2$ 3$ 4$ 1$ 2$ 3$ 4$ 1$ 2$ 3$ 4$ 1$ C A B

The most frequent site of development of an osteogenic sarcoma is the: A.Upper extremity B. Shoulder C. Pelvis D. Lower extremity E. Spine C1 $100

The most frequent site of development of an osteogenic sarcoma is the: A.Upper extremity B. Shoulder C. Pelvis D. Lower extremity E. Spine

C1 $200 Most important prognostic factor for sarcomas is: A. Tumor size (N) B. Lymph node status (N) C. Distant mets (M) D. Tumor grade E. Neural invasion

Most important prognostic factor for sarcomas is: A. Tumor size (N) B. Lymph node status (N) C. Distant mets (M) D. Tumor grade E. Neural invasion

C1 $300 Which of the following is FALSE for Merkel Cell tumors: A.It is a neuroendocrine tumor B. Highly aggressive tumor C. Neuron specific enolase (NSE) is a marker D. All patients need SLNB or formal LN dissection (if enlarged) E. Treatment involves chemoradiation

DISCUSS -Rx: WLE with 2-3 cm margin  postop chemoXRT -5 yr survival 60% Which of the following is FALSE for Merkel Cell tumors: A.It is a neuroendocrine tumor B. Highly aggressive tumor C. Neuron specific enolase (NSE) is a marker D. All patients need SLNB or formal LN dissection (if enlarged) E. Treatment involves chemoradiation

C1 $400 Histologic classification of soft tissue sarcomas includes all of the following except: A.Attention to assessment for cellular atypia, mitotic rate, tumor necrosis for assessing histologic grade B. Default diagnosis of malignant fibrous histiocytoma if the tumor has nonspecific pleomorphic features C. Use of chromosomal translocations as powerful and accurate diagnostic markers D. Classfication according to tissues they mimic rather than the type of tissue from which the tumor arises

C1 $400 DISCUSS - Approx. 10% of tumors have poorly differentiated cells and designated as spindle cell or pleomorphic sarcomas Histologic classification of soft tissue sarcomas includes all of the following except: A.Attention to assessment for cellular atypia, mitotic rate, tumor necrosis for assessing histologic grade B. Default diagnosis of malignant fibrous histiocytoma if the tumor has nonspecific pleomorphic features C. Use of chromosomal translocations as powerful and accurate diagnostic markers D. Classfication according to tissues they mimic rather than the type of tissue from which the tumor arises

C2 $100 Which of the following is the most common sarcoma? A.Liposarcoma- low grade B. Liposarcoma- high grade C. Malignant fibrous histiocytoma D. Rhabdomyosarcoma E. Osteosarcoma

C2 $100 Which of the following is the most common sarcoma? A.Liposarcoma- low grade B. Liposarcoma- high grade C. Malignant fibrous histiocytoma D. Rhabdomyosarcoma E. Osteosarcoma

C2 $200 Which is the most common site for sarcomas? A.Extremity (thigh) B. Retroperitoneal (abdomen) C. Head and neck D. Bone E. Presacral

C2 $200 Which is the most common site for sarcomas? A.Extremity (thigh) B. Retroperitoneal (abdomen) C. Head and neck D. Bone E. Presacral

C2 $300 Which of the following if NOT a risk factor for sarcomas: A. Asbestos (Mesothelioma) B. PVC and arsenic (Angiosarcoma) C. Chemotherapy (any sarcoma) D. Lymphedema (Lymphangiosarcoma) E. Radiation

C2 $300 DISCUSS Which of the following if NOT a risk factor for sarcomas: A. Asbestos (Mesothelioma) B. PVC and arsenic (Angiosarcoma) C. Chemotherapy (any sarcoma) D. Lymphedema (Lymphangiosarcoma) E. Radiation

C2 $400 Which of the following is FALSE: A.Desmin is a marker for rhabdomyosarcoma B. Sarcomas spread through hematogenous route, not lymphatics C. Most common site for metastasis is lungs D. Need to rule out lymphomas in retroperitoneal lesions E. Incisional biopsy is indicated for all sarcomas prior to resection

C2 $400 DISCUSS - Only if core needle not feasible  If <4 cm excisional biopsy Which of the following is FALSE: A.Desmin is a marker for rhabdomyosarcoma B. Sarcomas spread through hematogenous route, not lymphatics C. Most common site for metastasis is lungs D. Need to rule out lymphomas in retroperitoneal lesions E. Incisional biopsy is indicated for all sarcomas prior to resection

C3 $100 A patient with previous abdominal radiation and on betablockers for HTN now presents with bilateral hydronephrosis. An IVP shows bilateral ureteral compression. CT rules out any masses or localized disease process. What is the most likely treatment for this condition? A.Steroids +/- surgery if immunosuppression fails B. Chemoradiation followed by surgery C. XRT therapy alone D. Chemotherapy alone E. Brachytherapy

C3 $100 DISCUSS - Dx: Retroperitoneal fibrosis. Surgery involves freeing up ureters and wrapping in omentum A patient with previous abdominal radiation and on betablockers for HTN now presents with bilateral hydronephrosis. An IVP shows bilateral ureteral compression. CT rules out any masses or localized disease process. What is the most likely treatment for this condition? A.Steroids +/- surgery if immunosuppression fails B. Chemoradiation followed by surgery C. XRT therapy alone D. Chemotherapy alone E. Brachytherapy

C3 $200 Which of the following is TRUE regarding surgical resection of sarcomas: A.A 1 cm margin is needed for resection B. At least 2 uninvolved fascial planes are needed medially and laterally when resecting extremity sarcomas C. Limb sparing resection should be attempted whenever possible D. Preop chemoradiation has no role in allowing limb sparing resection E. Postop radiation is not needed for possible involvement of nerves or vessels

C3 $200 DISCUSS: -2 cm margin needed -1 uninvolved fascial plane needed -Preop chemoXRT may help in limb salvage -Few indications for postop XRT to follow Which of the following is TRUE regarding surgical resection of sarcomas: A.A 1 cm margin is needed for resection B. At least 2 uninvolved fascial planes are needed medially and laterally when resecting extremity sarcomas C. Limb sparing resection should be attempted whenever possible D. Preop chemoradiation has no role in allowing limb sparing resection E. Postop radiation is not needed for possible involvement of nerves or vessels

C3 $300 Indications for postoperative radiation therapy include all of the following EXCEPT: A.High grade lesion B. Close margins C. Tumor >5 cm D. Close margins next to a nerve, vessel or bone E. Definitive involvement of a non-functional nerve

C3 $300 DISCUSS: -Non functional nerve needs resection (usually amputation) -Rest are all indications for postop XRT Indications for postoperative radiation therapy include all of the following EXCEPT: A.High grade lesion B. Close margins C. Tumor >5 cm D. Close margins next to a nerve, vessel or bone E. Definitive involvement of a non-functional nerve

C3 $400 Which of the following is FALSE in regards to resection of extremity sarcomas: A.Plan for en bloc resection with reconstruction of vessels that are involved B. May shave off a functioning nerve or vessel that is close but NOT involved with tumor  leave markers for postop XRT C. Consider en bloc resection or likely amputation for nonfunctioning/ involved nerve D. Amputation for bone involvement is usually avoidable

C3 $400 DISCUSS Which of the following is FALSE in regards to resection of extremity sarcomas: A.Plan for en bloc resection with reconstruction of vessels that are involved B. May shave off a functioning nerve or vessel that is close but NOT involved with tumor  leave markers for postop XRT C. Consider en bloc resection or likely amputation for nonfunctioning/ involved nerve D. Amputation for bone involvement is usually avoidable

Which of the following is FALSE: A.MC location of bone sarcoma is knee B. MC soft tissue sarcoma in children is rhabdomyosarcoma C. MC subtype for childhood soft tissue sarcoma is embryonal D. Surgical resection is generally indicated in childhood soft tissue sarcomas E. MC retroperitoneal sarcoma is liposarcoma Questions 1-5 Questions 1

The following is FALSE regarding Gardners syndrome: A.Autosomal dominant disease B. Includes FAP (Familial Adenomatous Polyposis) C. Includes desmoids D. Includes osteomas E. APC gene mutation is absent Questions 2

Which of the following is FALSE regarding work up for sarcomas: A.MRI is indicated prior to treatment to rule out invasion of bone, vessels and nerves B. CT Chest, abd, pelvis indicated for staging in all cases C. Core needle biopsy is adequate for diagnosis. Choose site wisely D. Excisional biopsy is indicated for lesions 6 cm in size E. Incisional biopsy may be used, if core needle not feasible, for lesion >4 cm. Choose site wisely Questions 3

Questions 4 Which of the following statement about sarcomas is false? A.The staging system includes the features of tumor (T), nodes (N), metastasis (M) and age (A) B. These rare tumors develop from mesenchymal tissue (bone, muscle, fat and other connective tissue) C. Core needle biopsy provides adequate tissue for diagnosis in soft tissue sarcomas D. Radiation therapy plays a major role in the management strategy for many sarcoma patients E. Resection with negative margins is a primary part of therapy for extremity soft tissue sarcomas

Questions 5 Heritable syndromes that include risk of sarcoma include all of the following except: A.Li-Fraumeni syndrome B. Neurofibromatosis type 1 C. MEN type 1 D. Familial retinoblastoma

Questions 1-5 Questions 1 Which of the following is FALSE: A.MC location of bone sarcoma is knee B. MC soft tissue sarcoma in children is rhabdomyosarcoma C. MC subtype for childhood soft tissue sarcoma is embryonal D. Surgical resection is generally indicated in childhood soft tissue sarcomas E. MC retroperitoneal sarcoma is liposarcoma

Questions 2 DISCUSS - APC gene mutation is present The following is FALSE regarding Gardners syndrome: A.Autosomal dominant disease B. Includes FAP (Familial Adenomatous Polyposis) C. Includes desmoids D. Includes osteomas E. APC gene mutation is absent

Questions 3 DISCUSS -Core needle biopsy if feasible -If not and < 4 cm  excisional biopsy -If not and >4 cm  incisional biopsy Which of the following is FALSE regarding work up for sarcomas: A.MRI is indicated prior to treatment to rule out invasion of bone, vessels and nerves B. CT Chest, abd, pelvis indicated for staging in all cases C. Core needle biopsy is adequate for diagnosis. Choose site wisely D. Excisional biopsy is indicated for lesions 6 cm in size E. Incisional biopsy may be used, if core needle not feasible, for lesion >4 cm. Choose site wisely

Questions 4 DISCUSS: - Grading is important. So the staging system is a GTNM (not just TNM) system Which of the following statement about sarcomas is false? A.The staging system includes the features of tumor (T), nodes (N), metastasis (M) and age (A) B. These rare tumors develop from mesenchymal tissue (bone, muscle, fat and other connective tissue) C. Core needle biopsy provides adequate tissue for diagnosis in soft tissue sarcomas D. Radiation therapy plays a major role in the management strategy for many sarcoma patients E. Resection with negative margins is a primary part of therapy for extremity soft tissue sarcomas

Questions 5 Heritable syndromes that include risk of sarcoma include all of the following except: A.Li-Fraumeni syndrome B. Neurofibromatosis type 1 C. MEN type 1 D. Familial retinoblastoma DISCUSS: - MEN1  Hyperparathyroidism, pituitary adenoma, pancreatic neuroendocrine tumors