Oncology Oite 2015

Front 1

Name the most common malignant neoplasms of children (0 - 5 years old).

Back 1

Metastatic rhabdomyosarcoma

Metastatic neuroblastoma

Leukemia

Front 2

Name the most common malignant neoplasms of children and young adults (10 - 40 years old).

Back 2

Osteosarcoma

Ewing's

Desmoplastic fibroma

Leukemia

Lymphoma

Front 3

Name the benign tumors of children and young adults (10 - 40 years old).

Back 3

Non-ossifying fibroma

Osteoid osteoma

Giant cell tumor

ABC

UBC

Osteochondroma and MHE

Chondroblastoma

Fibrous dysplasia

Eosinophilic granuloma

Front 4

Most common malignant tumors of adults and elderly (40 - 80 years old).

Back 4

Metastatic bone disease

Myeloma

Lymphoma

Chondrosarcoma

Secondary sarcoma (Paget's irradiation)

Front 5

Benign bone lesions of adulthood are (40 - 80 years old)

Back 5

Enchondroma

Bone infarct

Bone island

Paget's

Hyperparathyroidism

Front 6

Translocation for Ewing's

Back 6

11:22. Fusion protein EWS-FLI1. Part of staging for Ewing's is a bone marrow biopsy.

Front 7

Translocation for Rhabdomyosarcoma

Back 7

2:13. Pax3-FKHR

Front 8

Translocation for myxoid liposarcoma

Back 8

12:16. TLS-CHOP

Front 9

Translocation for synovial sarcoma

Back 9

X:18 (synovial sarcoma is NOT (X) IN THE SYNOVIUM. SYT-SSX1, 2, or 4 fusion protein.

Front 10

Translocation for clear cell sarcoma

Back 10

12:22 (Use Clearsil for teen acne, 12 years old). Fusion protein EWS-ATF1

Front 11

Translocation for Chondrosarcoma (myxoid variant)

Back 11

9:22. Fusion protein EWS-CHN

Front 12

Mutation for osteosarcoma

Back 12

p53, Rb

Front 13

Genetic abnormality in Giant cell tumor

Back 13

telomere translocations.

Front 14

Carbohydrate Antigen -125 (CA -125)

Back 14

Ovarian Cancer

Front 15

Carbohydrate antigen 19-9 (CA 19-9)

Back 15

Pancreatic cancer

Front 16

Carbohydrate antigen 15-3 (CA 15-3)

Back 16

Breast cancer

Front 17

Alpha fetoprotein (AFP)

Back 17

Hepatocellular carcinoma (HCC)

Front 18

Carcinoembryonic antigen (CEA)

Back 18

Colorectal carcinoma

Front 19

A Northern blot tests:

Back 19

mRNA

Front 20

Southern blot

Back 20

DNA

Front 21

Western Blot

Back 21

Protein

Front 22

ELISA

Back 22

Protein Antigens and antibodies

Front 23

Southwest

Back 23

DNA-bound protein test

Front 24

Most common tumors to metastasize to bone (Think BLT with a Kosher Pickle)

Back 24

#1 Lung

#2 Liver

#3 Bone

BLT: Bacon = breast, Lettuce = Lung, Tomato = thyroid, Kosher Pickle = Kidney and prostate.

Front 25

Metastatic adenocarcinoma, NOT found on CT chest, abdomen, pelvis is most likely from:

Back 25

a small lung primary tumor.

Front 26

In patients with metastatic bone disease undergoing fixation, you can use ____________ to supplement fixation and __________ to improve local disease control.

Back 26

methylmethacrylate to supplement fixation and radiation to improve local disease control.

Front 27

Patient with proximal thigh pain with weight bearing has the following X ray and CT findings. What is the appropriate step prior to operative treatment?

Back 27

Pre operative embolization. You can seen the mass on the right kidney. Renal cell carcinoma is very vascular and benefits from pre op embolization.

Front 28

65 year old man with history of lung adenocarcinoma with thigh pain with weight bearing. Bone scan shows no other osseous lesions. What is the next step?

Back 28

Perform a biopsy

Front 29

Bone scan and MRI reveal the right proximal femoral lesion in a patient with hip pain with ambulation. What is the best next step?

Back 29

CT chest, abdomen, pelvis followed by bone biopsy.

Front 30

72 year old man community ambulator with left thigh pain with ambulation x3 weeks. Biopsy proven metastatic prostate cancer. What is the best next step.

Back 30

Long cephalomedullary fixation and radiotherapy.

Front 31

Describe the treatment for osteosarcoma

Back 31

Neoadjuvant chemo, wide resection, adjuvant chemo.

Front 32

Where is the most common site of metastasis for osteosarcoma?

Back 32

Pulmonary mets

Front 33

Describe the location in bone, of osteosarcoma.

Back 33

Osteosarcoma is INTRAMEDULLARY. This makes up 85% of osteosarcomas.

TREAT W/CHEMO

Front 34

Describe location in bone, of Periosteal Osteosarcoma

Back 34

Starts from periosteum but is DIAPHYSEAL. Still within bone. Makes of 5% of osteosarcomas.

TREAT W/CHEMO

Front 35

Describe location in bone, of Parosteal osteosarcoma

Back 35

Starts from the periosteum and is EXTRAMEDULLARY. Makes up <1% of osteosarcomas.

TREAT W/CHEMO

Front 36

This destructive pattern with no cortex and no ossification is classic for which type of osteosarcoma that makes up 4% of osteosarcomas.

Back 36

Telangiectatic osteosarcoma.

Front 37

This bone lesion's histology is similar in appearance to that of Telangiectatic osteosarcoma, but radiographic appearance is consistent with what benign bone lesion?

Back 37

Aneurysmal bone cyst. Seen in patients <25 years old. Shows an expanding cortical rim.

Front 38

18 year old girl with enlarging right thigh mass over a long period of time. Now with pain with ambulation. What is the diagnosis?

Back 38

This is osteosarcoma. It has bone intramedullary and extramedullary components (intramedullary component confirmed by MRI). Parosteal osteosarcoma spares the intramedullary cavity, so this cannot be the diagnosis. The histology shows pleomorphic cells, there are no "lakes of blood" to consider this an ABC.

Front 39

16 year old boy has leg pain for 6 weeks. What is the next best treatment?

Back 39

This is osteosarcoma of the proximal tibia. Neo adjuvant chemo, wide resection, adjuvant chemo.

Front 40

What percentage of solitary osteochondromas transform into chondrosarcoma?

Back 40

<1%

Front 41

What is the inheritance pattern and genetic abnormality in multiple hereditary exostosis?

Back 41

EXT1.

Front 42

What percentage of patients with MHE can have malignant transformation of lesions to chondrosarcoma?

Back 42

5-10%. The risk of malignant transformation has not been correlated with the size of the cartilage cap.

Front 43

14 year old, postmenarchal girl who has a prominence over her right hip. Pain with walking and running. Prominence is mildly tender, no skin changes. Full hip ROM. How do you treat?

Back 43

Excision. This is a solitary exostosis (benign osteochondroma).

Front 44

23 year old man with multiple bony masses that are intermittently symptomatic. What gene is the culprit?

Back 44

EXT1

Front 45

Name this tumor found in 20 - 40 year olds.

Back 45

Giant cell tumor. Benign, but aggressive tumor found that produces lytic lesions in the metaphysis and epiphysis of long bones. Often extends to the subchondral bone. <1% have malignant transformation. Treat with curettage and bone grafting and try to preserve the joint!

Front 46

26 year old man with progressive growth on wrist. What other imaging study should be ordered?

Back 46

Multinucleated giant cells and a lytic lesion in bone = Giant cell tumor. Giant cell can metastasize to lung, so... get a chest x ray.

Front 47

20 year old male has knee pain and swelling 1 year after curetting of a benign bone tumor. What is the diagnosis?

Back 47

Giant cell tumor of bone.

Front 48

What is the most common site of metastasis of a soft tissue sarcoma?

Back 48

Lung

Front 49

What are 3 poor prognostic factors for a soft tissue sarcoma?

Back 49

High grade lesion

Size >5cm

Extension below the deep fascia.

Front 50

When do you use pre op radiation for a soft tissue sarcoma?

Back 50

use pre op radiation when the mass is >5cm. If <5 cm, possibly perform post op radiation (+/-). Treat with wide resection, no chemo.

Front 51

62 year old man underwent resection of an anterior thigh mass, thought to be a lipoma. Pathology showed pleomorphic sarcoma and surgeon did not send frozen sections for margins. What treatment would best improve local control?

Back 51

Wide re-resection of the surgical bed.

Front 52

50 year old male has a slow growing mass in his right thigh. This was removed in a piecemeal manner and then diagnosed as an intermediate grade liposarcoma. This MR was taken prior to all the surgical excisions. What is the next best step?

Back 52

Repeat MR imaging of the extremity, followed by tumor bed excision vs transfemoral amputation if there is wide spread disease.

Front 53

What is the cause of OSTEOLYTIC bone lesions? (Big picture)

Back 53

Tumor-induced activation of osteoclasts via the RANK, RANK-ligand, osteoprotegrin pathway cause osteolytic lesions.

Front 54

What is the cellular/molecular cause of osteoblastic bone mets?

Back 54

Tumor secretion of endothelin 1, causes osteoblastic lesions.

Front 55

What is the name of the venous pathway that allows metastasis from organs to the axial skeleton?

Back 55

Batson's valveless vertebral plexus

Front 56

How do you treat this intermediate grade liposarcoma

Back 56

Treat intermediate liposarcomas with wide excision and radiation. Wide excision alone has high rate of local recurrence.

Front 57

HMB-45 positivity is seen in what malignancies?

Back 57

HMB-45 is positive in malignant melanoma and clear cell sarcoma.

Front 58

What gene can differentiate between atypicial lipomatous tumor and lipoma?

Back 58

MDM2 is positive in atypical lipoma.

Front 59

A 12 year old girl is diagnosed with high grade osteosarcoma. What tests are needed for staging and what is the next best step?

Back 59

CT chest and whole body bone scan are the imaging needed. Since neoadjuvant chemo is needed to treat osteosarcoma, you must refer to pediatric oncology immediately. There is no need for CT abdomen/pelvis for primary bone tumors.

Front 60

Is renal cell carcinoma radiosensitive or radioresistant?

Back 60

renal cell carcinoma tends to be radioresistant.

Front 61

Are breast cancer mets radiosensitive or radioresistant?

Back 61

They are radiosensitive! In a patient with a Mirel's score >8, proximal femoral lesion due to breast cancer met, you should treat with prophylactic internal fixation, followed by radiation for local control. Without radiation, the met will likely enlarge and cause construct failure.

Front 62

70 year old female with history of breast cancer. Has left groin pain and imaging reveals a proximal femur bone lesion in the femoral neck. What is the next best step?

Back 62

Laboratory evaluation with CBC, chem, UA as well as CT chest/abdomen/pelvis and bone lesion biopsy.

Front 63

Describe the staging for synovial sarcoma

Back 63

Chest x ray, chest CT, examination of local and regional lymph nodes. It has a tendency to metastasize to the lungs. If this were myxoid liposarcoma, get a bone scan as these can metastaize to bone.

Front 64

Patient with renal cell met to proximal femur resulting in pathologic pertrochanteric fracture undergoes proximal femoral replacement. What is her rehab plan?

Back 64

Full weight bearing with walker assistance and posterior hip precautions.

Front 65

Endocrine therapy guides breast cancer treatment. What receptor status must be assessed to guide treatment?

Back 65

estrogen receptor

HER2/neu receptor

Progesterone receptor

Front 66

MAny cancers directly produce receptor activator of nuclear factor kappa beta ligand (RANKL). This molecule is important in:

Back 66

osteoclastogenesis. Also, matrix metaloproteinases (MMPs) govern the bioavailability and function of RANKL.

Front 67

Besides RANKL, what other factor is necessary for osteoclast production?

Back 67

Macrophage colony -stimulating factor (M-CSF). This is produced by stromal cells within the bone marrow.

Front 68

Osteopontin is a protein that has the role of:

Back 68

biomineralization and bone remodeling.

Front 69

27 year old with progressive pain and sweling over upper thoracic spine. What is the next best step?

Back 69

Biopsy

This solid mass with hetergeneous uptake that involves fascia and subcutaneous tissue is a desmoid tumor. They are benign but locally aggressive.

Front 70

What tumor can be treated definitively with chemo and radiation?

Back 70

Ewing Sarcoma. Osteosarcoma is chemo and excision. Adamantinomas and schwannomas are treated with surgery alone.

Front 71

Why is the pain from osteoid osteomas responsive to NSAIDs?

Back 71

Osteoid osteomas produce prostaglandin E2 which causes inflammation in the surrounding structures. NSAIDs block the production of prostaglandins through inhibition of COX-2 which is involved in PGE2 synthesis.

Front 72

What is the inheritance pattern of osteogenesis imperfecta?

Back 72

Autosomal dominant and autosomal recessive.

Front 73

What is the most common location for giant cell tumor of bone?

Back 73

Distal femur is the most common. Then proximal tibia and distal radius.

Front 74

Local recurrence of primary malignant bone tumors is directly related to :

Back 74

surgical margin.

Front 75

10 year old girl with activity related bilateral knee pain. MR is shown. What is the best treatment?

Back 75

Treat with observation. This is a benign fibrous lesion. No periosteal reaction and no extraosseous lesions.

Front 76

19 year old girl with progressive right hip pain over 1 year. No trauma. How do you treat?

Back 76

This imaging is typical in character and location for osteoid osteoma. Treat with radiofrequency ablation. No need for protected weight bearing. Also need a chest CT scan for staging.

Front 77

15 year old girl with progressive knee pain and limp. How do you treat?

Back 77

This represents telangiectatic osteosarcoma. Treat with chemo therapy followed by surgical resection.