CME INFORMATION

FACULTY AFFILIATIONS AND DISCLOSURES

Case Studies

Case 1 from the practice of Dr Mary Ann K Allison: A 53-year-old woman who, as part of a clinical trial, received dose-dense AC, nanoparticle albumin-bound (nab) paclitaxel and tamoxifen for a 2.2-cm, Grade III, ER-negative, PR-positive, HER2-negative invasive ductal carcinoma with lymphovascular invasion and 1/16 positive nodes. Within a year, she developed a subpectoral mass.

Case 2 from the practice of Dr Frederick M Schnell: A 58-year-old woman who received CMF in 1988 after a modified radical mastectomy (MRM) for ER-positive, PR-positive, node-negative, invasive breast cancer. Eleven years later, she underwent excision and radiation therapy for a contralateral, 0.8-cm, ER-positive, PR-positive, HER2-negative, node-negative, invasive ductal carcinoma with DCIS. In 2004, she presented with widespread metastatic disease.

Case 3 from the practice of Dr Frederick P Smith: A 65-year-old woman treated four years ago for a 1.6-cm, ER-positive, PR-positive, HER2-negative, node-negative infiltrating ductal carcinoma. She received tamoxifen for three years, then began anastrozole, but three months later, a CT revealed hepatic metastases.

Case 4 from the practice of Dr Brenda L Towell: A 54-year-old woman treated with mastectomy, dose-dense AC/paclitaxel, radiation therapy and tamoxifen three years ago for a three-centimeter, ER-positive, PR-negative, HER2-negative breast tumor with 11 positive nodes. A year later, she was switched to goserelin and anastrozole because of rising serum tumor markers and within a few weeks exhibited lymphangitic lung metastases.

Case 5 from the practice of Dr William G Reeves: A 54-year-old woman who underwent a lumpectomy for a 2.3-cm, ER-positive, PR-positive, HER2-negative, moderately differentiated infiltrating ductal carcinoma with negative sentinel nodes and an Oncotype DX™ score of nine. She has been on anastrozole for the past 2.5 years.

Case 6 from the practice of Dr Sara M Garrido: A 53-year-old woman with a history of hypertension and hypercholesterolemia who underwent a lumpectomy for a 0.8-cm, poorly differentiated, ER-negative, PR-negative, HER2-positive, node-negative, invasive ductal carcinoma with DCIS. She received six cycles of TCH followed by trastuzumab for a year.

Case 7 from the practice of Dr Margaret A Deutsch: A 70-year-old woman who presented with a 1.8-cm, ER-positive, PR-negative, HER2-positive tumor. Refusing chemotherapy, she underwent radiation therapy and began anastrozole and trastuzumab.

Case 8 from the practice of Dr Atif M Hussein: A 35-year-old woman with a five- to six-centimeter breast mass consisting of DCIS and high-grade, ER-positive (in 35 percent of cells), PR-negative (in less than one percent of cells), HER2-negative invasive tumor. She received four cycles of TAC and underwent mastectomy. Pathology revealed a 2.7-cm area of DCIS and 14 negative nodes.

Case 9 from the practice of Dr Stephen A Grabelsky: A 57-year-old woman who underwent a modified radical mastectomy nine years ago for a 2.6-cm, ER-positive, PR-positive breast tumor with 2/12 positive nodes, followed by CMF and five years of tamoxifen. Two years later, she developed a chest wall recurrence.

Case 10 from the practice of Dr Deutsch: A 47-year-old woman who presented with a 1.1-cm, triple-negative, invasive medullary breast cancer. Three years ago, she was treated with lumpectomy, radiation therapy and tamoxifen for DCIS. The patient has a strong family history of breast cancer, including her mother and two aunts.

Case 11 from the practice of Dr Lowell L Hart: A 37-year-old mother of three who presented in the first trimester of pregnancy with a four- to five-centimeter, ER-positive, PR-negative, Grade III, HER2-amplified breast tumor. The pregnancy was terminated, and she received neoadjuvant TCH. At surgery, pathology revealed a 0.8-cm area of DCIS with 4/10 positive nodes.

Case 12 from the practice of Dr Allison: A 44-year-old woman who presented with bilateral axillary nodes, which were ER-positive, PR-positive, HER2-positive breast carcinoma. Staging work-up revealed bone and liver metastases.