A 15-year-old boy presents to the primary care physician complaining of constant pain around the knee. The pain has been worsening over several months and he has also lost some weight over the same time period. On examination, a swelling is noted at the site of pain. The lab investigations show a normal FBC, normal ESR but an elevated alkaline phosphatase. X-Ray of the knee is ordered and the diagnosis of osteosarcoma is made.
Which of the following X-ray findings is most characteristic of osteosarcoma?
D) Sunburst pattern
Osteosarcoma is the most common primary malignant tumour in the paediatric population. It typically presents between 10-25 years of age. Osteosarcomas tend to occur at the sites of bone growth, presumably because proliferation makes osteoblastic cells in this region prone to acquire mutations. The most common locations for osteosarcomas to affect are; distal femur, proximal tibia and the proximal humerus. Patients usually present with local pain and swelling at the site of the lesion. Systemic symptoms are rare. Lab results show elevated levels of alkaline phosphatase. Sunburst lesion on X-ray is the pathognomic sign for osteosarcoma.
Bony spur formation is a non-specific lesion on x-ray.
Onion skin pattern is characteristic of Ewing Sarcoma.
Punched-out lesions are a characteristic finding in multiple myeloma.
Which of the following would help to differentiate Hodgkin's Lymphoma from Non-Hodgkin's Lymphoma?
C) Reed-Sternberg cells in microscopy
The correct answer is Reed-Sternberg cells. Reed Sternberg cells are the characteristic cell type seen in patient's with Hodgkin's lymphoma and are typically absent in patients with Non-Hodgkins lymphoma.
The BCR-ABL gene is the hallmark feature of chronic myeloid leukemia.
Sickle-shaped cells are seen in patients who have sickle cell anemia.
Hypersegmented neutrophils are neutrophils with more than 6 lobes, and this is seen in patients who have macrocytic anaemia.
Which of the following is a hallmark feature of chronic myeloid leukemia?
C) Philadelphia chromosome
A Philadelphia chromosome forms when there is a translocation between the long arm of chromosome 9 and the long arm of chromosome 22, forming a fusion gene BCR/ABL on chromosome 22. This feature is present in >80% of those diagnosed with chronic myeloid leukaemia, and its presence determines the treatment of this condition.
Reed-Sternberg cells are the pathognomic feature of Hodgkin's Lymphoma, a disorder caused by the malignant proliferation of lymphocytes.
Spherocytes are spherical shaped RBCs which is seen in an autosomal dominant condition called hereditary spherocytosis.
Heinz bodies are inclusions within the RBCs, composed of denatured haemoglobin, which are found in G6PD deficiency, an X-linked genetic disease.