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Discussion Starter · #1 ·
A 45-year-old woman's x-ray mammogram reveals a small stellate radio-opaque mass in the left breast. A biopsy is ordered. Which of the following invasive carcinomas has the best prognosis?

A. ER (estrogen receptor)-positive, HER2-negative ductal carcinoma
B. ER-negative, HER2-negative ductal carcinoma
C. ER-negative, HER2-positive ductal carcinoma
D. ER-negative, HER2-positive papillary carcinoma
E. ER-positive, HER2-positive ductal carcinoma
 

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Discussion Starter · #4 ·
Correct!

The answer is A. ER-positive, HER2-negative ductal carcinoma. Also called "Luminal A", the majority of these cancers are moderately- to well-differentiated. Although they usually do not respond to standard chemotherapy, they are slow-growing and do respond well to hormonal treatments.
  • B. ER-negative, HER2-negative ductal carcinoma - these "triple-negative" carcinomas are also referred to as "basal-like" carcinomas. There is an increased incidence in women with BRCA1 mutations. They are generally high-grade and proliferative and are associated with an aggressive course, frequent metastasis, and a poor prognosis.
  • C. ER-negative, HER2-positive ductal carcinoma - these are usually poorly differentiated, have high rates of proliferation and brain metastasis, and are associated with poor prognosis.
  • D. ER-negative, HER2-positive papillary carcinoma - this is likely to be an invasive micropapillary carcinoma and have a poor prognosis (as opposed to ER+ invasive papillary carcinomas, which have a good prognosis).
  • E. ER-positive, HER2-positive ductal carcinoma - these "triple-positive" carcinomas are also called "Luminal B". While this would be the next best answer after A, these cancers are generally of higher grade, have a higher proliferative rate, and do not have quite as good a prognosis as Luminal A carcinomas.
 

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The answer is A. ER-positive, HER2-negative ductal carcinoma. Also called "Luminal A", the majority of these cancers are moderately- to well-differentiated. Although they usually do not respond to standard chemotherapy, they are slow-growing and do respond well to hormonal treatments.
  • B. ER-negative, HER2-negative ductal carcinoma - these "triple-negative" carcinomas are also referred to as "basal-like" carcinomas. There is an increased incidence in women with BRCA1 mutations. They are generally high-grade and proliferative and are associated with an aggressive course, frequent metastasis, and a poor prognosis.
  • C. ER-negative, HER2-positive ductal carcinoma - these are usually poorly differentiated, have high rates of proliferation and brain metastasis, and are associated with poor prognosis.
  • D. ER-negative, HER2-positive papillary carcinoma - this is likely to be an invasive micropapillary carcinoma and have a poor prognosis (as opposed to ER+ invasive papillary carcinomas, which have a good prognosis).
  • E. ER-positive, HER2-positive ductal carcinoma - these "triple-positive" carcinomas are also called "Luminal B". While this would be the next best answer after A, these cancers are generally of higher grade, have a higher proliferative rate, and do not have quite as good a prognosis as Luminal A carcinomas.
Well, thank you Mondoshawan for those explanations. New stuff for sure. Keep the good work.
 
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