Devita, Hellman, and Rosenberg's Cancer

LWBK1006-37 LWW-Govindan-Review November 24, 2011 11:29

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

Questions

37.14.–37.15.

A 55-year-old man presents with increasing abdominal girth and

abdominal pain. CT scan of his chest and abdomen shows diffuse sub

centimeter peritoneal nodules. Biopsy of the peritoneum is positive for

carcinoma. The tumor was positive for immunohistochemical staining

with calretinin, cytokeratin 5/6, and WT-1. It was negative for CEA,

Ber-Ep4, LeuM1, and Bg8.

Question 37.14. What is the most likely diagnosis in this patient?

A. Malignant peritoneal mesothelioma

B. Primary peritoneal carcinoma

C. Gastric adenocarcinoma

D. Appendiceal adenocarcinoma

Question 37.15. The patient is in excellent health and has no significant medical comor-

bidities. What would be his treatment of choice?

A. Surgical cytoreduction

B. Surgical cytoreduction and intraperitoneal chemotherapy

C. Systemic cisplatin and pemetrexed

D. Single-agent pemetrexed

Question 37.16. A 66-year-old man presented with nausea, vomiting, and abdominal pain.

He was diagnosed with appendicitis and subsequently underwent appen-

dectomy. During the surgery, he was noted to have tumor implants on his

peritoneum. Biopsy of these tumors was reported as well-differentiated

papillary mesothelioma. What would be the appropriate treatment option

for this patient?

A. Surgical resection

B. Chemotherapy with cisplatin and pemetrexed

C. Radiation therapy

D. Intraperitoneal chemotherapy

Question 37.17. A 40-year-old woman presented with abdominal distention and early sati-

ety. On examination, the patient was found to have massive ascites. CT

scan showed massive ascites and multiple peritoneal implants. In addi-

tion, a single 2-cm deposit was noted on the surface of the right ovary;

her bilateral ovaries otherwise appear normal. The patient underwent

paracentesis, which revealed malignant serous type cells. A PET scan did

not reveal other metastatic sites except what appears on the CT. What is

the diagnosis in this patient?

A. Primary peritoneal carcinoma

B. Peritoneal mesothelioma

C. Metastatic ovarian cancer

D. Adenocarcinoma of unknown primary