Soft Tissue Tumors, Melanoma, Lymphoma, Retroperitoneal Tumor

Question 1

The best diagnostic modality to detect distant metastasis from a cutaneous melanoma of the inguinal region is

A. Sestamibi scan
B. HIDA scan
C. Isolated limb perfusion
D. Chest x-ray

Answer 1

D. Chest x-ray

Question 2

65yo woman by CT has a 20cm left retroperitoneal mass. The patient presents with vomiting and intestinal obstruction. The mass is resectable. BMI is 14. Priority is

A. Tumor resection
B. Percutaneous needle biopsy
C. Colostomy
D. Nutritional assessment

Answer 2

D. Nutritional assessment

Question 3

A patient has a 2 cm lesion in the forehead. Incision biopsy revealed basal cell carcinona. The next procedure would be:

A. Wide excision with a 2 cm margin of skin with reconstruction
B. Wide excision with a 2 cm margin and resection of the underlying muscles with reconstruction
C. Sentinel lymph node biopsy
D. Moh’s microscopic surgery

Answer 3

D. Moh’s microscopic surgery

Question 4

62 year old male underwent a lymph node biopsy of the neck. If this is due to squamous cell carcinoma, result of immunostaining of the specimen would likely be: 
A. ( +) LCA, (+) cytokeratin 
B. (-) LCA, (-) cytokeratin 
C. (+) LCA, (-) cytokeratin 
D. (-) LCA, (+) cytokeratin

Answer 4

D. (-) LCA, (+) cytokeratin

Lymphoma (+) LCA (-) cytokeratin

Question 5

A patient has a suspicious melanoma-looking 2 cm lesion in the forehead. The next procedure should be:

A. Wide excision with a 3 cm margin of skin with reconstruction
B. Wide excision with a 3 cm margin and resection of the underlying muscles with reconstruction
C. Sentinel lymph node biopsy
D. Full thickness incisional biopsy

Answer 5

D. Full thickness incisional biopsy

Suspicious lesions should undergo excisional biopsy with 1- to 3-mm margins; however, tumors that are large or are in a cosmetically or anatomically challenging area can be approached by incisional biopsy, including punch biopsy.

Question 6

A 56 year old man presented with a 1.0 cm ulceration in the forehead. Incision biopsy done by another surgeon revealed squamous cell carcinoma. Your next procedure of choice is:

A. Wide excision with sentinel node biopsy
B. Microscopically controlled surgery
C. Interleukin injection of the tumor
D. Wide local excision with flap rotation surgery

Answer 6

B. Microscopically controlled surgery

Question 7

A 35 year old male presented with a non-movable mass in the left hemiabdomen. Magnetic resonance imaging showed a 23 x 16 x 14 cm retroperitoneal tumor involving the aorta thus seemed unresectable. There are signs and symptoms of bowel obstruction. Next option is:

A. Radiation therapy followed by chemotherapy B. Chemotherapy
C. Electrolyte determination
D. Radiofrequency ablation

Answer 7

C. Electrolyte determination

Question 8

A patient has a suspicious melanoma-looking 2.3 cm lesion in the right cheek. The best method in diagnosing the pathology of the lesion is:

A. Full thickness incisional biopsy
B. Wide excision with a 2 cm margin and resection of the underlying cheek bone
C. Sentinel lymph node biopsy
D. Wide excision with a 2 cm margin

Answer 8

A. Full thickness incisional biopsy

Suspicious lesions should undergo excisional biopsy with 1- to 3-mm margins; however, tumors that are large or are in a cosmetically or anatomically challenging area can be approached by incisional biopsy, including punch biopsy.

Question 9

A 33-year old male patient has a 5 cm subcutaneous mass in the right posterior thigh. It is hard and non movable and associated with pain. Your immediate procedure is:

A. Request for MRI of the thigh
B. Request for an x-ray of the right thigh
C. Mammotome excision
D. Refer to radiation oncologist

Answer 9

A. Request for MRI of the thigh

Magnetic resonance imaging (MRI) is the preferred imaging technique for soft tissue sarcomas of the extremities, whereas computed tomography (CT) is most useful for evaluating retroperitoneal, intra-abdominal, and truncal sarcomas.

Question 10

A 55 year old male with 6 cm preauricular mass suspected to be invading the masseter muscle came for consult. You will probably request:

A. Stereotactic biopsy
B. MRI
C. FDG PET scan
D. Upper GI endoscopic ultrasound

Answer 10

B. MRI

Salivary gland tumors are worked up with appropriate imaging, typically with an MRI because of the increased soft tissue definition.

Question 11

Your patient has a 1.2 cm squamous cell carcinoma of the parotid gland. it will most likely metastasize in:

A. Level I
B. Level IV
C. Level VI
D. Level V

Answer 11

A. Level I