Devita, Hellman, and Rosenberg's Cancer

LWBK1006-20 LWW-Govindan-Review December 12, 2011 19:4

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

Question 20.4.11.The patient in Question 20.4.10 was found to have three ileal lesions.

Exploratory laparotomy revealed a total of five 1 to 1.5-cm lesions in the

ileum. A frozen biopsy of one of the lesions confirmed a well-differentiated

neuroendocrine (carcinoid) tumor. Segmental resection of the small bowel

with regional lymph node revealed two mesenteric lymph nodes involved

with carcinoid. His diarrhea, flushing, and bleeding resolved after surgery.

Other than obtaining baseline scans, chromogranin A level, 24-hour urine

5-HIAA, what would be the most optimal management?

A. Short-acting octreotide 150g three times per day

B. Octreotide LAR 30 mg once per month

C. Adjuvant chemotherapy with 5FU, streptozotocin, and doxorubicin

D. No further therapy. The patient just needs follow-up with laboratory

tests±scans every 3 months.

Question 20.4.12.Which of the following is a criterion to differentiate between primary

intestinal and secondary lymphomas?

A. No superficial adenopathy

B. No evidence of splenic involvement except through direct extension

of the primary tumor

C. No evidence of peripheral blood or bone marrow involvement

D. All the above

Question 20.4.13.The risk for progressive disease for a patient with small intestinal GIST

measuring less than 2 cm with more than five mitoses/50 hpf is:

A. 0%

B. 4.3%

C. 24%

D. 50%

E. 85%

Question 20.4.14.A 20-year-old student presented to the emergency department with a

2-day history of right lower abdominal pain associated with fever. His

abdomen was slightly distended with diffuse tenderness but without

guarding or rebound tenderness. Rectal examination showed no masses

and was negative for occult blood. Complete blood count showed a

slightly elevated white blood cell at 11,000. CT scan showed a mass in

the terminal ileum with no evidence of free peritoneal air. Colonoscopy

revealed a terminal ileum mass, the biopsy of which showed sheets of

monotonous round nucleated cells with abundant basophilic cytoplasm

with numerous macrophages. Ki-67 index is 100%. What is your diag-

nosis?

A. MALT lymphoma

B. Burkitt’s lymphoma

C. Peripheral T-cell lymphoma

D. Medullary carcinoma of the small intestine