Bone and Soft Tissue Tumors and Tumor-Like Lesions — WACS Viva & Clinical Scenarios (Musculoskeletal and Trauma Imaging)

Exam-style bone and soft tissue tumors and tumor-like lesions viva scenarios with examiner probes and model answers for Radiology candidates.

Scenarios covered

• SCENARIO 1: A 15-year-old male presents with a painful, progressive swelling above the right knee over the past 3 months. Anteroposterior and lateral radiographs of the distal femur demonstrate a mixed lytic and sclerotic metaphyseal lesion with cortical breach, cloud-like mineralised matrix, Codman triangle, and a sunburst pattern of aggressive periosteal reaction extending into the surrounding soft tissue. Describe the radiographic findings, provide the principal diagnosis and relevant differentials, and outline the necessary local and systemic staging protocol.
• SCENARIO 2: A 30-year-old female presents with deep aching left knee pain. Frontal and lateral radiographs reveal a well-demarcated, eccentric, geographic lytic lesion in the medial condyle of the proximal tibia extending to the immediate subchondral cortex without a sclerotic margin or internal matrix mineralisation. Describe the classical radiological features of this lesion, formulate a differential diagnosis based on skeletal maturity, and discuss key magnetic resonance imaging findings that influence surgical planning.
• SCENARIO 3: Systematic Plain Film Analysis of Focal Bone Lesions. Detail the radiological evaluation of solitary bone lesions with specific reference to: (a) the Lodwick classification of bone destruction, (b) patterns of benign versus aggressive periosteal reaction, and (c) types of tumor matrix mineralisation and their histological implications.
• SCENARIO 4: A 62-year-old male presents with generalised bone pain, fatigue, and anaemia. Radiographs of the skull and lumbar spine reveal numerous well-defined, non-sclerotic punched-out lytic lesions and severe diffuse osteopenia with multiple compression fractures. Discuss the radiographic differential diagnosis between multiple myeloma and osteolytic metastases, appropriate laboratory and cross-sectional imaging investigations, and potential radiological pitfalls.
• SCENARIO 5: A 50-year-old male presents with a firm, enlarging, non-tender mass in the anterior thigh deep to the fascia lata. Describe the structured magnetic resonance imaging protocol for evaluating this soft-tissue mass, key imaging features that distinguish benign soft-tissue tumors from high-grade soft-tissue sarcomas, and the cardinal radiological rules governing safe image-guided percutaneous biopsy trajectory planning.