Q3. Which of the following is not an option for Imatinib resistant GIST
a) Increase the dose to 800 mg/day
b) Sunitinib
c) Chemotherapy with Cisplatin
d) Radiofrequency Abalation
Q 4. All of the following are signs of poor prognosis in GIST except
a)
Q 5. Which of the following is not an indication for surgery in Chronic pancreatitis
a) Extra hepatic portal hypertension
b) Recurrent pain abdomen
c) Duodenal obstruction
d) Biliary obstruction without jaundice
Answers
1. d
GIST are being recognized with increasing frequency now
Stomach- 60-70%
Small bowel- 20-30%
10% - Esophagus, Colon, Rectum
Rarely- Omentum, Mesentary and Retroperitoneum
2. b
FNAC is not indicated routinely
GIST are Vascular lesions- Can bleed
Risk of tumor rupture
Seeding along the needle tract
Peritoneal or mesenteric contamination
FNAC only indicated in unresectable lesions to make the diagnosis and start preoperative Imatinib
3. c
Imatinib resistance can develop after long-term treatment. In patients who have GIST that progresses while taking imatinib at a dose of 400 mg/day, the dose can be escalated to 800 mg/day. Five percent of patients who progress at 400 mg/day will respond to the elevated dose of imatinib and achieve at least partial remission.In patients who have imatinib-resistant GIST or who do not tolerate imatinib, sunitinib is the next line of therapy. It is a multitargeted tyrosine kinase inhibitor that has both antitumor and antiangiogenic abilities. Its mechanism involves inhibition of vascular endothelial cell growth factor receptors 1, 2, and 3; KIT; PDGFR?; PDGFRß; Fms-like tyrosine kinase-3 receptor; and the ret proto-oncogene receptor. The results of treatment with traditional chemotherapy have not been successful. Less than 10% response rate is there
4. b
EPH or extrahepatic portal hypertension is the most common vascular complication of chronic pancreatitis. Any part of splenomesentericoportal venous axis may be involved resulting in either occlusive or non occlusive portal hypertension
Splenic vein is the most frequently involved
Common causes of venous thrombosis are
Inflamatory process causing danage to vessel wall with vasospasm, venous stasis and thrombosis
Progressive fibrosis of Chronic pancreatitis
Extrinsic compression by pseudocyst
5. a
EPH as described above as such is not an indication of surgery in chronic pancreatitis. Recurrent pain abdomen and obstruction of surrounding structures form the main indication for surgery.
In case bleeding occurs due to EPH endoscopic sclerotherapy, variceal ligation and porto systemic shunting procedures are the treatment of choice.
