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BREAST CANCER CASE STUDY

Oct 01, 2014

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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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• receptor status
• oestrogen receptor
• staging investigations
• oestrogen receptor status
• sentinel lymph node biopsy

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BREAST CANCERCASE 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 • 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 CONTROL OESTROGEN POSITIVE

PROGESTERONE REC. STATUS PROG POSITIVE NEGATIVE CONTROL

HER-2 STATUS HER2 NEGATIVE NEGATIVE CONTROL

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.

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