Binder1.pdf

A)large cell lymphoma (BIA-ALCL), a type ofT-cell lymphoma, is associated with textured implants. Initial diagnosis is often made following ultrasound. CD30 is a cell surface marker detected on T-cells associated with BIA-ALCL. The other cell surface markers are not associated with BIA-AL...

A)large cell lymphoma (BIA-ALCL), a type ofT-cell lymphoma, is associated with textured implants. Initial diagnosis is often made following ultrasound. CD30 is a cell surface marker detected on T-cells associated with BIA-ALCL. The other cell surface markers are not associated with BIA-ALCL. These cells are also anaplastic lymphoma kinase (ALK) negative. CD3 and CD15 are nonspecific lymphocyte markers not related to BIA-ALCL. CD34 is an endothelial cell marker. CD45 is a marker expressed on all leukocytes. A) Large defects of the femur and tibia are typically reconstructed with intercalary allografts due to their high mechanical strength. This type of reconstruction can be augmented with an intramedullary free fibula flap, which has been shown to reduce long-term complications. Cancellous bone grafts offer superior osteogenesis, osteoinduction, and graft take in comparison with cortical grafts and allografts. Cost is not a significant consideration in reconstructing these highly complex defects. While an allograft has no donor site morbidity compared with autologous cancellous bone grafts, this is not the primary reason for their use in the described clinical scenario. A) Perineural involvement is the factor most associated with high risk for recurrence of basal cell carcinoma. Poorly defined borders, a recurrent lesion, an immunosuppressed patient, the site of prior radiotherapy, perineural involvement, and an aggressive histologic subtype (morpheaform, basosquamous, sclerosing, mixed infiltrative, or micronodular) are the factors associated with a high risk for recurrence of basal cell carcinoma. Poorly defined borders, recurrent disease, an immunosuppressed patient, the site of prior radiotherapy or chronic inflammation, a rapidly growing tumor, neurologic symptoms, perineural or vascular involvement, poor differentiation, or adenoid, adenosquamous, or desmoplastic subtypes are the factors associated with a high risk for recurrence of squamous cell carcinoma. A) for breast reconstruction, only the superficial inferior epigastric artery (SIEA) flap does not violate the abdominal fascia. Each of the other flaps are associated with abdominal bulge or hernia formation. Pedicled and free transverse rectus abdominus myocutaneous (TRAM) flaps both involve the harvest of significant abdominal muscle and are associated with more abdominal wall dysfunction than with deep inferior epigastric perforator (DIEP) flaps. It is unclear whether there is a difference in abdominal wall morbidity following muscle-sparing free TRAMs versus DIEPs. However, only the SIEA flap offers no muscle dissection or violation of the abdominal fascia. A) The most effective and reasonable treatment option would be systemic sirolimus therapy. Recent studies have shown that sirolimus is extremely effective in treating and clinically reducing the size of venous (90%) and lymphatic malformations (LM) (95%). It is especially useful in treating vascular tumors associated with Kasabach-Merritt phenomenon (96%, along with 93% normalization of coagulopathy). Propranolol therapy and intralesional steroid injection are treatments for hemangiomas, not malformations. Sclerotherapy would be useful in macrocystic LM but not microcystic LM. Surgical excision would be too destructive an option in this case given the location, diffuse nature of the disease, and the structures involved. indicated in cases of mastodynia, neck/back pain secondary to large size, difficulty with clothing due to asymmetry, and to alleviate patient concern. The differential diagnosis would include phyllodes tumor, breast hypertrophy, or cystic enlargement. Carcinoma would be unlikely in this age demographic. Phyllodes tumors are large, benign tumors that typically occur in the perimenopausal patient. They are histologically distinct from fibroadenomas, and transformation of a fibroadenoma to a phyllodes tumor is exceptionally rare. Juvenile breast hyp ertrophy may present as unilateral or bilateral breast enlargement. The enlargement is diffuse without evidence of a discrete mass or nodularity. Juvenile breast hypertrophy typically presents in early puberty, rarely regresses spontaneously, and is much more severe than simple breast hypertrophy. The underlying cause is attributed to estrogen stimulation at the onset of the first menses. Treatment is reduction mammoplasty.