LWBK1006-29 LWW-Govindan-Review December 9, 2011 15:36
Chapter 29•Cancers of Childhood 397Question 29.23. Factors associated with a good prognosis during the evaluation of Wilms’
tumor include which of the following:
A. Tumor size<550 g
B. Favorable histology with only focal anaplasia
C. Isolated single pulmonary metastatic nodule
D. Limited extension into renal veinQuestion 29.24. A 2-year-old child is brought to the emergency department with low-grade
fever, pallor, lethargy, extensive bruising, and “raccoon” eyes (periorbital
hematomas). On examination, it is noted that the child appears ill and
has a left-sided abdominal mass that is firm and nontender. He also has
involuntary rapid eye movements, noticed over 2 to 3 weeks. A biopsy of
the mass confirms the presence of a neuroblastoma. All of the following
procedures are helpful for further staging and workup, EXCEPT:
A. CT scan of the chest and abdomen, bone scan, and skeletal survey
B. Splenectomy, liver biopsy, and exploratory laparotomy
C. Biopsy of local lymph nodes, bone marrow aspiration/biopsy
D. Radiolabeled (123)I-metaiodobenzylguanidine (MIBG) scan and
determination of urine catecholaminesQuestion 29.25. Staging workup reveals stage IV neuroblastoma involving the periorbital
area, multiple bones, and bone marrow. Treatment modalities include all
of the following, EXCEPT:
A. Combination chemotherapy: carboplatinum, cyclophosphamide,
doxorubicin, and etoposide
B. High-dose chemotherapy and autologous stem cell rescue
C. Allogeneic stem cell transplant
D. Radiotherapy and biologic response modifiers, such as 13-cis retinoic
acidQuestion 29.26. Therapy planning for infants with a small adrenal mass and bone marrow
involvement and non-myc amplification includes:
A. Resection of the mass and short-course chemotherapy
B. Resection of the mass, radiation if residual disease, and short-course
chemotherapy
C. Monitoring for spontaneous regression
D. 13-cis retinoic acid therapy only