Devita, Hellman, and Rosenberg's Cancer

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

Chapter 19•Neoplasms of the Mediastinum 221

Question 19.18. A 33-year-old man presents with chest tightness and shortness of breath.

A chest radiograph shows a large mediastinal mass. CT scan shows a

9-cm lobulated anterior mediastinal mass invading the left lung and the

pericardium with a small pericardial effusion, a 3-cm right paratracheal

lymph node, and a 5-cm subcarinal lymph node. Echocardiogram shows

no tamponade. Serum LDH is 440 IU/L (normal, 120–240 IU/L), but

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

Bronchoscopic core biopsy of the subcarinal mass reveals seminoma.

Which of the following is the most appropriate management of this

patient?

A. Carboplatin plus etoposide

B. Radiotherapy

C. Surgical resection

D. Cisplatin, etoposide, and bleomycin

Question 19.19. A previously healthy 52-year-old man presents with hoarseness and vague

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

a CT scan confirms a large anterior mediastinal mass encasing the trachea

and abutting the superior vena cava, left pleura, and superior pericardium.

Serum-fetoprotein is normal, but -hCG is 10 mIU/mL (normal,

<5 mIU/mL). Biopsy shows seminoma. He is treated with cisplatin,

etoposide, and bleomycin. CT scan after treatment shows marked shrink-

age of the mediastinal mass, now measuring 2 cm in maximal diameter.

-hCG is now 1.2 mIU/mL. Which of the following is the most appro-

priate management of this patient?

A. Clinical surveillance

B. Cisplatin, ifosfamide, and vinblastine (VIP)

C. Resection of the residual mediastinal mass

D. Involved-field radiotherapy

Question 19.20. A 17-year-old boy is evaluated for cough and fatigue. Physical exam

is notable for scant facial, pubic and axillary hair, breast enlargement,

and small testes. His serum testosterone level is low, but serum follicle-

stimulating hormone (FSH) and luteinizing hormone (LH) levels are

mildly elevated. Karyotypic analysis reveals 47XXY. Chest radiograph

reveals an anterior mediastinal mass. CT scan of the chest shows a lob-

ulated, 5.2-cm anterior mediastinal mass with areas of hemorrhage and

necrosis. What is the most likely diagnosis?

A. Lymphoblastic lymphoma

B. Thymoma

C. NSGCT

D. Seminoma