NEOPLASIA CASES

CASE 1 A 20 year old female presented with a round mobile breast lump. She has no family history of breast cancer Question : What test should the doctor perform ? Answer : Fine Needle Aspiration ( FNA)

FNA on Breast

FNA slide

Question : What are the expected findings ? Answer : Benign smear of cohesive uniform cells of two types Diagnosis : Most likely Fibroadenoma

Question : What is a fibroadenoma ? Answer : An encapsulated tumor of the breast composed of ducts (epithelial cells) & stroma ( fibrous tissue) Therefore, this is an example of a mixed tumor

Fibroadenoma

Question : What is the behaviour of this tumor? Answer : Benign

Case 2 A 30 year old female with a hard mass in the breast, of several months duration. She has a strong family history of breast cancer Question : What genetic abnormality may be found in this patient ? Answer : ?????

Question : What investigations are recommended ? Answer : –Mammography –FNA –Chest X ray –Ultrasound, CT, MRI….. etc

Mammography machine

Mammography Picture

FNA suggesting cancer

Question : What is the diagnosis ? Answer : Cellular smear with pleomorphic cells mostly malignant

The patient underwent surgery for : 1- Frozen section 2- Wide Excision or Mastectomy Question : What is a frozen section ? Answer : Excision of a piece of the tumor processed by freezing rather than paraffin section, for rapid diagnosis.

Breast Cancer

The tumor was very hard & gritty on cutting. Why ? Answer : ?????

Desmoplasia

The patient also had several enlarged axillary lymph nodes & mass in the lung Question : What are they likely to show ? Answer : Metastatic carcinoma of breast origin

Tumor in lymphatic channels

Metastatic tumor in LN

Spread along pleura

Apart from the original diagnosis, the surgeon required other staining techniques 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

Tumor cells are ER positive

Tumor cells are HER2/NEU positive

CASE 3

Clinical History Clinical History 28 year old male complaining of nausea,vomiting, abdominal pain & BLOODY STOOL Family history of uncle & grandfather dying of colon cancer His liver is enlarged Investigations include : - Chest X-ray –Abdominal ultrasound and CT scan –Colonscopy

Results : Chest X ray : Multiple bilateral opacities in the lung fields Ultrasound : Liver shows multiple nodules Colonoscopy : Hundreds of polyps throughout the colon & an ulcerating mass in the sigmoid. QUESTION : What do these findings suggest ? Patient has a malignant tumor arising from one of the polyps, with metastases to liver & lung

Questions : Questions : What is the possible diagnosis ? Answer : Familial Adenomatosis Polyposis with malignant transformation to adenocarcinoma What genetic alterations are seen in such patients? Answer : Germ line mutation of one copy of APC gene followed by several others ( Multisteps )

Structure of Polyp Structure of Polyp Colonic Adenomatous Polyp

What is this process called ?

Adenocarcinoma

Liver Metastases

Lymph Node Metastases

Questions What other inherited Colon Carcinoma do you know ? Answer : Hereditary Nonpolyposis Colonic Carcinoma ( HNPCC) What is the genetic defect in this case ? Defective Mismatch Repair genes

ADENOCARCINOMA at ascending Colon, no polyp