Devita, Hellman, and Rosenberg's Cancer

LWBK1006-19 LWW-Govindan-Review December 7, 2011 21:24

Chapter 19•Neoplasms of the Mediastinum 217

Question 19.6. Which of the following paraneoplastic syndromes are associated with

thymoma?

A. Myasthenia gravis and pure red cell aplasia

B. Eaton–Lambert myasthenic syndrome and hypogammaglobulinemia

C. Polymyositis and hypothyroidism

D. All of the above

Question 19.7. A 62-year-old man presents with substernal chest pain. Cardiac evalua-

tion is negative. CT angiogram shows no aortic dissection, but does reveal

an irregular, anterior mediastinal mass abutting the upper lobe of the left

lung. PET scan shows a fluorodeoxyglucose (FDG)-avid anterior medi-

astinal mass without evidence of metastases. Resection of the mass with

en bloc wedge resection of the left upper lobe shows high-grade thymic

carcinoma (WHO type C) with invasion into the pericardium and the left

upper lobe. The surgical margins are positive on microscopic examina-

tion. He recovers from surgery without complications. What is the most

appropriate next step in the management of this patient?

A. Clinical surveillance

B. Adjuvant radiotherapy alone

C. Adjuvant chemotherapy alone

D. Adjuvant chemotherapy plus radiotherapy

Question 19.8. A previously healthy 38-year-old man presents with facial and bilateral

upper-extremity edema that has progressed over the past 2 weeks. Exam-

ination reveals moderate facial, cervical, and bilateral upper-extremity

edema with facial plethora and prominent anterior chest wall vasculature.

He is tachycardic, but his heart sounds are regular and his lungs are clear.

There is no lower-extremity edema. CT scan of the chest shows a large

anterior mediastinal mass encasing the superior vena cava, displacing the

aortic arch and trachea, and invading the pericardium and upper lobe of

the left lung. The superior vena cava is compressed and there are numer-

ous dilated, intrathoracic collateral vessels. An experienced thoracic sur-

geon deems that the lesion is primarily unresectable. Mediastinotomy with

biopsy of the mass reveals well-differentiated thymic carcinoma (WHO

type B3). PET scan shows a large FDG-avid mediastinal mass with no evi-

dence of metastatic disease. What is the most appropriate management

of this patient?

A. Palliative radiotherapy followed by chemotherapy

B. Definitive radiotherapy with concurrent chemotherapy

C. Neoadjuvant chemotherapy followed by surgical resection and post-

operative radiotherapy

D. Palliative chemotherapy alone