Devita, Hellman, and Rosenberg's Cancer

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

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

Question 19.9. Which of the following histologic features is associated with an unfavor-

able outcome in patients with thymic carcinoma?

A. Lobular growth pattern

B. Well-differentiated squamous cell carcinoma

C. Low mitotic activity

D. Clear cell carcinoma

Question 19.10. A 24-year-old man with multiple endocrine neoplasia type 1 (MEN I) has

undergone two resections for pancreatic islet cell carcinoma metastatic

to regional lymph nodes. He is asymptomatic. Examination shows well-

healed abdominal scars. Surveillance CT scan identifies a new 3-cm,

smooth, anterior mediastinal mass. Serum LDH, -fetoprotein, and

-hCG are normal. Testicular ultrasonography is unremarkable. Which

of the following is the most likely diagnosis?

A. Thymolipoma

B. Thymoma

C. Thymic carcinoid

D. Metastatic islet cell tumor

Question 19.11. A 24-year-old man presents with anterior chest discomfort and cough

of 3 weeks duration. Examination is unremarkable. Chest radiograph

shows widening of the superior mediastinum. CT scan shows a 6-cm

anterior mediastinal mass encasing the trachea and great vessels and three

1-cm pulmonary nodules. CT scan of the abdomen and pelvis and a tes-

ticular ultrasound examination are normal. Laboratory studies reveal a

hemoglobin of 11.4 with normal white blood cell count and platelet count,

LDH of 880 IU/L (normal, 120–240 IU/L),-fetoprotein of 1800 ng/mL

(normal,<8 ng/mL), and-hCG of 1.2 mIU/mL (normal,<5 mIU/mL).

What is the most likely diagnosis?

A. Hodgkin’s lymphoma

B. Benign teratoma

C. Nonseminomatous germ cell tumor (NSGCT)

D. Seminoma

Question 19.12. Which of the following statements regarding mediastinal germ cell tumors

is correct?

A. The incidence of malignant mediastinal germ cell tumors is the same

in men and women.

B. Seminoma is the most common mediastinal germ cell tumor.

C. An elevated serum-fetoprotein level in a patient with biopsy-proven

seminoma indicates the presence of a NSGCT component.

D. Mediastinal NSGCTs are associated with better overall survival than

testicular NSGCTs.