2017 Annual Meeting

Evening Specialty Conference
Breast Pathology

A Case That Taught Me Something

March 8 2017, 7:30pm to 9:30pm

Moderator:
Jean Simpson, MD
Panelists:
Andrea Kahn, MD - Hannah Wen, MD, PhD - Fouad Boulos, MD - Kalliopi Siziopikou, MD, PhD - Melinda Sanders, MD

Pre-Meeting Materials

Case 1

Faculty:
Andrea Kahn, MD

Clinical History:

The patient is a 46 year-old female with a suspicious left breast mass on screening mammogram (2.3 cm in greatest dimension), who underwent image guided needle biopsy interpreted as grade 1 triple negative invasive ductal carcinoma. The patient was treated with left mastectomy and sentinel lymph node biopsy. Images are obtained from the mastectomy specimen.

Morphological Findings (click to enlarge):

Figure 1 H&E 2x
Figure 2 H&E 10x
Figure 3 H&E 10x
Figure 4 H&E 10x
Figure 5 H&E 10x
Figure 6 H&E 20x
Figure 7 H&E 40x

Case 2

Faculty:
Hannah Wen, MD, PhD

Clinical History:

The patient is a 77-year old male. He has noted a cyst in the right upper chest for the past 20 years. Recently the cyst ulcerated so the patient sought medical attention and underwent surgical excision of this lesion. Gross examination reveals a nodular mass measuring 4.5 x 3.4 cm. Immunohistochemical stains show the tumor cells are positive for CK7, GATA-3, HER2 (3+), GCDFP-15 (focal), while negative for ER, PR and TTF-1.

Morphological Findings (click to enlarge):

Figure 1
Figure 2
Figure 3
Figure 4 Immunohistochemical stain for HER2
Figure 5 Immunohistochemical stain for GATA-3

Case 3

Faculty:
Fouad Boulos, MD

Clinical History:

47-year-old woman who presented with a firm retro-areolar mass. Mammogram showed a 2.3 cm stellate mass. Partial mastectomy was performed.

Morphological Findings (click to enlarge):

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7
Figure 8
Figure 9
Figure 10

Case 4

Faculty:
Kalliopi Siziopikou, MD, PhD

Clinical History:

The patient is a 33 year old G1P1 female who presented with self-detected right breast mass at 3 months post partum. A mammogram was performed which showed a 1.9 cm mass at 1 o'clock and 3 cm from the nipple corresponding to the palpable area of concern. A subsequent ultrasound evaluation revealed a mass with posterior acoustic shadowing corresponding to the mammographic findings. Breast imaging also showed an enlarged axillary lymph node. An ultrasound guided core needle biopsy was performed, followed by bilateral mastectomies with a right axillary lymph node dissection.

Morphological Findings (click to enlarge):

Figure 1Mammographic examination of the right breast mass
Figure 2Ultrasound examination of the right breast mass
Figure 3Needle core biopsy of the right breast, H-E of the mass
Figure 4Needle core biopsy of the right breast, ER immunostain
Figure 5Needle core biopsy of the right breast, PR immunostain
Figure 6Needle core biopsy of the right breast, HER2 immunostain
Figure 7Right breast mastectomy, H-E stain
Figure 8Right axillary lymph node, H-E stain
Figure 9Right breast mastectomy, ER, PR, HER2 and Ki-67 immunostains

Case 5

Faculty:
Melinda Sanders, MD

Clinical History:

74-year-old female overdue for preventative screening exams presented to her PCP with an inverted nipple. Her PCP subsequently recommended a Pap smear, colonoscopy and mammogram. Her Pap smear and colonoscopy were unremarkable, however, her mammogram revealed a 1.7 cm x 6.4 cm area of asymmetric density at the 12 o'clock position of the right breast, 2 cm from the nipple. A right breast ultrasound also revealed a 1.5 cm x 1.3 cm x 1.7 cm hypoechoic area with posterior shadowing at 12 o'clock, 2.5 cm from the nipple. A right axillary ultrasound also revealed multiple morphologically abnormal lymph nodes.

Morphological Findings (click to enlarge):

Figure 1 Core needle biopsy of breast tumor, low power
Figure 2 Core needle biopsy of breast tumor, high power
Figure 3 Breast tumor, mastectomy, low power, 2x
Figure 4 Breast tumor, mastectomy, higher power, 20 X
Figure 5 Breast tumor, mastectomy, high-power, 40 X
Figure 6 Right axillary lymph node, low power, 20 x
Figure 7 Right axillary lymph node, high power, 40 X

Meetings

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