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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor={{Rim}}, {{AJL}} {{Alison}}
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pathology
|MainCategory=Pathology
Line 20: Line 20:
|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Gastrointestinal
|SubCategory=Gastrointestinal
|Prompt=A 62-year-old male complains of four months history of worsening abdominal pain.  The pain is localized in the epigastric area and it is dull in nature, constant and progressively increasing in intensity independently from food intake or change in posture. Review of system is significant for several months history of increasing fatigue and weight loss. CT scan reveals a mass in the stomach.  Endoscopy guided biopsy of the mass reveals extensive aggregation of spindle cells highly suspicious of gastrointestinal stromal tumor (GIST). Immunohistochemistry of which of the following is diagnostic of GIST?
|Prompt=A 62-year-old male presents to the physician's office with complaints of abdominal pain, which has been worsening over the past four months.  The dull pain is localized in the epigastric area and persistently increasing in intensity, independently from food intake or change in posture. Upon further questioning, he describes symptoms of increasing fatigue and weight loss. A CT scan displays a mass in the stomach and an endoscopy-guided biopsy of the mass reveals clusters of thin, elongated spindle cells. Which of the following immunohistochemistry findings is most helpful in diagnosing the type of tumor in this patient?
|Explanation=The patient's symptoms of [[epigastric pain]], [[fatigue]], [[weight loss]] along with the CT finding of mass in the [[stomach]] points towards the diagnosis of [[malignancy]].  The spindle cells on pathology suggest the diagnosis of GIST which can be confirmed by positive immunohistochemistry for C-kit.
|Explanation=The patient's symptoms of epigastric pain, fatigue, and weight loss,  in conjunction with the CT finding of a mass in the stomach, points towards the diagnosis of malignancy.  The spindle cells on pathology are often diagnostic for a [[gastrointestinal stromal tumor]] (GIST), which can be confirmed by positive immunohistochemistry for C-kit.


Educational objective: [[C-kit]], also called [[CD 117]], is associated with [[gastrointestinal stromal tumor]]s (GIST).
|EducationalObjectives= [[C-kit]], also called [[CD 117]], is often associated with [[gastrointestinal stromal tumor]]s (GIST).
|AnswerA=C-kit
|AnswerA=C-kit
|AnswerAExp=[[C-kit]] oncogene is associated with [[GIST]]. This is the correct answer. C kit gene encodes the human homolog of the proto-oncogene c-kit, also called CD117.
|AnswerAExp= [[C-kit]] oncogene is associated with [[GIST]]. [[C-kit]] gene encodes the human homolog of the proto-oncogene c-kit, also called CD117.
|AnswerB=Ret
|AnswerB=Ret
|AnswerBExp=[[Ret gene|Ret oncogene]] is associated with [[MEN|MEN syndrome]] type IIa and IIb.
|AnswerBExp= The [[Ret gene|Ret oncogene]] is often associated with [[MEN|MEN syndrome]], type IIa and IIb.
|AnswerC=Abl
|AnswerC=Abl
|AnswerCExp=[[Abl gene|Abl oncogene]] is associated with CML.
|AnswerCExp= The [[Abl gene|Abl oncogene]] is often associated with CML.
|AnswerD=Ras
|AnswerD=Ras
|AnswerDExp=[[Ras]] oncogene is associated with colon carcinoma.
|AnswerDExp= The [[Ras]] oncogene is often associated with colon carcinoma.
|AnswerE=C-myc
|AnswerE=C-myc
|AnswerEExp=C-myc is associated with [[Burkitt's lymphoma]].
|AnswerEExp= [[C-myc]] is associated with [[Burkitt's lymphoma]].
|RightAnswer=A
|RightAnswer=A
|Approved=No
|Approved=Yes
}}
}}

Revision as of 13:31, 11 July 2014
Author [[PageAuthor::Rim Halaby, M.D. [1], Alison Leibowitz [2] (Reviewed by Alison Leibowitz)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pathology
Sub Category SubCategory::Gastrointestinal
Prompt [[Prompt::A 62-year-old male presents to the physician's office with complaints of abdominal pain, which has been worsening over the past four months. The dull pain is localized in the epigastric area and persistently increasing in intensity, independently from food intake or change in posture. Upon further questioning, he describes symptoms of increasing fatigue and weight loss. A CT scan displays a mass in the stomach and an endoscopy-guided biopsy of the mass reveals clusters of thin, elongated spindle cells. Which of the following immunohistochemistry findings is most helpful in diagnosing the type of tumor in this patient?]]
Answer A AnswerA::C-kit
Answer A Explanation [[AnswerAExp::C-kit oncogene is associated with GIST. C-kit gene encodes the human homolog of the proto-oncogene c-kit, also called CD117.]]
Answer B AnswerB::Ret
Answer B Explanation [[AnswerBExp::The Ret oncogene is often associated with MEN syndrome, type IIa and IIb.]]
Answer C AnswerC::Abl
Answer C Explanation [[AnswerCExp::The Abl oncogene is often associated with CML.]]
Answer D AnswerD::Ras
Answer D Explanation [[AnswerDExp::The Ras oncogene is often associated with colon carcinoma.]]
Answer E AnswerE::C-myc
Answer E Explanation [[AnswerEExp::C-myc is associated with Burkitt's lymphoma.]]
Right Answer RightAnswer::A
Explanation [[Explanation::The patient's symptoms of epigastric pain, fatigue, and weight loss, in conjunction with the CT finding of a mass in the stomach, points towards the diagnosis of malignancy. The spindle cells on pathology are often diagnostic for a gastrointestinal stromal tumor (GIST), which can be confirmed by positive immunohistochemistry for C-kit.

Educational Objective: C-kit, also called CD 117, is often associated with gastrointestinal stromal tumors (GIST).
References: ]]

Approved Approved::Yes
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