1. BREAST CANCER CASE STUDY FRAZER BELL STUDENT BMS BSc APPLIED BIOMEDICAL SCIENCE

2. PATIENT HISTORY 70 YEAR OLD FEMALE PRESENTED AT GP SURGERY 02/OCT/2012 EXAMINATION: RIGHT NIPPLE DRAWING IN & FIRM PALPABLE LUMP REFERRED TO THE BREAST CLINIC

3. BREAST CLINIC ATTENDED 18/OCT/2012 EXAMINATION: INVERTED NIPPLE RETRACTION AND PALPABLE LUMP ? PALPABLE LUMP RIGHT AXILLA GRADED P5: MALIGNANT FURTHER INVESTIGATIONS: MAMMOGRAM, ULTRASOUND & BREAST CORE BIOPSY

4. MAMMOGRAPHY AREA OF SUSPICIOUS ABNORMALITY ON RIGHT BREAST GRADED M4: PROBABLY MALIGNANT

5. ULTRASOUND ULTRASOUND : CORRESPONDING 2CM AREA GRADED U4: PROBABLY MALIGNANT

6. BIOPSY ULTRASOUND GUIDED BREAST CORE BIOPSIES FROM THE RIGHT BREAST ONE 13MM FIBROFATTY CORE PLUS 4 FIBROFATTY FRAGMENTS

7. NORMAL BREAST TISSUE

8. PATHOLOGY GRADED: B5b Infiltrating Breast Carcinoma

9. IMMUNOCYTOCHEMISTRY E-CAD NEGATIVE

10. RECEPTOR STATUS OESTROGEN RECEPTOR & HER-2 STATUS DETERMINE RECEPTOR STATUS FOR HORMONE THERAPY

11. OESTROGEN RECEPTOR STATUS NEGATIVE CONTROL OESTROGEN POSITIVE

12. PROGESTERONE REC. STATUS NEGATIVE CONTROLPROG POSITIVE

13. HER-2 STATUS NEGATIVE CONTROLHER2 NEGATIVE

14. TREATMENT PLAN BREAST MDT MEETING MASTECTOMY WITHOUT NEOADJUVANT TREATMENT SENTINEL LYMPH NODE BIOPSY SURGERY DATE 06/NOV/2012

15. PRE-OP ASSESSMENT ADMITTED PRE-OP CLINIC 01/NOV/2012 LABS TESTS: PRE-OP BLOODS HYPERTENSIVE MEDICAL WARD: ECG CONFIRMED LVH SURGERY CANCELLED

16. TREATMENT PLAN REDUCE BLOOD PRESSURE VIA ACE INHIBITORS CHEST X-RAY & U/S OF KIDNEYS STARTED ON LETROZOLE 2.5mg DAILY BP MONITORED FORTNIGHTLY RE-ASSESSMENT FOR SURGERY IN JANUARY

17. SURGERY BP STABILISED ADMITTED TO SURGICAL WARD 13/FEB/13 SURGERY 25/FEB/13 RIGHT BREAST MASTECTOMY SENTINEL LYMPH NODE BIOPSY

18. MASTECTOMY 19MM AND 7MM FIRM NODULES UPON DISSECTION NO LYMPHOVASCULAR INVASION 12MM CLEARANCE DEEP MARGIN

19. HISTOPATHOLOGY TUMOUR GRADE 2 INVASIVE LOBULAR CARCINOMA

20. SENTINEL LYMPH NODE FIVE SENTINEL NODES FOUR NEGATIVE ONE POSITIVE DEPOSIT OF METASTATIC TUMOUR ICC: AE1/AE3 CYTOKERATIN

21. SENTINEL LYMPH NODE AE1/AE3 POSITIVEH&E SENTINEL NODE

22. POST-OPERATIVE GRADE 2 INVASIVE LOBULAR CARCINOMA CLOSEST RELEVANT MARGIN 12MM SINGLE NODE POSITIVITY STAGING INVESTIGATIONS REQUIRED

23. STAGING INVESTIGATIONS STAGING INVESTIGATIONS TO EXCLUDE METASTASES CT SCAN - NEGATIVE BONE SCAN - NEGATIVE

24. FUTURE PATIENT DECLINED CHEMOTHERAPY WILL ATTEND THE BEATSON CANCER CENTRE RADIOTHERAPY TREATMENT CONTINUE LETROZOLE

25. ACKNOWLEDGEMENTS CONS. PATHOLOGIST Dr. A. W. Milne CROSSHOUSE PATHOLOGY DEPT.

26. THANK YOU