Devita, Hellman, and Rosenberg's Cancer

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

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

Question 19.3. Which of the following imaging modalities provides the most accurate

assessment of the invasiveness of a posterior mediastinal mass?

A. Posteroanterior (PA) and lateral chest radiograph

B. Intravenous contrast-enhanced CT scan

C. Transesophageal ultrasonography

D. Positron emission tomography (PET)

Question 19.4. A 36-year-old woman presents with an anterior mediastinal mass that was

identified incidentally on a chest radiograph done as part of an employ-

ment examination. She is asymptomatic and a lifelong nonsmoker, with

no significant medical history. Examination is unremarkable. CT scan

shows a 3-cm, smooth, anterior mediastinal mass without local invasion.

Resection of the mass reveals an encapsulated, lymphocyte-rich thymoma

(World Health Organization [WHO] type B1) with no capsular invasion.

She recovers from surgery without complications. What is the most appro-

priate 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 19.5. A 48-year-old man presents with progressive fatigue and dyspnea on

exertion over the past 6 months. He is a former smoker, and his med-

ical history is significant for well-controlled hypertension. Examination

reveals tachycardia with a regular rhythm, mild tachypnea, and conjuncti-

val and mucosal pallor. Stool is guaiac negative. Laboratory studies show

hemoglobin of 5.5 g/dL, hematocrit of 17%, white blood cell count of

6800/L, platelet count of 343,000/L, and normal electrolytes, renal

function, and liver function test results. A chest radiograph reveals supe-

rior mediastinal widening. CT scan shows a large, irregular, anterior

mediastinal mass. Bone marrow aspiration and biopsy show profound

erythrocytic hypoplasia with no dysplasia and normal granulocytic and

megakaryocytic maturation with no clonal lymphoid proliferation. Serum

LDH,-fetoprotein, and-hCG are normal. He is transfused with packed

red blood cells, and his hemoglobin increases to 10.4 g/dL. Resection

of the mass reveals a cortical thymoma (WHO type B2) with micro-

scopic invasion of the capsule and negative surgical margins. He recovers

without complications, and his hemoglobin is 11.5 g/dL 4 weeks after

surgery. 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