NEOPLASIA

Question 1

CHORDOMA

Answer 1

Chordoma is a rare slow-growing bone tumour. Their favored origin is remnants of the notochord.
There are three histological variants of chordoma: classical (or ‘conventional’), chondroid and de-differentiated.
The histological appearance of classical chordoma is of a lobulated tumor composed of groups of cells separated by fibrous septa. The cells have small round nuclei and abundant vacuolated cytoplasm.
Chondroid chordomas histologically show features of both chordoma and chondrosarcoma.
Chordoma is the second commonest primary malignancy of the spine and accounts for over 50% of primary sacral tumours. The neoplasm has a predilection for the sacrococcygeal (50%) and clival (40%) regions, with other areas of the spine rarely involved. More than one vertebral body can be affected in half the cases.

Question 2

LCIS

Answer 2

Lobular breast cancers are less common than their ductal counterparts. They typically present differently, the mass is usually more diffuse and less obvious on the usual imaging modalities of ultrasound and mammography. This is significant since the disease may be understaged resulting in inadequate treatment when wide local excision is undertaken.
In women with invasive lobular carcinoma it is usually safest to perform an MRI scan of the breast, if breast conserving surgery is planned.
Lobular carcinomas are also more likely to be multifocal and metastasise to the contralateral breast.
Lobular carcinoma in situ is occasionally diagnosed incidentally on core biopsies. Unlike DCIS, lobular carcinoma in situ is far less strongly associated with foci of invasion and is usually managed by close monitoring.

Question 3

RHABDOMYOSARCOMA

Answer 3

Rhabdomyosarcoma are paratesticular tumours with a bimodal distribution. Because the mass is felt separate to the testis, this is the more likely diagnosis.
5% of testicular tumors
Most often arises in distal portion of spermatic cord and may invade testis of surrounding tissues
60% occur in the first 2 decades of life
Bimodal age distribution - 3-4 months - 16 years
Arises from mesenchymal tissue - 90% embryonal variant (better prognosis) - 30% - 50% have metastasis (usually lymph node) at diagnosis

Question 4

MEN IIB

Answer 4

Medullary thyroid cancer
Phaeochromocytoma
Mucosal neuroma
Marfanoid appearance

Question 5

LUNG CANCER

Answer 5

Contraindications to lung cancer surgery include SVC obstruction, FEV < 1.5, MALIGNANT pleural effusion, and vocal cord paralysis

Question 6

ESOPHAGEAL CANCER

Answer 6

Oesophageal SCC can be managed with radical chemoradiotherapy. Radiotherapy alone is not usually curative. Segmental resection of the upper oesophagus is not practiced. An Ivor Lewis oesophagectomy would only address distal disease.

Question 7

LUMP IN A PT. WITH BREAST IM PLANTS

Answer 7

Unless there are concerns about implant rupture, the imaging of a breast lump in a young patient with implants would be USS initially. If this is not conclusive then MRI should be performed. Remember that MRI is the modality of choice where an implant related complication is suspected or there are concerns about malignant or pre malignant changes and none of these apply here.

Question 8

falsely elevated HIAA

Answer 8

It is important to be aware of what can falsely elevate 5-HIAA to avoid diagnosing carcinoid syndrome incorrectly. These include:

Food: spinach, cheese, wine, caffeine, tomatoes
Drugs: Naproxen, Monoamine oxidase inhibitors
Recent surgery