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
Breast / Mama
Sender / Patólogo:
ID case plataform:
Status of case:
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.
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)
Uneventful postoperative phase, except a seroma that needs to be drained twice.
The patient was evalued 3 weeks later and she was is asymptomatic.
General status within normal
Recent mastectomy scar in good condition