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  #1  
Old 05-24-2011
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GIT Iranian Woman with an Esophageal problem!

a 62 year old woman from iran complains upon swallowing tea. she states initially that the swallowing difficulty was only with meats but progressed to problems eating mashed and pureed food. she denies any other complaints before these symptoms occurred except for losing 15 lbs in 4 months. endoscopy is done and biopsies are taken. whic hof the flollowing results would be obtained?

a. exophytics lesions with atypical cells invading mucosa
b. flat lesions with gland-forming structures invading mucosa
c. lesions consisting of smooth muscle cells with no invasion
d. red velvety lesion conssitng of some cellular atypia but no invasion
e. web protruding into the lumen covered with squamous cells

im between a and e.

Last edited by absolutjag9; 05-24-2011 at 07:05 PM. Reason: photo
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  #2  
Old 05-24-2011
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Originally Posted by absolutjag9 View Post
a 62 year old woman from iran complains upon swallowing tea. see attached photo, please. im between a and e.
I believe her country of origin is a distractor, the 15 lb weight loss is probably due to her not being able to eat solids (aka meats), so this might be SCC of Esophagus? so I will guess

E)Web Protruding..........
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  #3  
Old 05-24-2011
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Quote:
Originally Posted by absolutjag9 View Post
a 62 year old woman from iran complains upon swallowing tea. she states initially that the swallowing difficulty was only with meats but progressed to problems eating mashed and pureed food. she denies any other complaints before these symptoms occurred except for losing 15 lbs in 4 months. endoscopy is done and biopsies are taken. whic hof the flollowing results would be obtained?

a. exophytics lesions with atypical cells invading mucosa
b. flat lesions with gland-forming structures invading mucosa
c. lesions consisting of smooth muscle cells with no invasion
d. red velvety lesion conssitng of some cellular atypia but no invasion
e. web protruding into the lumen covered with squamous cells

im between a and e.
I'm stuck between thinking it's either Achalasia or a Schatzki ring...

I don't think it's SCC of the Esophagus, because nothing in the history gives you any kind of risk factor for it, unless being from Iran increases the risk, which I don't think it does. If it's the ring then it'd be B, I think. If it's achalasia I don't know which one of the options really describes it best.

I'll go with B.
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Old 05-24-2011
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Quote:
Originally Posted by absolutjag9 View Post
a 62 year old woman from iran complains upon swallowing tea. she states initially that the swallowing difficulty was only with meats but progressed to problems eating mashed and pureed food. she denies any other complaints before these symptoms occurred except for losing 15 lbs in 4 months. endoscopy is done and biopsies are taken. whic hof the flollowing results would be obtained?

a. exophytics lesions with atypical cells invading mucosa
b. flat lesions with gland-forming structures invading mucosa
c. lesions consisting of smooth muscle cells with no invasion
d. red velvety lesion conssitng of some cellular atypia but no invasion
e. web protruding into the lumen covered with squamous cells

im between a and e.


I Think is A
She have esophageal cancer....because there is progressive dysphagia from solids------to liquids!! This type of cancer can come from different risk factore, which can be Achalasia, Barretts esophagus, Esophageal webs, etc. So i go with A......
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Old 05-24-2011
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IŽll go w/ a)
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Old 05-24-2011
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thanks everyone for your input. i don't have answer to the question but i thought it was SCC of esophagus due to 1)she's from iran-and worldwide SCC is MCC of esophageal cancer, compared to US which is opposite-adenocarcinoma is more common there and 2) she had progressive dysphagia-this is more common with cancer, compared to achlasia which is less gradual dysphagia. i was divided btwn A and E because part of me thought she may have plummer vinson which may lead to development of SCC..but the question doesn't mention glossitis or iron deficiency anemia as findings so E should be out then. The Schatzki rings are usually producing episodic dysphagia with solid foods (it seems to patient that the food sticks and that they must swallow more to get it down) but I've had many qs where that is right answer. B may be adenocarcinoma description, D is Barrett's? E is esophageal webs found commonly in pts with Plummer vinson and C is a ring description? IDK.
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Originally Posted by absolutjag9 View Post
thanks everyone for your input. i don't have answer to the question but i thought it was SCC of esophagus due to 1)she's from iran-and worldwide SCC is MCC of esophageal cancer, compared to US which is opposite-adenocarcinoma is more common there and 2) she had progressive dysphagia-this is more common with cancer, compared to achlasia which is less gradual dysphagia. i was divided btwn A and E because part of me thought she may have plummer vinson which may lead to development of SCC..but the question doesn't mention glossitis or iron deficiency anemia as findings so E should be out then. The Schatzki rings are usually producing episodic dysphagia with solid foods (it seems to patient that the food sticks and that they must swallow more to get it down) but I've had many qs where that is right answer. B may be adenocarcinoma description, D is Barrett's? E is esophageal webs found commonly in pts with Plummer vinson and C is a ring description? IDK.

Didn't the qbank provide an answer?
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no it's from a website without an explanation to the q
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no it's from a website without an explanation to the q
Oh alright, that sucks!
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Old 05-24-2011
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she is from iran so she drinks hot tea so much so she is in high risk of esophageal cancer so much! as in iran stomach and esophageal cancer is in high rates!
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Old 05-25-2011
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its A....
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Old 05-25-2011
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Esophageal SCC is more common than usual in the Caspian basin area, which includes Iran. The answer is A. Iran IS the clue and THE risk factor.
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