Devita, Hellman, and Rosenberg's Cancer

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

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

Answer 20.4.13. The answer is D.

GISTs arising from the small intestine appear to have a more malignant

behavior at a smaller size compared with those found in the stomach or

in the colon. For small tumors less than 2 cm, those with more than 5

mitoses per 50 hpf have a 0% risk of progression according to one study,

whereas those with more than 5 mitoses per 50 hpf have a 50% risk

for progression. GISTs larger than 10 cm with more than 10 mitoses per

50 hpf have a 90% risk of progression.

Answer 20.4.14. The answer is B.

This patient has Burkitt’s lymphoma arising from the terminal ileum

presenting with appendicitis-like symptoms. This type of lymphoma

accounts for less than 5% of all lymphomas in the small intestine. A

“starry-eyed” pattern interspersed throughout monomorphic cells with

abundant basophilic cytoplasm is characteristic and related to numerous

macrophages with ingested apoptotic tumors within. A high proliferative

index is also characteristic. Treatment consists primarily of aggressive

chemotherapy.

SECTION 5 COLORECTAL AND ANAL CANCERS

BENJAMIN R. TAN, Jr.

DIRECTIONS Each of the numbered items below is followed by lettered answers. Select the

ONE lettered answer that is BEST in each case unless instructed otherwise.

QUESTIONS

Question 20.5.1. A 30-year-old multigravid woman presents with a large abdominal mass

associated with abdominal pain. She underwent a total proctocolectomy

for colon cancer secondary to familial adenomatous polyposis (FAP)

4 years ago. She received adjuvant chemotherapy for node-positive dis-

ease. A recent esophagogastric endoscopy revealed only a tubulovillous

adenoma in the duodenum. A computed tomography (CT) scan revealed

a 10-cm mass filling the pelvis. Biopsy confirmed desmoid tumor. A TRUE

statement regarding desmoids tumors is:

A. Desmoid tumors represent the second most common cause of death

for patients with FAP.

B. Desmoid tumors are uniformly aggressive and locally invasive.

C. Adjuvant radiation is recommended.

D. Adjuvant chemotherapy is recommended.

Corresponding Chapters inCancer: Principles & Practice of Oncology,Ninth Edition: 88 (Molecular Biology of

Colorectal Cancer), 89 (Cancer of the Colon), 90 (Cancer of the Rectum), and 91 (Cancer of the Anal Region).