Devita, Hellman, and Rosenberg's Cancer

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

220 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

Question 19.15. A previously healthy 32-year-old man presents with fatigue and vague

chest discomfort. A chest radiograph shows a widened mediastinum, and

the CT scan confirms a large anterior mediastinal mass with focal areas

of hemorrhage that fills the substernal space and invades into the upper

lobe of the left lung. Laboratory studies show LDH of 850 IU/L (normal,

120–240 IU/L),-fetoprotein of 8700 ng/mL (normal,<8 ng/mL), and

-hCG of 220 mIU/mL (normal,<5 mIU/mL). Biopsy confirms embry-

onal carcinoma with elements of choriocarcinoma. After four cycles of

cisplatin, etoposide, and bleomycin, a CT scan shows marked shrinkage

of the mediastinal mass, now measuring 3 cm in maximal diameter. One

month after completion of therapy, LDH is 150 IU/L,-fetoprotein is

5.0 ng/mL, and-hCG 2.4 is mIU/mL. Which of the following is the

most appropriate management of this patient?

A. Clinical surveillance

B. Cisplatin, ifosfamide, and vinblastine (VIP)

C. Two additional cycles of cisplatin, etoposide, and bleomycin

D. Resection of the residual mediastinal mass

Question 19.16. A 22-year-old man has a retrosternal mass identified on a chest radiograph

done during his enlistment into military service. He is an asymptomatic

nonsmoker with no significant medical history. CT scan shows a 2.5-cm

smooth anterior mediastinal mass without local invasion. Serum LDH,

-hCG, and-fetoprotein are normal. Testicular ultrasound is normal.

He refuses primary surgical resection, and a percutaneous core biopsy

shows pure seminoma. Which of the following is the most appropriate

management of this patient?

A. Surgical resection

B. Radiotherapy

C. Cisplatin, etoposide, and bleomycin

D. Cisplatin plus etoposide followed by surgical resection

Question 19.17. An increased incidence of hematologic malignancies, such as acute

megakaryocytic leukemia, has been reported with which of the following

mediastinal tumors?

A. Seminoma

B. NSGCT

C. Malignant schwannoma

D. Thymic carcinoid