MCQ-Soft Tissue

FRCPath Part1 Course

Soft Tissue and Bone MCQ 1 An 85 year old man undergoes a skin and soft tissue excision biopsy for an ill-defined nodule on the posterior neck measuring 4cm in diameter: Histologically the epidermis is atrophic but otherwise normal. The sun-damaged dermis shows a pleomorphic epitheloid cells with many mitotic figures which extends into the subcutaneous tissue. Focal vascoformative pattern is seen.

Immunohistochemically, the tumour cells are positive for CD31, CD34 and focally for MNF116. It is negative for S100, HHV8, smooth muscle actin and desmin.

The most likely diagnosis is: A. B. C. D. E.

Spindle cell carcinoma Kaposi’s sarcoma Atypical fibroxanthoma Malignant melanoma Angiosarcoma

MCQ 2 A 40 year old man with a plaque like lesion on the chest. Histology shows a dermal cellular spindle cell lesion with a storiform pattern and stains positively for CD34 and negative for CD31, EMA, SMA, Desmin and S100. No epidermal attachment is seen.

The most likely diagnosis is: A. B. C. D. E.

Spindle cell carcinoma Kaposi’s sarcoma Dermatofibrosarcoma Protuberans Malignant melanoma Angiosarcoma

MCQ 3 23 year old man presents with a rapidly growing soft tissue mass on the arm. Histology shows a cellular lesion with plump fibroblast and myofibroblast-like cells with oedema and red cell extravasation. Mitoses are seen but no atypical forms or nuclear pleomorphism. What is the most likely diagnosis?

A. DFSP B. MPNST C. Sarcomatoid carcinoma D. Nodular fasciitis E. Angiosarcoma

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FRCPath Part1 Course EMQ 4 A. Pyogenic granuloma B. Synovial sarcoma C. Epithelioid sarcoma D. Ewing’s Sarcoma E. Giant cell tumour of tendon sheath F. Xanthoma G. Epithelioid haemangioma

H. Schwannoma I. Neurofibroma J. Angiolipoma K. Spindle cell lipoma L. Elastofibroma M. Solitary fibrous tumour N. Nodular fasciitis

1. A 35 year old man with nodule on the arm. Dermal lesion with is encapsulated and has S100 spindle cells in loose myxoid stroma and more hypercellular areas. Palisading of nuclei is seen.

2. A 44 year old builder with a nodule on the back of the neck. The nodule has spindle cell areas, ropey collagen and fat. There is no atypia and the tumour is CD34 positive.

3. A 27 year old man presents with a nodule on the foot. The tumour is epithelioid, malignant with central areas of necrosis and is EMA +, CD34 + and AE1/AE3. S100 negative.

4. 32 year old female with papules around the eye.

Histology shows bland foamy cells in the dermis.

5. 31 year old male with a mass around the knee. Histology shows a biphasic tumour with spindle cells and epithelioid cells. Cytogenetics shows t(x:18) translocation and radiology confirms pulmonary deposits.

EMQ 5 A. B. C. D. E. F. G. H. I.

Telangiectatic osteosarcoma Osteoblastoma Giant cell tumour Chondrosarcoma Osteochondroma Periosteal osteosarcoma Adamantinoma of the bone Aneurismal cyst Simple cyst

J. Fibrous dysplasia K. Parosteal osteosarcoma L. Conventional osteosarcoma M. Mesenchymal chondrosarcoma N. Ewing’s sarcoma O. Chordoma P. Osteoid osteoma

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FRCPath Part1 Course EMQ 5 1. A 19-year-old male presents with a jaw tumour, the microscopy of which, shows differentiated cartilage and a distinctive small cell component. In areas, the tumour is reminiscent of haemangiopericytoma.

2. A child presents with cranial nerve deficits and a lobulated soft tumour is excised from the cervical vertebrae. The tumour is S100 and EMA positive.

3. A 19- year-old female shows a superficial diaphyseal tumour with sunburst mineral arrays and it does not involve the medulla. In microscopy malignant chondroid matrix mixes with osteoid.

4. A 35-year-old female presents with inability to flex the knee. A metaphyseal tumour is seen on the posterior aspect of distal femur, which encircles the bone.

5. A lytic cystic red brown epiphyseal tumour is excised from the distal femur of a 25-year-old woman. You are told that in order to differentiate this tumour from the mimics, you have to check the calcium levels on this patient.

MCQ 6 A 44 year old man complains of swollen, tender and warm, knee joint. A biopsy of synovium shows villous hypertrophy, chronically inflamed tissue with lymphoid follicles and plasma cells.

The most likely diagnosis is: A. B. C. D. E.

Septic arthritis Osteoarthritis Rheumatoid arthritis Psoriatic arthritis None of the above

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