Get the GIST of it
What is the most common location of a GIST?
stomach 60-70%
This T stage and above you should perform a sentinel lymph node biopsy for
T1b (>=0.8 mm or ulcerated)
Cushing’s syndrome
mutation in this gene places increased risk of breast cancer, ovarian cancer, pancreatic and prostate cancer with lifetime risk being >60% in females
BRCA1
periumbilical mass or nodule signifying possible metastatic abdominal or pelvic malignancy
Sister Mary Joseph Nodule
T stage in the 8th edition of the AJCC is based solely on
tumor size
2 cm or less T1
2-5 cm T2
5-10 cm t3
>10 cm T4
What is the recommended margins for wide local excision based on?
Breslow Thickness
<1mm 1 cm
>1mm to 2mm 1-2 cm
>2mm is 2 cm
Adrenal tumor that arises from chromaffin cells within adrenal medulla associated with von Hippel Lindau disease, MEN type 2, NF 1, and familial paragangioma syndromes
Pheochromocytoma
Places patients at a 50% lifetime risk for breast cancer and a 70% lifetime risk of gastric adenocarcinoma in men where often prophylactic total gastrectomy is recommended
CDH1 mutation
Where is jaundice best detected?
Mucous membranes of the mouth
Approximately 75% of GISTS have activating mutation in the KIT gene, whereas another 10% have mutations in this gene
PDGFRA gene
This study was a phase 3 study looking at a sentinel lymph node biopsy positive patients that found at a median follow up of 43 months, 3 year melanoma specific survival was similar in the completion lymphadenectomy group compared to the observation group
MSLT 2
It is important to perform this which is usually initiated at diagnosis and important to do this for at least 1-3 weeks prior to operation for a pheochromocytoma
alpha-adrenergic blockade
Places patients at a risk of parathyroid adenoma, pancreatic or duodenal neuroendocrine tumor and pitutiary adenomas
Courvoisier’s sign
What is the cutoff of mitotic activity to determine if a GIST is high grade?
>5 mitosis by 5 mm2
This intralesional injection in unresectable intransit metastasis is an oncologic virus and repeated every two weeks
T-VEC
Amount of hounsfield units on unenhanced CT which strongly suggests a benign, lipid-rich adenoma
Hounsfield units <10
Mutation in this gene increases risk for breast cancer, colon cancer, endometrial cancer, renal cancer and thyroid cancer
PTEN (Cowdens)
Name of a collection of pancreatic fluid surrounded by a wall without epithelium seen after an episode of pancreatitis
More than 90% of metastatic GISTs have inactivation of the DMD gene on chromosome Xp21.1 encodingg for
dystrophin
This trial looked at biopsy proven nodal disease on presentation treated with immunotherapy and if patients had major pathologic response in their index node then they were randomized to therapeutic lymph node dissection
PRADO trial
Primary systemic treatment for ACC and is use for adjuvant therapy in those with high risk of recurrence or in unresectable disease and is cytotoxic for adrenal cortical cells
mitotane
Diagnosed by >5 juvenile colon polyps or multiple juvenile polyps throughout GI tract or any juvenile polyps, places increased risk of colon and stomach adenocarcinoma
SMAD4– Juvenile Polyposis syndrome
Forceful vomiting and retching, followed by upper GI bleed, typically in alcoholic or bulimic patients often resolve spontaneously
Mallory-Weiss tear