Month: April 2019

MCN

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Q) All about MCN of pancreas are true except?
1.Presence of eggshell calcification in CT is suggestive  of malignancy
2.cyst fluid analysis can diagnose accurately in 80%
3.invasive MCN is very aggressive with 30%  5YR Survival compared to adeno carcinoma
4. If MCN is non invasive, surgery  is curative

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GIST

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Q) True statement regarding GIST is  (AIIMS 2019)

a) 80% of GIST arise from stomach

b) ILeal GIST is resistant to Imatinab

c) Leiomyosarcomas do not express CD 117

d) Prognosis of GIST does not depend on the site of lesion 

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c
 They can appear anywhere within the GI tract, although they are usually found in the stomach (40% to 60%), small intestine (30%), and colon (15%).
 Development of imatinib mesylate has significantly altered previous treatment strategies. Imatinib mesylate is a tyrosine kinase inhibitor that blocks the unregulated mutant c-kit tyrosine kinase and inhibits the BCR-ABL and PDGF tyrosine kinases.
Current guidelines suggest that patients with high-risk disease should receive 3 years of adjuvant  therapy at all sites
Sabiston page 1280
Ileal GIST are more malignant than stomach GIST

Leiomyosarcomas

Among the gastric tumors, there were no examples of true leiomyosarcomas, whereas there were four small intestinal, four colonic, and two rectal tumors that histologically showed features of differentiated smooth muscle cells with blunt-ended nuclei and eosinophilic, sometimes granular, cytoplasm. These tumors were, by definition, all positive for SMA, and seven also were positive for desmin. Although all leiomyosarcomas were generally negative for CD117, scattered large neoplastic spindle cells (less than 1% of tumor cells) in two intestinal leiomyosarcomas showed strong cytoplasmic positivity; these four tumors were negative for CD34.

Ref https://www.nature.com/articles/3880210

Thyroid cancer USG

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Q)  Feature on USG that  has the highest sensitivity to predict thyroid carcinoma consistently across studies
a)Microcalcifications
b)More tall than wide
c)Solid hypoechoic nodule
d)Intranodular vascularity
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Pseudo achalasia

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Q) Most common cause of  pseudo achalasia is ?

(a) Benign tumors of esophagus
(b) Chagas disease
(c) Caustic injury
(d) Adenocarcinoma of cardia

Answer free for all 

d

Pseudoachalasia is an achalasia-like disorder that is usually produced by adenocarcinoma of the cardia
Other uncommon causes are
 1.benign tumours at this level.
2, Tumors of bronchus, pancreas
Ref Bailey page 1097