Devita, Hellman, and Rosenberg's Cancer

LWBK1006-35 LWW-Govindan-Review November 24, 2011 11:26

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

Question 35.4. Which of the following subgroups of patients diagnosed with carcinoma

of unknown primary is NOT associated with a favorable outcome?

A. Men with tumor in the mediastinum or retroperitoneal lymph nodes

B. Men with bilateral lung nodules and tumor in the supraclavicular

lymph nodes

C. Women with poorly differentiated neuroendocrine carcinoma

D. Women with peritoneal carcinomatosis

Question 35.5. A 19-year-old man presents with headaches, nausea, visual disturbances,

and diplopia of 3-week duration. MRI of the brain reveals a mass in the

pineal gland mass extending to the thalamus. Biopsy reveals poorly dif-

ferentiated carcinoma. Cytogenetic analysis reveals isochromosome 12p.

CT scan of the chest, abdomen, and pelvis and testicular ultrasound is

normal. Serum AFP is 74 ng/dL and-hCG is 94 mIU/mL. What is the

most likely diagnosis?

A. Pilocytic astrocytoma

B. Extragonadal germ cell tumor

C. Pineoblastoma

D. Meningioma

Question 35.6. A 40-year-old postmenopausal woman, who is a nonsmoker, presents for

evaluation of an incidentally discovered 3 cm liver lesion on abdominal

ultrasound. Biopsy of the lesion reveals adenocarcinoma. IHC studies

demonstrate the tumor to be CK7 and CA 19-9 negative, CK20 posi-

tive, CDX2 positive, TTF-1 negative, ER and Her-2/neu negative. CT of

the chest, abdomen pelvis with contrast, and PET scan fail to reveal the

primary site of origin. What diagnostic test would you order next?

A. Pancreatic protocol CT scan

B. Colonoscopy

C. Breast MRI

D. Bronchoscopy

Question 35.7. A 38-year-old premenopausal woman, who is a never smoker, presents

with a left axillary lump. She reports that her mother was treated for breast

cancer 5 years back. CT scan of the chest, abdomen, and pelvis reveals

a 2.5 cm left axillary lymph node, but is otherwise within normal limits.

Mammogram and breast ultrasound are normal. Biopsy reveals adeno-

carcinoma, with immunostains demonstrating the tumor to be negative

for CK20, TTF-1, ER, Her-2, but positive for CK7, mammaglobin, and

GCDFP-15. Which of the following tests would be helpful in determining

the site of origin?

A. Bronchoscopy

B. Multiple random biopsies of both breasts

C. MRI of the breasts

D. All of the above