A 70yr old male has a pathological fracture of femur. The lesion appears a lytic on X- rays film with a circumscribed punched out appearance .The curetting from fracture site is most likely to show which of the following?
**Core Concept**
The patient's presentation of a pathological fracture with a lytic, circumscribed punched-out appearance on X-rays is suggestive of a bone lesion, likely a primary bone tumor. The most common primary bone tumor in adults is a lytic lesion, which is characteristic of multiple myeloma, but can also be seen in other conditions.
**Why the Correct Answer is Right**
The curetting from the fracture site is most likely to show plasma cells, as the lytic lesion is characteristic of multiple myeloma. Multiple myeloma is a malignancy of plasma cells, which are a type of white blood cell that produces antibodies. The lytic lesions in multiple myeloma are caused by the proliferation of malignant plasma cells, which can lead to bone destruction and pathological fractures. The presence of plasma cells in the curetting from the fracture site would be diagnostic of multiple myeloma.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect as it does not mention any specific type of cell or tumor that would be associated with a lytic bone lesion.
**Option B:** This option is incorrect as it suggests a benign tumor, such as an osteochondroma, which would not typically present with a lytic lesion.
**Option C:** This option is incorrect as it suggests a type of infection, such as osteomyelitis, which would not typically present with a circumscribed punched-out appearance on X-rays.
**Clinical Pearl / High-Yield Fact**
It's essential to remember that multiple myeloma can present with a wide range of clinical features, including bone pain, anemia, and renal failure. The diagnosis of multiple myeloma is often made based on a combination of clinical findings, laboratory tests, and imaging studies.
**Correct Answer:** A. Plasma cells.