A Giant Necrotic and Hem orrhagic Papillary Carcinom a of the Breast: A Case Report Emily Klosterman, DO, MS MEd, PGY-1 Kai Huang, MD, PGY-2 Subhasis Misra, MD, MS, FACS 3/23/2019 This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this expressed in this publication represent those of the author(s) and do not necessarily represent the official 1 publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities. views of HCA or any of its affiliated entities.
10/17/2018 AV 78 year old female cc: “left breast bleeding” x 1 day This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this 2 publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities.
HPI -c/o left breast bleeding x 1 day, after minimal trauma -Left breast swelling and skin changes x 3 years Labs: WBC- 15.0, Hgb-11.1, -PMhx: None lactic acid-2.8 -PShx: None Physical Exam: -Afebrile, vitals stable -No findings, except… This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities.
This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this 4 publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities.
Im aging CT Chest -Partially necrotic left chest wall mass (14.1 x 19 x 20.3 cm) -Invasion into pectoralis muscle -Adjacent left axillary lymphadenopathy - Large necrotic lymph node (3.0x3.5 cm) This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this 5 publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities.
This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this 6 publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities.
This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this 7 publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities.
This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this 8 publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities.
This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this 9 publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities.
This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this 10 publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities.
This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this 11 publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities.
This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this 12 publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities.
This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this 13 publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities.
This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this 14 publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities.
This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this 15 publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities.
This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this 16 publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities.
This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this 17 publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities.
Pathology Invasive papillary carcinoma- Margins negative 95% of specimen comprised of necrotic tissue ER-positive, 3+, 100%, PR-positive, 3+, 75%, HER2-negative • 6/6 nodes within specimen-positive for metastatic adenocarcinoma • 3 from limited axillary node dissection positive for metastatic adenocarcinoma • extranodal spread evident This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this 18 publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities.
Sum m ary -78 year old female with giant necrotic and hemorrhagic invasive papillary carcinoma with metastasis to axillary nodes -Status post emergent left total mastectomy, partial chest wall resection, and limited axillary dissection This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this 19 publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities.
Invasive Papillary Breast Cancer -Rare form of breast cancer (< 1% of cases) -Typically in post menopausal women -Rarely metastatic - As a result, usually a more favorable prognosis This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this 20 publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities.
Questions? This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this 21 publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities.
References: Fakhreddine, M. H., Haque, W., & Ahmed, A., et, al. (2018). Prognostic Factors, Treatment, and Outcomes in Early Stage, Invasive Papillary Breast Cancer. American Journal of Clinical Oncology,41 (6), 532-537. Misra, Subhasis et al. (2010). Screening Criteria for Breast Cancer. Advances in Surgery , 44 (1) , 87 – 100. Pal, S. K., Lau, S. K., Kruper, L., Nwoye, U., Garberoglio, C., Gupta, R. K., Paz, B., Vora, L., Guzman, E., Artinyan, A., Somlo, G. (2010). Papillary carcinoma of the breast: an overview. Breast cancer research and treatment , 122 (3), 637-45. Soo, M.S, Williford, M.E., Walsh, R, et, al. (1995). Papillary carcinoma of the breast: imaging findings. American Journal of Roentgenology , 164(2), 321- 326. Wei, Shi ( 2016 ). Papillary Lesions of the Breast: An Update. Archives of Pathology & Laboratory Medicine , 140 (7), 628-643. Zheng, Y. Z., Hu, X., & Shao, Z. M. (2016). Clinicopathological Characteristics and Survival Outcomes in Invasive Papillary Carcinoma of the Breast: A SEER Population-Based Study. Scientific reports , 6 , 24037. This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this 22 publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities.
A complication of conservative management in penetrating chest trauma Chris Jacobs, MD; Tyler Loftus, MD; Frederick Moore, MD; Eddie Manning, MD; Scott Brakenridge, MD Department of Surgery, Division of Trauma Acute Care Surgery University of Florida
Disc lo sure s • No financial relationships to disclose
Case Pre se ntatio n • 46yM presented as a trauma alert with a GSW to the LLQ • GCS 15, SBP 80s, HR 110s, Hct 35 • No exit wound, + peritoneal signs • Transported emergently to trauma hybrid room for exploratory laparotomy
I ntrao pe rative findings • Multiple penetrating injuries • Left tube thoracostomy 500cc blood • Small bowel and transverse colonic resection • Diaphragmatic repair and gastrorraphy • Subxiphoid pericardial window minimal clotted blood o Copiously irrigated and no active bleeding noted • Washed out, anastomosed and closed by hospital day 2
Recommend
More recommend
