Devita, Hellman, and Rosenberg's Cancer

LWBK1006-21 LWW-Govindan-Review December 12, 2011 19:6

CHAPTER 21 GENITOURINARY

CANCER

WALTER M. STADLER

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 21.1. Activating mutations in which of the following genes is seen in patients

with hereditary papillary renal cell carcinoma?

A. VHL

B. MET

C. FLCN

D. SDHB

Question 21.2. A 56-year-old moderately obese woman with a medical history of chronic

hypertension well controlled on a thiazide diuretic presents to the emer-

gency department with a 1-day history of abdominal pain, diarrhea,

nausea, and fever. General physical examination is significant only for

some mild abdominal tenderness; negative stool guaiac; a white blood cell

count of 14.2/L; hemoglobin of 14.5 g/dL; a normal platelet count; nor-

mal electrolytes, amylase, lipase, and transaminases; and a creatinine of

0.9 mg/dL. Workup includes an abdominal computed tomography (CT)

scan, which is remarkable for a 1.5-cm enhancing left renal mass in the left

lower pole that is interpreted by the radiologist as a “probable renal cell

carcinoma” without evidence of other metastases. The patient undergoes

a laparoscopic partial nephrectomy. There are no postoperative compli-

cations, and she is back to work 3 weeks later. Postoperative creatinine

is 1.3, and pathology reveals a 2.5-cm renal cell carcinoma, granular cell

type, that is confined to the renal parenchyma. No lymph nodes were

recovered. The next appropriate step is:

A. Open retroperitoneal lymph node dissection

B. Adjuvant sunitinib

C. Adjuvant local radiotherapy

D. Submission of pathology specimen for second review

Corresponding Chapters inCancer: Principles & Practice of Oncology,Ninth Edition: 92 (Molecular Biology of

Kidney Cancer), 93 (Cancer of the Kidney), 94 (Molecular Biology of Bladder Cancer), 95 (Cancer of the Bladder,

Ureter, and Renal Pelvis), 96 (Molecular Biology of Prostate Cancer), 97 (Cancer of the Prostate), 98 (Cancer of the

Urethra and Penis).

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