CME INFORMATION

FACULTY AFFILIATIONS AND DISCLOSURES

Case Studies

Case 1 from the practice of Bonni L Gearhart, MD: A 49-year-old obese woman with insulin-dependent diabetes, hypertension and hypercholesterolemia presented with a palpable 3.3-cm, high-grade, ER-negative, PR-negative, HER2-positive, clinically node-negative but pN0(i+) infiltrating ductal carcinoma (IDC) (presented to Dr Cobleigh and Dr Holmes).

Case 2 from the practice of Carolyn B Hendricks, MD: A 44-year-old woman diagnosed two years prior with a 2.2-cm, Grade III, triple-negative IDC with negative axillary node dissection. She declined adjuvant chemotherapy despite recommendation by her treating oncologist, was lost to routine follow-up and now presents with disseminated bony and visceral metastases (presented to Dr Cobleigh and Dr Holmes).

Case 3 from the practice of Richard S Zelkowitz, MD: A 51-year-old perimenopausal woman was diagnosed in 2002 with two distinct, ipsilateral breast lesions in different quadrants, measuring 0.8 centimeters and 2.5 centimeters. Pathology postmastectomy revealed ER-positive, PR-negative, HER2-positive invasive breast cancer at both sites and a negative SLNBx. She received adjuvant FEC and initiated endocrine therapy. She now complains of shortness of breath and pleuritic chest pain (presented to Dr Cobleigh and Dr Holmes).

Case 4 from the practice of Philip Glynn, MD: A 76-year-old widow in otherwise good health presented with back pain and a large breast mass causing skin contracture and erosion. Biopsy revealed an ER-positive, PR-positive, HER2-positive infiltrating lobular carcinoma, and staging work-up revealed hypercalcemia and metastatic involvement of the thoracic and lumbar spine (presented to Dr Cobleigh and Dr Holmes).

Case 5 from the practice of Lowell L Hart, MD: A 59-year-old woman in excellent health diagnosed with a 3.1-cm, highly proliferative, triple-negative, node-negative breast tumor. The patient entered a clinical trial of adjuvant AC/docetaxel in combination with bevacizumab. (presented to Dr Cobleigh and Dr Holmes).

Case 6 from the practice of Kapisthalam S Kumar, MD: A 59-year-old woman with a right mammographic breast abnormality was found to have a 3-mm focus of atypia on excisional biopsy, subsequently determined to be an infiltrating ductal carcinoma with tubular features. Wide local excision and extended SLNBx demonstrated a small residual focus of a Grade I, ER-positive, PR-positive, HER2-negative tumor with negative margins and one of eight positive nodes (presented to Dr Cobleigh and Dr Holmes).

Case 7 from the practice of Kenneth R Hoffman, MD: A 34-year-old woman in her tenth week of pregnancy was found to have a 2.3-cm, ER-negative, PR-negative, HER2-positive IDC. She underwent therapeutic interruption of pregnancy followed by mastectomy and axillary dissection, revealing two of 21 positive nodes (presented to Dr Cobleigh and Dr Holmes).

Case 8 from the practice of Michael A Schwartz, MD: A 57-year-old postmenopausal woman reporting a two-year history of gradual right breast hardening ultimately presented with an ulcerating and bleeding lesion spanning both breasts. Surgical biopsy revealed ER-positive, PR-positive, HER2-negative, Grade II IDC with regional nodal and chest wall involvement and diffuse bone metastases (presented to Dr Schwartzberg and Dr Seidman).

Case 9 from the practice of Andrea F Stebel, MD: A 66-year-old woman was diagnosed with a 5-cm, ER-positive, PR-negative, HER2-negative sentinel lymph node-negative infiltrating lobular cancer, treated with lumpectomy and radiation therapy. The patient wished to avoid cytotoxic chemotherapy and, after an Oncotype DX™ recurrence score of 15, received only adjuvant endocrine systemic treatment (presented to Dr Schwartzberg and Dr Seidman).

Case 10 from the practice of Alan B Astrow, MD: An 86-year-old woman was found to have a 1.9-cm, Grade II, ER-negative, PR-negative, HER2-positive IDC with six of 15 positive axillary nodes. Extent of disease evaluation showed no evidence of distant metastases and medical history was notable for controlled hypertension and mild Parkinsonism. She received adjuvant capecitabine with trastuzumab (presented to Dr Schwartzberg and Dr Seidman).

Case 11 from the practice of Patricia A De Fusco, MD: A 65-year-old woman diagnosed five years prior with a 1.7-cm, ER-positive, HER2-negative, invasive breast tumor with associated LVI and two of 15 positive nodes. She was treated with mastectomy, four cycles of AC and 2.5 years of adjuvant tamoxifen followed by a planned switch to anastrozole. She now presents with increasing lower back pain (presented to Dr Schwartzberg and Dr Seidman).