Q 46) Endovenous Laser Ablation (EVLA) of varicose veins is best suited for those :
a) With needle phobia
c) Excess tortuousity
d) Primary varicose veins
Q 47) Which of the following is true about phyllodes tumor?
a) It has a fast spread and is locally invasive
b) It is benign proliferative in ANDI
c) Mammography is diagnostic
d) Young patients less than 20 years old are more commonly involved
Q48) Not true about GIST?
a) It is more common in females
b) They are mesodermal in origin
c) More than 5 cm are malignant
d) They can occur anywhere in the GI tract
Q49) Management of occult breast cancer with N1 lymph nodes:
a) Modified radical mastectomy (MRM) with axillary dissection
b) MRM with radiotherapy to axilla
c) Only axillary dissection with radiotherapy and chemotherapy to axilla
d) Simple mastectomy with chemotherapy
Q50) Which of the following thyroid cancers do not take up radio active iodine
a) Medullary carcinoma thyroid
b) Papillary carcinoma
c) Follicular carcinoma
d) Hurthle cell carcinoma
Primary Varicose veins
EVLA is thermal ablation of varicose veins in which laser fibre is inserted in the lumen and ablation is done from inside. It is a good modality for primary and recurrent varicose veins and work in both long and short segments.
This treatment is not effective in cases where there is needle phobia or the veins are having excessive tortuousity or thrombophlebitis. This procedure is done under ultrasound guidance and wire is passed from the superficial to the deep veins.
Tumescent local anesthesia also helps
Ref Bailey: Page 909
These benign tumors are more commonly seen in women above the age of 40 years but can occur in younger females as well.
These can grow to massive sizes before awareness is there and present as ulcerated bosselated masses. They can range from benign to malignant with even haematogenous spread.
There is genetic association with Li -Fraumeni syndrome
Mammography shows non specific oval mass which is well circumscribed with smooth margins.
They occur equally in male and female with no gender predisposition.
GIST can occur anywhere in the GI tract and arise from mesenchymal cells. Earlier they were called leiomyoma and leiomyosarcoma.
Size and mitotic index accurately predicts their metastatic and malignant behavior.
Ref: Bailey 1054
When we know that axillary lymph nodes are involved (as in this case) surgery of the axilla becomes the most important mdodality.
It not only prognosticates the patient (by suggesting about the metastatic potential of the disease) but also effects local cure.
Ref: Bailey Page 814
50 a - Medullary carcinoma
Medullary carcinoma of the thyroid is a tumor that arises from the C cells ie the parafollicular cells and not from cells of thyroid follicles.
These are not TSH dependent and hence do not take up radioactive iodine
Hurthle cell carcinoma is a variation of follicular carcinoma only.
In these tumors lymph node involvement is about 60%
Bailey page 769