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
• 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
FNA slide
Fibroadenoma
Fibroadenoma
Fibroadenoma
• Question :
What is the behaviour of this tumor?

• Answer :
Benign
Malignant change is extremely rare
 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 :
BRCA -1 or BRCA-2
• 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- 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 :
Because there was a dense fibrous
stromal reaction , called DESMOPLASIA
Desmoplasia
• The patient also had several enlarged
lymph nodes

• Question :
What are they likely to show ?
• Answer :
Metastatic ductal carcinoma of breast
origin
Tumor in lymphatic channels
Metastatic tumor in LN
• 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
• 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
• Question :
What are the routes of spread used
by cancer ?
• Answer :
– Direct invasion to skin, underlying
muscle …
–Lymphatic spread to lymph nodes
–Hematogenous spread
e.g. to lungs, brain, bone…etc
–Transcoelomic spread e.g. to ovaries
Liver Metastases
Metastases in lung
Angiogenesis in tumor metastases
Transcoelomic spread along pleura
Transcoelomic spread along peritoneum
• The patient received chemotherapy
& hormonal therapy but died with
wide spread metastases one year
later.
• 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
TNM Staging
• Question :
Why is staging important ?

• Answer :
To assess the best method of treatment
To asses the prognosis of the tumor
• Question :
What other tumors may show wide
spread metastases ?
• Answer :
–Small cell carcinoma of lung
–Melanoma
–Osteosarcoma
–And many others with high grade
phenotypic features
Multiple Nevi
Melanoma
Multiple metastases from melanoma
Osteosarcoma
Lung Metastases