Clinical case 1

Created by Administrator SEAP on Jun 9, 2016 11:51:30 AM, Last modified by Administrator SEAP on Jun 10, 2016 1:55:47 PM
 

Clinical information

Organ/Órgano/Localiz: Breast / Mama
Institution/Instituc: Undefined
Sender / Patólogo: Undefined
ID case plataform: Undefined
Status of case: Undefined
Priority/Prioridad: Undefined
Patient. Age: 82
Patient. Sex: Undefined
Comments Localizat: Undefined
82-year-old female patient. During her left breast self-examination detected a tumor a week ago. Asymptomatic. She refers loss of 25 kg in the last year but she has been studied and no specific cause was detected except for a diarrheic syndrome. Mammography and breast ultrasound: In inferior-external quadrant of her left breast two radiologically very suspicious nodules, one of about 2 cm and the other less than 1 cm with a distance between them of about 4 cm and an important trail of microcalcifications which all together measure more 45 mm. Needle biopsy: Infiltrative ductal carcinoma. Estrogen receptors positive (95%), progesterone receptors positve (5%), 20% Ki67, HER2 negative, cytokeratin-19 positive. Multidisciplinary Tumor Board Meeting: Mastectomy plus Sentinel Lymph Node study (using OSNA) is decided (since there are two tumor and broad trail of microcalcifications which is interpreted as extensive intraductal component foci). At the beguining of december a mastectomy is performed. Sentinel Lymph Node study (OSNA) is negative. Surgical Pathology Report: Left mastectomy specimen of 19 x 16 cm dimensions, which is partially covered by skin ellipse 9.5 x 4 cm largest dimensions, which externally shows no significant changes, which is oriented with two surgical sutures threads. After serial sectioning of the specimen, a tumoral nodular, indurated and poorly defined lesion with spiculated margins, measuring 2.3 cm in the horizontal axis of the specimen is detected. It is located more than 0.5 cm of the nearest resection margins which is the posterior margin. The rest of the specimen does not show macroscopic lesions except some areas of fibrosis and calcification, the largest located 1 cm from the previously described tumoral lesion in the upper-anterior plane. Blocks identification 1 and 2: Tumor 3 and 4: Possible satellite lesion of the primary lesion 5 and 6: Fibrosis area behind the ellipse skin 7: Upper internal quadrant 8: Lower-inner quadrant 9: Upper outer quadrant 10: Lower-outer quadrant 11: Areola-nipple complex FINAL PATHOLOGY DIAGNOSIS: LEFT breast (mastectomy-biopsy) .- BREAST INFILTRATING DUCTAL CARCINOMA -Size: 2.3 CM Degree of histological differentiation NOTTINGHAM I (SCORE: glandular structures 2, cellular atypia 2, mitosis: 1.TOTAL:5) Presence of peritumoral DCIS (high grade, solid pattern / cribiforme, without necrosis) Presence of microcalcifications in tumoral component (CDI / CDIS) RESECTION MARGINS: free of neoplasia (CDI / DCIS) Absence of lympho-vascular invesion -Other related studies: Previous Needle biopsy with cancer diagnosis and biomarkers Simultaneous molecular study of SLNB (NEGATIVE) PATHOLOGY STAGE: IIA of TNM (PT2 N0 [MOL -] Mx) EVOLUTION: Uneventful postoperative phase, except a seroma that needs to be drained twice. The patient was evalued 3 weeks later and she was is asymptomatic.   Physical examination: General status within normal Recent mastectomy scar in good condition

Media

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Ultrasound. Left Breast
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Mammography: Right Breast
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Mammography: Left Breast
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Mammography: Right Breast
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Mammography: Left Breast
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Mammography: Right Breast
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Mammography: Left Breast
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Mammography: Right Breast
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Mammography: Left Breast
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Mammography: Left Breast (zoom)
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Core Biopsy R Estrog Digital Slide
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Core Biopsy Ki67 Digiral Slide
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Core Biopsy Digtal Slide HER2
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Core Biopsy HE_0.7x
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Core Biopsy HE_1.8x
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Core Biopsy HE_20.0x
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Core Biopsy HE_20.1x
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Core Biopsy Ki67_10.0x
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Core Biopsy R Estrog_24.0x
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Core Biopsy R Progest_44.9x
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Core Biopsy HER2_17.8x
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Core Biopsy CK19_10.0x
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Core Biopsy e-cadherin_18.7x
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Core Biopsy p63_20.0x
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Mastectomy Digital Slide A1 HE
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Mastectomy A1 HE_0.4x
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Mastectomy A1 HE_10.0x
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Mastectomy A2 HE_10.0x
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Mastectomy A2
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Mastectomy A3 HE_4.3x
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Mastectomy A4 HE_2.2x
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Mastectomy A5 HE_5.3x
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Mastectomy A6 HE_1.7x
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Mastectomy A7 HE_5.8x
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Mastectomy A8 HE_4.4x
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Mastectomy A9 HE_11.2x
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Mastectomy A10 HE_2.0x
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Mastectomy A11 HE_2.7x
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Mastectomy A11 HE_3.2x
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Core Biopsy HE Digital Slide
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