Neoplasia Lab.3 Cases

8/3/2019 Neoplasia Lab.3 Cases

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NEOPLASIA CASES


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CASECASE 11

A 20 year old female presented witha round mobile breast lump.

She has no family history of breastcancer

Question : What test should thedoctor perform ?

Answer : Fine Needle Aspiration

( FNA)


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FNA on Breast


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FNA slide


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Question :

What are the expected findings ?

Answer :

Benign smear of cohesive uniform

cells of two types

Diagnosis :

Most likely Fibroadenoma


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Question : What is a fibroadenoma ?

Answer :An encapsulated tumor of the breastcomposed of ducts (epithelial cells)

& stroma ( fibrous tissue)

Therefore, this is an example of a mixed

tumor


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Fibroadenoma


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Fibroadenoma


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QuestionQuestion

What features distinguish a benign from amalignant growth ?

Answer :Circumscribed growth

Rate of growth

Differentiation

Metastases


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Case 2Case 2 A 30 year old female with a hard

mass in the breast, of several monthsduration. She has a strong family

history of breast cancer Question :

What genetic abnormality may be

found in this patient ? Answer :

BRCA -1 or BRCA-2


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Question :What investigations are recommended ?

Answer :

Mammography

FNA

Chest X ray

Ultrasound, CT, MRI.. etc


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Mammography machine


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Mammography Picture


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FNA suggesting cancer


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PAP Stain


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Question :

What is the diagnosis ?

Answer :

Cellular smear with pleomorphic cells

mostly malignant


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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 tumorprocessed by freezing rather thanparaffin section, for rapid diagnosis.


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Breast Cancer


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The tumor was very hard & gritty

on cutting.

Why ?

Answer :

Because there was a dense fibrousstromal reaction , called DESMOPLASIA


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Desmoplasia


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The patient also had several enlarged

axillary lymph nodes & mass in the

lung

Question :

What are they likely to show ? Answer :

Metastatic ductal carcinoma of breast

origin


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Tumor in lymphatic channels


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Metastatic tumor in LN


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Metastases in lung


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Angiogenesis in tumor metastases


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Spread along pleura


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Apart from the original diagnosis,

the surgeon required other stainingtechniques 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


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Tumor cells are ER positive


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Tumor cells are HER2/NEU positive


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Question :What is HER2/NEU ?

Answer :

It is belongs to the Epidermal Growth

Factor family of oncogenes

It is overexpressed in many high grade

breast cancers , which may be treated

by Anti HER2/NEU


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The patient received chemotherapy

& hormonal therapy but died with

wide spread metastases one yearlater.


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CASE 3CASE 3


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Clinical HistoryClinical History

28 year old male complaining ofnausea,vomiting, abdominal pain &BLOODY STOOL

Family history of uncle & grandfatherdying of colon cancer

His liver is enlarged

Investigations include : Chest X ray

Abdominal ultrasound

Colonscopy

Abdomina CT


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Results :Results :

Chest X ray :Multiple bilateral opacities in the lung fields

Ultrasound and CT:

Liver shows multiple nodules

Colonoscopy :

Hundreds of polyps throughout the colon & anulcerating mass in the sigmoid.

QUESTION :What do these findings suggest ?

Patient has a malignant tumor arising from oneof the polyps, with metastases to liver & lung


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Questions :Questions : What is the possible diagnosis ?

Answer :

Familial Adenomatosis Polyposis with

malignant transformation to adenocarcinoma

What genetic alterations are seen in suchpatients?

Answer :

Germ line mutation of one copy of APC genefollowed by several others ( Multisteps )


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Structure of PolypStructure of Polyp

Colonic Adenomatous Polyp


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What is this process called ?DYSPLASIA


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Question :Question : What are the features of dysplasia ?

o N/C ratio

PLEOMORPHISM

Loss of differentiating features

HYPERCHROMATISM

Prominent, sometimes multiple nucleoli

Increased mitotic figures

Presence of abnormal mitoses

Loss of polarity in an epithelial surface


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2

1

1- Big POLYP

2- Invasive ADENOCARCINOMA


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Adenocarcinoma


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W

all Invasion


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LiverMetastases


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Liver Metastases


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Liver

Metastases


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Lymph Node Metastases


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Transcoelomic spread along peritoneum


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QuestionsQuestions What other inherited Colon Carcinoma do

you know ?

Answer :

Hereditary Nonpolyposis ColonicCarcinoma ( HNPCC)

What is the genetic defect in this case ?

Defective Mismatch Repair genes


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ADENOCARCINOMA at ascending Colon, no polyp

Q ti


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Question :

What are the routes of spread used

by cancer ? Answer :

Direct invasion to skin, underlying

muscle (e.g. Breast cancer)Lymphatic spread to lymph nodes

Hematogenous spread

e.g. to lungs, brain, boneetc

Transcoelomic spread e.g. to ovaries,

intestine.etc.


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Question :

What is the STAGE of a tumor ? Answer :

Extent of spread of the tumor.

You have to use many tests to asses it Question :

How is the tumor staged ?

Answer :By using staging systems

Most used is the TNM system


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TNM Staging


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Question :

Why is staging important ?

Answer :

To assess the best method of treatment

To asses the prognosis of the tumor


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Question :

What other tumors may show widespread metastases ?

Answer :

Small cell carcinoma of lungMelanoma

Osteosarcoma

And many others with high gradephenotypic features


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Multiple Nevi


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Melanoma


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Osteosarcoma


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Neoplasia Lab.3 Cases