Devita, Hellman, and Rosenberg's Cancer

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

Chapter 35•Cancer of Unknown Primary Site 477

Question 35.8. A 40-year-old woman is BRCA1 mutation positive and has undergone

bilateral prophylactic mastectomies with reconstruction, and prophylac-

tic oophorectomy 3 years back. She presents with a 6-month history

of fatigue progressive abdominal girth distension. Physical examination

demonstrates ascites. CT scan of the abdomen and pelvis reveals dif-

fuse peritoneal carcinomatosis. CT-guided biopsy of a peritoneal nodule

reveals papillary serous adenocarcinoma. Which of the following would

you expect to see in this patient?

A. Psammoma bodies on histology

B. Elevated serum CA 125

C. Family history of breast and ovarian cancer

D. All of the above

Question 35.9. A 45-year-old man, with a 20 pack-year history of smoking, presents with

a right neck mass. CT of the neck with contrast reveals a 2 cm enlarged

right upper cervical lymph node. Biopsy of the mass reveals squamous cell

carcinoma. Which of the following tests would be helpful in identifying

the primary site?

A. Examination of upper esophagus by direct endoscopy

B. Examination of the pharynx and laryngoscopy

C. PET scan

D. All of the above

Question 35.10. A 45-year-old man presents with abdominal pain. CT of the abdomen

shows multiple abdominal masses, the largest of which is 4 cm. CT

of the chest is normal. Biopsy reveals poorly differentiated carcinoma.

Immunoperoxidase stains show the tumor to be desmin (+), vimentin

(+), and factor VIII antigen (+). What would be the most appropriate

next step?

A. Request CD117 staining

B. Surgical consultation

C. Systemic chemotherapy

D. Radiation oncology consultation

Question 35.11. A 30-year-old woman presents for a pre-employment physical exam. She

is a never-smoker, and has no significant past medical history, other than

a spontaneous abortion 2 months ago. Physical exam, including breast

exam, is within normal limits. Chest X-ray demonstrates multiple pul-

monary nodules. CT-guided biopsy demonstrates metastatic poorly dif-

ferentiated carcinoma. What is the next best step in her evaluation?

A. Request immunoperoxidase staining for CK 7, TTF-1, and CK 20

B. Request immunoperoxidase staining for ER and PR

C. Serum-hCG

D. EGFR mutational analysis on tumor