click on link for photo as I cant get it up!!!
Here are some of the thoughts describing the lesion..
lots of good answers ……
Next steps.. what else would you check if you saw this mass..
Obviously easier to assess mass in person though!. Important to assess
size (and ask if got bigger and how quickly) texture and location
(whether cutaneous/SC or attached to deeper structures), if the mass elicits pain/heat. ALSO….
CORRECT… important to palpate local LN…this should be done as part of a normal full clinical examination!!
WHICH ONES HMMMMMM……..
Now onto monitoring the mass –
Back to the mass…we now want to investigate the mass further and are considering a FNA and a tru cut biopsy..
FNA are quick, easy (and cheap) to carry out…and can quickly tell you what CELL TYPE is involved in as Dan says
Cytology is so important! Can quickly dx common lesions!
Other Pro’s – quick, cheap, relatively non invasive, can establish dx and a treatment plan, anaesthesia not necessary, basic interpretation can be performed in practice (if familiar with cytology of course.. =] )
Also as Dan says…
CONS of FNA…
Correct – but needed to clarify about seeding.
Zoe says – Some “old school” practioners think you can seed a cutaneous or S/C mass by FNA, but this is very very unlikey to be a problem – It would be an issue for a subset of carcinomas in deeper tissues but she wouldnt worry about it in this.
Very important to take multiple samples…
Some more CONS of an FNA suggested by Dan
Now onto tru cut biopsies…
So….it was decided to take an FNA of the mass and this is what was found… DISCUSS..DESCRIPTION AND DIAGNOSIS.
loads of good answers..
Yep – LOOKS LIKE A MAST CELL TUMOUR!
Zoe then went on to talk about how to determine a “good” MCT from a “bad one..” in terms of cytology and granule numbers...
Quite a hard question and most of us got it wrong haha.. Here is the right answer…
“FEWER GRANULES” = LESS DIFFERENTIATED = “MORE BAD” – quote Zoe!
better differentiated = better prognosis (esp if solitary easily excised mass)…
more on GRADING/STAGING of a MCT..
Important to FNA the local lymph nodes, which are the most common
sites of metastasis.
FNA of a local node is NOT grading (1-3 for MCT) but is TMN STAGING.
Grading is ONLY done on the PRIMARY LESION and ONLY with histo.
more on mets..
Some good answers..
US scanning liver and spleen v important
can do US guided biopsies of these too…
Important to note :
Now onto excision…
a lot of us thought for a mast cell tumor confined to the dermis with no nodal involvement = complete excision with a wide margin of at least 3 cm…..
Zoe corrected us on this 3cm rule…
WHAT ABOUT GRADE 3 MCT!?!!??!!??! Zoe said:
Zoe then ended the discussion talking about chemotherpeutic options for MCT..
Yes – apparently prednisone is useful for inducting reduction of MCTs and may facilitate resection when adequate surgicalmargins cannot be confidently attained because of mass location or size or both….
CCNU is Lomustine by the way…
That is that then!
BYE BYE ZOE THANK YOUUUUU.