1. 부산대학교병원 김 주 연 2012 년 세포병리학회 가을학술대회 월례집담회

2.  F/52  Past history : 03’ left breast operation, on follow up  Lower abdominal pain (12’ April)  Physical exam : R/O acute appendicitis  refer to PNUH  Lab: CA19-9 18.44U/ml, CA125 6.06 U/ml  MR pelvis : right ovary, 2.1cm sized solid mass  R/O metastasis, rec. PET  PET-CT : right ovary  R/O metastasis

3. MR pelvis T2WIPET CT

4.  Upper GIT endoscopy, stomach biopsy : erythematous lesion on UB, AW  Chronic gastritis  Exploratory laparotomy, frozen biopsy : right ovary  signet ring cell carcinoma  TAH, BSO, PLND, appendectomy, omentectomy  Pelvic cavity washing

15.  Moderate to marked cellularity  Predominantly small sized cells  Dispersed, individual cells  Signet ring or plasmacytoid appearance  Cytoplasmic vacuolization  Past history : 03’ left breast operation, on follow up  Radiologic finding: R/O metastasis

16. Body fluid, peritoneal, liquid-based cytology : Malignancy Adenocarcinoma, signet ring cell feature, consistent with metastatic mammary lobular carcinoma.

17. Right ovary

19. Uterus and left adnexa

20. Right ovary

23. Left breast, 03’

26. 03’ right breast Breast, left, quadrantectomy : Invasive lobular carcinoma, with 1) size: 8.0x5.0x2.0cm 2) involved deep margin 3) presence of lymphovascular invasion 4) metastasis to lymph node (2/7). ERPRHER2P53 +---

27. GCDFP-15 HMWCK ER E-cadherin

28. 03’ left breast 12’ right ovary ERPRHER2P53 +--- GCDFP-15ERHMWCK E- cadherin +++-

29. Ovary and salpinx, BSO : - Mammary lobular carcinoma, metastatic at ovary 1) involvement of ovarian capsule 2) presence of lymphovascular invasion - No tumor, bilateral salpinx. Uterus, TAH : - Mammary lobular carcinoma, metastatic - Metastasis to pelvic lymph node [Rt. lower pelvic 1/1, Rt. middle pelvic 1/2, paraaortic 1/2].

30.  Signet ring cell carcinoma, a form of ILC –The majority of so-called signet ring-cell carcinomas are forms of invasive lobular carcinoma –Intracytoplasmic mucin accumulation –When the secretion is prominent, the cells have a signet ring configuration Rosen’s breast pathology third edition Invasive lobular carcinoma p700-p702

31.  Distant metastasis –Lobular carcinoma (including signet ring cell variant) : Abdominal cavity, particularly to the gastrointestinal tract, ovaries and serosal surface –Ductal carcinoma : Skeletal system, lung and pleura, liver, ovary, adrenal gland, and central nerve system Rosai and Ackerman’s surgical pathology Vol.2 p.1715

32.  Less than 10% of patients with breast cancer have evidence of distant metastases at diagnosis, but 30% of them will have recurrent, metastatic disease.  Metastases in the ovaries have been reported with a prevalence ranging from 3% to 30% in various series, including autopsies, prophylactic or therapeutic oophorectomies, and incidental findings in routine surgery.  The data indicated a predominance of premenopausal and hormone receptor-positive status and a greater prevalence of lobular infiltrating carcinoma, bilateral breast cancer, and predisposing genetic factors.  Ovarian disease was diagnosed at a median of 5 years after breast cancer.  75% of patients were asymptomatic, and advanced-stage pelvic extent or extra- abdominal metastases were observed in 41.5% of patients.  Survival improved significantly when optimal debulking surgery was performed.

33. 2003 - 6 – 11 Left breast, Qt : ILC Post-op : tamoxifen 2004 ----> 2011Follow up : breast sono, PET CT 2011 - 8 - 20PET CT : no evidence of local recur. or metastasis 2012 - 4 - 20 Lower abdominal pain PET CT, MR : R/O metastasis 2012 - 5 - 8TAH, BSO, PLND, appendectomy, omentectomy 2012 - 5 - 30 2012 - 6 - 25 2012 - 8 - 8 2012 - 8 - 31 Chemotherapy : Taxol-carboplatin, 1 st to 4 th CT : 2.3cm, soft tissue density  R/O remnant mass 2012 - 9 - 29 2012 - 10 -25 Chemotherapy : Taxol-carboplatin, 5 th and 6 th