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Old 10-16-2012
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Arrow Billy Step 1 Questions # 31

An 18-year-old man sees the physician because he has had pain around the right knee for the past 3 months. There
are no physical findings except for local pain over the area of the distal right femur. A radiograph of the right leg shows an
ill-defined mass involving the metaphyseal area of the distal right femur, and there is elevation of the adjacent periosteum.
A bone biopsy specimen shows large, hyperchromatic, pleomorphic spindle cells forming an osteoid matrix. What is the
most likely diagnosis?


□ (A) Ewing sarcoma
□ (B) Chondrosarcoma
□ (C) Giant-cell tumor of bone
□ (D) Fibrous dysplasia
□ (E) Osteosarcoma
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Old 10-16-2012
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E) osteosarcoma
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Old 10-16-2012
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E. osteosarcoma
In metaphysis
Elevation of adjacent periosteum
And bone biopsy spindle cells
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Old 10-17-2012
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Correct Answer E is correct

The osteoid production by a sarcoma is diagnostic of osteosarcoma. The metaphyseal location in a long bone,
particularly in the region of the knee, is consistent with osteosarcoma, as is presentation in a young individual. Ewing
sarcoma is composed of small, round, blue cells without osteoid production, and these neoplasms are typically diaphyseal
in location. A chondrosarcoma does not produce osteoid. Most chondrosarcomas occur at an older age. Giant-cell tumors
of bone are most common between ages 20 and 40; they are composed of giant cells and a mononuclear cell stroma
without osteoid production. Fibrous dysplasia is a localized “developmental arrest” of bone formation with irregular woven
bone spicules in a fibroblastic stroma.
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