KCMC-FCCT Tumor Board September 2022

By Randy Hurley MD, cTropMed
HealthPartners and Regions Hospital Cancer Care Centers
Global Health Faculty, University of Minnesota
September 27, 2022

Two cases were discussed at the KCMC-Minnesota tumor board this month

The first case was a 60-year-old woman with a locally advanced breast cancer manifesting as a 5cm breast mass with palpable axillary and supraclavicular adenopathy. The patient also had an enlarged  contralateral right axillary lymph node concerning for either a second primary cancer in the right breast or, a rare situation of contralateral axillary metastases from a left sided breast cancer.  A biopsy of the left breast mass revealed infiltrating ductal carcinoma. Immunohistochemistry for estrogen receptor, progesterone receptor and Her2/neu were pending.  The tumor conference was attended by KCMC’s breast surgeon, Dr Marianne Gnanamuttupulle, who has training in nipple-sparing mastectomy techniques. Dr Gnanamuttupulle has recently published KCMC’s experience with breast cancer. (https://ecancer.org/en/journal/article/1282-clinicopathological-characteristics-of-breast-cancer-patients-from-northern-tanzania-common-aspects-of-late-stage-presentation-and-triple-negative-breast-cancer).

Breast cancer is the second most common cancer affecting women in Tanzania after cervical cancer.  Of the 4 main biologic subtypes of breast cancer (triple negative, luminal A, luminal B and her2 driven) the more aggressive histologic subtype, triple negative breast cancer, is the most common in Tanzanian women. This subtype is seen in 28% of the cases.   Recommendations were discussed including further staging with CT scan and  biopsy of the right axillary lymph node. It was anticipated that the patient would undergo neoadjuvant systemic therapy once her receptor status was known

The second case was a little more uncertain histologically.  This case involved a 37-year-old woman who developed right sided chest pain, shortness of breath and a palpable posterior chest wall mass during her last month of pregnancy.  Following a cesarean section, a CT scan identified a large right pleural based mass, collapse of the lower lobe of the right lung and mediastinal shift to the left.  An Incisional biopsy of the chest wall mass revealed a small round blue cell tumor. Histology slides were available for review by a participating pathologist from Froedtert Hospital in Milwaukee. A typical differential diagnosis of small round blue cell tumors would include small cell lung cancer, non-Hodgkin’s lymphoma, and rarer sarcomas such as Ewing sarcoma or rhabdomyosarcoma. Unfortunately, immunohistochemistry capability is currently limited at KCMC and thus a definitive diagnosis was hard to establish.  The patient’s poor performance status and distance from the medical center precluded any palliative cancer directed therapy