BREAST CANCERCASE STUDY

FRAZER BELLSTUDENT BMS

BSc APPLIED BIOMEDICAL SCIENCE

PATIENT HISTORY

• 70 YEAR OLD FEMALE• PRESENTED AT GP SURGERY 02/OCT/2012• EXAMINATION: RIGHT NIPPLE DRAWING IN &

FIRM PALPABLE LUMP• REFERRED TO THE BREAST CLINIC

BREAST CLINIC

• ATTENDED 18/OCT/2012• EXAMINATION: INVERTED NIPPLE

RETRACTION AND PALPABLE LUMP• ? PALPABLE LUMP RIGHT AXILLA• GRADED P5: MALIGNANT• FURTHER INVESTIGATIONS: MAMMOGRAM,

ULTRASOUND & BREAST CORE BIOPSY

MAMMOGRAPHY

•AREA OF SUSPICIOUS ABNORMALITY ON RIGHT BREAST

•GRADED M4: PROBABLY MALIGNANT

ULTRASOUND

• ULTRASOUND : CORRESPONDING 2CM AREA

• GRADED U4: PROBABLY MALIGNANT

BIOPSY

• ULTRASOUND GUIDED BREAST CORE BIOPSIES FROM THE RIGHT BREAST

• ONE 13MM FIBROFATTY CORE PLUS 4 FIBROFATTY FRAGMENTS

NORMAL BREAST TISSUE

PATHOLOGY

GRADED: B5b Infiltrating Breast Carcinoma

IMMUNOCYTOCHEMISTRY

E-CAD NEGATIVE

RECEPTOR STATUS

• OESTROGEN RECEPTOR & HER-2 STATUS• DETERMINE RECEPTOR STATUS FOR

HORMONE THERAPY

OESTROGEN RECEPTOR STATUS

NEGATIVE CONTROLOESTROGEN POSITIVE

PROGESTERONE REC. STATUS

NEGATIVE CONTROLPROG POSITIVE

HER-2 STATUS

NEGATIVE CONTROLHER2 NEGATIVE

TREATMENT PLAN

• BREAST MDT MEETING• MASTECTOMY WITHOUT NEOADJUVANT

TREATMENT • SENTINEL LYMPH NODE BIOPSY• SURGERY DATE 06/NOV/2012

PRE-OP ASSESSMENT

• ADMITTED PRE-OP CLINIC 01/NOV/2012• LABS TESTS: PRE-OP BLOODS• HYPERTENSIVE• MEDICAL WARD: ECG CONFIRMED LVH• SURGERY CANCELLED

TREATMENT PLAN

• REDUCE BLOOD PRESSURE VIA ACE INHIBITORS

• CHEST X-RAY & U/S OF KIDNEYS• STARTED ON LETROZOLE 2.5mg DAILY• BP MONITORED FORTNIGHTLY• RE-ASSESSMENT FOR SURGERY IN JANUARY

SURGERY

• BP STABILISED• ADMITTED TO SURGICAL WARD 13/FEB/13• SURGERY 25/FEB/13

• RIGHT BREAST MASTECTOMY • SENTINEL LYMPH NODE BIOPSY

MASTECTOMY

• 19MM AND 7MM FIRM NODULES UPON DISSECTION

• NO LYMPHOVASCULAR INVASION• 12MM CLEARANCE DEEP MARGIN

HISTOPATHOLOGY TUMOUR

GRADE 2 INVASIVE LOBULAR CARCINOMA

SENTINEL LYMPH NODE

• FIVE SENTINEL NODES• FOUR NEGATIVE• ONE POSITIVE DEPOSIT OF METASTATIC

TUMOUR• ICC: AE1/AE3 CYTOKERATIN

SENTINEL LYMPH NODE

AE1/AE3 POSITIVE H&E SENTINEL NODE

POST-OPERATIVE

• GRADE 2 INVASIVE LOBULAR CARCINOMA• CLOSEST RELEVANT MARGIN 12MM• SINGLE NODE POSITIVITY

• STAGING INVESTIGATIONS REQUIRED

STAGING INVESTIGATIONS

• STAGING INVESTIGATIONS TO EXCLUDE METASTASES

• CT SCAN - NEGATIVE• BONE SCAN - NEGATIVE

FUTURE

• PATIENT DECLINED CHEMOTHERAPY

• WILL ATTEND THE BEATSON CANCER CENTRE• RADIOTHERAPY TREATMENT• CONTINUE LETROZOLE

ACKNOWLEDGEMENTS

• CONS. PATHOLOGIST Dr. A. W. Milne• CROSSHOUSE PATHOLOGY DEPT.

THANK YOU