Download neoplasia lab.3 cases

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
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
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 :
• 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
Colonic Adenomatous Polyp
What is this process called ?
Adenocarcinoma
Liver
Metastases
Liver Metastases
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