breast cancer case study frazer bell student bms bsc applied biomedical science
TRANSCRIPT
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