A 9-year-old boy develops acute myelogenous leukemia (AML) one year after completion of therapy for soft tissue sarcoma at his right thigh. Which of the following chemotherapeutic agents is MOST likely the cause of secondary acute myelogenous leukemia AML in this boy?

Correct Answer: C

Rationale: The correct answer is C) etoposide. Etoposide is known to be associated with secondary acute myelogenous leukemia (AML) as a long-term complication of its use in cancer therapy. Etoposide can cause damage to the DNA of hematopoietic stem cells, leading to the development of AML later on. A) Cyclophosphamide is not typically associated with secondary AML as a long-term complication. B) Vincristine is not known to cause secondary AML. D) Doxorubicin is not commonly associated with secondary AML. In an educational context, it is essential for healthcare providers to be aware of the potential long-term side effects of chemotherapeutic agents. Understanding the specific risks associated with each drug can help in making informed decisions when selecting treatment options for pediatric patients. Monitoring for late effects, such as secondary malignancies, is crucial in survivorship care for pediatric oncology patients.

Correct Answer: B

Rationale: The correct answer is B) concomitant chemotherapy-radiotherapy. This approach is based on the standard treatment protocol for Wilms tumor, which involves a combination of surgery, chemotherapy, and sometimes radiotherapy. The rationale for using concomitant chemotherapy-radiotherapy in this case is to target any remaining cancer cells after surgery and reduce the risk of recurrence. Option A) radiotherapy alone is not the best approach for Wilms tumor as it is typically used in combination with chemotherapy to achieve better outcomes. Option C) another surgery is not recommended as the primary treatment for Wilms tumor is surgical resection of the tumor followed by adjuvant therapy. Option D) observation is not appropriate for a child with a known Wilms tumor rupture, as immediate intervention is necessary to prevent disease progression. In an educational context, understanding the treatment approach for Wilms tumor is crucial for healthcare providers caring for pediatric patients. By knowing the standard protocols and rationale behind treatment options, medical professionals can make informed decisions to provide the best possible care for children with cancer. It highlights the importance of a multidisciplinary approach involving surgery, chemotherapy, and radiotherapy in the management of Wilms tumor to optimize patient outcomes.

Correct Answer: C

Rationale: In this scenario, the correct statement that should be included in the discussion with parents of a 12-year-old girl diagnosed with papillary thyroid carcinoma (PTC) is option C) supraphysiologic levothyroxine therapy is required during long-term follow-up. The rationale for why option C is correct lies in the fact that after surgical treatment for PTC, patients often require lifelong thyroid hormone replacement therapy to suppress thyroid-stimulating hormone (TSH) levels, which helps prevent cancer recurrence. Supraphysiologic doses of levothyroxine are often needed to achieve this TSH suppression. Option A is incorrect because PTC, although it can be serious, does not always have a grim overall prognosis, especially when detected early and managed appropriately. Option B is incorrect because radioactive iodine therapy is often used in the treatment of differentiated thyroid cancers, including PTC. Option D is incorrect because calcitonin and carcinoembryonic antigen monitoring are more relevant for medullary thyroid carcinoma, not papillary thyroid carcinoma. In an educational context, understanding the nuances of managing thyroid cancer is crucial for healthcare providers to provide accurate information and support to patients and their families. Knowledge of the specific treatment protocols and follow-up care for different types of thyroid cancer is essential for optimizing patient outcomes and quality of life.

Correct Answer: D

Rationale: Granulocytic sarcoma, also known as chloroma, is a rare extramedullary tumor composed of immature granulocytic cells. It is commonly associated with acute myeloid leukemia (AML). The correct answer is D) AML because granulocytic sarcoma is a potential presenting feature of AML, often occurring before the diagnosis of leukemia is established. Option A) neuroblastoma is incorrect as it is a tumor of neuroblasts arising in sympathetic ganglia and the adrenal medulla, not associated with granulocytic sarcoma. Option B) rhabdomyosarcoma is a soft tissue tumor that arises from skeletal muscle progenitor cells, not related to granulocytic sarcoma. Option C) soft tissue sarcoma encompasses various types of tumors arising from soft tissues, but it is not specifically associated with granulocytic sarcoma. In an educational context, understanding the association of granulocytic sarcoma with AML is important for healthcare providers, especially in pediatrics. Recognizing this relationship can aid in early diagnosis and appropriate management of AML, improving patient outcomes. This question also highlights the need for clinicians to consider rare manifestations of malignancies in pediatric patients, emphasizing the importance of a comprehensive approach to diagnosis and treatment.

Correct Answer: A

Rationale: In this scenario, the correct answer is A) CT scan of the neck and chest. Neuroblastoma is a type of cancer that arises from immature nerve cells and commonly presents with symptoms such as ptosis, miosis, and Horner syndrome, which includes loss of sweating on one side of the face. The most common site for neuroblastoma is the abdomen, particularly the adrenal glands. Therefore, a CT scan of the neck and chest would be the most valuable investigation to confirm the diagnosis as it can help visualize any potential primary tumor or metastasis in these regions. Option B) CT scan of the abdomen is less likely to be the most valuable investigation in this case because while neuroblastoma commonly originates in the abdomen, the presenting symptoms in the child are suggestive of involvement of the sympathetic chain in the neck and chest. Option C) CT scan of the brain is not the most appropriate investigation for confirming a diagnosis of neuroblastoma as the symptoms and location of findings in this case are not indicative of brain involvement. Option D) MRI of the brain is also not the most valuable investigation in this case as it is more useful for evaluating brain structures rather than identifying tumors in the neck and chest regions. In an educational context, understanding the appropriate diagnostic approach in pediatric cases is crucial for healthcare providers working with children. Knowing the typical presentation and common locations of pediatric cancers like neuroblastoma can guide providers in ordering the most relevant investigations to confirm a diagnosis promptly and accurately, leading to timely initiation of treatment and better outcomes for the child.