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  #1  
Old 07-30-2011
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A 16-year-old boy presented with multiple flesh-colored papules and dermal nodules on his eyelids, lips, and tongue (Panels A, B, and C, respectively). Six years earlier, his mother had received a diagnosis of metastatic cancer, at the age of 38 years. At that time, both of her sons were found to have markedly elevated serum ??? levels
Which lab test is indicated
A. Alpha-fetoprotein
B. Beta2-microglobulin
C. Calcitonin
D. Insulin-like growth factor-1
E. Red-cell transketolase
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Last edited by axax; 07-30-2011 at 11:22 PM.
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Old 07-30-2011
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I agree

Quote:
Originally Posted by axax View Post
Which lab test is indicated
A. Alpha-fetoprotein
B. Beta2-microglobulin
C. Calcitonin
D. Insulin-like growth factor-1
E. Red-cell transketolase
insulin like growth factor.......
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  #3  
Old 07-30-2011
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should be calcitonin

you must complete the question.you cannot answer this question just by photo. need some clinical scenario too.
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Last edited by dr_lizard; 07-30-2011 at 10:49 PM.
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  #4  
Old 07-31-2011
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Quote:
Originally Posted by axax View Post
A 16-year-old boy presented with multiple flesh-colored papules and dermal nodules on his eyelids, lips, and tongue (Panels A, B, and C, respectively). Six years earlier, his mother had received a diagnosis of metastatic cancer, at the age of 38 years. At that time, both of her sons were found to have markedly elevated serum ??? levels
Which lab test is indicated
A. Alpha-fetoprotein
B. Beta2-microglobulin
C. Calcitonin
D. Insulin-like growth factor-1
E. Red-cell transketolase
calcitonin
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  #5  
Old 07-31-2011
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i think its men2b.. so calcitonin
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Old 07-31-2011
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Quote:
Originally Posted by axax View Post
A 16-year-old boy presented with multiple flesh-colored papules and dermal nodules on his eyelids, lips, and tongue (Panels A, B, and C, respectively). Six years earlier, his mother had received a diagnosis of metastatic cancer, at the age of 38 years. At that time, both of her sons were found to have markedly elevated serum ??? levels
Which lab test is indicated
A. Alpha-fetoprotein
B. Beta2-microglobulin
C. Calcitonin
D. Insulin-like growth factor-1
E. Red-cell transketolase
Calcitonin!
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  #7  
Old 07-31-2011
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I agree, i'll go with Calcitonin.
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  #8  
Old 07-31-2011
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Correct! Calcitonin
This patient had multiple flesh-colored papules on the eyelids, lips, and tongue. This phenotype is suggestive of multiple endocrine neoplasia (MEN) type 2B (MEN-2B), an autosomal dominant condition characterized by medullary thyroid cancer among other features. Serum calcitonin can be used to screen for medullary thyroid cancer

A 16-year-old boy presented with multiple flesh-colored papules and dermal nodules on his eyelids, lips, and tongue (Panels A, B, and C, respectively). Six years earlier, his mother had received a diagnosis of metastatic medullary thyroid cancer, at the age of 38 years. At that time, both of her sons were found to have markedly elevated serum calcitonin levels but no biochemical evidence of pheochromocytoma. Both boys subsequently underwent total thyroidectomy. On pathological examination, a medullary thyroid tumor measuring 0.5 cm by 0.5 cm had been discovered in the thyroid gland of this patient. This clinical history is suggestive of the multiple endocrine neoplasia type 2B syndrome, an autosomal dominant condition characterized by medullary thyroid cancer, pheochromocytoma, mucosal neuromas, intestinal ganglioneuromas, and marfanoid body habitus. Although comprehensive genotyping of the RET proto-oncogene was not available at the time of this family's presentation, such analysis now allows for highly specific screening of family members and subsequent initiation of genetic counseling, pheochromocytoma screening, and prophylactic thyroidectomy. The boy continues to receive levothyroxine replacement therapy and appropriate screening investigations.
Source -> http://www.nejm.org
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