Question

A: You have a patient with the following pathology report

• Patient is a 47 year-old female with liver tumor
• Biopsy reveals tumor with very high mitotic index and many large,irregular nuclei
• TNM staging results indicate T3N1M0
• Based upon the above data, the patient has

Select one:

a. Low 1 hepatosarcoma

b. High grade hepatoma

c. High grade hepatocarcinoma

d. High grade adenoma

e. Low grade chondrosarcoma

B: You have a patient with the following pathology report

• Patient is a 47 year-old female with liver tumor
• Biopsy reveals tumor with very high mitotic index and many large,irregular nuclei
• TNM staging results indicate T3N1M0

Based upon the above data, the patient has

Select one:

a. Stage III, large tumor mass spread to the lymph nodes and a distant metastasis

b. Stage IV , large tumor mass spread to the lymph nodes and a distant metastasis

c. Stage II, large tumor mass spread to lymph nodes only

d. Stage I, localized large tumor mass; no evidence of spread to lymph nodes or distant metastasis

e. Stage II, large tumor mass; no evidence of lymph node cancer, however, presence of distant metastasis

Answer 1

A)

Correct choice is C

Predisposing factors are chronic hepatitis, alcoholic liver disease, cirrhosis etc.

From the description its evident that its a malignant tumour. High mitotic index, high nucleocytoplasmic ratio, nodal metastasis etc favour malignancy. Adenoma and hepatoma are benign tumors.

Most common hepatic malignancy is hepatocellular carcinoma. Hepatosarcoma and chondrosarcoma are rare.

Other common hepatic malignancies are fibrolamellar carcinoma, intrahepatic cholangio carcinoma, hepatoblastoma and metastasis.

B)

Correct choice is C

Stage II with large tumour mass spread to lymphnodes only.

TNM is staging of a tumour. T represent tumour characteristics. N is lymphnode spread and M is distant metastasis.

M0 means no distant metastasis.  

So choices a, b and e are ruled out.

N1 means there is Lymphnode node involvement. So d is ruled out.

There are different staging systems. AJCC is the most standard one. Given system is not AJCC.