenal

Answer

Breast

Question 8

Herringbone pattern is seen in which of the following tumors?

Accepted Answer

Fibrosarcoma

Answer

Rhabdomyosarcoma

Answer

Fibrocytic Histiocytoma

Answer

Liposarcoma

Question 9

What is the characteristic finding in muscular dystrophy?

Accepted Answer

Heterogeneity of fiber size

Answer

Inflammatory cell infiltrate

Answer

Nuclear proliferation beneath sarcolemma

Answer

All of the above

Question 10

A 50-year-old lady presented with a 3-month history of pain in the lower third of the right thigh. There was no local swelling; tenderness was present under deep pressure. Plain X-rays showed an ill-defined intramedullary lesion with blotchy calcification at the lower end of the right femoral diaphysis, possibly enchondroma or chondrosarcoma. Sections showed a cartilaginous tumor. Which of the following histological features would be most helpful to differentiate between enchondroma and chondrosarcoma?

Accepted Answer

Tumor permeation between bone trabeculae at the periphery

Answer

Focal necrosis and lobulation

Answer

Extensive myxoid change

Answer

High cellularity

Bone and Soft Tissue Pathology — MCQs

Bone and Soft Tissue Pathology — MCQs

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