TUMOUR BOARD PRESENTATION AIIMS BHOPAL.pptx

This is a case discussed in tumour board of AIIMS bhopal on 10/9/24. It is a case of metastatic breast cancer not responding to chemo

1. 13/09/2024 Metastatic Breast Carcinoma Tumor Board Discussion

2. History 54/y unmarried female No h/o any addiction Family History- Not significant Chief Complaints- Low backache since 28/02/2024 Swelling Left lower Back since 5 months Discharge from left Breast since 5 months Itching left breast since June 2024 History of Present illness (duration,Progression and a/w symptoms) Low backache aggravating on get up from bed and relieving after analgesic gel since 1 to 1.5 year Fatigue and decreased speed of walking since 2 years Discharge from left Breast associated with itching since June 2024

3. Clinical Examination No comorbidity Gen. Examination -conscious, well oriented to time place and person Temperature 98.6Deg F, Pulse 90/min, BP 136/84, SPO2: 98% on room air No pallor/Icterus/Cyanosis PS-2 No Systemic abnormality detected Breast Examination- 5x5 cm mass in left breast, without ulceration or discharge and peak d orange present. Axillary Examination- NAD Any Other Significant- SI joint paint bony tenderness

4. Imaging CECT(18/06/2024)- 4.2 x 3.5 cm Well defined lobulated heterogeneously enhancing lesion retro-areolar region of left breast adherent to skin surface. CECT abdomen (18/06/2024) - Multiple uterine fibroids largest- 12 x 9.4 x 10.9 cm Whole body F18 FDG PETCT (31/07/2024)- 4.1x3.1 cm FDG avid lobulated heterogeneously enhancing soft tissue lesion lower medial quadrant left breast(SUVmax 10.5) infiltrating the overlying skin and abuting the chest wall. Non FDG avid B/L axillary subcm nodes- reactive FDG avid focal lytic lesion left scapula along base of acromion process (SUVmax 7.1)- likely metastatic Diffuse FDG avid increased metabolic activity in left SI joint along with subchondral sclerosis along left iliac bone(SUVmax 11.1)- ? Metastatic?infective ? Inflama

5. MRI Pelvis with contrast (03/09/2024)- Moderate subchondral and bone marrow edema with enhancement of left SI joint with effusion within joint space as well as synovitis. Left iliopsoas muscle shows diffuse infiltration with abscess, edema also seen in gluteus Maximus and pyriformis muscle Likely infective ethology , ? Metastasis. MRI Lumbo- sacral spine with contrast(03/09/2024)- Diffuse disc bulge with bilateral ligamentum flavum thickening at L3-L4, AND L4-L5, causing indentation of theca sac causing narrowing of b/l neural foramina. No nerve root compression.

6. Pathology Trucut Biopsy from Left Breast(22/07/2024)- AIIMS BPL Tumor Site- UOQ Histological type- Invasive Carcinoma of NOS(duct) Grade- Overall 1 (2+2+1=5) No DCIS No Lymphatic and/or Vascular invasion Receptor status- ER 7/8, PR 7/8, Her2neu- 2+ equivocal(08/08/2024) FISH for Her 2 neu -Medgenome lab(02/09/2024) - Her2neu- Negative by FISH, Ki 67 Proliferation index- 30%

7. Core Biopsy from L3,L4,L5 Vertbrae(06/09/2014)-Fibromuscular tissue with areas of haemorrhage only Microbiology(23/08/2024)- No Pus cells, No micro-organisms, Mtb- Non detected, AFB staining- No acid fast bacilli see(? On trucut Biopsy sample left breast)

8. Staging cT4b cN0 M1(Scapula) Clinical group Stage -IV

9. Discussion Points SI Joint- ? Metastasis ? Infective? Inflammatory Further Management Plan Team inputs

10. Conclusion Case summary Next steps