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CASE 1CASE 1
A 20 year old female presented witha round mobile breast lump.
She has no family history of breastcancer
Question : What test should thedoctor perform ?
Answer : Fine Needle Aspiration
( FNA)
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FNA on Breast
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Question :
What are the expected findings ?
Answer :
Benign smear of cohesive uniform
cells of two types
Diagnosis :
Most likely Fibroadenoma
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Question : What is a fibroadenoma ?
Answer :An encapsulated tumor of the breastcomposed of ducts (epithelial cells)
& stroma ( fibrous tissue)
Therefore, this is an example of a mixed
tumor
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FNA slide
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Fibroadenoma
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Fibroadenoma
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Fibroadenoma
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Question :
What is the behaviour of this tumor?
Answer :
Benign
Malignant change is extremely rare
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Case 2Case 2 A 30 year old female with a hard
mass in the breast, of several monthsduration. She has a strong family
history of breast cancer Question :
What genetic abnormality may be
found in this patient ? Answer :
BRCA -1 or BRCA-2
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Question :What investigations are recommended ?
Answer :
Mammography
FNA
Chest X ray
Ultrasound, CT, MRI.. etc
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Mammography machine
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Mammography Picture
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FNA suggesting cancer
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Question :
What is the diagnosis ?
Answer :
Cellular smear with pleomorphic cells
mostly malignant
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The patient underwent surgery
for :
1- Frozen section
2- Mastectomy
Question :
What is a frozen section ?
Answer :
Excision of a piece of the tumorprocessed by freezing rather thanparaffin section, for rapid diagnosis.
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Breast Cancer
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The tumor was very hard & gritty
on cutting.
Why ?
Answer :
Because there was a dense fibrousstromal reaction , called DESMOPLASIA
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Desmoplasia
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The patient also had several enlarged
lymph nodes
Question :
What are they likely to show ?
Answer :Metastatic ductal carcinoma of breastorigin
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Tumor in lymphatic channels
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Metastatic tumor in LN
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Apart from the original diagnosis,
the surgeon required other stainingtechniques in order to guide him for
further therapy & assess prognosis.
Question:What were they ?
Answer :
Immunohistochemical stains for Estrogen receptors
Progesteron receptors
HER 2/NEU
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Tumor cells are ER positive
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Tumor cells are HER2/NEU positive
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Question :What is HER2/NEU ?
Answer :
It is belongs to the Epidermal Growth
Factor family of oncogenes
It is overexpressed in many high grade
breast cancers , which may be treated
by Anti HER2/NEU
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Question :
What are the routes of spread usedby cancer ?
Answer :
Direct invasion to skin, underlyingmuscle
Lymphatic spread to lymph nodes
Hematogenous spreade.g. to lungs, brain, boneetc
Transcoelomic spread e.g. to ovaries
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Liver Metastases
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Metastases in lung
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Angiogenesis in tumor metastases
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Transcoelomic spread along pleura
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Transcoelomic spread along peritoneum
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The patient received chemotherapy
& hormonal therapy but died with
wide spread metastases one yearlater.
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Question :
What is the STAGE of a tumor ? Answer :
Extent of spread of the tumor.
You have to use many tests to asses it Question :
How is the tumor staged ?
Answer :By using staging systems
Most used is the TNM system
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TNM Staging
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Question :
Why is staging important ?
Answer :
To assess the best method of treatment
To asses the prognosis of the tumor
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Question :
What other tumors may show widespread metastases ?
Answer :
Small cell carcinoma of lungMelanoma
Osteosarcoma
And many others with high gradephenotypic features
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Multiple Nevi
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Melanoma
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Multiple metastases from melanoma
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Osteosarcoma
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Lung Metastases
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