WBR0169: Difference between revisions

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(Created page with "{{WBRQuestion |QuestionAuthor={{Rim}} |ExamType=USMLE Step 1 |MainCategory=Pathology |SubCategory=Oncology |MainCategory=Pathology |SubCategory=Oncology |MainCategory=Patholog...")
 
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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor={{Rim}} {{AJL}} {{Alison}}
|ExamType=USMLE Step 1
|MainCategory=Pathology
|SubCategory=Oncology
|SubCategory=Oncology
|MainCategory=Pathology
|MainCategory=Pathology
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|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Oncology
|SubCategory=Oncology
|Prompt=A 54 year old woman presents to the physician's office complaining of abdominal distention. Following appropriate work-up, the patient is found to have a metastatic bilateral ovarian tumor obstructing the lymphatic drainage with subsequent ascites. Pathological analysis of the ovarian tumor shows signet ring cell adenocarcinoma consistent with the diagnosis. What is the most appropriate next step in management?
|Prompt=A 54-year-old woman presents to the physician's office with complaints of abdominal distention. Following appropriate work-up, the patient is found to have a metastatic bilateral ovarian tumor obstructing the lymphatic drainage, with subsequent ascites. Upon athological analysis of the ovarian tumor you observe signet ring cell adenocarcinoma consistent with the diagnosis. Which of the following is the most appropriate next step in management?
|Explanation=The patient is most likely diagnosed with Krukenberg tumor. It is characterized by epithelial and stromal mass, whose epithelial component contains mucin-laden signet ring cells with hyperchromatic nuclei and eosinophilic granular cytoplasm. It usually appears as a bilateral tumor with signs of lymphatic obstruction. Krukenberg tumor are often diagnosed in patients in their fifth decade. The most common primary site of malignancy is the stomach, warranting radiographic and endoscopic evaluation of the digestive system once the diagnosis is made.
|Explanation=The patient in this scenario is most likely diagnosed with a [[Krukenberg tumor]]. A [[Krukenberg tumor]] is characterized by the presence of an epithelial and stromal mass, with an epithelial component containing mucin-laden signet ring cells, which have hyperchromatic nuclei and eosinophilic granular cytoplasm. A [[Krukenberg tumor]] usually appears as bilateral with signs of lymphatic obstruction. [[Krukenberg tumors]] are often diagnosed in patients who are in their 50s. The most common primary site of malignancy is the stomach, warranting radiographic and endoscopic evaluation of the digestive system following diagnosis.


Educational Objective: The stomach is the most common primary site of Krukenberg tumor. Work-up to rule out GI involvement is indicated once the diagnosis is made.
|EducationalObjectives= The stomach is the most common primary site of [[Krukenberg tumor]]s. Work-up to rule out GI involvement is indicated upon diagnosis.


Reference:
|References= Al-Agha OM, Nicastri AD. An in-depth look at krukenberg tumor - an overview. Arch Pathol Lab Med. 2006;130:1725-30
Al-Agha OM, Nicastri AD. An in-depth look at krukenberg tumor - an overview. Arch Pathol Lab Med. 2006;130:1725-30
|AnswerA=Gastroscopy
|AnswerA=Gastroscopy
|AnswerAExp=Most Krukenberg tumors arise from the stomach, thus necessitating radiographic and endoscopic work-up of the digestive system.
|AnswerAExp=Most [[Krukenberg tumors]] originate in the stomach, thus necessitating radiographic and endoscopic work-up of the digestive system.
|AnswerB=Observation with annual check-up
|AnswerB=Observation with annual check-up
|AnswerBExp=Evaluation of a primary site of malignancy is indicated in Krukenberg tumor.
|AnswerBExp=Evaluation of the primary site of malignancy is indicated in [[Krukenberg tumors]], which often originate in the stomach.
|AnswerC=Brain MRI
|AnswerC=Brain MRI
|AnswerCExp=Brain MRI is not indicated in Krukenberg tumor if no clinical suspicion of brain involvement is found.
|AnswerCExp=A brain MRI is not necessary upon diagnosis of a [[Krukenberg tumor]] if no clinical suspicion of brain involvement is found.
|AnswerD=Lumbar puncture
|AnswerD=Lumbar puncture
|AnswerDExp=Lumbar puncture is not helpful.
|AnswerDExp=Lumbar punctures usually are not necessary, because [[Krukenberg tumors]] often originate in the stomach.
|AnswerE=Bronchoscopy
|AnswerE=Bronchoscopy
|AnswerEExp=Bronchoscopy is not indicated once Krukenberg tumor is diagnosed with no suspicion of pulmonary involvement.
|AnswerEExp=A bronchoscopy is not necessary upon diagnosis of a [[Krukenberg tumor]], which often originate in the stomach.
|RightAnswer=A
|RightAnswer=A
|WBRKeyword=krukenberg, tumor, ovarian, mass, malignant, malignancy, cancer, stomach, gastroscopy, work, up, endoscopy, management, next, step, ascites, abdominal, distention
|WBRKeyword=krukenberg, tumor, ovarian, mass, malignant, malignancy, cancer, stomach, gastroscopy, work, up, endoscopy, management, next, step, ascites, abdominal, distention
|Approved=No
|Approved=Yes
}}
}}

Revision as of 17:40, 10 July 2014
Author [[PageAuthor::Rim Halaby, M.D. [1] Alison Leibowitz [2] (Reviewed by Alison Leibowitz)]]
Exam Type ExamType::
Main Category MainCategory::Pathology
Sub Category SubCategory::Oncology
Prompt [[Prompt::A 54-year-old woman presents to the physician's office with complaints of abdominal distention. Following appropriate work-up, the patient is found to have a metastatic bilateral ovarian tumor obstructing the lymphatic drainage, with subsequent ascites. Upon athological analysis of the ovarian tumor you observe signet ring cell adenocarcinoma consistent with the diagnosis. Which of the following is the most appropriate next step in management?]]
Answer A AnswerA::Gastroscopy
Answer A Explanation [[AnswerAExp::Most Krukenberg tumors originate in the stomach, thus necessitating radiographic and endoscopic work-up of the digestive system.]]
Answer B AnswerB::Observation with annual check-up
Answer B Explanation [[AnswerBExp::Evaluation of the primary site of malignancy is indicated in Krukenberg tumors, which often originate in the stomach.]]
Answer C AnswerC::Brain MRI
Answer C Explanation [[AnswerCExp::A brain MRI is not necessary upon diagnosis of a Krukenberg tumor if no clinical suspicion of brain involvement is found.]]
Answer D AnswerD::Lumbar puncture
Answer D Explanation [[AnswerDExp::Lumbar punctures usually are not necessary, because Krukenberg tumors often originate in the stomach.]]
Answer E AnswerE::Bronchoscopy
Answer E Explanation [[AnswerEExp::A bronchoscopy is not necessary upon diagnosis of a Krukenberg tumor, which often originate in the stomach.]]
Right Answer RightAnswer::A
Explanation [[Explanation::The patient in this scenario is most likely diagnosed with a Krukenberg tumor. A Krukenberg tumor is characterized by the presence of an epithelial and stromal mass, with an epithelial component containing mucin-laden signet ring cells, which have hyperchromatic nuclei and eosinophilic granular cytoplasm. A Krukenberg tumor usually appears as bilateral with signs of lymphatic obstruction. Krukenberg tumors are often diagnosed in patients who are in their 50s. The most common primary site of malignancy is the stomach, warranting radiographic and endoscopic evaluation of the digestive system following diagnosis.

Educational Objective: The stomach is the most common primary site of Krukenberg tumors. Work-up to rule out GI involvement is indicated upon diagnosis.
References: Al-Agha OM, Nicastri AD. An in-depth look at krukenberg tumor - an overview. Arch Pathol Lab Med. 2006;130:1725-30]]

Approved Approved::Yes
Keyword WBRKeyword::krukenberg, WBRKeyword::tumor, WBRKeyword::ovarian, WBRKeyword::mass, WBRKeyword::malignant, WBRKeyword::malignancy, WBRKeyword::cancer, WBRKeyword::stomach, WBRKeyword::gastroscopy, WBRKeyword::work, WBRKeyword::up, WBRKeyword::endoscopy, WBRKeyword::management, WBRKeyword::next, WBRKeyword::step, WBRKeyword::ascites, WBRKeyword::abdominal, WBRKeyword::distention
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