Devita, Hellman, and Rosenberg's Cancer

LWBK1006-25 LWW-Govindan-Review December 12, 2011 19:21

Chapter 25•Cancer of the Endocrine System 351

Question 25.7. A 64-year-old man was found to have an abnormal PET scan on follow-

up. He was diagnosed with papillary thyroid carcinoma 10 years ago.

He was treated with total thyroidectomy and radioactive iodine abla-

tion; follow-up iodine scans have always been normal. He presents now

with dysphagia. TG level is found to be 80 ng/mL with negative anti-TG

antibodies and suppressed TSH. Computed tomography (CT) chest scan

reveals a 3-cm mass in the upper chest causing mild esophageal compres-

sion corresponding to PET findings. You recommend which one of the

following as the best initial approach?

A. Esophageal stent placement

B. External beam radiotherapy

C. Cytotoxic chemotherapy

D. Radioactive iodine ablation

E. Surgical resection to achieve local control, possibly followed by exter-

nal beam radiation therapy

Question 25.8. A 34-year-old woman who was treated with external beam radiation for

Hodgkin’s lymphoma when she was 14 years old was recently diagnosed

with papillary thyroid carcinoma. Which genetic defect is expected to be

found in this case?

A. BRAF mutation

B. APC gene mutation

C. RET proto-oncogene mutation

D. RET/PTC rearrangement

Question 25.9. Which of the following factors is (are) considered poor prognostic features

of papillary thyroid carcinoma?

A. Age; men>40 years

B. Tumor size>5cm

C. Extracapsular invasion

D. All of the above

Question 25.10. A 35-year-old woman is found to have bilateral lung nodules on chest CT

scan. Six years ago she underwent total thyroidectomy for a 3-cm pap-

illary thyroid carcinoma, followed by radioiodine ablation. She was lost

to follow-up until she recently presented with a cough. Serum TG level is

found to be 192 ng/mL. Chest CT with intravenous (IV) contrast shows

small bilateral lung nodules. Biopsy obtained by thoracoscopy shows pap-

illary histology. A whole-body radioiodine scan reveals no iodine-avid

lesions. TSH is suppressed. A well-healed scar is seen on the neck, with

no palpable nodes detected, and the rest of the examination shows normal

results. Which is the most appropriate next step?

A. Chemotherapy

B. Repeat iodine scan in 6 to 8 weeks

C. Surgical resection of the lung nodules

D. External beam radiation