LWBK1006-35 LWW-Govindan-Review November 24, 2011 11:26
Chapter 35•Cancer of Unknown Primary Site 481Answer 35.10. The answer is A.
The immunoperoxidase staining pattern is suggestive of sarcoma. In
patients with abdominal masses with carcinoma or sarcoma histology,
CD117 (C-KIT) staining should be performed on the biopsy specimen, to
rule out gastrointestinal stroma tumors. In these patients, imatinib ther-
apy may be considered.Answer 35.11. The answer is C.
In young women with poorly differentiated carcinoma and lung nodules,
the possibility of metastatic gestational choriocarcinoma should be con-
sidered. The history of recent pregnancy, miscarriage, or missed periods
should help guide the diagnosis. Imaging of the abdomen may show an
enlarged uterus, and dilation and curettage may be indicated. Single-agent
methotrexate therapy can be curative in this setting.Answer 35.12. The answer is A.
The immunoperoxidase staining pattern TTF-1 (+), Surf-A and Surf-B
(+), is characteristic of adenocarcinoma of the lung. The typical pattern
for small cell lung cancer is TTF-1 (+), chromogranin (+), and NSE (+).
The other associations are correct.Answer 35.13. The answer is B.
The characteristic cytogenetic abnormality seen in alveolar rhab-
domyosarcoma is t(2;13), while deletion of 11p is seen in Wilm tumor.
The other associations are correct.Answer 35.14. The answer is D.
Most patients with a tumor in the inguinal lymph nodes have a detectable
primary site in the genital or anorectal areas. In patients in whom a
primary site is not identified, surgical resection, with or without radi-
ation therapy to the inguinal area, may result in long-term survival.
These patients should also be considered for neoadjuvant or adjuvant
chemotherapy.