A 50 year-old woman noticed a lump in her left breast. Both her mother and sister died of breast cancer in their late 40s. However, she thought that the lump would disappear and, therefore, she did not go to see her doctor. Since the breast lump did not disappear but increased in size steadily, she was admitted to the hospital. A fine needle aspiration biopsy was performed and the diagnosis of breast cancer was made. She underwent "lumpectomy" and axillary lymph node dissection. She was given chemotherapy and radiation therapy. However, she did not respond to the treatment and she died three years later with distant metastases to the brain, liver, lungs and bones.

Discussion topics

1. How would you have staged this cancer at a time of presentation using the data that was provided to you?
2. Discuss the possible risk factors of breast cancer in this woman and the possibility that she carried a mutation in the BRCA-1 gene.
3. Compare lymphatic vs. hematogenous metastasis of breast cancer.

A 26 year-old male was diagnosed with ulcerative colitis (UC) at the age of 12. He was successfully managed medically, and his ulcerative colitis was in clinical remission for the last two years. He presented to the Emergency Room with bright-red blood in the stools. A gastroenterology work-up demonstrated a large mass in the ascending colon, with diffuse changes of colitis along the entire length of the colon. Endoscopic biopsy from the mass revealed an adenomatous polyp. The patient underwent total colectomy. An invasive adenocarcinoma was present in the ascending colon. The tumor had spread through the wall of the colon, infiltrating into the pericolonic fat, and was present in three of twenty submitted lymph nodes.

1. The endoscopic biopsy revealed only an adenomatous polyp (benign). How then could the surgical pathologist report an adenocarcinoma following the colectomy?
2. What Duke's stage is this tumor? What is the prognosis?
3. Why do you think UC patients are at increased risk of carcinoma?

A 7 year-old child from Uganda was admitted to the hospital with a large jaw mass. Fine needle aspiration biopsy revealed that the lesion was a lymphoma. An attempt to resect the tumor provided more material for histologic examination at which time the diagnosis of Burkitt lymphoma was made. Immunohistochemical studies revealed evidence of EB virus and the chromosomal analysis revealed evidence of a chromosomal translocation typical of Burkitt lymphoma. Immunohistochemically, the tumor was classified as a B-cell lymphoma.

Discussion topics

1. Is this an endemic or sporadic Burkitt lymphoma and how do you think it is related to the EB virus infection?
2. Could lymphomas originate in the jaws, i.e., outside of the lymph nodes?
3. What chromosomal changes are often detected in this type of case? How is this related to the activation of oncogenes ?

A 30 year-old man noticed enlargement of the left testicle. The physical examination revealed that he had a firm nodule in the testicle which measured approximately 4 cm. in diameter. The diagnosis of a malignant germ cell tumor was made by fine needle aspiration biopsy. CAT scanning was performed and retroperitoneal lymph node metastases were detected. The patient underwent an orchiectomy and periaortic lymph node dissection. At the same time the blood analysis gave positive results for hCG and AFP.

Discussion topics

1. Is it unusual to diagnose tumors in this age group?
2. How did this tumor metastasize?
3. What is the significance of elevated hCG and AFP in the serum of this patient?