Prognosis

[ericdamiansean]

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Hey guys, what do you think of the prognosis of a person with the following report, and does she need chemo? If so, which would be best?

A) Specimen consists of a right breast with axillary tail. The skin ellipse measures 13cm x 6cm. Skin and nipple shows no abnormality. Axillary tail measures 10cm. Cut section through the breast parenchyma shows a tumour measuring 2cm x 3cm x 3cm situated lower outer quadrant. The surrounding breast parenchyma shows no significant abnormality. This tumour is situated 9cm from the medial margin, 6cm from the superior margin, 2cm from the inferior margin, 1.5cm from the deep margin.

Block 1 – nipple
Block 2 – tumour with deep margin
Block 3 – medial margin
Block 4 – superior margin
Block 5 – inferior margin
Block 6&7 – lymph nodes

B) Lymph nodes are taken in 1 block.
C) Lymph nodes measuring 0.3cm. Submitted in 1 block


Histology:

A) Sections of breast tissue show malignant cells disposed in solid nests, tubules and anastomosing masses invading into stroma radiating around a central area of hyalinization. The cells exhibit moderate nuclear pleomorphism with vesicular nuclei and prominent nucleoli. Mitotic rate is 7/10 hpf. Tubule formation is <10%.
All the margins are clear of malignancy.
No obvious lymphovascular permeation seen.
No Paget’s disease seen.
There are 14 axillary lymph nodes identified exhibiting sinus histiocytosis.
Immunohistochemistry:
ER : Negative
PR : Negative
C-erb-B2 : Negative
B) One lymph node seen exhibiting sinus histiocytosis.
C) Fibrofatty tissue seen


Interpretation:

A) Right breast : Infiltrating Ductal carcinoma, Bloom and Richardson grade 2
B) Axillary lymph node : No metastasis seen
C) Lateral lymph node : No lymphoid tissue seen.

 

[ronmexico]

T2N0Mx s/p mastectomy.
(-) margins, nodes, hormone receptors, and Her2-Neu

looks like no further treatment is indicated.
someone more experienced than myself might want to weigh in.
I cant speak in detail to the question on prognosis, although it seems encouraging at this point.

Hey guys, what do you think of the prognosis of a person with the following report, and does she need chemo? If so, which would be best?

A) Specimen consists of a right breast with axillary tail. The skin ellipse measures 13cm x 6cm. Skin and nipple shows no abnormality. Axillary tail measures 10cm. Cut section through the breast parenchyma shows a tumour measuring 2cm x 3cm x 3cm situated lower outer quadrant. The surrounding breast parenchyma shows no significant abnormality. This tumour is situated 9cm from the medial margin, 6cm from the superior margin, 2cm from the inferior margin, 1.5cm from the deep margin.

Block 1 – nipple
Block 2 – tumour with deep margin
Block 3 – medial margin
Block 4 – superior margin
Block 5 – inferior margin
Block 6&7 – lymph nodes

B) Lymph nodes are taken in 1 block.
C) Lymph nodes measuring 0.3cm. Submitted in 1 block


Histology:

A) Sections of breast tissue show malignant cells disposed in solid nests, tubules and anastomosing masses invading into stroma radiating around a central area of hyalinization. The cells exhibit moderate nuclear pleomorphism with vesicular nuclei and prominent nucleoli. Mitotic rate is 7/10 hpf. Tubule formation is <10%.
All the margins are clear of malignancy.
No obvious lymphovascular permeation seen.
No Paget’s disease seen.
There are 14 axillary lymph nodes identified exhibiting sinus histiocytosis.
Immunohistochemistry:
ER : Negative
PR : Negative
C-erb-B2 : Negative
B) One lymph node seen exhibiting sinus histiocytosis.
C) Fibrofatty tissue seen


Interpretation:

A) Right breast : Infiltrating Ductal carcinoma, Bloom and Richardson grade 2
B) Axillary lymph node : No metastasis seen
C) Lateral lymph node : No lymphoid tissue seen.

 

[3dtp]

T2N0Mx s/p mastectomy.
(-) margins, nodes, hormone receptors, and Her2-Neu

looks like no further treatment is indicated.
someone more experienced than myself might want to weigh in.
I cant speak in detail to the question on prognosis, although it seems encouraging at this point.

Agree, no radiation therapy is indicated (NSABP-B04). With favorable histology, (tubular) node negative, adequate ALND, and receptor negative, there is no role for hormone or Herceptin therapy.

But, the tumor was 2 x 3 x 3 cm. This would indicate, depending on comorbid conditions the consideration of chemotherapy. Probably AC x 4 then T x 4 cycles.

Other ideas? Rebuttals?

 

[Zap]

Agree, no radiation therapy is indicated (NSABP-B04). With favorable histology, (tubular) node negative, adequate ALND, and receptor negative, there is no role for hormone or Herceptin therapy.

But, the tumor was 2 x 3 x 3 cm. This would indicate, depending on comorbid conditions the consideration of chemotherapy. Probably AC x 4 then T x 4 cycles.

Other ideas? Rebuttals?

I agree that radiotherapy is not indicated. However, chemotherapy is likely indicated. It will depend somewhat on the patient's age and comorbidities. Assuming the patient is 60 yrs old and in otherwise good health, ACx4 and Tx4 would give an ~8% absolute survival benefit at 10 yrs.

 

[clintpark]

that the Original Poster is talking about someone he knows personally.

I know it's very easy to intellectualize things like this, especially for well-educated people like us. I know because I did the same thing when my mother had a stroke and then a cancer...

The treatment should be taken care of my her doctors. Your job is to be there for her and be her moral support (and maybe interpret what her doctors tell her).

Sorry if I'm barking up the wrong tree. Maybe you're getting ready for a pimping session tomorrow. ^^

Good luck and God bless.

 

[stephew]

folks, please do not try to elicit medical opinions for real cases on this board. Its not appropriate for many reasons.

If this is a personally related case, I do wish you all the best.

 

[ericdamiansean]

Assuming the patient is 60 yrs old and in otherwise good health, ACx4 and Tx4 would give an ~8% absolute survival benefit at 10 yrs.

The patient is 50 years old. What chemo would be good then? Btw, there was this lady on tv the other day, apparently herceptin drugs are really expensive, she had to sell her house etc.

This is not a real case, it was based on a real one, with certain parts of the report altered for students to interpret 😀