醫學五 楊世慧 詹舜文 屠冠翔. 2007/11/26 Breast Partial mastectomy Invasive ductal...
-
Upload
roy-mcdowell -
Category
Documents
-
view
244 -
download
0
Transcript of 醫學五 楊世慧 詹舜文 屠冠翔. 2007/11/26 Breast Partial mastectomy Invasive ductal...
![Page 1: 醫學五 楊世慧 詹舜文 屠冠翔. 2007/11/26 Breast Partial mastectomy Invasive ductal carcinoma, Grade 3, pT1bN1Mx HER-2/Neu: 1+, negative ER: 70% strongly positive PR:](https://reader033.fdocuments.net/reader033/viewer/2022061522/56649ec85503460f94bd547f/html5/thumbnails/1.jpg)
醫學五楊世慧詹舜文屠冠翔
![Page 2: 醫學五 楊世慧 詹舜文 屠冠翔. 2007/11/26 Breast Partial mastectomy Invasive ductal carcinoma, Grade 3, pT1bN1Mx HER-2/Neu: 1+, negative ER: 70% strongly positive PR:](https://reader033.fdocuments.net/reader033/viewer/2022061522/56649ec85503460f94bd547f/html5/thumbnails/2.jpg)
2007/11/26 Breast Partial mastectomy
Invasive ductal carcinoma, Grade 3 , pT1bN1MxHER-2/Neu: 1+, negative
ER: 70% strongly positive
PR: 50% strongly postive
![Page 3: 醫學五 楊世慧 詹舜文 屠冠翔. 2007/11/26 Breast Partial mastectomy Invasive ductal carcinoma, Grade 3, pT1bN1Mx HER-2/Neu: 1+, negative ER: 70% strongly positive PR:](https://reader033.fdocuments.net/reader033/viewer/2022061522/56649ec85503460f94bd547f/html5/thumbnails/3.jpg)
2010-7-20 Endometrium curettage
![Page 4: 醫學五 楊世慧 詹舜文 屠冠翔. 2007/11/26 Breast Partial mastectomy Invasive ductal carcinoma, Grade 3, pT1bN1Mx HER-2/Neu: 1+, negative ER: 70% strongly positive PR:](https://reader033.fdocuments.net/reader033/viewer/2022061522/56649ec85503460f94bd547f/html5/thumbnails/4.jpg)
![Page 5: 醫學五 楊世慧 詹舜文 屠冠翔. 2007/11/26 Breast Partial mastectomy Invasive ductal carcinoma, Grade 3, pT1bN1Mx HER-2/Neu: 1+, negative ER: 70% strongly positive PR:](https://reader033.fdocuments.net/reader033/viewer/2022061522/56649ec85503460f94bd547f/html5/thumbnails/5.jpg)
![Page 6: 醫學五 楊世慧 詹舜文 屠冠翔. 2007/11/26 Breast Partial mastectomy Invasive ductal carcinoma, Grade 3, pT1bN1Mx HER-2/Neu: 1+, negative ER: 70% strongly positive PR:](https://reader033.fdocuments.net/reader033/viewer/2022061522/56649ec85503460f94bd547f/html5/thumbnails/6.jpg)
![Page 7: 醫學五 楊世慧 詹舜文 屠冠翔. 2007/11/26 Breast Partial mastectomy Invasive ductal carcinoma, Grade 3, pT1bN1Mx HER-2/Neu: 1+, negative ER: 70% strongly positive PR:](https://reader033.fdocuments.net/reader033/viewer/2022061522/56649ec85503460f94bd547f/html5/thumbnails/7.jpg)
![Page 8: 醫學五 楊世慧 詹舜文 屠冠翔. 2007/11/26 Breast Partial mastectomy Invasive ductal carcinoma, Grade 3, pT1bN1Mx HER-2/Neu: 1+, negative ER: 70% strongly positive PR:](https://reader033.fdocuments.net/reader033/viewer/2022061522/56649ec85503460f94bd547f/html5/thumbnails/8.jpg)
CD10
![Page 9: 醫學五 楊世慧 詹舜文 屠冠翔. 2007/11/26 Breast Partial mastectomy Invasive ductal carcinoma, Grade 3, pT1bN1Mx HER-2/Neu: 1+, negative ER: 70% strongly positive PR:](https://reader033.fdocuments.net/reader033/viewer/2022061522/56649ec85503460f94bd547f/html5/thumbnails/9.jpg)
Uterus, endometrium, curettage
-----malignant Tumor, favor adenosarcoma with sarcomatous overgrowth
![Page 10: 醫學五 楊世慧 詹舜文 屠冠翔. 2007/11/26 Breast Partial mastectomy Invasive ductal carcinoma, Grade 3, pT1bN1Mx HER-2/Neu: 1+, negative ER: 70% strongly positive PR:](https://reader033.fdocuments.net/reader033/viewer/2022061522/56649ec85503460f94bd547f/html5/thumbnails/10.jpg)
AdenosarcomaMicroscopic findings
Benign epithelial component: Resembles inactive or proliferative
endometrial epithelium
Malignant mesenchymal component: Low-grade sarcoma Resembles ESS, fibrosarcoma Periglandular cuffs: hypercellularity May contain heterologous elements
![Page 11: 醫學五 楊世慧 詹舜文 屠冠翔. 2007/11/26 Breast Partial mastectomy Invasive ductal carcinoma, Grade 3, pT1bN1Mx HER-2/Neu: 1+, negative ER: 70% strongly positive PR:](https://reader033.fdocuments.net/reader033/viewer/2022061522/56649ec85503460f94bd547f/html5/thumbnails/11.jpg)
Immunohistochemistry
Epithelial component Keratin (+), ER (+), PR (+)
Mesenchymal component Cytoplasmic CD 10 (+) Nuclear ER (+), PR (+), WT-1 (+) Smooth muscle actin sometimes (+), desmin (+)
![Page 12: 醫學五 楊世慧 詹舜文 屠冠翔. 2007/11/26 Breast Partial mastectomy Invasive ductal carcinoma, Grade 3, pT1bN1Mx HER-2/Neu: 1+, negative ER: 70% strongly positive PR:](https://reader033.fdocuments.net/reader033/viewer/2022061522/56649ec85503460f94bd547f/html5/thumbnails/12.jpg)
Differential Diagnosis Adenofibromas
Benign epithelial and stromal components paucicellular stroma , no periglandular cuffing, no stromal
atypia
Benign endometrial polyp Benign epithelial and stromal components inactive glands, No periglandular cuffing , no stromal mitoses
Atypical polypoid adenomyoma Atypical epithelial component and benign stromal component cellular smooth muscle ,glandular component with squamous
morules
![Page 13: 醫學五 楊世慧 詹舜文 屠冠翔. 2007/11/26 Breast Partial mastectomy Invasive ductal carcinoma, Grade 3, pT1bN1Mx HER-2/Neu: 1+, negative ER: 70% strongly positive PR:](https://reader033.fdocuments.net/reader033/viewer/2022061522/56649ec85503460f94bd547f/html5/thumbnails/13.jpg)
Malignant mixed mullerian tumor (MMMTs) Malignant epithelial and stromal components carcinomatous glandular component
Endometrial stromal sarcomas Malignant stromal component only no glandular component
![Page 14: 醫學五 楊世慧 詹舜文 屠冠翔. 2007/11/26 Breast Partial mastectomy Invasive ductal carcinoma, Grade 3, pT1bN1Mx HER-2/Neu: 1+, negative ER: 70% strongly positive PR:](https://reader033.fdocuments.net/reader033/viewer/2022061522/56649ec85503460f94bd547f/html5/thumbnails/14.jpg)
Sarcomatous overgrowth Uncommon variant
a benign glandular component sarcomatous portion constituting more than 25%
of the tumor
Higher grade and higher mitotic rate
High recurrence and mortality, comparable to carcinosarcoma
![Page 15: 醫學五 楊世慧 詹舜文 屠冠翔. 2007/11/26 Breast Partial mastectomy Invasive ductal carcinoma, Grade 3, pT1bN1Mx HER-2/Neu: 1+, negative ER: 70% strongly positive PR:](https://reader033.fdocuments.net/reader033/viewer/2022061522/56649ec85503460f94bd547f/html5/thumbnails/15.jpg)
2010/08/06
Uterus, Endometrium, total Hysterectomy Bilateral salpingooophorectomy Pelvic lymph node dissection Partial omentectomy
![Page 16: 醫學五 楊世慧 詹舜文 屠冠翔. 2007/11/26 Breast Partial mastectomy Invasive ductal carcinoma, Grade 3, pT1bN1Mx HER-2/Neu: 1+, negative ER: 70% strongly positive PR:](https://reader033.fdocuments.net/reader033/viewer/2022061522/56649ec85503460f94bd547f/html5/thumbnails/16.jpg)
Gross Features
Endometrial polypoid tumor occupying the endometrial cavity and measuring 7.5 x 5 x 4.2 cm. Foci of necrosis and hemorrhage present.
No definite myometrial invasion grossly Ovaries: no tumor Omentum: 4.1 x 2.8 x 0.4 cm, no tumor
![Page 17: 醫學五 楊世慧 詹舜文 屠冠翔. 2007/11/26 Breast Partial mastectomy Invasive ductal carcinoma, Grade 3, pT1bN1Mx HER-2/Neu: 1+, negative ER: 70% strongly positive PR:](https://reader033.fdocuments.net/reader033/viewer/2022061522/56649ec85503460f94bd547f/html5/thumbnails/17.jpg)
![Page 18: 醫學五 楊世慧 詹舜文 屠冠翔. 2007/11/26 Breast Partial mastectomy Invasive ductal carcinoma, Grade 3, pT1bN1Mx HER-2/Neu: 1+, negative ER: 70% strongly positive PR:](https://reader033.fdocuments.net/reader033/viewer/2022061522/56649ec85503460f94bd547f/html5/thumbnails/18.jpg)
Sarcomatous overgrowth
![Page 19: 醫學五 楊世慧 詹舜文 屠冠翔. 2007/11/26 Breast Partial mastectomy Invasive ductal carcinoma, Grade 3, pT1bN1Mx HER-2/Neu: 1+, negative ER: 70% strongly positive PR:](https://reader033.fdocuments.net/reader033/viewer/2022061522/56649ec85503460f94bd547f/html5/thumbnails/19.jpg)
![Page 20: 醫學五 楊世慧 詹舜文 屠冠翔. 2007/11/26 Breast Partial mastectomy Invasive ductal carcinoma, Grade 3, pT1bN1Mx HER-2/Neu: 1+, negative ER: 70% strongly positive PR:](https://reader033.fdocuments.net/reader033/viewer/2022061522/56649ec85503460f94bd547f/html5/thumbnails/20.jpg)
Diagnosis
Uterine adenosarcoma with sarcomatous overgrowth
Myometrial invasion less than 25% of myometrial wall thickness
All else negative
![Page 21: 醫學五 楊世慧 詹舜文 屠冠翔. 2007/11/26 Breast Partial mastectomy Invasive ductal carcinoma, Grade 3, pT1bN1Mx HER-2/Neu: 1+, negative ER: 70% strongly positive PR:](https://reader033.fdocuments.net/reader033/viewer/2022061522/56649ec85503460f94bd547f/html5/thumbnails/21.jpg)
2011 / 02/ 18 Intra-abdomen tumor resection with right hemicolectomy
![Page 22: 醫學五 楊世慧 詹舜文 屠冠翔. 2007/11/26 Breast Partial mastectomy Invasive ductal carcinoma, Grade 3, pT1bN1Mx HER-2/Neu: 1+, negative ER: 70% strongly positive PR:](https://reader033.fdocuments.net/reader033/viewer/2022061522/56649ec85503460f94bd547f/html5/thumbnails/22.jpg)
![Page 23: 醫學五 楊世慧 詹舜文 屠冠翔. 2007/11/26 Breast Partial mastectomy Invasive ductal carcinoma, Grade 3, pT1bN1Mx HER-2/Neu: 1+, negative ER: 70% strongly positive PR:](https://reader033.fdocuments.net/reader033/viewer/2022061522/56649ec85503460f94bd547f/html5/thumbnails/23.jpg)
Omentectomy
Gross: Multiple nodules measuring up to 1.5 x 1.5 x 1.0 cm
![Page 24: 醫學五 楊世慧 詹舜文 屠冠翔. 2007/11/26 Breast Partial mastectomy Invasive ductal carcinoma, Grade 3, pT1bN1Mx HER-2/Neu: 1+, negative ER: 70% strongly positive PR:](https://reader033.fdocuments.net/reader033/viewer/2022061522/56649ec85503460f94bd547f/html5/thumbnails/24.jpg)
Reference
[1] Piura B, Rabinovich A, Meirrovitz M, Yanai I. Müllerian adenosarcoma of the uterus: case report and review of literature. Eur J Gynecol Oncol. 2000;21:387–390.
[2] American Cancer Society, Inc [3] Atlas of Gynecologic Surgical Pathology [4] Blaustein’s pathology of the female genital tract ,
fourth edition