Small Bowel And Gist

Question 1

Si tumor distribution

Answer 1

Adenoca 30-50% 15% has high msi
Net 25-30
Lumphoma 25

Question 2

Life time risk of sb adenoca in syndromes
Fap
Lynch
Pjs

Answer 2

Fap 3-5% duo and periamp
Pjs- 1.7-13% RR-520
Lynch- 4% RR 100

Question 3

Max serotonin production which gut net

Answer 3

Midgut net

Question 4

Percent mets in appendiceal and ileal net

Answer 4

35 and 3%

Question 5

Chance of mets per size of net

Answer 5

• NETs < 1 cm in diameter - 2% metastases
• NETs 1 to 2 cm - 50% metastases
• NETS > 2 cm - 80-90% metastases.

Question 6

Small bowel nets multicentricitu

Answer 6

20-30%

Question 7

Synchronous adenoca esp in large bowel in %

Answer 7

10-20%

Question 8

Carcinoid syndrome in % of nets

Answer 8

10%

Question 9

Mc heart ailmet in carcinoid

Answer 9

Rt heart
Pulm stenois
Tricuspid

Question 10

Increased nterminal pro bmp and chrga prognosis

Answer 10

Worser than chrg a alome

Question 11

Petct in net

Answer 11

68 ga dotatate-ioc in localisation

68cu dotatate

Question 12

Tnm of net T

Answer 12

1- lp or sm and less than or eq to 1cm
2- muscprop or more than 1 cm
3- musc prop into subseros 
4- visceral periton serosa and other organs
N1- 12 nodes
2- large more than 2 cm mass or more than 12 nodes
M1aliver 
B extrahep
C both

Question 13

RADIANT TRIAL

Answer 13

Everolimus in net

Question 14

Netter trial

Answer 14

Lu 177 dotatate

Question 15

Mc intestinal neoplasm in less thna 10 yrs

Answer 15

Si lymphoma distal ileum

Question 16

Mets to si mc is

Answer 16

Melanoma

Question 17

Gist sdh deficient

Answer 17

1Carney triad gist pulm chondroma extradrenal paragangliom
2Carney stratakis syndromegist and familial paragangliomas
3. Nf1

Question 18

Wt for kit and pdgfra

Answer 18

10-15%
1.sdh def
2- nf1
3. Braf ras

Question 19

Tyoes of gust

Answer 19

Spindle m/c
Epitheloid
And mixed

Question 20

IHC FOR GIST

Answer 20

Cd117 ckit
Dog1
Cd34
Moleculygentic kit (m/c)and pdffra

Question 21

Exons in gist

Answer 21

Kit- mc 11

Pdgfra mc 18 D842V

Question 22

Mc site of exon 9

Answer 22

Kit si

Pdgfra stomach

Question 23

Response rates to imatinib

Answer 23

Response rates to imatinib:
• KIT exon 11 mutation - 90%.
KIT exon 9 mutation
- 50% - improves with
400 mg bd dose.
Most PDGFRA mutations are associated with a
response to imatinib, with the exception of
D842V (Responds only to avapritinib)

Question 24

Better prognoisis which site

Answer 24

Stomach

Question 25

Surveillance feasible in gist?

Answer 25

Very small gastric gists les than 2 cm | Eithout high risk eus features like irregular border heterogenus echo pattern custic spaces echogenic foci

Question 26

Adjuvant imatinib duration in gist

Answer 26

``` 3 yrs for high risk gist - mitotic more than 5/50hpf Tumor rupture Sie more than five cm Nok gastric location In mets disease continue drug till progression ```

Question 27

Fletchers criteria aka

Answer 27

Nih consensus criteria | To assess recurence rate

Question 28

Miettinens criteria

Answer 28

Armed forces ip criteria risk stratification

Question 29

Dose of adjuvant imatinib

Answer 29

400 mg od 800 mg if progressive Or if exon 9 kit

Question 30

Sunitinb dose

Answer 30

50 mg od 4 wks every 6 wks

Question 31

Regorafenib dose

Answer 31

160 mg od 3 wks every 4 wks

Question 32

Dasatinib when

Answer 32

D842 Vpdfra