Surgical Oncology Tumor Board

1
Surgical OncologyTumor Board

• December 23, 2008
• Sunil S. Karhadkar MD

2
Case Presentation

• 56/F school secretary, Jehovahs witness
• Cc bloody nipple discharge from Rt breast Nov
  08
• h/o fibrocystic dz
• Yearly mammograms- no masses
• Menopausal
• Para 3-0-0-1, 1st pregnancy _at_ 35
• Breast fed for 18mos

3
Case Presentation

• Non smoker
• Family hx Paternal aunt breast cancer
  diagnosed in 50s
• PaMhx HTN, anemia
• PaSHx 91- Tubal ligation, 00 duodenal adenoma,
  05 Rt. oophorectomy
  

4
Case presentation

• Physical Exam
• 58, 155lb well nourished
• No palpable masses
• Rt sided hemorrhagic nipple discharge
• Abd NAD
• Op Course
• Duct cannulation
• Duct excision, nipple reconstruction

5
Surgical pathology

• A. Duct excision
• Grade 2 DCIS, positive margins
• B. Deeper tissue
• Invasive ductal carcinoma, margins
• 0.6 cm
• Micropapillary, Nuclear grade 2
• Extensive DCIS margins
• ER PR - HER2/NEU - Ki67 -

6
Although experience is limited because of the
small number of patients, duct-lobular segmentecto
my with an adequate free margin (ideally gt1 cm)
should be the procedure of choice for patients
with nipple discharge who are diagnosed or are
strongly suspected of having breast cancer
(57). Intraductal spreading of carcinoma is an
unfavorable pathologic factor in
breast-conserving surgery for patients with
nipple discharge (58).
7
Non-palpable breast cancerwith nipple discharge
How should it be treated?

• AnticancerRes 1997 17 791794

8
Central segmentectomy
9
Adjuvant therapy for early stage breast cancer

• T1b N0i Tumor 0.5- 0.99 cm, Pathologically
  negative nodes, positive IHC, no tumor clusters
  gt0.2 mm

10
(No Transcript)