Breast Cancer: October 2019 Multidisciplinary Molecular Tumor Boards

ASCO University
Oct 07, 2019 10:26 AM

Participant Instructions: Welcome to the Multidisiplinary Molecular Oncology Tumor Board Series! This educational initiative is a collaboration between the American Society of Clinical Oncology (ASCO), College of American Pathologists (CAP), and Association for Molecular Pathology (AMP).

A new case will be presented bi-monthly with discussions led by an expert pathologist and medical oncologist. This month’s topic is led by Drs. Jairam Krishnamurthy (Medical Oncologist from Nebraska Medicine) and Subodh Lele (Pathologist from Nebraska Medicine).

Do you have an interesting case in mind? Submit your hypothetical patient cases for consideration in an upcoming Multidisciplinary Molecular Tumor Board discussion forum.

Participants are encouraged to leave comments and post questions about the case in order to generate a wide discussion among the cancer care community. You can also receive email notifications when new comments are posted by clicking the “Follow this Conversation” option located at the bottom of this page.

When posting, please abide by the terms and conditions of this website.

Comments

16626

ASCO University
Re: Breast Cancer: October 2019 Multidisciplinary Molecular Tumor Boards
Oct 09, 2019 7:36 AM

Patient Case

Ms. Q is a 27 year old Caucasian female with no major past medical history. She noticed a lump in the left breast about 4 weeks back, which she feels is increasing in size. She denies any recent trauma, fever, chills or skin rash. She has regular menstrual periods and her last menstrual period was 2 weeks back. She denies unintentional weight loss, loss of appetite or bone pain. She is very active and continues to work out 4-5 times a week. She denies any other symptoms.

Her vital signs are normal. On physical exam, there is a 3 x 3 cm firm mobile mass palpable in the left breast upper outer quadrant with no nipple or skin changes. There is one mobile palpable lymph node in the left axilla. Right breast and right axilla are unremarkable. The remainder of the physical exam is unremarkable.

Mammogram of the right breast is unremarkable. Mammogram of the left breast shows a well circumscribed mass in the left breast upper outer quadrant and no other abnormalities. An ultrasound of the left breast and left axilla demonstrates a solid mass measuring 3.2 cm x 2.5 cm x 3.1 cm in the left breast at the 5 o’clock position with one abnormal looking enlarged lymph node in the left axilla.

Ultrasound guided biopsy of this left breast mass and the left axillary lymph node are both reported as invasive ductal carcinoma, grade 3/3, Ki-67 index of 90%, Estrogen receptor positive (2%, weak intensity), Progesterone receptor negative (0%) and Her-2/neu  was 2+ by IHC.

16631

ASCO University
Re: Breast Cancer: October 2019 Multidisciplinary Molecular Tumor Boards
Oct 09, 2019 7:37 AM

Discussion Questions

  1. What additional workup is needed?
  2. Are these pathology results sufficient to start treatment?
Re: Breast Cancer: October 2019 Multidisciplinary Molecular Tumor Boards
Oct 09, 2019 3:13 PM

Need additional staging (CT scans) and ECHO. Additionally need FISH for the equivocal HER2 IHC

Daniel Morganstern, MD
Re: Breast Cancer: October 2019 Multidisciplinary Molecular Tumor Boards
Oct 09, 2019 4:20 PM

Needs definitive determination of her2 status by fish or cish

does not need body imaging if basic labs CBC and  chemistries are normal.  

Re: Breast Cancer: October 2019 Multidisciplinary Molecular Tumor Boards
Oct 11, 2019 10:48 PM

Given positive node she requires systemic staging to exclude metastasis: CT/bone scan or PET.

Needs FISH to confirm her2neu amplification.

16636

Re: Breast Cancer: October 2019 Multidisciplinary Molecular Tumor Boards
Oct 09, 2019 3:16 PM

Agreed. In addition, I would request repeat ER testing due to 2% low staining. Following these staging and path results, I would want to include genetics for a full family hx and germline test to rule out BRCA/ATM/etc mutations given her young age. 

16646

Re: Breast Cancer: October 2019 Multidisciplinary Molecular Tumor Boards
Oct 09, 2019 3:31 PM

<p>HER2 fby FISH</p>

16651

Maaz Kamal Alata, MD, MBBS
Re: Breast Cancer: October 2019 Multidisciplinary Molecular Tumor Boards
Oct 09, 2019 4:13 PM

1. FiSH for HER2
2. Routine labs CBC Diff , Renal and hepatic profiles , Ca level and ALP.
3. Baseline ECHO
4. Tumor Board meeting schedule

16661

Re: Breast Cancer: October 2019 Multidisciplinary Molecular Tumor Boards
Oct 09, 2019 6:29 PM

I agree with all recommendations 

16666

dehebert
Re: Breast Cancer: October 2019 Multidisciplinary Molecular Tumor Boards
Oct 10, 2019 2:36 AM

Her2 FISH testing, genetic counselling and testing especially BRCA1/2. Imaging work -up because of G3 , Ki67 90%

16671

Sarabjeet Kaur Arneja
Re: Breast Cancer: October 2019 Multidisciplinary Molecular Tumor Boards
Oct 10, 2019 4:36 AM

1) Additional testing for Her2 Status by FISH or CISH

2) Imaging studies ( PET CT) for staging purposes

 

16681

Re: Breast Cancer: October 2019 Multidisciplinary Molecular Tumor Boards
Oct 12, 2019 10:56 PM

I agree with all recommendation (fish, genetic and CT scan)


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