Chapter 11 Scenario Two clinics have identical performance: Average waiting time = 30 minutes Same arrival rate and staffing However: Clinic A: patients are always seen within 25–35 minutes Clinic B: patients are seen between 5–90 minutes Question Which clinic will patients perceive as better? Little’s Law:

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Patient presented for TURP. The medical record only tells us that the patient has elevated PSA of 9.62. Biopsy revealed prostatic adenocarcinoma, in the right and left apex, Gleason score of 9. MRI of Pelvis revealed extraprostatic extension of the prostatic mass, no LAD seen. Radical prostatectomy performed revealing prostate carcinoma, with extraprostatic extension, no seminal vesicle involvement, Gleason score of 10, 1/4 external iliac LN pos, margins are clear. What is the pathological Stage group?

Patient presented for TURP. The medical record only tells us that the patient has elevated PSA of 9.62. Biopsy revealed prostatic adenocarcinoma, in the right and left apex, Gleason score of 9. MRI of Pelvis revealed extraprostatic extension of the prostatic mass, no LAD seen. Radical prostatectomy performed revealing prostate carcinoma, with extraprostatic extension, no seminal vesicle involvement, Gleason score of 10, 1/4 external iliac LN pos, margins are clear. What is the Pathological N category?

Patient presented for TURP. The medical record only tells us that the patient has elevated PSA of 9.62. Biopsy revealed prostatic adenocarcinoma, in the right and left apex, Gleason score of 9. MRI of Pelvis revealed extraprostatic extension of the prostatic mass, no LAD seen. Radical prostatectomy performed revealing prostate carcinoma, with extraprostatic extension, no seminal vesicle involvement, Gleason score of 10, 1/4 external iliac LN pos, margins are clear. What is the Summary Stage?

Patient presented for a TURB which revealed a bladder neck mass showing Urothelial Carcinoma and Papillary Urothelial Carcinoma.  What is the histology and what was the H rule? (there will be more than one answer) 

Patient had a PET scan revealed hilar lymphadenopathy, supraclavicular lymphadenopathy, and multiple lung lesions. Biopsy of the hilar nodes revealed diffuse large b-cell lymphoma. What is the AJCC Clinical stage group?

Patient presented for hematuria. CTAP revealed no abnormalities seen. Cystoscopy with transurethral resection of the bladder was performed revealing papillary urothelial carcinoma invades subepithelial connective tissue, LG. What is the Clinical AJCC stage group?

Colonoscopy: 5cm circumferential mass in the sigmoid colon. Biopsy revealed mucinous adenocarcinoma, G1. CTAP colon wall thickening c/w known colon malignancy.  No lymph nodes noted in imaging. Hemicolectomy performed revealing mucinous adenocarcinoma of sigmoid colon, G2, invading pericolorectal tissue, 0/12 pericolorectal nodes, one tumor deposit, margins clear. What is the pathological stage group?

CT Chest revealed 2cm nodule in the RUL c/w bronchogenic malignancy, right lower paratracheal lymph nodes suspicious for involvement. PET scan showed 2.2cm mass with pericardial effusion. Cytology pericardial effusion positive for carcinoma. What is the Clinical AJCC M category?