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BREAST CANCER CASE STUDY

BREAST CANCER CASE STUDY. FRAZER BELL STUDENT 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

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BREAST CANCER CASE STUDY

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  1. BREAST CANCERCASE STUDY FRAZER BELL STUDENT BMS BSc APPLIED BIOMEDICAL SCIENCE

  2. 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

  3. 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

  4. MAMMOGRAPHY • AREA OF SUSPICIOUS ABNORMALITY ON RIGHT BREAST • GRADED M4: PROBABLY MALIGNANT

  5. ULTRASOUND • ULTRASOUND : CORRESPONDING 2CM AREA • GRADED U4: PROBABLY MALIGNANT

  6. BIOPSY • ULTRASOUND GUIDED BREAST CORE BIOPSIES FROM THE RIGHT BREAST • ONE 13MM FIBROFATTY CORE PLUS 4 FIBROFATTY FRAGMENTS

  7. NORMAL BREAST TISSUE

  8. PATHOLOGY GRADED: B5b Infiltrating Breast Carcinoma

  9. IMMUNOCYTOCHEMISTRY E-CAD NEGATIVE

  10. RECEPTOR STATUS • OESTROGEN RECEPTOR & HER-2 STATUS • DETERMINE RECEPTOR STATUS FOR HORMONE THERAPY

  11. OESTROGEN RECEPTOR STATUS NEGATIVE CONTROL OESTROGEN POSITIVE

  12. PROGESTERONE REC. STATUS PROG POSITIVE NEGATIVE CONTROL

  13. HER-2 STATUS HER2 NEGATIVE NEGATIVE CONTROL

  14. TREATMENT PLAN • BREAST MDT MEETING • MASTECTOMY WITHOUT NEOADJUVANT TREATMENT • SENTINEL LYMPH NODE BIOPSY • SURGERY DATE 06/NOV/2012

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

  16. 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

  17. SURGERY • BP STABILISED • ADMITTED TO SURGICAL WARD 13/FEB/13 • SURGERY 25/FEB/13 • RIGHT BREAST MASTECTOMY • SENTINEL LYMPH NODE BIOPSY

  18. MASTECTOMY • 19MM AND 7MM FIRM NODULES UPON DISSECTION • NO LYMPHOVASCULAR INVASION • 12MM CLEARANCE DEEP MARGIN

  19. HISTOPATHOLOGY TUMOUR GRADE 2 INVASIVE LOBULAR CARCINOMA

  20. SENTINEL LYMPH NODE • FIVE SENTINEL NODES • FOUR NEGATIVE • ONE POSITIVE DEPOSIT OF METASTATIC TUMOUR • ICC: AE1/AE3 CYTOKERATIN

  21. SENTINEL LYMPH NODE AE1/AE3 POSITIVE H&E SENTINEL NODE

  22. POST-OPERATIVE • GRADE 2 INVASIVE LOBULAR CARCINOMA • CLOSEST RELEVANT MARGIN 12MM • SINGLE NODE POSITIVITY • STAGING INVESTIGATIONS REQUIRED

  23. STAGING INVESTIGATIONS • STAGING INVESTIGATIONS TO EXCLUDE METASTASES • CT SCAN - NEGATIVE • BONE SCAN - NEGATIVE

  24. FUTURE • PATIENT DECLINED CHEMOTHERAPY • WILL ATTEND THE BEATSON CANCER CENTRE • RADIOTHERAPY TREATMENT • CONTINUE LETROZOLE

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

  26. THANK YOU

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