Surgery videos & books

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Correct Answer - C Total gastrectomy with adjuvant chemotherapy is the treatment of choice [Ref: Sabiston 18/e p1269 (17/c p1312); Harrison 17/e, p 573; Schwartz 9/e p935 (8/e, p981)] Stomach is the most common extranodal site of lymphoma. It is of two types - Primary & Secondary Primary gastric lymphoma - is lymphoma of the stomach which exhibits no evidence of liver, spleen, mediastinal lymph nodes or bone marrow involvement at the time of diagnosis (regional lymph node involvement may be present) Primary gastric lymphoma is mainly (>95%) Non-Hodgkin's lymphoma of B cell origin. Most of the primary lymphomas (about 60%) arise in MALT (mucosa associated lymphoid tissue). MALT is usually associated with chronic H. pylori infection. So low-grade MALT lymphomas are thought to arise because of chronic H. pylori infection. These low grade lymphomas may later on degenerate to high grade lymphomas Immunodeficiency and H. pylori infection are risk factors for B cell lymphoma. Most common site of involvement (like that of adenocarcinoma) is gastric antrum. Secondary gastric lymphoma Stomach is the most common extranodal site of systemic lymphoma. Almost all of them are Non-Hodgkins types Treatment The role of gastric resection is controversial. Recent studies have shown similar disease free 5 year survival rates in patients treated with surgery+chemotherapy+radiotherapy and patients treated with chemotherapy+ radiation therapy alone. (Most patients with high grade gastric lymphomas are now treated with chemoradiation alone, without surgical resection. For disease limited to the stomach and regional nodes, radical subtotal gastrectomy may be performed, esnecially for bulky tumors with bleeding and/or obstruction.) ommon chemotherapeutic regimen is - CHOP plus rituximab 5/676 stands for cyclophosphamide, doxorubicin, vincristine, & prednisole

Tomosynthesis (3D mammography) performed along with conventional 2D mammography has high detection rates for breast carcinoma. Hence, among the given options, this is the best method. Breast Tomosynthesis: It is typically performed in conjunction with conventional mammography. Hence, the radiation dose is doubled. However, the accuracy is improved and false positives are lesser. It can be used for dense breasts and those with high risk factors. Screen-film mammography is the conventional 2D mammography. Digital mammography/full-field digital mammography uses digital technology instead of films. The diagnostic accuracy is similar to that of screen-film mammography. A minor advantage is the greater accuracy in predicting lesions in dense breasts. Note: Overall, the best modality for detecting breast carcinoma is MRI.

Category/score 0 in BIRADS suggests incomplete assessment.

Trucut/core-needle biopsy is the investigation of choice for confirming the diagnosis of breast carcinoma. If it is inconclusive excisional biopsy can be done. Trucut needle biopsy: A 14 G-16 G needle is used. It permits the analysis of breast tissue architecture. The advantages include a low complication rate, minimal scarring, and a lower cost as compared to excisional breast biopsy. Fine-needle aspiration cytology (FNAC) is a cytological investigation and, hence, not the investigation of choice. It is, however, the initial investigation in many cases. A 22-30 G needle is used for FNAC. Image-guided biopsy is used only in the ca non-palpable lesions.

Cluster microcalcification in mammography indicates maximum risk of malignancy. Types of microcalcification indicating malignancy (in decreasing order of risk::: • Cluster microcalcification (maximum risk) • Linear microcalcification Segmental microcalcification Diffuse microcalcification (minimum risk)

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