Dataset Viewer
Case
string | Patient History
string | Important Radiologic
string | After Neoadjuvant Chemotherapy
string | Courses of Treatment
string | Pathology Report
string | Label
string | Cluster
string |
|---|---|---|---|---|---|---|---|
Case 20
|
Female/54 years old, post-menopause. Screen detected mass lesion on left breast 11
o’clock direction. Family history of breast cancer, aunt
(paternal).
No comorbidities.
BRCA 1 and 2 mutation: Not detected.
|
Report 1: Mammography (Oct. 2020): irregular hyperdense mass in the upper mid portion of left breast (marked by BB
marker). Enlarged lymph node in left axilla. Report 2:Breast US (Oct. 2020): irregular hypoechoic
mass at the 12 o’clock direction of left breast. Report 3: Breast MRI (Oct. 2020): irregular enhancing
mass at the 12 o’clock direction of left breast.
|
Report 1: Mammography (Mar. 2021): mammography after treatment demonstrates residual focal asymmetry that is decreased in the longest diameter (marked by radiopaque marker). Report 2: Breast MRI (Mar. 2021): MRI after treatment
demonstrates residual non-mass enhancement (white
arrow) that is decreased in the longest diameter. Report 3: Lymphoscintigraphy shows visualized sentinel lymph nodes in the left axilla.
|
Neoadjuvant chemotherapy (#6 cycles of
docetaxel and carboplatin and trastuzumab and
pertuzumab) + Operation + Post-operative radiation therapy + Trastuzumab.
Operation
Left breast conserving surgery, sentinel lymph
node biopsy. (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on each direction.
|
Invasive Ductal Carcinoma
1. Post-chemotherapy status.
2. Size of tumor: 1.1 cm (ypT1c).
3. Histologic grade: 3/3 (tubule formation: 3/3,
nuclear pleomorphism: 3/3, mitotic count:
3/3, 3/HPF).
4. Intraductal component: present, intratumoral/extratumoral (10%) (nuclear grade:
high, necrosis: absent, architectural pattern:
solid, extensive intraductal component:
absent).
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) superior margin: 10 mm,
(b) inferior margin: 10 mm,
(c) medial margin: 15 mm,
(d) lateral margin: 10 mm,
(e) deep margin: 2 mm,
(f) superfcial margin: 2 mm.
7. Lymph nodes:
(a) metastasis in one out of two axillary
lymph nodes (ypN1a(sn)) (sentinel LN:
1/2),
(b) perinodal extension: absent,
(c) size of metastatic carcinoma: 2.5 mm. 8. Arteriovenous invasion: absent.
9. Lymphovascular invasion: present,
intratumoral.
10. Tumor border: infltrative.
11. Microcalcifcation: present, tumoral/
non-tumoral.
12. Pathological TN category (AJCC 2017):
ypT1cN1a(sn).
|
HR(−) HER2(+) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 21
|
Female/55 years old, pre-menopause.
Self-detected palpable mass lesion on right
breast.
No family history.
S/P Tuberculosis.
|
Report 1: Mammography (Apr. 2021): irregular hyperdense mass in the upper outer quadrant of right breast. Enlarged lymph nodes in right axilla. Report 2: Breast US (Apr. 2021): irregular hypoechoic
mass at the 11 o’clock direction of right breast. Report 3:Breast MRI (Apr. 2021): irregular enhancing
mass (white arrow) at the 11 o’clock direction of right
breast. Several enlarged lymph nodes (black arrow) in
right axilla. Report 4: PET-CT shows (a) hypermetabolic mass in right breast, upper outer
quadrant (mSUV = ~12.0) and (b)
hypermetabolic lymph nodes in right axilla
level I area.
|
Report 1: Mammography (Sept. 2021): mammography after treatment demonstrates residual mass that is decreased in
the longest diameter. Decrease in size of enlarged lymph nodes in right axilla. Report 2: Breast US (Sept. 2021): US after treatment
demonstrates residual hypoechoic mass that is decreased
in the longest diameter. Report 3: Breast MRI (Sept. 2021): MRI after treatment
demonstrates residual enhancing mass (white arrow) that
is decreased in the longest diameter and disappearance of
enlarged lymph nodes in right axilla. Report 4: Lymphoscintigraphy shows
visualized sentinel lymph nodes in the right
axilla.
|
Neoadjuvant chemotherapy (#6 cycles of
docetaxel and carboplatin and trastuzumab and
pertuzumab) + Operation + Post-operative radiation therapy + Trastuzumab and Pertuzumab.
Operation
Right breast conserving surgery, sentinel lymph
node biopsy. Fig. 156 (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors
on each direction
|
Invasive Ductal Carcinoma
1. Post-chemotherapy status.
2. Size of tumor: 1.0 cm (ypT1b).
3. Histologic grade: 3/3 (tubule formation: 2/3,
nuclear pleomorphism: 3/3, mitotic count:
3/3, 49/10HPF).
4. Intraductal component: absent. 5. Surgical margins:
(a) superior margin: 15 mm,
(b) inferior margin: 35 mm,
(c) medial margin: 5 mm,
(d) lateral margin: 15 mm,
(e) deep margin: 10 mm,
(f) superfcial margin: 3 mm.
6. Lymph nodes: no metastasis in three axillary
lymph nodes (ypN0(sn)) (sentinel LN: 0/2,
axillary LN: 0/1).
7. Arteriovenous invasion: absent.
8. Lymphovascular invasion: absent.
9. Tumor border: infltrative.
10. Microcalcifcation: present, non-tumoral.
11. Pathological TN category (AJCC 2017):
ypT1bN0(sn).
|
HR(−) HER2(+) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 22
|
Female/53 years old, peri-menopause.
Self-detected palpable mass lesion on right
breast 4 o’clock direction. No family history.
S/P hemorrhoids operation.
|
Report 1: Magnifcation (Mar. 2021): irregular mass with fne pleomorphic microcalcifcations in the lower inner of right breast. Report 2: Breast US (Mar. 2021): irregular hypoechoic
mass with microcalcifcations at the 4 o’clock direction of
right breast. Report 3:Breast MRI (Mar. 2021): irregular enhancing
mass at the 4 o’clock direction of right breast. Report 4:Lymphoscintigraphy shows visualized sentinel
lymph nodes in the right axilla.
| null |
Operation + Adjuvant chemotherapy (#4 cycles
of doxorubicin and cyclophosphamide) + Postoperative radiation therapy + Trastuzumab.
Operation
Right breast conserving surgery, sentinel lymph
node biopsy. (a) Gross pathology of lumpectomy specimen. (b, c) The margins get marked and sliced with different colors on each direction.
|
Invasive Ductal Carcinoma with apocrine differentiation and medullary pattern
1. Size of invasive component: 1.3 cm (pT1c).
2. Size of intraductal component: 3.0 cm.
3. Histologic grade: 3/3 (tubule formation: 3/3,
nuclear pleomorphism: 3/3, mitotic count:
2/3, 15/10HPF).
4. Intraductal component: present, extratumoral
(70%) (nuclear grade: high, necrosis: present, architectural pattern: solid/comedo,
extensive intraductal component: present).
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) superior margin: 6 mm,
(b) inferior margin: 6 mm,
(c) medial margin: positive for ductal carcinoma in situ (Fro 4) (see note),
(d) lateral margin: 6 mm,
(e) deep margin: 2 mm,
(f) superfcial margin: 5 mm.
7. Lymph nodes: no metastasis in two axillary
lymph nodes (pN0(sn)) (sentinel LN: 0/2).
8. Arteriovenous invasion: absent.
9. Lymphovascular invasion: absent.
10. Tumor border: infltrative.
11. Microcalcifcation: present, tumoral/
non-tumoral.
12. Pathological TN category (AJCC 2017):
pT1cN0(sn).
Note: 1. Ductal carcinoma in situ is present
only in the permanent section of Fro 4.
|
HR(−) HER2(+) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 23
|
Female/49 years old, pre-menopause.
Self-detected bloody discharge on nipple of
right breast.
No family history.
No comorbidities.
|
Report 1: Magnifcation (Aug. 2020): regional fne pleomorphic microcalcifcations in right upper outer quadrant. Report 2: Breast US (Aug. 2020): irregular hypoechoic
mass with microcalcifcations at the 10 o’clock direction
of right breast. Report 3:Breast MRI (Aug. 2020): regional heterogeneous non-mass enhancement in the upper portion of right
breast. Report 4: Lymphoscintigraphy shows visualized sentinel
lymph nodes in the right axilla.
| null |
Operation + Operation + Adjuvant paclitaxel and
trastuzumab.
Operation
Right nipple–areolar complex sparing mastectomy+ implant reconstruction, sentinel lymph
node biopsy (1st, Sept. 2020). (a) Gross pathology of lumpectomy specimen. (b–d) The margins get marked and sliced with different colors
on each direction.Second Operation
Right nipple excision + left breast partial mastectomy with reduction mammoplasty (2nd, May
2020)
|
First Report: Breast, right, nipple-sparing mastectomy:
Microinvasive Ductal Carcinoma
1. Size of invasive component: <0.1 cm
(pT1mi).
2. Size of intraductal component: 6.0 cm.
3. Histologic grade: 3/3 (tubule formation: 3/3,
nuclear pleomorphism: 3/3, mitotic count:
3/3, 3/10HPF).
4. Intraductal component: present, intratumoral/extratumoral (99%) (nuclear grade:
high, necrosis: present, architectural pattern:
micropapillary/cribriform/solid/comedo,
extensive intraductal component: present).
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) deep margin: 2 mm,
(b) superfcial margin: 2 mm.
7. Lymph nodes: no metastasis in one axillary
lymph node (pN0(sn)) (sentinel LN: 0/1).
8. Arteriovenous invasion: absent.
9. Lymphovascular invasion: absent.
10. Tumor border: infltrative. 11. Microcalcifcation: present, tumoral/
non-tumoral.
12. Pathological TN category (AJCC 2017):
pT1miN0(sn). Second Report: Invasive Ductal Carcinoma
1. Post nipple-sparing mastectomy status.
2. Size of tumor: 0.7 cm (rpT1b).
3. Histologic grade: 3/3 (tubule formation: 3/3,
nuclear pleomorphism: 3/3, mitotic count:
3/3, 21/10HPF). 4. Intraductal component: absent.
5. Skin and nipple: no involvement of tumor.
6. Surgical margins:
(a) superior margin: 3 mm,
(b) inferior margin: 21 mm,
(c) medial margin: 25 mm,
(d) lateral margin: 10 mm,
(e) deep margin: 2 mm,
(f) superfcial margin: 18 mm.
7. Lymph nodes: not submitted (rpNx).
8. Arteriovenous invasion: absent.
9. Lymphovascular invasion: absent.
10. Tumor border: infltrative.
11. Microcalcifcation: absent.
12. Pathological TN category (AJCC 2017):
rpT1bNx.
|
HR(−) HER2(+) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 24
|
Female/55 years old, pre-menopause.
Self-detected palpable mass lesion on left
breast 10–12 o’clock direction.
No family history.
Hypertension.
|
Report 1: Mammography (Apr. 2021): irregular hyperdense mass with fne pleomorphic microcalcifcations in the upper inner quadrant of left breast (marked BB marker). Enlarged lymph nodes in left axilla. Report 2: Breast US (Apr. 2021): irregular hypoechoic
mass with microcalcifcations at the 11 o’clock direction
of left breast. Report 3: Breast MRI (Apr. 2021): irregular enhancing
mass at the 11 o’clock direction of left breast. Enlarged
lymph node in left axilla (black arrow). Report 4:PET-CT shows (a) hypermetabolic lesion
in left breast, upper inner
quadrant (mSUV = ~6.6)
and (b) hypermetabolic lymph nodes in left SCN (2.4), left axilla level II and interpectoral area.
|
Report 1: Mammography:
mammography after
treatment demonstrates
residual mass that is
decreased in the longest
diameter. Report 2: Breast US: US after treatment demonstrates
residual hypoechoic mass that is decreased in the longest
diameter. Report 3: Breast MRI: MRI after treatment demonstrates
residual non-mass enhancement (white arrow) that is
decreased in the longest diameter and in the degree of
enhancement. No change of suspected metastatic lymph
nodes (black arrow) in left axilla. Report 4: Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left axilla.
|
Neoadjuvant chemotherapy (#3 cycles of
docetaxel and carboplatin and trastuzumab and
pertuzumab) + Operation + Post-operative radiation therapy + Trastuzumab and pertuzumab. Operation Left breast conserving surgery, sentinel lymph node biopsy. (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on each direction
|
1. No residual tumor with stromal fbrosis.
(a) Post-chemotherapy status.
(b) Lymph nodes: no metastasis in two axillary lymph nodes (ypN0(sn)) (sentinel
LN: 0/2).
2. Sclerosing adenosis with microcalcifcation.
|
HR(−) HER2(+) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 25
|
Female/82 years old, post-menopause.
Screen detected mass lesion on left breast 2:30
o’clock direction.
No family history.
S/P Left hemiplegia (due to brain hemorrhage), hypertension, S/P spinal stenosis operation, s/p Tuberculosis.
|
Report 1:Mammography (Apr. 2021): irregular hyperdense mass with fne pleomorphic microcalcifcations in the
upper outer quadrant of left breast. Report 2:Breast US (Apr. 2021): irregular hypoechoic
mass with echogenic halo and microcalcifcations at the 2
o’clock direction of left breast. Report 3:Breast MRI (Apr. 2021): irregular enhancing
mass (white arrow) with associated non-mass enhancement (black arrow) at the 2 o’clock direction of left breast.
| null |
Operation + Post-operative radiation therapy
(adjuvant chemotherapy refuse).
Operation
Left breast conserving surgery, sentinel lymph
node biopsy. (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on each direction.
|
Invasive Ductal Carcinoma
1. Size of invasive component: 2.5 cm (pT2).
2. Size of intraductal component: 4.0 cm.
3. Histologic grade: 3/3 (tubule formation: 3/3,
nuclear pleomorphism: 3/3, mitotic count:
2/3, 11/10HPF).
4. Intraductal component: present, intratumoral/extratumoral (50%) (nuclear grade:
high, necrosis: present, architectural pattern:
cribriform/solid/comedo, extensive intraductal component: present).
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) superior margin: 15 mm,
(b) inferior margin: positive for ductal carcinoma in situ (Fro 2) (see note),
(c) medial margin: 10 mm,
(d) lateral margin: 20 mm,
(e) deep margin: <2 mm from ductal carcinoma in situ (slide 11),
(f) superfcial margin: 13 mm.
7. Lymph nodes:
(a) metastasis in two out of four axillary
lymph nodes (pN1a(sn)) (sentinel LN:
2/4),
(b) perinodal extension: present,
(c) size of metastatic carcinoma: 8 mm.
8. Arteriovenous invasion: absent.
9. Lymphovascular invasion: present,
peritumoral. 10. Tumor border: infltrative.
11. Microcalcifcation: present, tumoral/
non-tumoral.
12. Pathological TN category (AJCC 2017):
pT2N1a(sn).
Note: 1. Ductal carcinoma in situ is focally
present only in the permanent section of Fro 2.
|
HR(−) HER2(+) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 26
|
Female/49 years old, pre-menopause.
Self-detected palpable mass lesion on right
breast 1 o’clock direction.
No family history.
No comorbidities.
|
Report 1:Breast US (May 2021): irregular hypoechoic
mass at the 2 o’clock direction of right breast. Report 2: Breast MRI (May 2021): irregular enhancing
mass at the 2 o’clock direction of right breast. Report 3:Lymphoscintigraphy shows visualized sentinel
lymph nodes in the right axilla.
| null |
Operation + Adjuvant chemotherapy (#4 cycles
of doxorubicin + cyclophosphamide) + Postoperative radiation therapy + Trastuzumab.
Operation
Right breast conserving surgery, sentinel lymph
node biopsy. (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on each direction.
|
Invasive Ductal Carcinoma with medullary
pattern
1. Size of tumor: 1.5 cm (pT1c).
2. Histologic grade: 3/3 (tubule formation: 3/3,
nuclear pleomorphism: 3/3, mitotic count:
2/3, 12/10HPF).
3. Intraductal component: present, intratumoral/extratumoral (5%) (nuclear grade:
high, necrosis: absent, architectural pattern:
solid, extensive intraductal component:
absent). 4. Skin: no involvement of tumor.
5. Surgical margins:
(a) superior margin: 20 mm,
(b) inferior margin: 5 mm,
(c) medial margin: 5 mm,
(d) lateral margin: 5 mm,
(e) deep margin: 2 mm,
(f) superfcial margin: 2 mm.
6. Lymph nodes: no metastasis in one axillary
lymph node (pN0(sn)) (sentinel LN: 0/1).
7. Arteriovenous invasion: absent.
8. Lymphovascular invasion: present,
intratumoral.
9. Tumor border: infltrative.
10. Microcalcifcation: present, tumoral/
non-tumoral.
11. Pathological TN category (AJCC 2017):
pT1cN0(sn).
|
HR(−) HER2(+) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 27
|
Female/69 years old, post-menopause.
Screen detected mass lesion on right breast 9
o’clock direction.
Family history of breast cancer, sister.
Hypertension, dyslipidemia.
BRCA 1 and 2 mutation: Not examination.
|
Report 1: Breast US (May 2021): irregular hypoechoic
mass with microcalcifcations at the 9 o’clock direction of
right breast. Report 2: Breast MRI (May 2021): irregular enhancing
mass at the 9 o’clock direction of right breast. Report 3: Lymphoscintigraphy shows visualized sentinel
lymph nodes in the right axilla.
|
Operation + Post-operative radiation therapy + Adjuvant paclitaxel and trastuzumab.
Operation
Right breast conserving surgery, sentinel lymph
node biopsy. (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on each direction
|
1. Invasive ductal carcinoma with medullary
pattern.
(a) Size of tumor: 0.8 cm (pT1b).
(b) Histologic grade: 3/3 (tubule formation:
3/3, nuclear pleomorphism: 3/3, mitotic
count: 3/3, 4/HPF).
(c) Intraductal component: present, intratumoral/extratumoral (50%) (nuclear grade:
high, necrosis: absent, architectural pattern: solid, extensive intraductal component: present).
(d) Skin: no involvement of tumor.
(e) Surgical margins:
• superior margin: 5 mm,
• inferior margin: 20 mm,
• medial margin: 5 mm,
• lateral margin: 5 mm,
• deep margin: 1.5 mm from ductal carcinoma in situ (slide 1),
• superfcial margin: 2 mm.
(f) Lymph nodes: no metastasis in one axillary lymph node (pN0(sn)) (sentinel LN:
0/1).
(g) Arteriovenous invasion: absent.
(h) Lymphovascular invasion: present,
intratumoral. (i) Tumor border: infltrative.
(j) Microcalcifcation: present, tumoral/
non-tumoral.
(k) Pathological TN category (AJCC 2017):
pT1bN0(sn).
2. Intraductal papilloma with usual ductal
hyperplasia.
|
HR(−) HER2(+) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
|
Case 28
|
Female/61 years old, post-menopause.
Screen detected mass lesion on right breast 9
o’clock direction.
No family history.
Hypertension.
|
Report 1: Mammography (June 2021): irregular hyperdense mass in the upper outer quadrant of right breast (marked by BB marker). Enlarged lymph nodes in right axilla. Report 2: Breast US (June 2021): irregular heterogeneous echoic mass at the 9 o’clock direction of right breast. Report 3: Breast MRI (June 2021): irregular rim enhancing mass (white arrow) at the 9 o’clock direction of right
breast. Associated non-mass enhancement (black arrow)
in the outer portion of right breast. Report 4: PET-CT shows (a) a hypermetabolic breast mass, right outer (mSUV = 5.7) and (b) hypermetabolic LNs along right axilla, level I–III.
|
Report 1: Mammography
(Oct. 2021): mammography after treatment demonstrates residual mass (white arrow) that is decreased in the longest diameter and no change of associated fne linear microcalcifcations. Decrease in size of enlarged lymph nodes in right axilla. Report 2: Breast US (Oct. 2021): US after treatment demonstrates residual hypoechoic mass that is decreased in the longest diameter. Report 3: Breast MRI (Oct. 2021): MRI after treatment
demonstrates residual non-mass enhancement that is decreased in the longest diameter and in the degree of enhancement and decrease in size of enlarged right axillary lymph node.
|
Neoadjuvant chemotherapy (#6 cycles of
docetaxel and carboplatin and trastuzumab and
pertuzumab) + Operation + Post-operative radiation therapy + Trastuzumab and pertuzumab.
Operation Right breast conserving surgery, sentinel lymph node biopsy. (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors
on each direction
|
Ductal Carcinoma In Situ
1. Post-chemotherapy status.
2. Size of tumor: 0.2 cm (ypTis).
3. Nuclear grade: high.
4. Necrosis: absent.
5. Architectural pattern: solid.
6. Skin: no involvement of tumor.
7. Surgical margins:
(a) superior margin: 20 mm,
(b) inferior margin: 10 mm,
(c) medial margin: 30 mm,
(d) lateral margin: 5 mm,
(e) deep margin: 2 mm,
(f) superfcial margin: 2 mm.
8. Lymph nodes: no metastasis in three axillary
lymph nodes (ypN0(sn)) (sentinel LN: 0/3).
9. Microcalcifcation: present, tumoral/
non-tumoral.
10. Pathological TN category (AJCC 2017):
ypTisN0(sn).
|
HR(−) HER2(+) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 29
|
Female/39 years old, pre-menopause.
Self-detected palpable mass lesion on upper
outer portion of left breast.
No family history.
S/P Left salpingo-oophorectomy.
BRCA 1 and 2 mutation: Not detected.
|
Report 1: Breast US (May 2021): irregular hypoechoic
masses with microcalcifcations in the upper portion of
left breast. Report 2: Breast MRI (May 2021): regional heterogeneous non-mass enhancement in the upper portion of left
breast. Report 3: Lymphoscintigraphy shows visualized sentinel
lymph nodes in the right axilla.
| null |
Operation (adjuvant chemotherapy refuse).
Operation
Left nipple–areolar complex sparing mastectomy
with implant reconstruction, sentinel lymph node
biopsy. (a) Preoperative and (b) immediate post-operative appearance. (a) Gross pathology of mastectomy specimen. (b, c) The margins get marked and sliced with different colors
on each direction
|
Microinvasive Ductal Carcinoma
1. Size of invasive component: <0.1 cm (pT1mi).
2. Size of intraductal component: 5.0 cm.
3. Histologic grade: not applicable.
4. Intraductal component: present, intratumoral/extratumoral (99%) (nuclear grade:
high, necrosis: present, architectural pattern:
micropapillary/cribriform/comedo, extensive intraductal component: present).
5. Skin: no involvement of tumor.
6. Surgical margins: (see Note 1).
(a) deep margin: 2 mm,
(b) superfcial margin: 2 mm.
7. Lymph nodes: no metastasis in two axillary
lymph nodes (pN0(sn)) (sentinel LN: 0/2,
axillary LN: 0/0).
8. Arteriovenous invasion: absent.
9. Lymphovascular invasion: absent.
10. Tumor border: infltrative.
11. Microcalcifcation: present, tumoral/
non-tumoral.
12. Pathological TN category (AJCC 2017):
pT1miN0(sn).
Breast, left nipple, excision: Ductal carcinoma
in situ (see Note 2).
Breast, left nipple margin, excision: Ductal
carcinoma in situ (see Note 2).
Note: 1. The lateral border of the mastectomy
specimen (slide MG8) is close to ductal carcinoma in situ (<1 mm).
2. The nipple margin separately submitted for
permanent diagnosis (slides B&C) is positive for
ductal carcinoma in situ but this margin submitted for frozen diagnosis (Fro 9) is free of tumor.
|
HR(−) HER2(+) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 30
|
Female/41 years old, pre-menopause.
Self-detected palpable mass and nipple discharge on left breast.
No family history.
No comorbidities.
BRCA 1 and 2 mutation: Not detected.
|
Report 1:Breast US (June 2021): irregular heterogeneous
echoic mass at the 9 o’clock direction of left breast. Report 2: Breast MRI (June 2021): regional heterogeneous non-mass enhancement in the inner portion of left breast. Report 3:PET-CT shows (a)
known breast cancer with
uptake, Lt 8´ (mSUV = 7.3),
(b) another hypermetabolic
lesion in left breast 9´
(mSUV = 3.6), (c) hypermetabolic LNs in left
internal mammary area, and
(d) hypermetabolic LNs in
left axilla, level I–II.
|
Report 1:Breast US (Nov. 2021): US after treatment
demonstrates residual hypoechoic mass that is decreased
in the longest diameter. Report 2: Breast MRI (Nov. 2021): MRI after treatment
shows complete resolution of enhancement in the left
breast. Report 3: Lymphoscintigraphy shows
visualized sentinel lymph nodes in the left
axilla.
|
Neoadjuvant chemotherapy (#6 cycles of
docetaxel and carboplatin and trastuzumab and
pertuzumab) + Operation + Post-operative radiation therapy + Trastuzumab and pertuzumab.
|
Microinvasive Ductal Carcinoma
1. Post-chemotherapy status.
2. Size of tumor: <0.1 cm (ypT1mi).
3. Histologic grade: not applicable.
4. Intraductal component: absent.
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) superior margin: 10 mm,
(b) inferior margin: (see note),
(c) medial margin: 10 mm,
(d) lateral margin: 10 mm,
(e) deep margin: 2 mm,
(f) superfcial margin: 2 mm.
7. Lymph nodes: no metastasis in three axillary
lymph nodes (ypN0(sn)) (sentinel LN: 0/3).
8. Arteriovenous invasion: absent.
9. Lymphovascular invasion: absent.
10. Tumor border: infltrative.
11. Microcalcifcation: present, tumoral.
12. Pathological TN category (AJCC 2017):
ypT1miN0(sn).
Note: 1. The inferior margin of the lumpectomy specimen (slide 5) is close to microinvasive
ductal carcinoma (2 mm) but this margin submitted for frozen diagnosis (Fro 2) is free of tumor.
|
HR(−) HER2(+) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 31
|
Female/74 years old, post-menopause.
Screen detected mass lesion on left breast 1
o’clock direction.
No family history.
Hypertension.
|
Report 1:Mammography (May 2021): Focal asymmetry with fne linear microcalcifcations in the upper mid portion
of left breast (marked by BB marker) . Report 2: Breast US (May 2021): irregular hypoechoic
mass with microcalcifcations at the 1 o’clock direction of
left breast. Report 3: Breast MRI (May 2021): irregular enhancing
masses in the upper outer quadrant of left breast. Report 4:Lymphoscintigraphy shows visualized sentinel lymph nodes in the left axilla.
| null |
Operation + Adjuvant chemotherapy (#4 cycles
of doxorubicin and cyclophosphamide) + Postoperative radiation therapy + Trastuzumab.
Operation
Left breast conserving surgery, sentinel lymph
node biopsy. (a) Gross pathology of lumpectomy specimen. (b, c) The margins get marked and sliced with different colors
on each direction.
|
Invasive Ductal Carcinoma
1. Size of tumor: 2.1 cm (pT2).
2. Histologic grade: 3/3 (tubule formation: 3/3,
nuclear pleomorphism: 3/3, mitotic count:
3/3, 5/HPF).
3. Intraductal component: present, intratumoral/extratumoral (50%) (nuclear grade:
high, necrosis: present, architectural pattern:
solid/comedo, extensive intraductal component: present). 4. Skin: no involvement of tumor.
5. Surgical margins:
(a) superior margin: 10 mm,
(b) inferior margin: 10 mm,
(c) medial margin: 20 mm,
(d) lateral margin: 15 mm,
(e) deep margin: 2 mm,
(f) superfcial margin: 2 mm.
6. Lymph nodes: no metastasis in one axillary
lymph node (pN0(sn)) (sentinel LN: 0/1).
7. Arteriovenous invasion: absent.
8. Lymphovascular invasion: present, intratumoral.
9. Tumor border: infltrative.
10. Microcalcifcation: present, tumoral/
non-tumoral.
11. Pathological TN category (AJCC 2017):
pT2N0(sn).
|
HR(−) HER2(+) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 32
|
Female/55 years old, post-menopause.
Screen detected mass lesion on right breast 8
o’clock direction.
No family history.
Hypertension, thyroid nodules.
|
Report 1:Mammography (Feb. 2021): irregular hyperdense mass in the upper outer quadrant of right breast
(marked BB marker). Spiculated hyperdense mass (white
arrow) with pleomorphic microcalcifcations in the lower
outer portion of right breast. Enlarged lymph nodes in
right axilla. Report 2: Breast US (Feb. 2021): irregular heterogeneous
echoic mass with microcalcifcations at the 7 o’clock
direction of right breast. Report 3:Breast MRI (Feb. 2021): two irregular enhancing masses at the 9 and 7 o’clock direct.
|
Report 1: Mammography (June 2021): mammography
after treatment demonstrates residual masses that are
decreased in the longest diameter in lower outer and upper
outer portion of right breast. Decrease in size of enlarged
LNs in right axilla. Report 2:Breast MRI (June 2021): MRI after treatment
shows complete resolution of enhancement in the right
breast and decrease in size of enlarged lymph nodes in
right axilla. Report 3:Lymphoscintigraphy shows visualized sentinel
lymph nodes in the right axilla.
|
Neoadjuvant chemotherapy (#5 cycles of
docetaxel and carboplatin and trastuzumab and
pertuzumab after followed #1 cycle of trastuzumab and pertuzumab) + Operation + Postoperative radiation therapy + Trastuzumab.
32.4.1 Operation
Right breast conserving surgery, sentinel lymph
node biopsy (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on each direction.
|
No residual tumor with stromal degeneration.
1. Post-chemotherapy status.
2. Lymph nodes: no metastasis in three axillary
lymph nodes (ypN0(sn)) (sentinel LN: 0/3).
|
HR(−) HER2(+) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 33
|
Female/63 years old, post-menopause.
Self-detected palpable mass lesion on left
breast 2 o’clock direction.
No family history
|
Report 1:Mammography
(Feb. 2021): irregular
hyperdense mass in the
upper outer quadrant of
left breast. Enlarged
lymph nodes in left axilla. Report 2:Breast US (Feb. 2021): irregular hypoechoic
mass at the 2 o’clock direction of left breast. Report 3:Breast MRI (Feb. 2021): irregular enhancing
mass (white arrow) with associated non-mass enhancement (black arrow) at the 1 o’clock direction of left breast. Report 4:PET-CT shows (a) hypermetabolic mass in left breast, 1´ (mSUV = 14.8) and (b) small left axillary LNs, level
I–II (mSUV = 1.3).
|
Report 1:Mammography (May 2021): mammography after treatment demonstrates no residual mass that is decreased
in the longest diameter. Report 2:Breast US (May 2021): US
after treatment demonstrates residual
hypoechoic mass that is decreased in the
longest diameter. Report 3:Lymphoscintigraphy shows
visualized sentinel lymph nodes in the left
axilla.
|
Neoadjuvant chemotherapy (#6 cycles of
docetaxel and carboplatin and trastuzumab and
pertuzumab) + Operation + Post-operative radiation therapy + Trastuzumab.
Operation
Left breast conserving surgery, sentinel lymph
node biopsy (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors
on each direction.
|
1. No residual tumor with foamy histiocytic
collection.
(a) Post-chemotherapy status.
(b) Lymph nodes: no metastasis in four axillary lymph nodes (ypN0(sn)) (sentinel
LN: 0/4).
(c) Microcalcifcation: present, tumoral/
non-tumoral.
(d) Related slides: C21-518.
2. Intraductal papilloma.
|
HR(−) HER2(+) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 34
|
Female/54 years old, post-menopause.
Self-detected palpable mass lesion on left
breast.
No family history.
S/P unilateral salpingo-oophorectomy,
dyslipidemia.
|
Report 1:Mammography (June 2021): irregular hyperdense mass in the upper inner quadrant of left breast. Report 2:Breast US (Feb. 2021): irregular hypoechoic
mass with microlobulated margin at the 9 o’clock direction of left breast. Report 3:Breast MRI (Feb. 2021): irregular enhancing
masses (white arrow) in the inner portion of left breast.
Enhancing lesion (black arrow) in left nipple. Report 4:Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left axilla.
| null |
Operation + Adjuvant chemotherapy (#4 cycles
of doxorubicin + cyclophosphamide) +
Operation + Trastuzumab.
34.3.1 Operation
Left modifed radical mastectomy, sentinel lymph
node biopsy (a) Gross pathology of mastectomy specimen. (b, c) The margins get marked and sliced with different colors
on each direction
|
Invasive Ductal Carcinoma
1. Size of tumor: 1.5 cm (pT1c(Paget)).
2. Histologic grade: 3/3 (tubule formation: 3/3,
nuclear pleomorphism: 3/3, mitotic count:
2/3, 11/10HPF).
3. Intraductal component: absent.
4. Nipple: Paget disease.
5. Skin: no involvement of tumor. 6. Surgical margins: deep margin: 2 mm.
7. Lymph nodes: no metastasis in one axillary
lymph node (pN0(sn)) (sentinel LN: 0/1).
8. Arteriovenous invasion: absent.
9. Lymphovascular invasion: present, intratumoral.
10. Tumor border: infltrative.
11. Microcalcifcation: present, tumoral/nontumoral.
12. Pathological TN category (AJCC 2017):
pT1c(Paget)N0(sn). Self-detected palpable mass lesion on right
breast.
Family history of breast cancer, cousin
(maternal).
s/p cholecystectomy, s/p unilateral salpingooophorectomy, hypertension, diabetes mellitus.
BRCA 1 and 2 mutation: Not detected.
|
HR(−) HER2(+) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 35
|
Female/73 years old, post-menopause.
Self-detected palpable mass lesion on right
breast.
Family history of breast cancer, cousin
(maternal).
s/p cholecystectomy, s/p unilateral salpingooophorectomy, hypertension, diabetes mellitus.
BRCA 1 and 2 mutation: Not detected.
|
Report 1:Mammography (July 2021): irregular hyperdense mass in the upper mid portion of right breast (marked by
BB marker). Enlarged lymph nodes in right axilla. Report 2: Breast US (July 2021): irregular
heterogeneous echoic mass with microcalcifcations at the 12 o’clock direction of right
breast. Report 3: Breast MRI (July 2021): irregular
enhancing mass at the 12 o’clock direction of
right breast. Enlarged lymph node in right
axilla. Report 4:PET-CT shows (a) a hypermetabolic mass at right breast (mSUV = 13.8)
and (b, c) a few hypermetabolic lymph nodes
in right axillary level I, III (mSUV = 5.5).
|
Report 1:Mammography (Nov. 2021): mammography after treatment demonstrates residual mass that is decreased in
the longest diameter. Decrease in size of enlarged LNs in right axilla. Report 2: Breast US (Nov. 2021): US after treatment
demonstrates residual hypoechoic mass that is decreased
in the longest diameter. Report 3:Breast MRI (Nov. 2021): MRI after
treatment demonstrates residual enhancing foci (white
arrow) that are decreased in the longest diameter and
in the degree of enhancement and a normal-appearing
axillary lymph node (black arrow). Report 4:Lymphoscintigraphy shows
visualized sentinel lymph nodes in the right
axilla.
|
Neoadjuvant chemotherapy (#5 cycles of
docetaxel and trastuzumab and pertuzumab) + Operation + Post-operative radiation
therapy + Trastuzumab and pertuzumab.
Operation
Right breast conserving surgery, sentinel lymph
node biopsy (a) Gross pathology of mastectomy specimen. (b) The margins get marked and sliced with different colors on
each direction
|
Microinvasive Ductal Carcinoma
1. Post-chemotherapy status.
2. Size of invasive component: <0.1 cm
(ypT1mi).
3. Size of intraductal component: 0.8 cm.
4. Histologic grade: not applicable 5. Intraductal component: present, intratumoral/extratumoral (99%) (nuclear grade:
low, necrosis: present, architectural pattern:
solid/comedo, extensive intraductal component: present).
6. Skin: no involvement of tumor.
7. Surgical margins:
(a) superior margin: 5 mm,
(b) inferior margin: 20 mm,
(c) medial margin: positive for microinvasive ductal carcinoma (Fro 3) (see note),
(d) lateral margin: 5 mm,
(e) deep margin: 2 mm,
(f) superfcial margin: 2 mm.
8. Lymph nodes: no metastasis in three axillary
lymph nodes (ypN0(sn)) (sentinel LN: 0/3).
9. Arteriovenous invasion: absent.
10. Lymphovascular invasion: absent.
11. Tumor border: infltrative.
12. Microcalcifcation: present, tumoral/
non-tumoral.
13. Pathological TN category (AJCC 2017):
ypT1miN0(sn).
Note: 1. Microinvasive ductal carcinoma is
focally present only in the permanent section of
Fro 3.Screen detected mass lesion on left breast 2
o’clock direction.
No family history.
Hypertension, chronic renal failure, ventricular premature contraction.
S/P cholecystectomy (due to stone).
|
HR(−) HER2(+) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 36
|
Female/63 years old, post-menopause.
Screen detected mass lesion on left breast 2
o’clock direction.
No family history.
Hypertension, chronic renal failure, ventricular premature contraction.
S/P cholecystectomy (due to stone).
|
Report 1: PET-CT
shows (
a) a
hypermetabolic mass in
the left breast
(mSUV = 14.8), (
b)
small hypermetabolic
lesions in the left upper
outer breast
(mSUV = 1.6), and (
c)
small lymph nodes in
the left axilla level I–II
(mSUV = 1.3). Report 2:Lymphoscintigraphy
shows visualized sentinel lymph
nodes in the left axilla.
| null |
Neoadjuvant chemotherapy (#6 cycles of
docetaxel and carboplatin and trastuzumab
and pertuzumab) + Operation + Postoperative radiation therapy + Trastuzumab.
Operation: Left breast conserving surgery,
sentinel lymph node biopsy (
|
1. No residual tumor with foamy histiocytic
collection.
(a) Post-chemotherapy status.
(b) Lymph nodes: no metastasis in four axillary lymph nodes (ypN0(sn)) (sentinel
LN: 0/4).
(c) Microcalcifcation: present, tumoral/
non-tumoral.
2. Intraductal papilloma.
|
HR(−) HER2(+) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 37
|
Female/63 years old, post-menopause.
Self-detected nipple discharge on left breast.
No family history.
S/P Total hysterectomy, s/p right lung lobectomy (benign), diabetes mellitus.
|
Report 1: Mammography: segmental fne pleomorphic microcalcifcations with focal asymmetries in the upper outer
quadrant of left breast, irregular hypoechoic mass with microcalcifcations at the 2 o’clock direction of left breast. Report 2: 7 Breast US: irregular hypoechoic mass with
microcalcifcations at the 2 o’clock direction of left breast. Report 3:Breast MRI: two irregular enhancing masses in
the upper outer quadrant of left breast.
|
Report 1:Mammography (Dec. 2020): no change of segmental fne pleomorphic microcalcifcations and decrease in size of focal asymmetries in the upper outer quadrant of left breast. Report 2:Breast US (Dec. 2020): US after treatment
demonstrates residual hypoechoic mass that is decreased
in the longest diameter. Report 3:Breast MRI (Dec. 2020): MRI after treatment
shows residual non-mass enhancement in left breast. Report 4:Lymphoscintigraphy shows visualized sentinel lymph nodes in the left axilla.
|
Neoadjuvant chemotherapy (#6 cycles of
docetaxel and carboplatin and trastuzumab
and pertuzumab) + Operation + Postoperative radiation therapy + Trastuzumab.
Operation: Left breast conserving surgery,
sentinel lymph node biopsy 3 (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors
on each direction.
|
Ductal Carcinoma In Situ
1. Post-chemotherapy status.
2. Size of tumor: 0.5 cm (ypTis).
3. Nuclear grade: high.
4. Necrosis: present.
5. Architectural pattern: solid/comedo.
6. Skin: no involvement of tumor.
7. Surgical margins:
(a) superior margin: 10 mm,
(b) inferior margin: 10 mm,
(c) medial margin: 30 mm, (d) lateral margin: 20 mm,
(e) deep margin: 2 mm,
(f) superfcial margin: 2 mm.
8. Lymph nodes: no metastasis in two axillary
lymph nodes (ypN0(sn)) (sentinel LN: 0/2).
9. Microcalcifcation: present, tumoral/
non-tumoral.
10. Pathological TN category (AJCC 2017):
ypTisN0(sn). Self-detected palpable mass lesion on right
breast.
Family history of breast cancer, sister.
Dyslipidemia.
BRCA 1 and 2 mutation: Not detected,
MUTYH and RAD50 VUS (variant of
uncertain).
|
HR(−) HER2(+) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 38
|
Female/55 years old, post-menopause.
Self-detected palpable mass lesion on right
breast.
Family history of breast cancer, sister.
Dyslipidemia.
BRCA 1 and 2 mutation: Not detected,
MUTYH and RAD50 VUS (variant of
uncertain).
|
Report 1:Magnifcation (Jan. 2021): indistinct hyperdense mass with microcalcifcations in right upper outer
quadrant. Report 2:Breast US (Jan. 2021): irregular hypoechoic
mass with microcalcifcations at the 11 o’clock direction
of right breast. Report 3:Breast MRI (Jan. 2021): irregular enhancing
mass at the 11 o’clock direction of right breast. Report 4:Breast MRI (Jan. 2021): irregular enhancing
mass at the 11 o’clock direction of right breast.
| null |
Operation + Adjuvant chemotherapy (#4
cycles of docetaxel and cyclophosphamide) +
Post-operative radiation therapy +
Trastuzumab.
Operation: Right breast conserving surgery,
sentinel lymph node biopsy (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors
on each direction
|
Invasive Ductal Carcinoma with medullary
pattern
1. Size of tumor: 1.1 cm (pT1c).
2. Histologic grade: 3/3 (tubule formation: 3/3,
nuclear pleomorphism: 3/3, mitotic count:
3/3, 30/10HPF).
3. Intraductal component: present, intratumoral/extratumoral (60%) (nuclear grade:
high, necrosis: present, architectural pattern:
cribriform/solid/comedo, extensive intraductal component: present).
4. Skin: no involvement of tumor.
5. Surgical margins:
(a) superior margin: 10 mm,
(b) inferior margin: 15 mm,
(c) medial margin: 5 mm,
(d) lateral margin: 10 mm,
(e) deep margin: 10 mm,
(f) superfcial margin: 7 mm. 6. Lymph nodes: no metastasis in nine axillary
lymph nodes (pN0) (sentinel LN: 0/4, axillary LN: 0/5).
7. Arteriovenous invasion: absent.
8. Lymphovascular invasion: absent.
9. Tumor border: infltrative.
10. Microcalcifcation: present, non-tumoral.
11. Pathological TN category (AJCC 2017):
pT1cN0.
|
HR(−) HER2(+) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 1
|
Female/87 years old, post-menopause.
Screen detected mass lesion on left breast subareolar area.
No family history.
Hypertension, diabetes mellitus, arrhythmia,
total knee replacement, cerebrovascular accident.
|
Report 1:1 Left mammography (Nov. 2020): an irregular
mass with nipple retraction at subareolar area. Report 2: Left breast US (Dec. 2020): a hypervascular irregular mass at subareolar area. US-CNB = IDC. Report 3:Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left axilla.
| null |
Operation + Letrozole 2.5 mg/day
Operation
Left total mastectomy, sentinel lymph node
biopsy (a) Gross pathology of mastectomy specimen. (b, c) The margins get marked and sliced with different colors on
each direction
|
Invasive Ductal Carcinoma
Associated with encapsulated papillary
carcinoma.
1. Size of tumor: 2.5 cm (pT2).
2. Histologic grade: 2/3 (tubule formation: 2/3,
nuclear pleomorphism: 2/3, mitotic count:
2/3, 11/10 HPF).
3. Intraductal component: present, intratumoral/extratumoral (30%) (nuclear grade:
low, necrosis: absent, architectural pattern:
cribriform/solid, extensive intraductal component: present).
4. Skin and nipple: dermal involvement of tumor.
5. Surgical margins: deep margin: 7 mm.
6. Lymph nodes:
(a) metastasis in one out of seven axillary
lymph nodes (pN1mi) (sentinel LN: 1/7), (b) perinodal extension: present,
(c) size of metastatic carcinoma: 0.2 mm.
7. Arteriovenous invasion: present,
peritumoral.
8. Lymphovascular invasion: present,
peritumoral.
9. Tumor border: infltrative.
10. Microcalcifcation: present, tumoral/
non-tumoral.
11. Pathological TN category (AJCC 2017):
pT2N1mi.
|
HR(+) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 2
|
Female/61 years old, post-menopause.
Screen detected mass lesion on left breast 2
o’clock direction.
No family history.
Hepatitis B virus carrier, dyslipidemia
|
Report 1:Left CC mammography (Oct. 2018, Sept. 2020):
negative fnding in 2018. A developing asymmetry at
outer breast in 2020. Report 2:Left breast US (Nov. 2020): a hypoechoic mass at
upper outer quadrant. US-CNB = IDC. Report 3:Breast MRI
(Dec. 2020): an irregular
enhancing mass in the
left breast. Report 4:Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left axilla.
| null |
Operation + Post-operative radiation therapy + Anastrozole 1 mg/day.
Operation
Left breast conserving surgery, sentinel lymph
node biopsy (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on
each direction
|
Invasive Ductal Carcinoma
1. Size of tumor: 0.8 cm (pT1b).
2. Histologic grade: 2/3 (tubule formation: 3/3,
nuclear pleomorphism: 2/3, mitotic count:
2/3, 11/10 HPF).
3. Intraductal component: present, intratumoral/extratumoral (20%) (nuclear grade:
low, necrosis: absent, architectural pattern:
cribriform, extensive intraductal component:
absent).
4. Skin: no involvement of tumor.
5. Surgical margins:
(a) superior margin: 20 mm,
(b) inferior margin: 15 mm,
(c) medial margin: 20 mm,
(d) lateral margin: 10 mm,
(e) deep margin: 2 mm,
(f) superfcial margin: 2 mm.
6. Lymph nodes: no metastasis in one axillary
lymph node (pN0(sn)) (sentinel LN: 0/1).
7. Arteriovenous invasion: absent.
8. Lymphovascular invasion: absent.
9. Tumor border: infltrative.
10. Microcalcifcation: present, tumoral/
non-tumoral.
11. Pathological TN category (AJCC 2017):
pT1bN0(sn).
|
HR(+) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 3
|
Female/78 years old, post-menopause.
Screen detected mass lesion on right breast 10
o’clock direction.
No family history.
L-spine disc herniation.
|
Report 1:Right mammography (Nov. 2020): two irregular
masses at subareolar area (white arrow) and upper outer
quadrant (black arrow). Report 2: Right breast US (Nov. 2020): two irregular masses at subareolar area (white arrow, US-CNB = IDC) and upper
outer quadrant (black arrow, US-CNB = IDC). Report 3:Breast MRI (Dec. 2020): two irregular enhancing masses at subareolar area (white arrow) and upper outer
quadrant (black arrow) of right breast. Report 4: Lymphoscintigraphy shows faintly visualized
sentinel lymph nodes in the right axilla.
| null |
Operation + Post-operative radiation therapy + Letrozole 2.5 mg/day.Operation
Right breast conserving surgery, sentinel lymph
node biopsy (a) Gross pathology of lumpectomy specimen (10 o’ clock direction). (c) Gross pathology of lumpectomy
specimen (subareolar area). (b, d) The margins get marked and sliced with different colors on each direction.
|
Breast, right 10 o’clock:
Invasive Ductal Carcinoma
1. Size of tumor: 0.9 cm.
2. Histologic grade: 2/3 (tubule formation: 3/3,
nuclear pleomorphism: 2/3, mitotic count:
2/3, 11/10 HPF).
3. Intraductal component: present, intratumoral/extratumoral (5%) (nuclear grade:
low, necrosis: absent, architectural pattern:
cribriform, extensive intraductal component:
absent).
4. Skin: no involvement of tumor.
5. Surgical margins:
(a) superior margin: 10 mm,
(b) inferior margin: 20 mm,
(c) medial margin: 10 mm,
(d) lateral margin: 10 mm (see note 1),
(e) deep margin: 2 mm,
(f) superfcial margin: 2 mm.
6. Lymph nodes: no metastasis in three axillary
lymph nodes (pN0(sn)) (sentinel LN: 0/1,
non-sentinel LN: 0/2).
7. Arteriovenous invasion: absent.
8. Lymphovascular invasion: present,
intratumoral.
9. Tumor border: infltrative.
10. Microcalcifcation: present, tumoral/
non-tumoral.
Breast, right subareolar:
Invasive Ductal Carcinoma
1. Size of tumor: 1.1 cm (pT1c).
2. Histologic grade: 2/3 (tubule formation: 3/3,
nuclear pleomorphism: 2/3, mitotic count:
2/3, 11/10 HPF).
3. Intraductal component: present, intratumoral/extratumoral (10%) (nuclear grade:
low, necrosis: absent, architectural pattern:
cribriform, extensive intraductal component:
absent).
4. Skin: no involvement of tumor.
5. Surgical margins:
(a) superior margin: 10 mm,
(b) inferior margin: (see note 2),
(c) medial margin: 10 mm,
(d) lateral margin: 10 mm,
(e) deep margin: 1 mm from invasive ductal
carcinoma (slide 9),
(f) superfcial margin: 2 mm.
6. Arteriovenous invasion: absent.
7. Lymphovascular invasion: present,
intratumoral.
8. Tumor border: infltrative.
9. Microcalcifcation: present, tumoral/
non-tumoral.
10. Pathological TN category (AJCC 2017):
pT1cN0(sn).
|
HR(+) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 4
|
Female/57 years old, post-menopause.
Screen detected mass lesion on right breast 10
o’clock direction.
No family history.
Dyslipidemia.v
|
Report 1:Right mammography (Nov. 2020): a focal asymmetry at upper outer quadrant. Report 2:Right breast US (Dec. 2020): an irregular hypoechoic mass at upper outer quadrant (white arrow,
US-CNB = IDC). An enlarged lymph node at the right axillary fossa (black arrow). Report 3:Breast MRI (Dec. 2020): an irregular enhancing mass in the right breast (white arrow) and an enlarged lymph
node at the right axillary fossa (black arrow). Report 4:Lymphoscintigraphy shows visualized sentinel
lymph nodes in the right axilla.
| null |
Right breast conserving surgery, sentinel lymph
node biopsy. (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on
each direction
|
Invasive Ductal Carcinoma
1. Size of tumor: 1.8 cm (pT1c).
2. Histologic grade: 2/3 (tubule formation: 3/3,
nuclear pleomorphism: 3/3, mitotic count:
2/3, 17/10 HPF).
3. Intraductal component: present, intratumoral/extratumoral (10%) (nuclear grade:
high, necrosis: present, architectural pattern:
solid/comedo, extensive intraductal component: absent).
4. Skin: no involvement of tumor.
5. Surgical margins:
(a) superior margin: 10 mm,
(b) inferior margin: (see note),
(c) medial margin: 10 mm,
(d) lateral margin: 15 mm,
(e) deep margin: 2 mm,
(f) superfcial margin: 2 mm.
6. Lymph nodes:
(a) metastasis in one out of fve axillary
lymph nodes (pN1a(sn)) (sentinel LN:
1/1, axillary LN: 0/4),
(b) perinodal extension: present,
(c) size of metastatic carcinoma: 23 mm.
7. Arteriovenous invasion: absent.
8. Lymphovascular invasion: present,
intratumoral.
9. Tumor border: infltrative.
10. Microcalcifcation: present, tumoral/
non-tumoral.
11. Pathological TN category (AJCC 2017):
pT1cN1a(sn).
|
HR(+) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 5
|
Female/58 years old, post-menopause.
Screen detected mass lesion on right breast 4
o’clock direction.
No family history.
No comorbidities.
|
Report 1:. Report 2:Right mammography (Nov. 2020): a focal asymmetry with fne pleomorphic microcalcifcations at lower
inner quadrant. Report 3:Right breast US (Dec. 2020): an irregular
hypoechoic mass. US-CNB = IDC with mucinous
component. Report 4:Breast MRI
(Dec. 2020): a focal
non-mass enhancement
in the right breast.
| null |
Operation + Adjuvant chemotherapy
(#4 cycles of docetaxel & cyclophosphamide) + Post-operative radiation therapy + Letrozole 2.5 mg/day.
Operation (1st, Dec. 2020)
Right breast conserving surgery, sentinel lymph
node biopsy . 4 (a) Gross pathology of lumpectomy specimen (black arrow). (b) The margins get marked and sliced with different colors on each direction. Operation (2nd, Jan. 2021)
Right breast wide excision . Gross pathology of breast wide excision
specimen.
|
Operation 1: Invasive Ductal Carcinoma
1. Size of tumor: 2.1 cm (pT2).
2. Histologic grade: 2/3 (tubule formation: 3/3,
nuclear pleomorphism: 2/3, mitotic count:
2/3, 14/10 HPF).
3. Intraductal component: present, intratumoral/extratumoral (20%) (nuclear grade:
low, necrosis: present, architectural pattern:
micropapillary/cribriform/comedo, extensive intraductal component: absent).
4. Skin: no involvement of tumor.
5. Surgical margins:
(a) superior margin: (see note 2),
(b) inferior margin: 5 mm,
(c) medial margin: positive for invasive ductal carcinoma (Fro 6),
(d) lateral margin: (see note 3),
(e) deep margin: positive for invasive ductal
carcinoma (slide 1),
(f) superfcial margin: 2 mm.
6. Lymph nodes: (a) metastasis in two out of three axillary
lymph nodes (pN1a(sn)) (sentinel LN:
2/3),
(b) perinodal extension: absent,
(c) size of metastatic carcinoma: 2.5 mm.
7. Arteriovenous invasion: absent.
8. Lymphovascular invasion: present,
intratumoral.
9. Tumor border: infltrative.
10. Microcalcifcation: present, tumoral/
non-tumoral.
11. Pathological TN category (AJCC 2017):
pT2N1a(sn).
Note: 1. Micrometastasis is present in the
frozen section of Fro 2.
2. The superior margin of the lumpectomy
specimen (slide 6) is close to invasive ductal
carcinoma (<1 mm) but this margin submitted for frozen diagnosis (Fro 4) is free of
tumor.
3. The lateral margin of the lumpectomy
specimen (slide 8) is close to invasive ductal
carcinoma (<1 mm) but this margin submitted for frozen diagnosis (Fro 7) is free of
tumor. Operation 2: Invasive Ductal Carcinoma
1. Post-lumpectomy status.
2. Size of tumor: 0.2 cm, residual.
3. Histologic grade: 2/3 (tubule formation: 3/3,
nuclear pleomorphism: 2/3, mitotic count:
1/3).
4. Intraductal component: absent.
5. Surgical margins: 9 mm.
6. Arteriovenous invasion: absent.
7. Lymphovascular invasion: present,
extratumoral.
8. Tumor border: infltrative.
9. Microcalcifcation: present, non-tumoral..
|
HR(+) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 6
|
Female/51 years old, pre-menopause.
Screen detected mass lesion on right breast 2
o’clock direction.
No family history.
S/P Thyroid benign mass, excision.
|
Report 1:Right mammography (Oct. 2020): a spiculated
mass with microcalcifcations at upper inner quadrant. Report 2:Right breast US (Oct. 2020): an irregular
hypoechoic mass (white arrow, US-CNB = IDC) with
adjacent smaller masses (not shown). Report 3:Breast MRI
(Nov. 2020): an irregular
enhancing mass (white
arrow) with adjacent
satellite lesions (black
arrows) in the right
breast. Report 4:Lymphoscintigraphy shows visualized sentinel
lymph nodes in the right axilla.
| null |
Operation + Post-operative radiation therapy + Tamoxifen 20 mg/day.
Operation
Right breast conserving surgery, sentinel lymph
node biopsy. (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on
each direction
|
Invasive Ductal Carcinoma
1. Size of invasive component: 1.8 cm (pT1c).
2. Size of intraductal component: 4.0 cm.
3. Histologic grade: 2/3 (tubule formation: 3/3,
nuclear pleomorphism: 2/3, mitotic count:
2/3, 11/10 HPF).
4. Intraductal component: present, intratumoral/extratumoral (60%) (nuclear grade:
low, necrosis: present, architectural pattern:
solid/comedo, extensive intraductal component: present).
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) superior margin: 5 mm,
(b) inferior margin: 5 mm,
(c) medial margin: 5 mm,
(d) lateral margin: 5 mm,
(e) deep margin: 2 mm,
(f) superfcial margin: 1 mm from ductal
carcinoma in situ (slide 12).
7. Lymph nodes:(a) metastasis in one out of four axillary
lymph nodes (pN1a(sn)) (sentinel LN:
1/1, axillary LN: 0/3),
(b) perinodal extension: present,
(c) size of metastatic carcinoma: 7 mm.
8. Arteriovenous invasion: absent.
9. Lymphovascular invasion: present,
intratumoral.
10. Tumor border: infltrative.
11. Microcalcifcation: present, tumoral/
non-tumoral.
12. Pathological TN category (AJCC 2017):
pT1cN1a(sn).
|
HR(+) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 7
|
Female/42 years old, pre-menopause.
Screen detected mass lesion on left breast 2:30
and 3 o’clock direction.
No family history.
Depression.
|
Report 1:Left mammography (Nov. 2020): an irregular
palpable mass (white arrow) and another smaller mass
(black arrow) at upper outer quadrant. Report 2:Left breast US (Nov. 2020): an irregular mass
(white arrow, US-CNB = Mucinous carcinoma) with adjacent smaller masses (black arrows). Report 3:Breast MRI (Nov. 2020): an enhancing mass (white arrow) with increased T2 signal intensity (black arrow) in
the left breast. Report 4:Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left axilla. Report 5:Breast MRI for routine surveillance (Aug. 2021): no abnormal fnding in both breasts. Report 6:.
| null |
Operation + Post-operative radiation therapy + Tamoxifen 20 mg/day.
Operation
Left breast conserving surgery, sentinel lymph
node biopsy. 6 (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on
each direction
|
Mucinous Carcinoma
1. Size of invasive component: 1.8 cm (pT1c).
2. Size of intraductal component: 3.0 cm.
3. Histologic grade: 2/3 (tubule formation: 3/3,
nuclear pleomorphism: 2/3, mitotic count:
1/3, 6/10 HPF). 4. Intraductal component: present, intratumoral/extratumoral (60%) (nuclear grade:
low, necrosis: absent, architectural pattern:
micropapillary/cribriform, extensive intraductal component: present).
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) superior margin: 10 mm,
(b) inferior margin: (see note),
(c) medial margin: 10 mm,
(d) lateral margin: 5 mm,
(e) deep margin: <1 mm from ductal carcinoma in situ (slide 9),
(f) superfcial margin: 2 mm.
7. Lymph nodes: no metastasis in six axillary
lymph nodes (pN0(sn)) (sentinel LN: 0/2,
non-sentinel LN: 0/4).
8. Arteriovenous invasion: absent.
9. Lymphovascular invasion: present,
intratumoral.
10. Tumor border: infltrative.
11. Microcalcifcation: present, tumoral/
non-tumoral.
12. Pathological TN category (AJCC 2017):
pT1cN0(sn).
Note: 1. The inferior margin of the
lumpectomy specimen (slide 2) is close to
ductal carcinoma in situ (3 mm) but this margin submitted for frozen diagnosis (Fro 2) is
free of tumor.
|
HR(+) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 8
|
Female/46 years old, pre-menopause.
Screen detected mass lesion on right breast 12
o’clock and left breast 2 o’clock direction.
No family history.
No comorbidities.
BRCA 1 and 2 mutation: not detected.
|
Report 1:Both mammography (Nov. 2020): irregular mass at upper inner quadrant of the right breast (white arrow) and
upper outer quadrant of the left breast (black arrow). Report 2:Both breast US (Nov. 2020): irregular masses at upper inner quadrant of the right breast (white arrow) and
upper outer quadrant of the left breast (black arrow). Both US-CNB = IDC. Report 3:Breast MRI (Nov. 2020): irregular enhancing masses in both breasts. Report 4:Lymphoscintigraphy shows visualized sentinel
lymph nodes in both axilla.
| null |
Operation + Post-operative radiation therapy + Tamoxifen 20 mg/day.
Operation
Right nipple–areolar complex sparing mastectomy, sentinel lymph node biopsy, Left nipple–
areolar complex sparing mastectomy, sentinel
lymph node biopsy.(a) Gross pathology of right mastectomy specimen. (b, c) The margins get marked and sliced with different
colors on each direction. (a) Gross pathology of left mastectomy specimen. (b, c) The margins get marked and sliced with different
colors on each direction.
|
[Right Breast]
Invasive Ductal Carcinoma
1. Size of invasive component: 1.5 cm (pT1c). 2. Size of intraductal component: 3.5 cm.
3. Histologic grade: 2/3 (tubule formation: 3/3,
nuclear pleomorphism: 2/3, mitotic count:
2/3, 18/10 HPF).
4. Intraductal component: present, intratumoral/extratumoral (60%) (nuclear grade:
low, necrosis: present, architectural pattern:
micropapillary/cribriform/solid/comedo,
extensive intraductal component: present).
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) nipple margin: positive for ductal carcinoma in situ (Fro 2), (b) deep margin: <1 mm from ductal carcinoma in situ (slide 3),
(c) superfcial margin: <1 mm from ductal
carcinoma in situ (slide 5).
7. Lymph nodes: no metastasis in seven axillary
lymph nodes (pN0) (sentinel LN: 0/1, nonsentinel LN: 0/6).
8. Arteriovenous invasion: absent.
9. Lymphovascular invasion: present,
intratumoral.
10. Tumor border: infltrative.
11. Microcalcifcation: present, tumoral/
non-tumoral.
12. Pathological TN category (AJCC 2017):
pT1cN0. [Left Breast]
Invasive Ductal Carcinoma
1. Size of tumor: 1.5 cm (pT1c).
2. Histologic grade: 2/3 (tubule formation: 2/3,
nuclear pleomorphism: 2/3, mitotic count:
2/3, 17/10 HPF).
3. Intraductal component: present, intratumoral/extratumoral (10%) (nuclear grade:
low, necrosis: absent, architectural pattern:
cribriform/solid, extensive intraductal component: absent).
4. Skin: no involvement of tumor.
5. Surgical margins:
(a) nipple margin: positive for ductal carcinoma in situ (Fro 1) (see note),
(b) deep margin: 1 mm from invasive ductal
carcinoma (slide 1).
6. Lymph nodes: no metastasis in eight axillary
lymph nodes (pN0) (sentinel LN: 0/3, nonsentinel LN: 0/5).
7. Arteriovenous invasion: absent.
8. Lymphovascular invasion: absent.
9. Tumor border: partly infltrative.
10. Microcalcifcation: present, tumoral.
11. Pathological TN category (AJCC 2017):
pT1cN0.
Note: 1. Ductal carcinoma in situ is present only in the permanent section of Fro 1
|
HR(+) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 9
|
Female/55 years old, pre-menopause.
Self-detected palpable mass lesion on left
breast 11 o’clock direction.
Family history of Prostate cancer, paternal
uncle.
No comorbidities.
|
Report 1:Left mammography (Dec. 2020): an irregular
mass with microcalcifcations at upper inner quadrant. Report 2:Left breast US (Dec. 2020): an irregular
hypoechoic mass with angular margins. US-CNB = IDC. Report 3:Breast MRI (Dec. 2020): an irregular enhancing mass in the left breast. Report 4:Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left axilla.
| null |
Operation + Adjuvant chemotherapy
(#4 cycles of docetaxel & cyclophosphamide) + Post-operative radiation therapy + Tamoxifen 20 mg/day.
Operation
Left breast conserving surgery, sentinel lymph
node biopsy (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on
each direction.
|
Invasive Ductal Carcinoma
1. Size of tumor: 3.0 cm (pT2).
2. Histologic grade: 3/3 (tubule formation: 3/3,
nuclear pleomorphism: 2/3, mitotic count:
3/3, 40/10 HPF).
3. Intraductal component: present, intratumoral/extratumoral (25%) (nuclear grade:
high, necrosis: present, architectural pattern:
solid/comedo, extensive intraductal component: present).
4. Skin: no involvement of tumor.
5. Surgical margins:
(a) superior margin: (see note),
(b) inferior margin: 22 m,
(c) medial margin: 1 mm,
(d) lateral margin: 18 mm,
(e) deep margin: 3 mm,
(f) superfcial margin: positive for ductal
carcinoma in situ (slide 9).
6. Lymph nodes: no metastasis in two axillary
lymph nodes (pN0(sn)) (sentinel LN: 0/2).
7. Arteriovenous invasion: absent.
8. Lymphovascular invasion: present,
peritumoral.
9. Tumor border: pushing.
10. Microcalcifcation: present, tumoral/
non-tumoral.
11. Pathological TN category (AJCC 2017):
pT2N0(sn).
Intraductal Papilloma with Usual Ductal
Hyperplasia
Note: 1. The superior margin of the lumpectomy
specimen (slide 1) is close to ductal carcinoma
in situ (<1 mm) but this margin submitted for
frozen diagnosis (Fro 3) is free of tumor.
|
HR(+) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 10
|
Female/50 years old, pre-menopause.
Screen detected mass lesion on left breast 12
o’clock direction.
No family history.
No comorbidities.
|
Report 1:Left mammography (Nov. 2020): an irregular
hyperdense mass at upper center. Report 2:Left breast US (Nov. 2020): an irregular
hypoechoic mass with spiculated margins. US-CNB = IDC. Report 3:Breast MRI (Dec. 2020): an irregular enhancing mass in the left breast. Enlarged lymph nodes at the left axilla
(white arrow) and internal mammary chain (black arrow). Report 4:Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left axilla.
| null |
Operation + Adjuvant chemotherapy
(#4 cycles of docetaxel & cyclophosphamide) + Post-operative radiation therapy + Tamoxifen 20 mg/day.
Operation
Left breast conserving surgery, axillary lymph
node dissection. (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on
each direction.
|
Invasive Ductal Carcinoma
1. Size of tumor: 2.7 cm (pT2). 2. Histologic grade: 3/3 (tubule formation: 3/3,
nuclear pleomorphism: 2/3, mitotic count:
3/3, 24/10 HPF).
3. Intraductal component: present, intratumoral/extratumoral (20%) (nuclear grade:
high, necrosis: present, architectural pattern:
cribriform/solid/comedo, extensive intraductal component: absent).
4. Skin: no involvement of tumor.
5. Surgical margins:
(a) superior margin: 10 mm,
(b) inferior margin: 30 mm,
(c) medial margin: (see note),
(d) lateral margin: 19 mm,
(e) deep margin: 11 mm,
(f) superfcial margin: 2 mm.
6. Lymph nodes:
(a) metastasis in one out of seventeen axillary lymph nodes (pN1a) (sentinel LN:
1/3, axillary LN: 0/14),
(b) perinodal extension: absent,
(c) size of metastatic carcinoma: 5 mm.
7. Arteriovenous invasion: absent.
8. Lymphovascular invasion: present,
peritumoral.
9. Tumor border: pushing.
10. Microcalcifcation: absent.
11. Pathological TN category (AJCC 2017):
pT2N1a.
Note: 1. The medial margin of the lumpectomy specimen (slide 7) is close to ductal
carcinoma in situ (2 mm) but this margin
submitted for frozen diagnosis (Fro 6) is free
of tumor.
|
HR(+) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 11
|
Female/60 years old, post-menopause.
Screen detected mass lesion on upper outer
portion of left breast.
No family history.
Dyslipidemia.
|
Report 1:Left CC mammography (Nov. 2016, Nov. 2020):
negative fnding in 2016. A new mass at the outer breast in
2020. Report 2:Left breast US (Dec. 2020): an irregular
hypoechoic mass at upper outer quadrant. US-CNB = IDC. Report 3:Breast MRI (Dec. 2020): a rim-enhancing mass in the left breast. Report 4:Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left axilla.
| null |
Operation + Adjuvant chemotherapy
(#4 cycles of docetaxel & cyclophosphamide) + Post-operative radiation therapy + Letrozole 2.5 mg/day.
Operation
Left breast conserving surgery, sentinel lymph
node biopsy (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on
each direction.
|
Invasive Ductal Carcinoma
1. Size of tumor: 2.5 cm (pT2). 2. Histologic grade: 3/3 (tubule formation: 3/3,
nuclear pleomorphism: 2/3, mitotic count:
3/3, 29/10 HPF).
3. Intraductal component: present, intratumoral/extratumoral (10%) (nuclear grade:
low, necrosis: absent, architectural pattern:
cribriform, extensive intraductal component:
absent).
4. Skin: no involvement of tumor.
5. Surgical margins:
(a) superior margin: 5 mm,
(b) inferior margin: 15 mm,
(c) medial margin: 15 mm,
(d) lateral margin: 25 mm,
(e) deep margin: 10 mm,
(f) superfcial margin: positive for invasive
ductal carcinoma (slide 3).
6. Lymph nodes:
(a) metastasis in one out of four axillary
lymph nodes (pN1a(sn)) (sentinel LN:
0/3, intramammary LN: 1/1),
(b) perinodal extension: absent,
(c) size of metastatic carcinoma: 3.5 mm.
7. Arteriovenous invasion: absent.
8. Lymphovascular invasion: absent.
9. Tumor border: infltrative.
10. Microcalcifcation: present, non-tumoral.
11. Pathological TN category (AJCC 2017):
pT2N1a(sn).
|
HR(+) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 12
|
Female/55 years old, pre-menopause.
Screen detected mass lesion on right breast 5
o’clock direction.
No family history.
S/P hysterectomy, dyslipidemia, diabetes mellitus, s/p cervical spine disc operation.
|
Report 1:Right mammography (Nov. 2020): a spiculated
mass with architectural distortion at lower inner quadrant. Report 2:Right breast US (Dec. 2020): an irregular
hypoechoic mass with non-parallel orientation.
US-CNB = IDC. Report 3:Breast MRI (Dec. 2020): an irregular enhancing mass in the right breast. Report 4:Lymphoscintigraphy shows visualized sentinel
lymph nodes in the right axilla.
| null |
Operation + Adjuvant chemotherapy
(#4 cycles of docetaxel & cyclophosphamide) + Post-operative radiation therapy + Tamoxifen 20 mg/day.
Operation
Right breast conserving surgery, sentinel lymph
node biopsy. (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on
each direction.
|
Invasive Ductal Carcinoma
1. Size of tumor: 2.3 cm (pT2). 2. Histologic grade: 2/3 (tubule formation: 3/3,
nuclear pleomorphism: 1/3, mitotic count:
1/3, 5/10 HPF).
3. Intraductal component: present, intratumoral/
extratumoral (30%) (nuclear grade: low,
necrosis: present, architectural pattern: solid,
extensive intraductal component: present).
4. Skin: no involvement of tumor.
5. Surgical margins:
(a) superior margin: 3 mm,
(b) inferior margin: 17 mm,
(c) medial margin: 10 mm,
(d) lateral margin: <1 mm from ductal carcinoma in situ (slides 10 and 11),
(e) deep margin: 5 mm,
(f) superfcial margin: positive for ductal
carcinoma in situ (slide 8).
6. Lymph nodes: no metastasis in fve axillary
lymph nodes (pN0(sn)) (sentinel LN: 0/2,
non-sentinel LN: 0/3).
7. Arteriovenous invasion: absent.
8. Lymphovascular invasion: present,
peritumoral.
9. Tumor border: pushing.
10. Microcalcifcation: absent.
11. Pathological TN category (AJCC 2017):
pT2N0(sn).
|
HR(+) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 13
|
Female/64 years old, post-menopause.
Screen detected mass lesion on left breast 10
o’clock direction.
No family history.
S/P Tuberculosis, S/P appendectomy
|
Report 1: Mammography (Nov. 2020): an irregular mass
with microcalcifcations at upper inner quadrant of the left
breast. Associated global asymmetry and thickening of
the nipple–areolar complex (black arrow). Enlarged
lymph nodes at the left axilla (white arrows). Report 2:Left breast US (Nov. 2020): an irregular
hypoechoic mass with microcalcifcations.
US-CNB = IDC. Report 3:Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left axilla. Report 4:5 Breast MRI (Dec. 2020): an irregular enhancing mass (white arrow) with diffuse non-mass enhancement
(black arrows) in the left breast.
| null |
Operation + Adjuvant chemotherapy
(#4 cycles of doxorubicin & cyclophosphamide
followed by #4 cycles of docetaxel) + Postoperative radiation therapy + Letrozole
2.5 mg/day.
Operation
Left modifed radical mastectomy
|
Invasive Ductal Carcinoma
1. Size of tumor: 5.2 cm (pT3). 2. Histologic grade: 3/3 (tubule formation: 3/3,
nuclear pleomorphism: 3/3, mitotic count:
2/3, 10/10 HPF).
3. Intraductal component: present, intratumoral
(5%) (nuclear grade: high, necrosis: present,
architectural pattern: solid/comedo, extensive intraductal component: absent).
4. Skin and nipple: dermal involvement of
tumor.
5. Surgical margins: (see note).
(a) deep margin: <1 mm from invasive ductal carcinoma (slide 3).
(b) superfcial margin: 2 mm.
6. Lymph nodes: (a) metastasis in eight out of nine axillary
lymph nodes (pN2a) (sentinel LN: 4/4,
axillary LN: 4/5).
(b) perinodal extension: present.
(c) size of metastatic carcinoma: 11 mm.
7. Arteriovenous invasion: absent.
8. Lymphovascular invasion: present,
intratumoral.
9. Tumor border: infltrative.
10. Microcalcifcation: present, tumoral.
11. Pathological TN category (AJCC 2017):
pT3N2a.
Note: 1. The medial border of the mastectomy
specimen (slide 10) is close to invasive ductal
carcinoma (<1 mm).
|
HR(+) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 14
|
Female/43 years old, pre-menopause.
Screen detected mass lesion on left breast 1
and 3 o’clock direction.
No family history.
No comorbidities.
|
Report 1:Left mammography (Dec. 2020): a focal asymmetry with microcalcifcations (black arrows) at outer
subareolar area. Report 2: Left breast US (Dec. 2020): an oval isoechoic
mass with microcalcifcations. US-CNB = IDC with
mucinous component. Report 3:Breast MRI (Dec. 2020): a rim-enhancing mass in the left breast. Report 4: Post-NAC breast MRI (June 2021): decreased
tumor burden after NAC. Report 5: Breast MRI (Dec. 2020): a rim-enhancing mass in the left breast.
| null |
Neoadjuvant therapy (Palbociclib 125 mg/day
& tamoxifen 20 mg/day with goserelin) + Operation + Post-operative radiation
therapy + Letrozole 2.5 mg/day with
goserelin.
Operation
Left breast conserving surgery, sentinel lymph
node biopsy (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on
each direction.
|
Mucinous Carcinoma
1. Post-chemotherapy status.
2. Size of tumor: 2.0 cm (ypT1c).
3. Histologic grade: 2/3 (tubule formation: 3/3,
nuclear pleomorphism: 2/3, mitotic count:
1/3, 6/10 HPF). 4. Intraductal component: present, intratumoral/extratumoral (30%) (nuclear grade:
low, necrosis: absent, architectural pattern:
cribriform/solid, extensive intraductal component: present).
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) superior margin: 5 mm.
(b) inferior margin: (see note 1).
(c) medial margin: (see note 2).
(d) lateral margin: (see note 3).
(e) deep margin: <1 mm from mucinous
carcinoma (slide 1).
(f) superfcial margin: <1 mm from mucinous carcinoma (slide 1). 7. Lymph nodes: no metastasis in three axillary
lymph nodes (ypN0(sn)) (sentinel LN: 0/3).
8. Arteriovenous invasion: absent.
9. Lymphovascular invasion: absent.
10. Tumor border: infltrative.
11. Microcalcifcation: present, tumoral/
non-tumoral.
12. Pathological TN category (AJCC 2017):
ypT1cN0(sn).
Note: 1. The inferior margin of the lumpectomy specimen (slide 4) is close to mucinous
carcinoma (<1 mm) but this margin submitted
for frozen diagnosis (Fro 3) is free of tumor.
2. The medial margin of the lumpectomy specimen (slide 3) is close to mucinous carcinoma
(1 mm) but this margin submitted for frozen
diagnosis (Fro 4) is free of tumor.
3. The lateral margin of the lumpectomy specimen (slide 7) is close to ductal carcinoma in
situ (<1 mm) but this margin submitted for
frozen diagnosis (Fro 11) is free of tumor.
|
HR(+) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 15
|
Female/58 years old, post-menopause.
Screen detected mass lesion on left breast 12
o’clock direction.
No family history.
Hypertension, dyslipidemia, s/p transobturator tape for stress urinary incontinence.
|
Report 1:Left mammography (Dec. 2020): negative
fnding. Report 2:Left breast US (Dec. 2020): a hypoechoic mass
with non-parallel orientation at upper outer quadrant.
US-CNB = IDC. Report 3:Breast MRI (Dec. 2020): an irregular enhancing mass in the left breast. Report 4:Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left axilla.
| null |
Operation + Post-operative radiation therapy + Anastrozole 1 mg/day.
Operation
Left breast conserving surgery, sentinel lymph
node biopsy. (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on
each direction.
|
Invasive Ductal Carcinoma
1. Size of tumor: 0.9 cm (pT1b).
2. Histologic grade: 2/3 (tubule formation: 2/3,
nuclear pleomorphism: 2/3, mitotic count:
2/3, 10/10 HPF).
3. Intraductal component: absent.
4. Skin: no involvement of tumor.
5. Surgical margins:
(a) superior margin: 35 mm.
(b) inferior margin: 10 mm.
(c) medial margin: 15 mm.
(d) lateral margin: 5 mm.
(e) deep margin: 12 mm.
(f) superfcial margin: 4 mm.
6. Lymph nodes: no metastasis in two axillary
lymph nodes (pN0(sn)) (sentinel LN: 0/2).
7. Arteriovenous invasion: absent.
8. Lymphovascular invasion: absent.
9. Tumor border: infltrative.
10. Microcalcifcation: present, tumoral/
non-tumoral.
11. Pathological TN category (AJCC 2017):
pT1bN0(sn).
|
HR(+) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 16
|
Female/51 years old, peri-menopause.
Screen detected mass lesion on left breast 2
o’clock direction.
No family history.
No comorbidities.
|
Report 1:Left mammography (Oct. 2020): one-view
asymmetry at outer breast. Outside US-VABE = IDC (no
available image). Report 2:Left breast US (Dec. 2020): an irregular
hypoechoic area at the VABE site. Report 3:Breast MRI (Dec. 2020): some enhancing foci at the VABE site. Report 4:Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left axilla.
| null |
Operation + Post-operative radiation therapy + Tamoxifen 20 mg/day.
Operation
Left breast conserving surgery, sentinel lymph
node biopsy. (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on
each direction
|
Invasive Ductal Carcinoma
1. Post-mammotome excision status.
2. Size of tumor: 0.6 cm, residual.
3. Histologic grade: 2/3 (tubule formation: 3/3,
nuclear pleomorphism: 2/3, mitotic count:
1/3, 1/10 HPF).
4. Intraductal component: present, intratumoral/extratumoral (40%) (nuclear grade:
low, necrosis: absent, architectural pattern:
cribriform/solid, extensive intraductal component: present).
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) superior margin: 20 mm.
(b) inferior margin: (see note).
(c) medial margin: 10 mm.
(d) lateral margin: 15 mm.
(e) deep margin: positive for ductal carcinoma in situ (slide 6).
(f) superfcial margin: 15 mm.
7. Lymph nodes: no metastasis in three axillary
lymph nodes (pN0(sn)) (sentinel LN: 0/2,
non-sentinel LN: 0/1).
8. Arteriovenous invasion: absent.
9. Lymphovascular invasion: absent.
10. Tumor border: infltrative.
11. Microcalcifcation: present, non-tumoral. Note: 1. The inferior margin of the
lumpectomy specimen (slide 6) is close to
ductal carcinoma in situ (<1 mm) but this
margin submitted for frozen diagnosis (Fro
7) is free of tumor
|
HR(+) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 17
|
Female/50 years old, peri-menopause.
Screen detected mass lesion on left breast 4
o’clock direction.
No family history.
S/P Lumbar spine disc herniation operation,
s/p pain block in lumbar spine.
S/p hormone replacement due to amenorrhea.
|
Report 1:Left mammography, MLO view (Dec. 2020):
negative fnding. Report 2:Left breast US (Dec. 2020): a small hypoechoic
mass at lower outer quadrant. US-CNB = IDC. Report 3:Breast MRI (Dec. 2020): no suspicious fnding in both breasts. Report 4:Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left axilla.
| null |
Operation + Post-operative radiation therapy + Tamoxifen 20 mg/day.
Operation
Left breast conserving surgery, sentinel lymph
node biopsy. 8 (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on
each direction
|
Invasive Ductal Carcinoma
1. Size of invasive component: 0.4 cm (pT1a).
2. Size of intraductal component: 3.0 cm.
3. Histologic grade: 2/3 (tubule formation: 3/3,
nuclear pleomorphism: 2/3, mitotic count:
1/3, 1/10 HPF).
4. Intraductal component: present, extratumoral
(80%) (nuclear grade: low, necrosis: absent,
architectural pattern: cribriform/solid, extensive intraductal component: present).
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) superior margin: 5 mm.
(b) inferior margin: (see note 1).
(c) medial margin: 5 mm.
(d) lateral margin: (see note 2).
(e) deep margin: 1 mm from invasive ductal
carcinoma (slide 5).
(f) superfcial margin: 3 mm.
7. Lymph nodes: no metastasis in one axillary
lymph node (pN0(i+)(sn)) (see note 3) (sentinel LN: 0/1).
8. Arteriovenous invasion: absent.
9. Lymphovascular invasion: absent.
10. Tumor border: infltrative.
11. Microcalcifcation: present, non-tumoral.
12. Pathological TN category (AJCC 2017):
pT1aN0(i+)(sn). Note: 1. The inferior margin of the lumpectomy
specimen (slide 3) is close to ductal carcinoma in situ (2 mm) but this margin submitted for frozen diagnosis (Fro 4) is free of
tumor.
2. The lateral margin of the lumpectomy specimen (slide 5) is close to invasive ductal carcinoma (1 mm) but this margin submitted for
frozen diagnosis (Fro 4) is free of tumor.
3. A few isolated tumor cells are present only in
the permanent section of Fro 5.
|
HR(+) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 18
|
Female/61 years old, post-menopause.
Screen detected microcalcifcation of upper
outer portion on left breast.
No family history.
S/P unilateral salpingo-oophorectomy, s/p
hysterectomy, Hypertension.
|
Report 1:Left mammography (July 2010): regional amorphous microcalcifcations at upper outer quadrant. Report 2:Breast MRI (Aug. 2010): regional non-mass enhancement at the operative site (white arrow). A benign appearing mass in the right breast (black arrow). Report 3:Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left axilla (Aug. 2010). Report 4:Left mammography (Nov. 2011): post-operative
change at upper outer quadrant. An intramammary lymph
node at upper outer quadrant (black arrow). Report 5:Left mammography (Nov. 2020): newly developed irregular masses at the operative site (white arrows).
No change in the benign intramammary lymph node
(black arrow) . Report 6:Left breast US (Nov. 2020): two masses with
non-parallel orientation. US-CNB = IDC. Report 7: Breast MRI (Nov. 2020): an irregular enhancing mass in the left breast (white arrow). No change of a benign
appearing mass in the right breast (black arrow). Report 8:Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left axilla (Jan. 2021). Report 9:Gross pathology of breast excision specimen. Report 10:Gross pathology of lumpectomy specimen.
| null |
Operation (1st & 2nd, Aug. 2010) + Postoperative radiation therapy + Tamoxifen
20 mg/day.
Operation (3rd, Jan. 2021) + Adjuvant chemotherapy (docetaxel & cyclophosphamide) +
Letrozole 2.5 mg/day.
Operation (1st, Aug. 2010)
Left breast excision .(a) Gross pathology of right mastectomy specimen. (b, c and d) The margins get marked and sliced with different colors on each direction
|
[Right Breast]
1. Fibroadenoma
2. Sclerosing adenosis with microcalcifcation.
[Left Breast]
Invasive Ductal Carcinoma
1. Post-lumpectomy status.
2. Size of tumor: 2.0 cm (rpT1c). 3. Histologic grade: 2/3 (tubule formation: 3/3,
nuclear pleomorphism: 2/3, mitotic count:
1/3, 3/10 HPF).
4. Intraductal component: present, intratumoral
(5%) (nuclear grade: low, necrosis: absent,
architectural pattern: solid, extensive intraductal component: absent).
5. Skin and nipple: no involvement of tumor.
6. Surgical margins:
(a) deep margin: 3 mm.
(b) superfcial margin: 2 mm.
7. Lymph nodes: no metastasis in two axillary
lymph nodes (rpN0(sn)) (axillary LN: 0/2).
8. Arteriovenous invasion: present,
intratumoral.
9. Lymphovascular invasion: present, intratumoral/peritumoral.
10. Tumor border: infltrative.
11. Microcalcifcation: present, tumoral.
12. Pathological TN category (AJCC 2017):
rpT1cN0(sn).
|
HR(+) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 19
|
Female/43 years old, pre-menopause.
Screen detected mass lesion of lower inner on
left breast.
No family history.
No comorbidities.
|
Report 1:Left mammography (Jan. 2021): an irregular
mass at lower inner quadrant. Report 2:Left breast US (Jan. 2021): a hypoechoic mass
with angular margins at lower inner quadrant.
US-CNB = IDC. Report 3:Breast MRI (Jan. 2021): an irregular enhancing mass at lower inner quadrant of the left breast (white arrow,
proven IDC). Another irregular enhancing mass at the lower outer quadrant of the left breast (black arrow). Report 4:4 MRI-directed left breast US (Jan. 2021): a
hypoechoic mass with non-parallel orientation at lower
outer quadrant. US-CNB = IDC. Report 5:5 Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left axilla.
| null |
Operation + Tamoxifen 20 mg/day with leuprolide acetate.
19.3.1 Operation
Left nipple–areolar complex sparing mastectomy
with immediate implant reconstruction, sentinel
lymph node biopsy. (a) Preoperative and (b) immediate post-operative appearance. (a) Gross pathology of mastectomy specimen. (b, c) The margins get marked and sliced with different colors
on each direction.
|
Invasive Ductal Carcinoma
1. Size of tumor: 1.7 cm and 0.5 cm (pT1c(2)).
2. Histologic grade: 2/3 (tubule formation: 3/3,
nuclear pleomorphism: 2/3, mitotic count:
2/3, 11/10 HPF).
3. Intraductal component: present, intratumoral/extratumoral (20%) (nuclear grade:
low, necrosis: present, architectural pattern:
cribriform/solid/comedo, extensive intraductal component: present).
4. Skin: no involvement of tumor.
5. Surgical margins:
(a) deep margin: 2 mm.
(b) superfcial margin: 2 mm. 6. Lymph nodes: no metastasis in one axillary
lymph node (pN0(sn)) (sentinel LN: 0/1).
7. Arteriovenous invasion: absent.
8. Lymphovascular invasion: present,
intratumoral.
9. Tumor border: infltrative.
10. Microcalcifcation: present, tumoral/
non-tumoral.
11. Pathological TN category (AJCC 2017):
pT1c(2)N0(sn).
|
HR(+) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 20
|
Female/59 years old, post-menopause.
Screen detected mass lesion on left breast 9:30
o’clock direction.
Family history of breast cancer, aunt
(maternal).
|
Report 1:Mammography
(Aug. 2020): An irregular
hyperdense mass in the
center portion of the left
breast. Report 2:Breast US (Aug. 2020): An irregular hypoechoic
mass with microlobulated margins in the left subareolar
area. Enlarged LN of left axilla level I and interpectoral
space (level II). Report 3:Breast MRI (Aug. 2020): An irregular enhancing mass in the center portion of the left breast. Enlarged
lymph node (black arrow) in the left axilla. Report 4:PET-CT
shows (a) a
hypermetabolic lesion in
the left upper inner
breast (mSUV = 4.5),
(b) hypermetabolic LNs
in the left axilla level II,
and (c) hypermetabolic
LNs in the left axilla,
level I.
|
Report 1:Breast US (Dec. 2020): Mammography (Mar. 2021): mammography after treatment demonstrates residual mass that is decreased in the longest diameter. Report 2:Breast US (Mar. 2021): US after treatment
demonstrates residual isoechoic mass that is decreased in
the longest diameter. Report 3:Breast MRI (Mar. 2021): MRI after treatment
demonstrates residual enhancing mass (white arrow) that
is decreased in the longest diameter and decrease in size
of the previously enlarged lymph node in the left axilla. Report 4:Lymphoscintigraphy shows visualized sentinel lymph nodes in the left axilla.
|
Neoadjuvant chemotherapy (#4 cycles of
doxorubicin and cyclophosphamide + #4
cycles of docetaxel) + Operation + Postoperative radiation therapy. Operation
Left breast conserving surgery, axillary lymph
node sampling. (a) A schematic illustration of tumor location
and axillary lymph node metastasis and (b) breast and
axillary incision lines on left breast. (c) Gross pathology
of lumpectomy specimen. (d) The margins get marked
and sliced with different colors on each direction
|
No residual tumor with stromal fbrosis 1. Post-chemotherapy status.
2. Lymph nodes: no metastasis in seven axillary
lymph nodes (ypN0) (sentinel LN: 0/1, nonsentinel LN: 0/6).
3. Microcalcifcation: present, tumoral/
non-tumoral.
|
HR(−) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 21
|
Female/50 years old, pre-menopause.
Screen detected mass lesion on left breast 1
o’clock direction.
No family history
|
Report 1: Mammography
(Mar. 2021): grouped
microcalcifcations with
subtle architectural
distortion in left upper outer
quadrant. Enlarged LN, left
axilla. Report 2: Breast US (Mar. 2021): An irregular mass at the
2 o’clock direction of the left breast. Report 3:Breast MRI (Mar. 2021): focal heterogeneous
non-mass enhancement at the left upper outer quadrant. Report 4:PET-CT shows
(a) hypermetabolic
lesions in Lt. breast
(mSUV = 2.9),
(b) hypermetabolic
lesions in Lt. axillary
LNs level II, and
(c) hypermetabolic
lesions in Lt. axillary
LNs level I.
|
Report 1:Mammography
(Oct. 2021):
mammography after
treatment demonstrates
residual
microcalcifcations in the
left upper outer quadrant. Report 2:Breast US (Oct. 2021): US after treatment demonstrates residual hypoechoic mass that is decreased in
the longest diameter. Report 3:Breast MRI (Oct. 2021): MRI after treatment
demonstrates residual enhancing foci and non-mass
enhancement that is decreased in the longest diameter. Report 4:Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left axilla.
|
Neoadjuvant chemotherapy (#4 cycles of
doxorubicin and cyclophosphamide + #4
cycles of docetaxel) + Operation + Postoperative radiation therapy + Letrozole
2.5 mg + Adjuvant capecitabine. Operation
Left breast conserving surgery, axillary lymph
node dissection(a) A schematic illustration of tumor location
and axillary lymph node metastasis. (b) Breast and axillary incision lines on left breast. (c) Gross pathology of
lumpectomy specimen. (d) The margins get marked and
sliced with different colors on each direction.
|
Microinvasive Ductal Carcinoma
1. Post-chemotherapy status.
2. Size of invasive component: <0.1 cm
(ypT1mi).
3. Size of intraductal component: 2.0 cm.
4. Histologic grade: not applicable.
5. Intraductal component: present, intratumoral/extratumoral (>95%) (nuclear grade:
high, necrosis: present, architectural pattern:
cribriform/solid/comedo, extensive intraductal component: present).
6. Skin: no involvement of tumor.
7. Surgical margins: (a) Superior margin: positive for ductal carcinoma in situ (Fro 1) (see note).
(b) Inferior margin: 5 mm.
(c) Medial margin: 5 mm.
(d) Lateral margin: 5 mm.
(e) Deep margin: 2 mm.
(f) Superfcial margin: <1 mm from invasive ductal carcinoma (slide 5).
8. Lymph nodes:
(a) Metastasis in two out of six axillary
lymph nodes (ypN1a(sn)) (sentinel LN:
2/2, axillary LN: 0/4).
(b) Perinodal extension: absent.
(c) Size of metastatic carcinoma: 3 mm.
9. Arteriovenous invasion: absent.
10. Lymphovascular invasion: present,
peritumoral.
11. Tumor border: infltrative.
12. Microcalcifcation: absent.
13. Pathological TN category (AJCC 2017):
ypT1miN1a(sn).
Note: 1. Ductal carcinoma in situ is present
only in the permanent section of Fro 1.
|
HR(−) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 22
|
Female/57 years old, post-menopause.
Self-detected palpable mass lesion on right
breast.
Family history of breast cancer, uncle
(paternal).
s/p retinal detachments operation.
BRCA 1 and 2 mutation: Not detected, PALB2
PV, STK11 VUS (variant of uncertain).
|
Report 1:Mammography
(Mar. 2021): An oval
hyperdense mass in the upper
outer quadrant of the right
breast. Enlarged lymph nodes in
the right axilla. Report 2:Breast US (Mar. 2021): An irregular hypoechoic
mass at the 10 o’clock direction of the right breast. Report 3:Breast MRI (Mar. 2021): An irregular enhancing mass (white arrow) at the 10 o’clock direction of the
right breast. Multiple enlarged lymph nodes (black arrow)
in the right axilla. Report 4:PET-CT
shows (a)
hypermetabolic mass in
right breast, upper outer
quadrant
(mSUV = ~10.8) and (b)
hypermetabolic lymph
nodes in right axilla
level I area
(mSUV = ~8.3).
|
Report 1: Mammography
(Sep. 2021):
mammography after
treatment demonstrates
residual mass that is
decreased in the longest
diameter. A clip marker
(black arrow) was seen
within the residual mass. Report 2:Breast US (Sep. 2021): US after treatment demonstrates residual hypoechoic mass that is decreased in
the longest diameter. A clip marker (arrow) was seen
within the residual mass. Report 3:Breast MRI (Sep. 2021): MRI after treatment
shows complete resolution of enhancement in the right
breast. Report 4:Lymphoscintigraphy shows visualized sentinel
lymph nodes in the right axilla.
|
Neoadjuvant chemotherapy (#4 cycles of
doxorubicin and cyclophosphamide + #4
cycles of docetaxel) + Operation + Postoperative radiation therapy + Adjuvant
capecitabine. Operation
Right breast conserving surgery, sentinel lymph
node biopsy. (a) A schematic illustration of tumor location
and axillary lymph node metastasis. (b) Breast and axillary incision lines on right breast. (c) Gross pathology of lumpectomy specimen. (d) The margins get marked and
sliced with different colors on each direction
|
Invasive Ductal Carcinoma
1. Post-chemotherapy status.
2. Size of tumor: 0.9 cm (ypT1b).
3. Histologic grade: 3/3 (tubule formation: 3/3,
nuclear pleomorphism: 3/3, mitotic count:
3/3, 11/10HPF).
4. Intraductal component: absent.
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) Superior margin: 25 mm.
(b) Inferior margin: 20 mm.
(c) Medial margin: 5 mm.
(d) Lateral margin: 10 mm.
(e) Deep margin: 5 mm.
(f) Superfcial margin: 10 mm.
7. Lymph nodes:
(a) Metastasis in two out of three axillary
lymph nodes (ypN1a(sn)) (sentinel LN:
2/3).
(b) Perinodal extension: absent.
(c) Size of metastatic carcinoma: 5 mm.
8. Arteriovenous invasion: absent.
9. Lymphovascular invasion: absent.
10. Tumor border: infltrative.
11. Microcalcifcation: absent.
12. Pathological TN category (AJCC 2017):
ypT1bN1a(sn).
|
HR(−) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 23
|
Female/56 years old, post-menopause.
Self-detected mass lesion on right breast.
Family history of breast cancer, aunt
(maternal).
s/p Right knee fracture operation.
BRCA 1 and 2 mutation: Not detected,
POLD1 VUS (variant of uncertain).
|
Report 1:Mammography
(Aug. 2020): An irregular
hyperdense mass in the
upper portion of the right
breast (marked by BB
marker). Enlarged lymph
nodes in the right axilla. Report 2:Breast US (Aug. 2020): An irregular hypoechoic
mass at the 12 o’clock direction of the right breast. Report 3:Breast MRI (Aug. 2020): An irregular heterogeneous enhancing mass at the 12 o’clock direction of the
right breast.
|
Report 1:Mammography
(Mar. 2021):
mammography after
treatment demonstrates no
residual mass. A clip
marker (white arrow) was
seen at the tumor bed. Report 2:Breast US (Mar. 2021): US after treatment
demonstrates residual hypoechoic mass that is decreased
in the longest diameter. A clip marker (arrow) was seen
around the residual mass. Report 3:Breast MRI (Mar. 2021): MRI after treatment
shows complete resolution of enhancement in the right
breast. Report 4:Lymphoscintigraphy shows visualized sentinel
lymph nodes in the right axilla.
|
Neoadjuvant chemotherapy (#4 cycles of
doxorubicin and cyclophosphamide + #4
cycles of docetaxel) + Operation + Postoperative radiation therapy. Operation
Right breast conserving surgery, sentinel lymph
node biopsy (a) A schematic illustration of tumor location
and (b) breast and axillary incision lines on right breast.
(c) Gross pathology of lumpectomy specimen. (d) The
margins get marked and sliced with different colors on
each direction.
|
No residual tumor with foamy histiocytic
collection
1. Post-chemotherapy status.
2. Lymph nodes: no metastasis in one axillary
lymph node (ypN0(sn)) (sentinel LN: 0/1).
Note: Histologic mapping has been done
|
HR(−) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 24
|
Female/44 years old, pre-menopause.
Self-detected mass lesion on right breast.
Family history of breast cancer, aunt
(paternal).
Family history of ovarian cancer, sister.
No comorbidities.
BRCA 1 and 2 mutation: Not detected,
EPCAM and MLH1 VUS (variant of uncertain).
|
Report 1:Mammography
(Apr. 2021): An oval
isodense mass in the upper
outer quadrant of right
breast (marked by BB
marker). Report 2:Breast US (Apr. 2021): An oval hypoechoic
mass at the 10 o’clock direction of the right breast. Report 3:Breast MRI (Apr. 2021): An irregular heterogeneous enhancing mass with associated non-mass enhancement in the upper outer quadrant of the right breast.
|
Report 1:Mammography
(Sep. 2021): An irregular
hyperdense mass in the
upper outer quadrant of
the right breast, showing
interval increase in size. Report 2:Breast US (Sep. 2021): US after treatment demonstrates the irregular hypoechoic mass that is increased
in the longest diameter. Report 3:Breast MRI (Sep. 2021): MRI after treatment
demonstrates enhancing mass that is increased in the longest diameter.
|
Neoadjuvant chemotherapy (#4 cycles of
doxorubicin and cyclophosphamide + #4
cycles of paclitaxel) + Operation + Postoperative radiation therapy + Adjuvant
capecitabine. Operation
Right breast conserving surgery, sentinel lymph
node biopsy (a) A schematic illustration of tumor location
and (b) breast and axillary incision lines on right breast.
(c) Gross pathology of lumpectomy specimen. (d) The
margins get marked and sliced with different colors on
each direction.
|
Invasive Ductal Carcinoma
1. Post-chemotherapy status.
2. Size of tumor: 2.7 cm (ypT2).
3. Histologic grade: 3/3 (tubule formation: 3/3,
nuclear pleomorphism: 3/3, mitotic count:
3/3, 54/10HPF).
4. Intraductal component: present, intratumoral/extratumoral (5%) (nuclear grade:
high, necrosis: absent, architectural pattern:
micropapillary, extensive intraductal component: absent).
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) Superior margin: (see note).
(b) Inferior margin: 15 mm.
(c) Medial margin: 10 mm.
(d) Lateral margin: 20 mm.
(e) Deep margin: 10 mm.
(f) Superfcial margin: 2.5 mm.
7. Lymph nodes: no metastasis in three axillary lymph nodes (ypN0(sn)) (sentinel
LN: 0/3). 8. Arteriovenous invasion: absent.
9. Lymphovascular invasion: absent.
10. Tumor border: infltrative.
11. Microcalcifcation: present, non-tumoral.
12. Pathological TN category (AJCC 2017):
ypT2N0(sn).
Note: 1. The superior margin of the lumpectomy specimen (slide 3) is positive for invasive
ductal carcinoma, but this margin submitted for
frozen diagnosis (Fro 1) is free of tumor.
|
HR(−) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 25
|
Female/70 years old, post-menopause.
Screen detected mass lesion on left breast 2
o’clock direction.
Family history of breast cancer, cousin
(paternal).
Macular degeneration.
BRCA 1 and 2 mutation: Not tested.
|
Report 1: Mammography
(Apr. 2021): An irregular
isodense mass in the
upper outer quadrant of
the left breast. Report 2:Breast US (Apr. 2021): An irregular hypoechoic
mass at the 2 o’clock direction of the left breast. Report 3:Breast MRI (Apr. 2021): An irregular enhancing mass at the 2 o’clock direction of the left breast.
|
Report 1:Mammography
(Oct. 2021):
mammography after
treatment demonstrates the
residual mass that is
decreased in the longest
diameter. Report 2:Breast US (Oct. 2021): US after treatment demonstrates the residual hypoechoic mass that is decreased
in the longest diameter. Report 3:Breast MRI (Oct. 2021): MRI after treatment
demonstrates the residual enhancing mass that is
decreased in the longest diameter. Report 4:Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left axilla.
|
Neoadjuvant chemotherapy (#4 cycles of doxorubicin and cyclophosphamide + #4 cycles of
docetaxel) + Operation + Post-operative radiation therapy + Adjuvant capecitabine. Operation
Left breast conserving surgery, sentinel lymph
node biopsy. (a) A schematic illustration of tumor location
and (b) breast and axillary incision lines on left breast. (c)
Gross pathology of lumpectomy specimen. (d, e) The
margins get marked and sliced with different colors on
each direction
|
Invasive Ductal Carcinoma with (a) focal squamous differentiation, (b) focal papillary pattern.
1. Post-chemotherapy status.
2. Size of tumor: 1.2 cm (ypT1c).
3. Histologic grade: 2/3 (tubule formation: 3/3,
nuclear pleomorphism: 3/3, mitotic count:
1/3, <1/10HPF).
4. Intraductal component: present, intratumoral/
extratumoral (15%) (nuclear grade: high,
necrosis: absent, architectural pattern: papillary, extensive intraductal component: absent).
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) Superior margin: 10 mm.
(b) Inferior margin: 15 mm.
(c) Medial margin: 10 mm.
(d) Lateral margin: 35 mm.
(e) Deep margin: 6 mm.
(f) Superfcial margin: 15 mm.
7. Lymph nodes: no metastasis in two axillary
lymph nodes (ypN0(sn)) (sentinel LN: 0/1,
non-sentinel LN: 0/1).
8. Arteriovenous invasion: absent.
9. Lymphovascular invasion: absent.
10. Tumor border: infltrative.
11. Microcalcifcation: absent.
12. Pathological TN category (AJCC 2017):
ypT1cN0(SN).
|
HR(−) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 26
|
Female/53 years old, post-menopause.
Self-detected mass lesion on right breast.
Family history of breast cancer, grandmother.
Family history of ovarian cancer, sister.
S/P appendectomy, s/p bilateral salpingooophorectomy, s/p left shoulder operation.
BRCA 1 mutation carrier.
|
Breast, right, needle biopsy: Invasive ductal carcinoma, histologic grade 3 with medullary pattern.. Report 1:Mammography
(Apr. 2021): An irregular
hyperdense mass in the upper
outer quadrant of the right
breast. Report 2:Breast US (Apr. 2021): An irregular hypoechoic
mass at the 10 o’clock direction of the right breast. Report 3:Breast MRI (Apr. 2021): An irregular enhancing mass at the 10 o’clock direction of the right breast.
|
Report 1:Mammography
(Oct. 2021):
mammography after
treatment demonstrates no
residual mass. Report 2:Breast US (Oct. 2021): US after treatment demonstrates no residual mass. Report 3:Breast MRI (Jun. 2021): MRI after treatment
shows complete resolution of enhancement in the right
breast.
|
Neoadjuvant chemotherapy (#4 cycles of
doxorubicin and cyclophosphamide + #3
cycles of docetaxel + Trastuzumab) + Operati
on + Adjuvant capecitabine + Trastuzumab. Operation
Robotic bilateral nipple-areolar complex sparing
mastectomy, bilateral sentinel lymph node biopsy. (a) Preoperative and (b) postoperative appearance. 4 (a) Gross pathology of mastectomy (right) specimen. (b, c) The margins get marked and sliced with different colors on each direction.
|
<Right Breast>
No residual tumor with stromal fbrosis
1. Post-chemotherapy status.
2. Lymph nodes: no metastasis in two axillary
lymph nodes (ypN0(sn)) (sentinel LN: 0/2).
<Left Breast>
Invasive Ductal Carcinoma
1. Post-chemotherapy status.
2. Size of tumor: 1.8 cm (ypT1c).
3. Histologic grade: 2/3 (tubule formation: 3/3,
nuclear pleomorphism: 2/3, mitotic count:
1/3, <1/10HPF).
4. Intraductal component: present, intratumoral
(60%) (nuclear grade: high, necrosis: absent,
architectural pattern: solid, extensive intraductal component: present).
5. Surgical margins:
(a) Deep margin: 1 mm from ductal carcinoma in situ (slide 3).
(b) Superfcial margin: 13 mm.
6. Lymph nodes:
(a) Metastasis in one out of eight axillary
lymph nodes (ypN1mi) (see note)
(sentinel LN: 1/2, non-sentinel LN:
0/6).
(b) Perinodal extension: absent.
(c) Size of metastatic carcinoma: 0.5 mm.
7. Arteriovenous invasion: absent.
8. Lymphovascular invasion: present,
intratumoral.
9. Tumor border: infltrative. 10. Microcalcifcation: present, non-tumoral.
11. Pathological TN category (AJCC 2017):
ypT1cN1mi.
Note: 1. Micrometastasis is present only in the
permanent section of Fro 3.
|
HR(−) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 27
|
Female/36 years old, pre-menopause.
Self-detected palpable mass lesion on left
breast.
Family history of breast cancer, aunt
(maternal).
No comorbidities.
BRCA 1 and 2 mutation: Not detected,
RAD50 VUS (variant of uncertain).
|
Report 1:Mammography
(May. 2021): An irregular
hyperdense mass in the
upper outer quadrant of
left breast (marked by BB
marker). Enlarged lymph
nodes in the left axilla. Report 2:Breast US (May. 2021): An irregular hypoechoic
mass at the 2 o’clock direction of the left breast. Report 3:Breast MRI (May. 2021): Two irregular enhancing masses at the 2 o’clock direction of left breast.
Multiple enlarged lymph nodes in the left axilla. Report 4:PET-CT shows (a) a hypermetabolic mass in the left breast parenchyma, upper outer quadrant (mSUV = ~12.4) and (b) hypermetabolic lymph nodes in the left axilla level I area (mSUV = ~6.7).
|
Report 1:Mammography (Nov. 2021): mammography after treatment demonstrates residual mass that is decreased in
the longest diameter. A clip marker (black arrow) was seen within the residual mass. Report 2:Breast MRI (Nov . 2021): MRI after treatment
demonstrates residual enhancing mass (white arrow) that
is decreased in the longest diameter. Report 3:Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left axilla.
|
Neoadjuvant chemotherapy (#4 cycles of
doxorubicin and cyclophosphamide + #4
cycles of docetaxel) + Operation + Postoperative radiation therapy + Adjuvant
capecitabine. Operation
Left breast conserving surgery, axillary lymph
node sampling. (a) A schematic illustration of tumor location
and lymph node metastasis. (b) Breast and axillary incision lines on left breast. (c) Gross pathology of lumpectomy specimen. (d) The margins get marked and sliced
with different colors on each direction.
|
Invasive Ductal Carcinoma
1. Post-chemotherapy status.
2. Size of tumor: 2.8 cm (ypT2).
3. Histologic grade: 3/3 (tubule formation: 3/3,
nuclear pleomorphism: 3/3, mitotic count:
3/3, 14/10HPF).
4. Intraductal component: absent.
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) Superior margin: 5 mm.
(b) Inferior margin: 5 mm.
(c) Medial margin: 5 mm.
(d) Lateral margin: 5 mm.
(e) Deep margin: 2 mm.
(f) Superfcial margin: 2 mm.
7. Lymph nodes: no metastasis in three axillary
lymph nodes (ypN0(i+)(sn)) (sentinel LN:
0/2, axillary LN: 0/1).
8. Arteriovenous invasion: absent.
9. Lymphovascular invasion: present,
intratumoral.
10. Tumor border: infltrative.
11. Microcalcifcation: present, tumoral/
non-tumoral.
12. Pathological TN category (AJCC 2017):
ypT2N0(i+)(sn).
Note: 1. A few isolated tumor cells are present
only in the permanent section of Fro 6 for
immunohistochemical staining.
|
HR(−) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 28
|
Female/57 years old, post-menopause.
Self-detected palpable mass lesion on right.
No family history.
S/P right neck excision (due to
lymphadenitis).
|
Report 1:Mammography
(Sep. 2020): An irregular
hyperdense mass in the upper
outer quadrant of the right
breast. Report 2:Breast US (Sep. 2020): An irregular hypoechoic
mass in the upper outer quadrant of the right breast. Report 3:Breast MRI (Apr. 2021): An irregular enhancing mass in the upper outer quadrant of the right breast.
| null |
Operation + Post-operative radiation therapy
(Adjuvant chemotherapy refuse). Operation
Right breast conserving surgery. (a) A schematic illustration of tumor location. (b) Breast and axillary incision lines on right breast. (c) Gross
pathology of lumpectomy specimen. (d) The margins get marked and sliced with different colors on each direction
|
Malignant Adenomyoepithelioma (EpithelialMyoepithelial Carcinoma)
1. Size of tumor: 2.0 cm (pT1c). 2. Histologic grade: 3/3 (tubule formation: 3/3,
nuclear pleomorphism: 2/3, mitotic count:
3/3, 23/10HPF).
3. Intraductal component: absent.
4. Skin: no involvement of tumor.
5. Surgical margins:
(a) Superior margin: 10 mm.
(b) Inferior margin: 10 mm.
(c) Medial margin: 15 mm.
(d) Lateral margin: 25 mm.
(e) Deep margin: 9 mm.
(f) Superfcial margin: <1 mm from
epithelial-myoepithelial carcinoma
(slides 2 and 7).
6. Arteriovenous invasion: absent.
7. Lymphovascular invasion: absent.
8. Tumor border: pushing.
9. Microcalcifcation: present, non-tumoral.
10. Pathological TN category (AJCC 2017):
pT1c.
|
HR(−) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 29
|
Female/27 years old, pre-menopause.
Self-detected mass lesion on left breast.
No family history.
No comorbidities.
BRCA 1 and 2 mutation: Not detected.
|
Report 1:Mammography
(May. 2021): An irregular
hyperdense mass with fne
pleomorphic
microcalcifcations in the
upper center portion of the left
breast. Report 2:Breast US (May. 2021): An irregular hypoechoic
mass with microcalcifcations at the 11 o’clock direction
of the left breast. Report 3:Breast MRI (May. 2021): An irregular enhancing mass at the 11 o’clock direction of the left breast.
Multiple enlarged lymph nodes in the left axilla. Report 4:PET-CT
shows (a) a
hypermetabolic mass in
left breast (mSUV = 7.3)
and (b) a few prominent
LNs on the left axilla
level I (mSUV = 1.3).
|
Report 1:Mammography
(Nov. 2021): mammography
after treatment demonstrates
residual microcalcifcations. Report 2:Breast MRI (Nov. 2021): MRI after treatment
shows complete resolution of enhancement in the left
breast. Report 3:Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left axilla.
|
Neoadjuvant chemotherapy (#4 cycles of doxorubicin and cyclophosphamide + #4 cycles of
docetaxel) + Operation + Post-operative radiation therapy + Adjuvant capecitabine. Operation
Left breast conserving surgery, axillary lymph
node dissection. (a) A schematic illustration of tumor location
and lymph node metastasis. (b) Breast and axillary incision lines on left breast. (c) Gross pathology of lumpectomy specimen. (d) The margins get marked and sliced
with different colors on each direction
|
Microinvasive Ductal Carcinoma
1. Post-chemotherapy status.
2. Size of tumor: <0.1 cm (ypT1mi).
3. Histologic grade: not applicable.
4. Intraductal component: absent.
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) Superior margin: 10 mm.
(b) Inferior margin: 10 mm.
(c) Medial margin: 10 mm.
(d) Lateral margin: 10 mm.
(e) Deep margin: 2 mm.
(f) Superfcial margin: 2 mm.
7. Lymph nodes: no metastasis in six axillary
lymph nodes (ypN0) (sentinel LN: 0/3, nonsentinel LN: 0/3).
8. Arteriovenous invasion: absent.
9. Lymphovascular invasion: absent.
10. Tumor border: infltrative.
11. Microcalcifcation: present, tumoral/nontumoral.
12. Pathological TN category (AJCC 2017):
ypT1miN0.
|
HR(−) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 30
|
Female/69 years old, post-menopause.
Self-detected palpable mass lesion on left
breast.
No family history. h/o Tuberculosis, s/p thoracic vertebra compression fracture.
|
Report 1:Mammography (Apr. 2021): An obscured hyperdense mass in the upper portion of the left breast (marked by BB marker). Report 2:Breast US (Apr. 2021): An irregular hypoechoic
mass at the 12 o’clock direction of the left breast. Report 3:Breast MRI (Apr. 2021): An irregular rim enhancing mass at the 12 o’clock direction of the left breast.
|
Report 1:PET-CT
shows a hypermetabolic
mass in left breast
(mSUV = 11.6). Report 2:Mammography (Aug. 2021): Mammography after treatment demonstrates the hyperdense mass that shows
interval increase in size. Report 3:Breast US (Aug. 2021): US after treatment
demonstrates the irregular hypoechoic mass that is
increased in the longest diameter. Report 4:Breast MRI (Aug. 2021): MRI after treatment
demonstrates the irregular enhancing mass that is
increased in the longest diameter. Report 5:Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left axilla.
|
Neoadjuvant chemotherapy (#2 cycles of
doxorubicin and cyclophosphamide + #3
cycles of paclitaxel) + Operation + Adjuvant
capecitabine. Operation
Left modifed radical mastectomy, sentinel lymph
node biopsy (a) Gross pathology of mastectomy specimen. (b, c) The margins get marked and sliced with different colors on each direction
|
Invasive Ductal Carcinoma
1. Post-chemotherapy status.
2. Size of tumor: 3.5 cm (ypT2).
3. Histologic grade: 3/3 (tubule formation: 3/3,
nuclear pleomorphism: 3/3, mitotic count:
3/3, 4/1HPF).
4. Intraductal component: present, extratumoral
(5%) (nuclear grade: high, necrosis: absent,
architectural pattern: solid, extensive intraductal component: absent).
5. Skin and nipple: no involvement of tumor.
6. Surgical margins:
(a) Deep margin: 1 mm from invasive ductal
carcinoma (slide 6).
(b) Superfcial margin: 2 mm. 7. Lymph nodes: no metastasis in two axillary
lymph nodes (ypN0(sn)) (sentinel LN: 0/2).
8. Arteriovenous invasion: absent.
9. Lymphovascular invasion: present,
intratumoral.
10. Tumor border: infltrative.
11. Microcalcifcation: present, tumoral/
non-tumoral.
12. Pathological TN category (AJCC 2017):
ypT2N0(sn).
|
HR(−) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 31
|
Female/41 years old, pre-menopause.
Self-detected mass lesion on right breast.
No family history.
No comorbidities.
BRCA 1 and 2 mutation: Not detected, STK11
VUS (variant of uncertain).
|
Report 1:Mammography
(Oct. 2020): An obscured
mass in the upper outer
quadrant of the right breast. Report 2:Breast US (Oct. 2020): An irregular heterogeneous echoic mass with posterior acoustic enhancement at
the 9 o’clock direction of the right breast. Report 3:Breast MRI (Oct. 2020): An irregular rim
enhancing mass at the 9 o’clock direction of the right
breast. Report 4:PET-CT
shows (a)
hypermetabolic necrotic
mass in the right upper
outer breast
(mSUV = 6.1) and (b)
small LN with subtle
uptake in the right axilla
level I (mSUV = 0.9).
|
Report 1:Mammography (Apr. 2021): mammography after treatment demonstrates residual mass that is decreased in
the longest diameter. Report 2:Breast US (Apr. 2021): US after treatment demonstrates residual hypoechoic mass that is decreased in
the longest diameter. Report 3:Breast MRI (Apr. 2021): MRI after treatment
demonstrates residual enhancing mass (white arrow) that
is decreased in the longest diameter. Report 4:Lymphoscintigraphy shows visualized sentinel
lymph nodes in the right axilla.
|
Neoadjuvant chemotherapy (#4 cycles of
doxorubicin and cyclophosphamide + #4
cycles of docetaxel) + Operation + Postoperative radiation therapy + Adjuvant
capecitabine. Operation
Right breast conserving surgery, axillary lymph
node sampling. (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors
on each direction
|
Invasive Ductal Carcinoma
1. Post-chemotherapy status.
2. Size of tumor: 0.9 cm (ypT1b).
3. Histologic grade: 3/3 (tubule formation: 3/3,
nuclear pleomorphism: 3/3, mitotic count:
3/3, 18/10HPF).
4. Intraductal component: absent.
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) Superior margin: 38 mm.
(b) Inferior margin: 21 mm.
(c) Medial margin: 20 mm.
(d) Lateral margin: 15 mm.
(e) Deep margin: 6 mm.
(f) Superfcial margin: 22 mm.
7. Lymph nodes: no metastasis in fve axillary
lymph nodes (ypN0(sn)) (sentinel LN: 0/3,
non-sentinel LN: 0/2). 8. Arteriovenous invasion: absent.
9. Lymphovascular invasion: absent.
10. Tumor border: infltrative.
11. Microcalcifcation: absent.
12. Pathological TN category (AJCC 2017):
ypT1bN0(sn).
|
HR(−) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 32
|
Female/49 years old, pre-menopause.
Self-detected mass lesion on left breast.
Family history of breast cancer, aunt and
cousin (paternal).
Family history of prostate cancer, father. Hyperthyroidism.
BRCA 1 and 2 mutation: Not detected.
|
Report 1:4 Mammography
(Nov. 2020): A huge
hyperdense mass in left
breast. Enlarged lymph
node in the left axilla. Report 2:Breast US (Nov. 2020): A huge irregular heterogeneous echoic mass with direct skin invasion (white
arrow) in the left breast. Report 3:Breast MRI (Nov. 2020): A huge irregular heterogeneous enhancing mass in the left breast. Report 4:.
| null |
Neoadjuvant chemotherapy (#4 cycles of
doxorubicin and cyclophosphamide + #4 cycles
of docetaxel) + Operation + Post-operative
radiation therapy + Adjuvant capecitabine. Operation
Left modifed radical mastectomy, axillary lymph
node dissection. (a) Gross pathology of lumpectomy specimen. (b, c) The margins get marked and sliced with different colors
on each direction.
|
Invasive Ductal Carcinoma
1. Post-chemotherapy status.
2. Size of tumor: 2.7 cm (ypT2).
3. Histologic grade: 3/3 (tubule formation: 3/3,
nuclear pleomorphism: 3/3, mitotic count:
3/3, 20/10HPF).
4. Intraductal component: absent.
5. Skin: dermal involvement of tumor. 6. Nipple: no involvement of tumor.
7. Surgical margins:
(a) Deep margin: 22 mm.
(b) Superfcial margin: 7 mm.
8. Lymph nodes: no metastasis in 14 axillary
lymph nodes (ypN0) (sentinel LN: 0/1, nonsentinel LN: 0/13).
9. Arteriovenous invasion: absent.
10. Lymphovascular invasion: absent.
11. Tumor border: infltrative.
12. Microcalcifcation: absent.
13. Pathological TN category (AJCC 2017):
ypT2N0.
|
HR(−) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 33
|
Female/79 years old, post-menopause.
Screen detected mass lesion on left breast 12
o’clock direction.
No family history.
S/P paraffn injection, s/p appendectomy, s/p
hysterectomy, s/p hemicolectomy (colon cancer).
S/P radical total gastrostomy (advanced gastric cancer).
BRCA 1 and 2 mutation: Not detected,
BARD1 VUS (variant of uncertain).
|
Report 1:Mammography: multiple rim calcifcations and hyperdense masses in the left breast (patient with history of foreign body injection for cosmetic augmentation. Report 2:Breast MRI: irregular heterogeneous enhancing masses in the upper portion of the left breast. Report 3:Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left axilla.
| null |
Neoadjuvant chemotherapy (#4 cycles of
doxorubicin and cyclophosphamide + #4
cycles of docetaxel) + Operation + Postoperative radiation therapy. Operation
Left breast conserving surgery, sentinel lymph node biopsy. (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors
on each direction.
|
Atypical ductal hyperplasia, focal
1. Post-chemotherapy status.
2. Lymph nodes: no metastasis in one axillary
lymph node (ypN0(sn)) (sentinel LN: 0/1).
|
HR(−) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 34
|
Female/79 years old, post-menopause.
Screen detected mass lesion on left breast 12
o’clock direction.
No family history.
S/P paraffn injection, s/p appendectomy, s/p
hysterectomy, s/p hemicolectomy (colon cancer).
S/P radical total gastrostomy (advanced gastric cancer).
BRCA 1 and 2 mutation: Not detected,
BARD1 VUS (variant of uncertain).
|
Report 1:Mammography: multiple rim calcifcations and hyperdense masses in the left breast (patient with history of foreign body injection for cosmetic augmentation. Report 2:Breast MRI: irregular heterogeneous enhancing masses in the upper portion of the left breast. Report 3:Lymphoscintigraphy shows visualized sentinel lymph nodes in the left axilla.
| null |
Operation + Adjuvant chemotherapy (#1
cycles of docetaxel and cyclophosphamide,
stop d/t mucositis). Operation
Left modifed radical mastectomy, sentinel lymph
node biopsy. (a) Gross pathology of lumpectomy specimen. (b, c, d) The margins get marked and sliced with different colors on each direction.
|
Invasive Ductal Carcinoma associated with
paraffnoma
1. Size of tumor: 3.0 cm (pT2). 2. Histologic grade: 3/3 (tubule formation: 3/3,
nuclear pleomorphism: 3/3, mitotic count:
2/3, 8/10HPF).
3. Intraductal component: absent.
4. Skin and nipple: no involvement of tumor.
5. Surgical margins:
(a) Deep margin: 10 mm.
(b) Superfcial margin: 21 mm.
6. Lymph nodes: no metastasis in fve axillary
lymph nodes (pN0(sn)) (sentinel LN: 0/5).
7. Arteriovenous invasion: absent.
8. Lymphovascular invasion: absent.
9. Tumor border: infltrative.
10. Microcalcifcation: absent.
11. Pathological TN category (AJCC 2017):
pT2N0(sn).
|
HR(−) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 35
|
Female/75 years old, post-menopause. Screen detected mass lesion on left breast 2 o’clock direction. No family history. Hypertension, Hyperlipidemia, s/p hysterectomy, arrhythmia (s/p operation).
|
Report 1:Mammography (May 2021): A focal asymmetry at the 3 o’clock direction of the left breast. Report 2:Breast US (May. 2021): An irregular hypoechoic
mass with echogenic halo at the 3 o’clock direction of the
left breast. Report 3: Breast MRI (May. 2021): An irregular enhancing mass at the 3 o’clock direction of the left breast.
| null |
Left breast conserving surgery (nautilus trial:
sentinel lymph node biopsy skip arm) (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colorson each direction
|
Invasive Ductal Carcinoma with apocrine
differentiation
1. Size of tumor: 1.1 cm (pT1c).
2. Histologic grade: 3/3 (tubule formation: 3/3,
nuclear pleomorphism: 3/3, mitotic count:
2/3, 6/10HPF).
3. Intraductal component: present, extratumoral
(10%) (nuclear grade: high, necrosis: present, architectural pattern: cribriform/solid/
comedo, extensive intraductal component:
absent).
4. Skin: no involvement of tumor.
5. Surgical margins:
(a) Superior margin: 8 mm.
(b) Inferior margin: 13 mm.
(c) Medial margin: (see note).
(d) Lateral margin: 15 mm.
(e) Deep margin: 2 mm.
(f) Superfcial margin: 15 mm.
6. Arteriovenous invasion: absent.
7. Lymphovascular invasion: absent.
8. Tumor border: infltrative.
9. Microcalcifcation: present, tumoral/
non-tumoral.
10. Pathological TN category (AJCC 2017):
pT1cNx.
Note: 1. The medial margin of the lumpectomy specimen (slide 5) is close to ductal carcinoma in situ (2 mm), but this margin submitted
for frozen diagnosis (Fro 3) is free of tumor.
|
HR(−) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 36
|
Female/46 years old, pre-menopause.
Self-detected palpable mass lesion on left
axillary.
Family history of breast cancer, aunt
(maternal).
Hepatitis B virus carrier.
BRCA 1 and 2 mutation: Not detected, RET
VUS (variant of uncertain).
|
Report 1:Mammography (Jun. 2021): A focal asymmetry with microcalcifcations in the upper outer quadrant of left breast (marked by BB marker). Multiple lymph nodes (black arrow) in left axilla. Report 2: Breast US (Jun. 2021): An irregular hypoechoic mass with microcalcifcations at the 2 o’clock direction of the left breast. Report 3: Breast MRI (Jun. 2021): An irregular enhancing mass at the 2 o’clock direction of the left breast. Enlarged lymph nodes in the left axilla. Report 4:PET-CT shows (a) hypermetabolic mass in the left breast (mSUV = 13.4), (b) an enlarged hypermetabolic lymph node in left internal mammary area (mSUV = 6.7), and (c) hypermetabolic lymph node in the left axilla level I–III (mSUV = 8.7).
|
Report 1: 4 Mammography
(Nov. 2021): mammography
after treatment demonstrates
residual mass that is
decreased in size. Decrease in
size of previously enlarged
lymph nodes in the left axilla
(black arrow). Report 2:Breast MRI (Nov. 2021): MRI after treatment
shows complete resolution of enhancement in the left
breast. Report 3:Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left axilla. Report 4:(a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors
on each direction.
|
Neoadjuvant chemotherapy (#4 cycles of
doxorubicin and cyclophosphamide + #4 cycles
of docetaxel) + Operation + Post-operative
radiation therapy. Operation Left breast conserving surgery, sentinel lymph node biopsy. (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors
on each direction.
|
1. No residual tumor with foamy histiocytic
collection.
(a) Post-chemotherapy status.
(b) Lymph nodes: no metastasis in two axillary lymph nodes (ypN0(sn)) (sentinel
LN: 0/2).
(c) Related slides: S21–10541, S21–10544.
2. Adenomyoepithelial hyperplasia with
microcalcifcation.
|
HR(−) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 37
|
Female/46 years old, pre-menopause.
Self-detected palpable mass lesion on right breast.
Family history of breast cancer, aunt (maternal).
s/p myomectomy.
BRCA 1 and 2 mutation: Not detected.
|
Report 1: Mammography (Jun. 2021):
An irregular hyperdense mass with
microcalcifcations in the upper outer
quadrant of the right breast (marked
by BB marker). Report 2:Breast US (Jun. 2021): An irregular hypoechoic
mass with microcalcifcation at the 10 o’clock direction of
the right breast. Report 3: Breast MRI (Jun. 2021): An irregular enhancing masses (white arrow) with associated heterogeneous
non-mass enhancement (black arrow) in the upper outer
quadrant of the right breast. Report 4: PET-CT
shows (a)
hypermetabolic lesions
in the right breast
(mSUV = 8.0) and (b)
hypermetabolic LNs in
the right axilla, level I
(mSUV = 9.4).
|
Report 1: Mammography
(Dec. 2021): Mammography
after treatment demonstrates
residual mass that is decreased
in the longest diameter. Report 2: Breast US (Dec. 2021): US after treatment
demonstrates residual hypoechoic mass with microcalcifcations that is decreased in the longest diameter. Report 3:Breast MRI (Dec. 2021): MRI after treatment
demonstrates residual non-mass enhancement (white arrows). 6 (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on each direction
|
Neoadjuvant chemotherapy (#4 cycles of
doxorubicin and cyclophosphamide + #4
cycles of docetaxel) + Operation + Postoperative radiation therapy + Adjuvant
capecitabine. Operation
Right breast conserving surgery, sentinel lymph
node biopsy.
|
Invasive Ductal Carcinoma
1. Post-chemotherapy status.
2. Size of invasive component: up to 0.3 cm,
multifocal (ypT1a).
3. Size of intraductal component: 2.0 cm.
4. Histologic grade: 3/3 (tubule formation: 3/3,
nuclear pleomorphism: 3/3, mitotic count:
2/3, 3/HPF).
5. Intraductal component: present, intratumoral/extratumoral (80%) (nuclear grade:
high, necrosis: present, architectural pattern:
papillary/micropapillary/cribriform/solid/
comedo, extensive intraductal component:
absent/present).
6. Skin: no involvement of tumor.
7. Surgical margins:
(a) Superior margin: 20 mm.
(b) Inferior margin: 5 mm.
(c) Medial margin: (see note).
(d) Lateral margin: 5 mm.
(e) Deep margin: 2 mm.
(f) Superfcial margin: 2 mm.
8. Lymph nodes:
(a) metastasis in two out of six axillary lymph
nodes (ypN1a) (sentinel LN: 1/1, axillary
LN: 0/4, intramammary LN: 1/1),
(b) perinodal extension: present,
(c) size of metastatic carcinoma: 4 mm.
9. Arteriovenous invasion: absent. 10. Lymphovascular invasion: present, intratumoral/peritumoral.
11. Tumor border: infltrative.
12. Microcalcifcation: present, tumoral/
non-tumoral.
13. Pathological TN category (AJCC 2017):
ypT1aN1a.
|
HR(−) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 38
|
Female/52 years old, post-menopause.
Self-detected palpable mass lesion on right
breast.
No family history.
s/p bilateral salpingo-oophorectomy.
BRCA 1 mutation carrier.
|
Report 1: Mammography
(Jun. 2021): An irregular
hyperdense mass with fne
pleomorphic in the upper
portion of the right breast. Report 2: Breast US (Jun. 2021): An irregular hypoechoic
mass with microcalcifcation at the 12 o’clock direction of
the right breast. Report 3: Breast MRI (Jun. 2021): An irregular enhancing mass at the 12 o’clock direction of the right breast. Report 4: PET-CT shows hypermetabolic mass in the right upper breast (mSUV = 11.1).
|
Report 1: Mammography
(Dec. 2021): mammography
after treatment demonstrates
residual mass that is decreased
in the longest diameter. Report 2: Breast US (Dec. 2021): US after treatment
demonstrates residual hypoechoic mass that is decreased
in the longest diameter. Report 3: Breast MRI (Dec. 2021): MRI after treatment
demonstrates the residual non-mass enhancement (white
arrow). Report 4: Lymphoscintigraphy shows visualized sentinel
lymph nodes in the right axilla.
|
Neoadjuvant chemotherapy (#4 cycles of
doxorubicin and cyclophosphamide + #4
cycles of docetaxel) + Operation + Postoperative radiation therapy. Operation
Bilateral nipple-areolar complex sparing mastectomy+ implant reconstruction, sentinel lymph
node biopsy (right)(a) Preoperative and (b) postoperative appearance. (a) Gross pathology of mastectomy (right) specimen. (b, c) The margins get marked and sliced with different
colors on each direction.
|
No residual tumor with stromal degeneration
1. Post-chemotherapy status.
2. Lymph nodes: no metastasis in one axillary
lymph node (ypN0(sn)) (sentinel LN: 0/1).
3. Microcalcifcation: present.
|
HR(−) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 1
|
Female/47 years old, pre-menopause.
Screen detected mass lesion on left breast 5
o’clock direction.
No family history.
No comorbidities.
|
Report 1: Left mammography (Dec. 2020): an irregular
mass with microcalcifcations at lower outer quadrant . Report 2: Left breast US (Dec. 2020): multiple hypoechoic
masses at lower outer quadrant. US-CNB = IDC. Report 3: Breast MRI (Dec. 2020): an irregular enhancing mass in the left breast. Report 4: Post-NAC breast MRI (May 2021): a residual
enhancing focus after NAC. Report 5: PET-CT shows
(a) a hypermetabolic
mass in the left lower
outer breast
(mSUV = 9.9) and (b)
hypermetabolic lymph
node in the left axilla
level I (mSUV = 3.7). Report 6: Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left axilla.
| null |
Neoadjuvant chemotherapy (#6 cycles of
docetaxel and carboplatin and trastuzumab
and pertuzumab) + Operation + Postoperative radiation therapy + Tamoxifen
20 mg/day.
Operation: Left breast conserving surgery,
sentinel lymph node biopsy. (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on
each direction
|
Invasive Ductal Carcinoma
1. Post-chemotherapy status.
2. Size of invasive component: 0.2 cm (pT1a).
3. Size of intraductal component: 1.0 cm.
4. Histologic grade:1/3 (tubule formation: 2/3,
nuclear pleomorphism: 2/3, mitotic count:
1/3, 4/10 HPF).
5. Intraductal component: present, extratumoral
(99%) (nuclear grade: high, necrosis: present, architectural pattern: cribriform/solid/
comedo, extensive intraductal component:
present).
6. Surgical margins: (a) superior margin: 18 mm,
(b) inferior margin: 17 mm,
(c) medial margin: 10 mm,
(d) lateral margin: 10 mm,
(e) deep margin: 4 mm,
(f) superfcial margin: 14 mm.
7. Lymph nodes:
(a) metastasis in one out of fve axillary
lymph nodes (ypN1mi(sn)) (sentinel
LN: 1/5),
(b) perinodal extension: absent,
(c) size of metastatic carcinoma: 1 mm.
8. Arteriovenous invasion: absent.
9. Lymphovascular invasion: absent.
10. Tumor border: infltrative.
11. Microcalcifcation: present, non-tumoral.
12. Pathological TN category (AJCC 2017):
ypT1aN1mi(sn).
|
HR(+) HER2(+) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 2
|
Female/42 years old, pre-menopause.
Screen detected mass lesion on left breast
1:30 and 2 o’clock direction.
No family history.
S/P Cervical spine disc operation.
|
Report 1: Left mammography (Dec. 2020): no discernible
focal lesion at the palpable area at upper outer quadrant. Report 2: Left breast US (Jan. 2021): multiple masses with
microlobulated margins at upper outer quadrant.
US-CNB = IDC. Report 3: Breast MRI (Jan. 2021): multiple enhancing masses in the left breast. Report 4: Post-NAC breast MRI (May 2021): no residual
enhancing lesion after NAC.
| null |
Neoadjuvant chemotherapy (#6 cycles of
docetaxel and carboplatin and trastuzumab
and pertuzumab) + Operation + Postoperative radiation therapy + Trastuzumab
emtansine + Tamoxifen 20 mg/day.
Operation: Left breast conserving surgery,
sentinel lymph node biopsy. (a) Gross pathology of lumpectomy specimen (black arrow). (b) The margins get marked and sliced with different colors on each direction
|
1. Microinvasive ductal carcinoma.
(a) Post-chemotherapy status.
(b) Size of tumor: <0.1 cm (ypT1mi). (c) Histologic grade: 2/3 (tubule formation:
3/3, nuclear pleomorphism: 2/3, mitotic
count: 2/3, 11/10 HPF).
(d) Intraductal component: absent.
(e) Skin: no involvement of tumor.
(f) Surgical margins:
• superior margin: 2 mm from microinvasive ductal carcinoma (Fro 6),
• inferior margin: 30 mm,
• medial margin: >10 mm,
• lateral margin: >10 mm,
• deep margin: 2 mm,
• superfcial margin: 2 mm.(g) Lymph nodes: no metastasis in two axillary lymph nodes (ypN0(sn)) (sentinel
LN: 0/2).
(h) Arteriovenous invasion: absent.
(i) Lymphovascular invasion: absent.
(j) Tumor border: infltrative.
(k) Microcalcifcation: present, tumoral/
non-tumoral.
(l) Pathological TN category (AJCC 2017):
ypT1miN0(sn).
(m) Related slides:
2. Sclerosing adenosis with microcalcifcation.
|
HR(+) HER2(+) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 3
|
Female/58 years old, post-menopause.
Screen detected mass lesion on right breast 7
o’clock direction.
No family history.
Dyslipidemia.
|
Report 1: Right mammography (Dec. 2020): an irregular
mass at lower outer quadrant. Report 2: Right breast US (Dec. 2020): an irregular
hypoechoic mass. US-CNB = IDC. Report 3: Breast MRI (Jan. 2021): an irregular enhancing mass in the right breast. Report 4: Lymphoscintigraphy shows visualized sentinel
lymph nodes in the right axilla.
| null |
Operation + Adjuvant chemotherapy (#4
cycles of doxorubicin and cyclophosphamide) + Post-operative radiation therapy + Trastuzumab + Letrozole 2.5 mg/day.
|
Invasive Ductal Carcinoma
1. Size of tumor: 1.8 cm (pT1c).
2. Histologic grade: 3/3 (tubule formation: 3/3,
nuclear pleomorphism: 3/3, mitotic count:
2/3, 10/10 HPF).
3. Intraductal component: present, intratumoral/extratumoral (10%) (nuclear grade:
high, necrosis: present, architectural pattern:
solid/comedo, extensive intraductal component: absent).
4. Skin: no involvement of tumor.
5. Surgical margins:
(a) superior margin: 10 mm,
(b) inferior margin: (see note),
(c) medial margin: 5 mm,
(d) lateral margin: 10 mm,
(e) deep margin: 2 mm,
(f) superfcial margin: 4 mm.
HR(+) HER2(+) Breast Cancer
308
6. Lymph nodes: no metastasis in one axillary
lymph node (pN0(sn)) (sentinel LN: 0/1).
7. Arteriovenous invasion: absent.
8. Lymphovascular invasion: absent.
9. Tumor border: infltrative.
10. Microcalcifcation: present, tumoral/
non-tumoral.
11. Pathological TN category (AJCC 2017):
pT1cN0(sn).
Note: 1. The inferior margin of the lumpectomy specimen (slides 3 and 4) is close to ductal
carcinoma in situ (2 mm) but this margin submitted for frozen diagnosis (Fro 2) is free of tumor.
|
HR(+) HER2(+) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 4
|
Female/56 years old, post-menopause.
Screen detected mass lesion on right breast 12
o’clock direction.
No family history.
S/P Thyroid radiofrequency ablation.
|
Report 1: Right mammography (Dec. 2020): grouped fnepleomorphic microcalcifcations (white arrow) and an asymmetry (black arrow) at upper center. Report 2: Right breast US (Dec. 2020): a hypoechoic mass
with non-parallel orientation (black arrow) and adjacent
microcalcifcations (white arrows). US-CNB = IDC. Report 3: Breast MRI (Jan. 2021): an irregular enhancing mass in the right breast. Report 4: Lymphoscintigraphy shows visualized sentinel
lymph nodes in the right axilla.
| null |
Operation + Adjuvant chemotherapy (#4
cycles of doxorubicin and cyclophosphamide) + Post-operative radiation therapy + Letrozole 2.5 mg/day.
Operation: Right breast conserving surgery,
sentinel lymph node biopsy. (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on
each direction
|
Invasive Ductal Carcinoma
1. Size of tumor: 0.6 cm (pT1b).
2. Histologic grade: 3/3 (tubule formation: 3/3,
nuclear pleomorphism: 3/3, mitotic count:
2/3, 10/10 HPF).
HR(+) HER2(+) Breast Cancer
310
Fig. 19 Right mammography (Dec. 2020): grouped fnepleomorphic microcalcifcations (white arrow) and an
asymmetry (black arrow) at upper center
Fig. 20 Right breast US (Dec. 2020): a hypoechoic mass
with non-parallel orientation (black arrow) and adjacent
microcalcifcations (white arrows). US-CNB = IDC
3. Intraductal component: present, extratumoral
(50%) (nuclear grade: high, necrosis: present, architectural pattern: micropapillary/
cribriform/comedo, extensive intraductal
component: present).
4. Skin: no involvement of tumor.
5. Surgical margins:
(a) superior margin: 10 mm,
(b) inferior margin: 5 mm,
(c) medial margin: 15 mm,
(d) lateral margin: 25 mm,
(e) deep margin: 1.5 mm from ductal carcinoma in situ (slide 3),
(f) superfcial margin: 8 mm.
6. Lymph nodes: no metastasis in two axillary
lymph nodes (pN0(sn)) (sentinel LN: 0/2).
7. Arteriovenous invasion: absent.
8. Lymphovascular invasion: absent.
9. Tumor border: infltrative.
10. Microcalcifcation: present, tumoral/
non-tumoral.
11. Pathological TN category (AJCC 2017):
pT1bN0(sn).
|
HR(+) HER2(+) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 5
|
Female/53 years old, peri-menopause.
Screen detected mass lesion on right breast 12
o’clock direction.
No family history.
Hypothyroidism, dyslipidemia, s/p cold knife
conization of cervix.
|
Report 1: Right mammography (Jan. 2021): a focal asymmetry at upper inner quadrant. Report 2: Right breast US (Jan. 2021): a hypoechoic mass
with microlobulated margins. US-CNB = IDC. Report 3: Breast MRI (Jan. 2021): an irregular enhancing mass in the right breast. Report 4: Lymphoscintigraphy shows visualized sentinel
lymph nodes in the right axilla.
| null |
Operation + Adjuvant chemotherapy (#4
cycles of docetaxel and cyclophosphamide) + Post-operative radiation therapy + Trastuzumab + Tamoxifen 20 mg/day.
Operation: Right breast conserving surgery,
sentinel lymph node biopsy. (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on
each direction
|
Invasive Ductal Carcinoma
1. Size of tumor: 1.5 cm (pT1c).
2. Histologic grade: 3/3 (tubule formation: 3/3,
nuclear pleomorphism: 3/3, mitotic count:
3/3, 3/HPF).3. Intraductal component: present, intratumoral/extratumoral (20%) (nuclear grade:
high, necrosis: present, architectural pattern:
solid/comedo, extensive intraductal component: present).
4. Skin: no involvement of tumor.
5. Surgical margins:
(a) superior margin: 10 mm,
(b) inferior margin: (see note),
(c) medial margin: 5 mm,
(d) lateral margin: (see note),
(e) deep margin: <1 mm from invasive ductal carcinoma (slide 4),
(f) superfcial margin: 2 mm.
6. Lymph nodes: no metastasis in one axillary
lymph node (pN0(sn)) (sentinel LN: 0/1).
7. Arteriovenous invasion: absent.
8. Lymphovascular invasion: present,
intratumoral.
9. Tumor border: infltrative.
10. Microcalcifcation: present, tumoral/
non-tumoral.
11. Pathological TN category (AJCC 2017):
pT1cN0(sn).
Note: 1. The inferior and lateral margins of the
lumpectomy specimen (slides 9 and 10, respectively) are close to ductal carcinoma in situ
(<1 mm) but these margins submitted for frozen
diagnosis (Fro 3 and Fro 5, respectively) are free
of tumor.
|
HR(+) HER2(+) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 6
|
Female/42 years old, pre-menopause.
Screen detected mass lesion on right breast 12
o’clock direction.
No family history.
Hypertension.
|
Report 1:Left mammography (Dec. 2020): an obscured
mass at upper outer quadrant. Report 2: Left breast US (Dec. 2020): an irregular
hypoechoic mass. US-CNB = IDC. Report 3: Breast MRI (Dec. 2020): an irregular enhancing mass in the left breast. Report 4: PET-CT shows
(a) a hypermetabolic
mass in the left upper
outer breast
(mSUV = 4.8) and (b)
there was no enlarged
hypermetabolic lymph
node in the left axilla. Report 5: Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left axilla. Report 6: Breast MRI for routine surveillance (Feb. 2022): no abnormal fnding in both breasts.
| null |
Operation + Adjuvant chemotherapy (#4
cycles of doxorubicin and cyclophosphamide) + Post-operative radiation therapy + Trastuzumab + Tamoxifen 20 mg/day. Operation: Left breast conserving surgery,
sentinel lymph node biopsy. Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on each direction
|
1. Invasive ductal carcinoma.
(a) Size of tumor: 1.5 cm (pT1c).
(b) Histologic grade: 3/3 (tubule formation:
3/3, nuclear pleomorphism: 3/3, mitotic
count: 3/3, 5/HPF).(c) Intraductal component: present, intratumoral/extratumoral (10%) (nuclear grade:
high, necrosis: present, architectural pattern: solid/comedo, extensive intraductal
component: absent).
(d) Skin: no involvement of tumor.
(e) Surgical margins:
• superior margin: 10 mm,
• inferior margin: 10 mm,
• medial margin: 20 mm,
• lateral margin: 10 mm,
• deep margin: 2 mm,
• superfcial margin: 2 mm.
(f) Lymph nodes: no metastasis in seven
axillary lymph nodes (pN0) (sentinel LN:
0/4, non-sentinel LN: 0/3).
(g) Arteriovenous invasion: absent.
(h) Lymphovascular invasion: absent.
(i) Tumor border: infltrative.
(j) Microcalcifcation: present, tumoral/
non-tumoral.
(k) Pathological TN category (AJCC 2017):
pT1cN0.
2. Intraductal papilloma with (1) myoepithelial
hyperplasia usual ductal hyperplasia.
|
HR(+) HER2(+) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 7
|
Female/50 years old, pre-menopause.
Screen detected mass lesion on left breast 3
o’clock direction.
No family history.
Paroxysmal supraventricular tachycardia, s/p
atrial septal defect closure.
S/P thyroid lobectomy (thyroid cancer).
|
Report 1: Left mammography (Aug. 2020): a focal asymmetry at outer breast. Report 2: Left breast US (Sep. 2020): an irregular hypoechoic mass. US-CNB = IDC. Report 3: Breast MRI (Sep. 2020): an enhancing mass with central necrosis in the left breast. Report 4: Post-NAC breast MRI (Feb. 2021): a residual focal non-mass enhancement after NAC. Report 5:Breast MRI (Sep. 2020): an enhancing mass with central necrosis in the left breast . Report 6: Post-NAC breast MRI (Feb. 2021): a residual
focal non-mass enhancement after NAC.
| null |
Neoadjuvant chemotherapy (#6 cycles of
docetaxel and carboplatin and trastuzumab
and pertuzumab) + Operation + Postoperative radiation therapy + Trastuzumab
emtansine + Tamoxifen 20 mg/day.
Operation: Left breast conserving surgery,
sentinel lymph node biopsy. ) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on
each direction
|
Invasive Ductal Carcinoma
1. Post-chemotherapy status.
2. Size of tumor: 1.1 cm (ypT1c).
3. Histologic grade: 2/3 (tubule formation: 3/3,
nuclear pleomorphism: 2/3, mitotic count:
1/3, 6/10 HPF).
HR(+) HER2(+) Breast Cancer
320
Fig. 36 Left mammography (Aug. 2020): a focal asymmetry at outer breast
Fig. 37 Left breast US (Sep. 2020): an irregular
hypoechoic mass. US-CNB = IDC
4. Intraductal component: present, intratumoral/extratumoral (30%) (nuclear grade:
high, necrosis: absent, architectural pattern:
solid, extensive intraductal component:
present).
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) superior margin: 10 mm,
(b) inferior margin: (see note),
(c) medial margin: 10 mm,
(d) lateral margin: 5 mm,
(e) deep margin: 2 mm,
(f) superfcial margin: 2 mm.
7. Lymph nodes: no metastasis in 13 axillary
lymph nodes (ypN0) (sentinel LN: 0/3, axillary LN: 0/10).
8. Arteriovenous invasion: absent.
9. Lymphovascular invasion: present,
intratumoral.
10. Tumor border: infltrative.
11. Microcalcifcation: present, tumoral/
non-tumoral.
12. Pathological TN category (AJCC 2017):
ypT1cN0.
Note: 1. The inferior margin of the lumpectomy specimen (slide 7) is close to ductal carcinoma in situ (<1 mm) but this margin submitted
for frozen diagnosis (Fro 2) is free of tumor.
|
HR(+) HER2(+) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 8
|
Female/61 years old, post-menopause.
Screen detected mass lesion on right breast 9
o’clock direction.
No family history.
Hypertension, s/p cholecystectomy,
arrhythmia.
|
Report 1: Right mammography (Dec. 2020): negative
fnding. Report 2: Right breast US (Jan. 2021): an irregular
hypoechoic mass at 9 o’clock direction. Outside
US-CNB = ADH. Excision = IDC. Report 3: Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left axilla. Report 4: Breast MRI (Mar. 2021): post-operative fuid collection (*) without the residual suspicious enhancing lesion.
| null |
Operation + Adjuvant chemotherapy (#4
cycles of doxorubicin and cyclophosphamide) + Post-operative radiation therapy + Trastuzumab + Letrozole 2.5 mg/day.
Operation: Right breast conserving surgery,
sentinel lymph node biopsy. (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on
each direction
|
1. No residual tumor with foreign body
reaction.
(a) Post-excision status.
(b) Lymph nodes: no metastasis in one axillary lymph node (pN0(sn)) (sentinel LN:
0/1).
2. Intraductal papilloma.
|
HR(+) HER2(+) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 9
|
Female/44 years old, pre-menopause. Screen detected mass lesion on left breast 7 o’clock direction. Family history of breast cancer, two sisters. Family history of pancreatic cancer, mother. No other history of disease, operation, or medication. BRCA 1 and 2 mutation: Not detected, RAD50 VUS (variant of uncertain).
|
Report 1: Left mammography (Jan. 2021): an irregular
mass at lower inner quadrant. Report 2: Left breast US (Jan. 2021): a hypoechoic mass
with microlobulated margins. US-CNB = IDC. Report 3: Breast MRI (Jan. 2021): an irregular enhancing mass in the left breast.
| null |
Operation + Adjuvant chemotherapy (#4
cycles of doxorubicin and cyclophosphamide) + Post-operative radiation
therapy + Trastuzumab.
Operation: Left breast conserving surgery. (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on
each direction
|
Invasive Ductal Carcinoma
1. Size of tumor: 1.3 cm (pT1c).
2. Histologic grade: 3/3 (tubule formation: 3/3,
nuclear pleomorphism: 3/3, mitotic count:
3/3, 4/HPF).
3. Intraductal component: present, intratumoral/extratumoral (30%) (nuclear grade:
high, necrosis: present, architectural pattern:
solid/comedo, extensive intraductal component: present).
4. Skin: no involvement of tumor. 5. Surgical margins:
(a) superior margin: 5 mm,
(b) inferior margin: (see Note 1),
(c) medial margin: (see Note 2),
(d) lateral margin: 10 mm,
(e) deep margin: 2 mm,
(f) superfcial margin: 2 mm.
Fig. 48 Left mammography (Jan. 2021): an irregular
mass at lower inner quadrant
S. Park et al.
327
6. Arteriovenous invasion: absent.
7. Lymphovascular invasion: present,
intratumoral.
8. Tumor border: infltrative.
9. Microcalcifcation: present, tumoral/
non-tumoral.
10. Pathological TN category (AJCC 2017):
pT1c.
Note: 1. The inferior margin of the lumpectomy specimen (slide 2) is close to ductal
carcinoma in situ (3 mm) but this margin submitted for frozen diagnosis (Fro 4) is free of tumor.
2. The medial margin of the lumpectomy
specimen (slide 5) is close to ductal carcinoma in situ (<1 mm) but this margin submitted for frozen
diagnosis (Fro 4) is free of tumor.
|
HR(+) HER2(+) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 10
|
Female/32 years old, pre-menopause.
Self-detected skin changes and mass lesion on
left breast.
Family history of breast cancer, maternal aunt.
No comorbidities.
BRCA 1 and 2 mutation: Not detected, NBN
and PALB2 VUS (variant of uncertain).
|
Report 1: Left mammography (Mar. 2021): an irregular
mass with microcalcifcations at upper inner quadrant. Report 2: Left breast US (Mar. 2021): an oval breast mass
(white arrow, US-CNB = IDC) with multiple enlarged
lymph nodes at ipsilateral axilla (US-CNB = metastatic
ductal carcinoma), internal mammary chain, and supraclavicular area (black arrows). Report 3: Breast MRI (Mar. 2021): an enhancing mass with central necrosis (white arrow) in the left breast. Enlarged
lymph nodes at the left axilla and internal mammary chain (black arrows). Report 4: PET-CT shows
(a) a hypermetabolic
mass in the left breast
(mSUV = 12.4) and (b)
hypermetabolic lymph
nodes in the left axilla
level I–II, left internal
mammary area, and (c)
left supraclavicular
fossa. (d) A
hypermetabolic mass
(white arrow) in the left
breast. Hypermetabolic
lymph nodes at the left
axilla, internal
mammary chain, and
supraclavicular area
(black arrows). Report 5: Post-NAC breast MRI (July 2021): a residual left breast mass (white arrow) and axillary lymph node (black
arrow) after NAC. Report 6: Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left axilla.
| null |
Neoadjuvant chemotherapy (#6 cycles of
docetaxel and carboplatin and trastuzumab
and pertuzumab) + Operation + Postoperative radiation therapy + Trastuzumab
emtansine + Letrozole 2.5 mg/day with
goserelin. Operation: Left modifed radical mastectomy. Gross pathology of mastectomy specimen. (b, c) The margins get marked and sliced with different colors
on each direction
|
1. Invasive Ductal Carcinoma.
(a) Post-chemotherapy status.
(b) Size of tumor: 3.0 cm (ypT2).
(c) Histologic grade: 2/3 (tubule formation:
3/3, nuclear pleomorphism: 3/3, mitotic
count: 1/3, 3/10 HPF).
(d) Intraductal component: present, intratumoral/extratumoral (5%) (nuclear grade:
high, necrosis: present, architectural pattern: cribriform/solid/comedo, extensive
intraductal component: absent).
(e) Skin: dermal involvement of tumor.
(f) Nipple: no involvement of tumor.
(g) Surgical margins:
• deep margin: (see Note 1),
• superfcial margin: (see Note 2) (h) Lymph nodes:
• metastasis in seven out of nine axillary lymph nodes (ypN2a) (sentinel
LN: 1/3, axillary LN: 6/6),
• perinodal extension: present,
• size of metastatic carcinoma: 10 mm.
(i) Arteriovenous invasion: absent.
(j) Lymphovascular invasion: present, intratumoral/peritumoral.
(k) Tumor border: infltrative.
(l) Microcalcifcation: present, tumoral/
non-tumoral.
(m) Pathological TN category (AJCC 2017):
ypT2N2a.2. Fibroadenoma
Note: 1. The deep margin of the lumpectomy
specimen (slides 1 and 2) is close to invasive ductal carcinoma (<1 mm) but this margin submitted
for frozen diagnosis (Fro 5) is free of tumor.
2. The superfcial margin of the lumpectomy
specimen (slide 1) is close to invasive ductal carcinoma (<1 mm) but this margin submitted for
frozen diagnosis (Fro 6) is free of tumor.
|
HR(+) HER2(+) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 11
|
Female/60 years old, post-menopause.
Screen detected microcalcifcation on upper
outer portion of right breast.
No family history.
Hypertension.
|
Report 1: Right mammography (Oct. 2020): an irregular
mass (white arrow) with adjacent microcalcifcations
(black arrow). Report 2: MG-guided needle localization and excision
(Jan. 2021): retrieval of the microcalcifcations (black
arrow) and mass (white arrow) in the surgical specimen. Report 3: Breast MRI (Feb. 2021): post-operative change (white arrows) without residual enhancing lesion in the right
breast. Report 4: Lymphoscintigraphy shows visualized sentinel
lymph nodes in the right axilla.
| null |
Operation + Adjuvant chemotherapy (#4
cycles of doxorubicin and cyclophosphamide) + Post-operative radiation therapy + Trastuzumab + Letrozole 2.5 mg/day.
Operation: Right breast conserving surgery
(frst operation), sentinel lymph node biopsy
(second operation) (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on
each direction
|
1. Invasive Ductal Carcinoma.
(a) Size of tumor: 1.1 cm (pT1c).
(b) Histologic grade: 2/3 (tubule formation:
3/3, nuclear pleomorphism: 2/3, mitotic
count: 1/3, 2/10HPF).
(c) Intraductal component: present, intratumoral (20%) (nuclear grade: low, necrosis: absent, architectural pattern:
cribriform, extensive intraductal component: absent). Lymph node, right sentinel, excision: No
metastasis in fve axillary lymph nodes (pN0(sn))
(right sentinel LN: 0/5).
1. Post-excision status.
|
HR(+) HER2(+) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 12
|
Female/63 years old, post-menopause.
Screen detected mass lesion on left breast 10
o’clock direction.
No family history.
s/p Idiopathic thrombocytopenic purpura
(2020).
|
Report 1: Left mammography (Sep. 2020): an irregular
mass at upper inner quadrant. Report 2: Left breast US (Oct. 2020): an irregular
hypoechoic mass. US-CNB = IDC. Report 3: Breast MRI (Oct. 2020): an irregular enhancing mass in the left breast. Report 4: Post-NAC breast MRI and US (Mar. 2021): decreased size of the tumor after NAC. Report 5: Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left axilla.
| null |
Neoadjuvant chemotherapy (#1 cycle of
docetaxel and carboplatin and trastuzumab
and pertuzumab followed by #5 cycles of
docetaxel and carboplatin) + Operation +
Adjuvant chemotherapy (doxorubicin and
cyclophosphamide) + Post-operative radiation
therapy + Letrozole 2.5 mg/day.
Operation: Left breast conserving surgery,
sentinel lymph node biopsy. Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on
each direction
|
Invasive Ductal Carcinoma
1. Post-chemotherapy status.
2. Size of tumor: 0.3 cm (ypT1a).
3. Histologic grade: 3/3 (tubule formation: 3/3,
nuclear pleomorphism: 3/3, mitotic count:
2/3, 11/10HPF).
4. Intraductal component: present, intratumoral/extratumoral (50%) (nuclear grade:
high, necrosis: absent, architectural pattern:
micropapillary, extensive intraductal component: present).
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) superior margin: 10 mm,
(b) inferior margin: (see Note 1),
(c) medial margin: (see Note 2),
(d) lateral margin: 20 mm,
(e) deep margin: 2 mm,
(f) superfcial margin: 2 mm.
7. Lymph nodes: no metastasis in one axillary
lymph node (ypN0(sn)) (sentinel LN: 0/1).
8. Arteriovenous invasion: absent.
9. Lymphovascular invasion: absent.
10. Tumor border: infltrative.
11. Microcalcifcation: present, tumoral/
non-tumoral.
12. Pathological TN category (AJCC 2017):
ypT1aN0(sn). Note: 1. The inferior margin of the lumpectomy specimen (slide A3) is close to ductal carcinoma in situ (2 mm) but this margin submitted
for frozen diagnosis (Fro 2) is free of tumor.
2. The medial margin of the lumpectomy
specimen (slide 1) is close to ductal carcinoma in
situ (<1 mm) but this margin submitted for frozen
diagnosis (Fro 3) is free of tumor.
|
HR(+) HER2(+) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 13
|
Female/51 years old, peri-menopause.
Screen detected mass lesion on portion of
lower of right breast.
Family history of breast cancer, sister.
Hypothyroidism (taking on synthroid).
BRCA 1 and 2 mutation: Not detected.
|
Report 1: Right mammography (Mar. 2021): an irregular
mass with microcalcifcations at lower outer quadrant. Report 2: Right breast US (Mar. 2021): an irregular
enhancing mass at 7 o’clock direction (white arrow,
US-CNB = IDC). Two isoechoic masses with non-parallel
orientation at 12 o’clock direction (black arrows,
US-CNB = IDC). Report 3: Lymphoscintigraphy shows visualized sentinel lymph nodes in the right axilla.
| null |
Operation + Adjuvant chemotherapy (#4
cycles of doxorubicin and cyclophosphamide
followed by #4 cycles of docetaxel and trastuzumab) + Post-operative radiation therapy + Trastuzumab + Tamoxifen 20 mg/day.
Operation: Right breast conserving surgery,
sentinel lymph node biopsy Right mammography (Mar. 2021): an irregular
mass with microcalcifcations at lower outer quadrant (a) Gross pathology of lumpectomy specimen. (b–d) The margins get marked and sliced with different colors
on each direction
|
Operation + Adjuvant chemotherapy (#4
cycles of doxorubicin and cyclophosphamide
followed by #4 cycles of docetaxel and trastuzumab) + Post-operative radiation therapy + Trastuzumab + Tamoxifen 20 mg/day.
Operation: Right breast conserving surgery,
sentinel lymph node biopsy
|
HR(+) HER2(+) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 14
|
Female/51 years old, peri-menopause.
Screen detected mass lesion on portion of
lower of right breast.
Family history of breast cancer, sister.
Hypothyroidism (taking on synthroid).
BRCA 1 and 2 mutation: Not detected.
|
Report 1: Right mammography (Mar. 2021): an irregular
mass with microcalcifcations at lower outer quadrant. Report 2: Right breast US (Mar. 2021): an irregular
enhancing mass at 7 o’clock direction (white arrow,
US-CNB = IDC). Two isoechoic masses with non-parallel
orientation at 12 o’clock direction (black arrows,
US-CNB = IDC). Report 3: Lymphoscintigraphy shows visualized sentinel lymph nodes in the right axilla. Report 4: .
| null |
Operation + Adjuvant chemotherapy (#4
cycles of doxorubicin and cyclophosphamide
followed by #4 cycles of docetaxel and trastuzumab) + Post-operative radiation therapy + Trastuzumab + Tamoxifen 20 mg/day.
Operation: Right breast conserving surgery,
sentinel lymph node biopsy
|
Invasive Ductal Carcinoma
1. Size of tumor: 1.5 cm (pT1c(m)).
2. Histologic grade: 2/3 (tubule formation: 2/3,
nuclear pleomorphism: 3/3, mitotic count:
2/3, 11/10 HPF). 3. Intraductal component: present, intratu- lymph nodes in the right axilla
moral/extratumoral (50%) (nuclear grade:
high, necrosis: present, architectural pattern:
cribriform/solid/comedo, extensive intraductal component: present).
4. Skin: no involvement of tumor.
5. Surgical margins:
(a) superior margin: 10 mm,
(b) inferior margin: 10 mm,
(c) medial margin: 10 mm,
(d) lateral margin: 5 mm,
(e) deep margin: 2 mm,
(f) superfcial margin: 2 mm.
6. Lymph nodes:
(a) metastasis in one out of one axillary
lymph node (pN1mi(sn)) (sentinel LN:
1/1),
(b) perinodal extension: present,
(c) size of metastatic carcinoma: 2 mm.
7. Arteriovenous invasion: absent. 8. Lymphovascular invasion: present,
intratumoral.
9. Tumor border: infltrative.
10. Microcalcifcation: present, tumoral/
non-tumoral.
11. Pathological TN category (AJCC 2017):
pT1c(m)N1mi(sn).
Invasive Ductal Carcinoma
1. Size of tumor: 0.6, 0.5 and 0.5 cm.
2. Histologic grade: 2/3 (tubule formation: 2/3,
nuclear pleomorphism: 2/3, mitotic count:
2/3, 11/10 HPF).
3. Intraductal component: absent.
4. Skin: no involvement of tumor. 5. Surgical margins:
(a) superior margin: 10 mm,
(b) inferior margin: 10 mm,
(c) medial margin: 5 mm,
(d) lateral margin: 5 mm,
(e) deep margin: 2 mm,
(f) superfcial margin: 2 mm.
6. Arteriovenous invasion: absent.
7. Lymphovascular invasion: absent.
8. Tumor border: infltrative.
9. Microcalcifcation: present, tumoral.
|
HR(+) HER2(+) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 15
|
Female/42 years old, pre-menopause.
Self-detected palpable mass lesion on right
breast 6 o’clock direction.
Family history of breast cancer, maternal aunt.
No comorbidities.
BRCA 1 and 2 mutation: Not detected.
|
Report 1: Right mammography (Mar. 2021): linear distributed microcalcifcations (black arrows) with an asymmetry (white arrow). Report 2: Right breast US (Mar. 2021): an irregular
hypoechoic mass (white arrow) with microcalcifcations
(black arrow). US-CNB = IDC. Report 3: Breast MRI (Mar. 2021): an irregular enhancing mass in the right breast. Report 4: Lymphoscintigraphy shows visualized sentinel
lymph nodes in the right axilla.
| null |
Operation + Adjuvant chemotherapy (#4
cycles of doxorubicin and cyclophosphamide) + Post-operative radiation therapy + Trastuzumab + Tamoxifen 20 mg/day.
Operation: Right breast conserving surgery,
sentinel lymph node biopsy. Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on
each direction
|
1. Invasive Ductal Carcinoma with apocrine
differentiation.
(a) Size of tumor: 1.3 cm (pT1c).
(b) Histologic grade: 2/3 (tubule formation:
3/3, nuclear pleomorphism: 2/3, mitotic
count: 1/3, 5/10 HPF).
(c) Intraductal component: present, intratumoral/extratumoral (15%) (nuclear grade:
low, necrosis: absent, architectural pattern: solid, extensive intraductal component: absent).
(d) Skin: no involvement of tumor. (e) Surgical margins:
• nipple margin: positive for ductal carcinoma in situ (Fro 1),
• superior margin: 10 mm,
• inferior margin: 15 mm,
• medial margin: 20 mm,
• lateral margin: (see note),
• deep margin: 5 mm,
• superfcial margin: <1 mm from invasive ductal carcinoma (slide 2).
(f) Lymph nodes: no metastasis in one axillary lymph node (pN0(sn)) (sentinel LN:
0/1).
(g) Arteriovenous invasion: absent.
(h) Lymphovascular invasion: absent.
(i) Tumor border: infltrative.
(j) Microcalcifcation: present, tumoral/
non-tumoral.
(k) Pathological TN category (AJCC 2017):
pT1cN0(sn).
2. Fibroadenoma
3. Capillary hemangioma
Note: 1. The lateral margin of the lumpectomy
specimen (slide 13) is close to ductal carcinoma
in situ (3 mm) but this margin submitted for frozen diagnosis (Fro 5) is free of tumor.
|
HR(+) HER2(+) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 16
|
Female/54 years old, peri-menopause.
Self-detected palpable mass lesion on right
breast 6 o’clock direction.
No family history.
Diabetes mellitus, S/P hysterectomy,
agoraphobia.
|
Report 1: Right mammography (Mar. 2021): an irregular
mass at lower outer quadrant. Report 2: Right breast US (Apr. 2021): an irregular
hypoechoic mass. US-CNB = IDC. Report 3:Breast MRI (Apr. 2021): an irregular enhancing mass in the right breast. Report 4: Lymphoscintigraphy shows visualized sentinel
lymph nodes in the right axilla.
| null |
Operation + Adjuvant chemotherapy (#4
cycles of docetaxel and cyclophosphamide) + Post-operative radiation therapy + Trastuzumab + Letrozole 2.5 mg/day.
Operation: Right breast conserving surgery,
sentinel lymph node biopsy . (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on
each direction
|
1. Invasive Ductal Carcinoma.
(a) Size of tumor: 1.1 cm (pT1c).
(b) Histologic grade: 3/3 (tubule formation:
3/3, nuclear pleomorphism: 3/3, mitotic
count: 2/3, 10/10 HPF).
(c) Intraductal component: present, extratumoral (30%) (nuclear grade: high, necrosis: present, architectural pattern:
papillary/cribriform, extensive intraductal
component: present).
(d) Skin: no involvement of tumor.
(e) Surgical margins:
• superior margin: (see note),
• inferior margin: 15 mm,
• medial margin: 6 mm,
• lateral margin: 10 mm,
• deep margin: 3 mm,
• superfcial margin: 11 mm. (f) Lymph nodes: no metastasis in two axillary lymph nodes (pN0(sn)) (sentinel LN:
0/2).
(g) Arteriovenous invasion: absent.
(h) Lymphovascular invasion: absent.
(i) Tumor border: infltrative.
(j) Microcalcifcation: present, tumoral.
(k) Pathological TN category (AJCC 2017):
pT1cN0(sn).
2. Intraductal papilloma with usual ductal
hyperplasia.Note: 1. The superior margin of the lumpectomy specimen (slide 3) is close to ductal carcinoma in situ (2 mm) but this margin submitted
for frozen diagnosis (Fro 3) is free of tumor.
|
HR(+) HER2(+) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 17
|
Female/38 years old, post-menopause.
Self-detected palpable mass lesion on left
breast 1 o’clock direction.
Family history of prostate cancer, maternal
father.
S/P salpingo-oophorectomy (2022).
BRCA 2 mutation carrier.
|
Report 1: Left mammography (Apr. 2021): a focal asymmetry with microcalcifcations at upper outer quadrant. Report 2: Left breast US (Apr. 2021): an irregular mass
with angular margins. US-CNB = IDC. Report 3: Breast MRI (Apr. 2021): an irregular enhancing mass in the left breast (white arrow). Linear non-mass
enhancement in the right breast (black arrow). Report 4: Lymphoscintigraphy shows visualized sentinel lymph nodes in the left axilla.
| null |
Operation + Adjuvant chemotherapy (#4
cycles of doxorubicin and cyclophosphamide) + Trastuzumab + Tamoxifen 20 mg/day.
Operation: Left nipple–areolar complex sparing mastectomy with immediate implant reconstruction, sentinel lymph node biopsy, Right
prophylactic nipple–areolar complex sparing
mastectomy with immediate implant reconstruction. (a) Preoperative and (b) immediate post-operative appearance. 3 (a) Gross pathology of right mastectomy specimen. (b–d) The margins get marked and sliced with different colors on each direction. (a) Gross pathology of left mastectomy specimen. (b–d) The margins get marked and sliced with different
colors on each direction.
|
[Right Breast].
1. Ductal carcinoma in situ.
(a) Size of tumor: 0.7 cm (pTis). Note: 1. The nearest resection margin of the
excision specimen (slides A1 and A2) is close to
ductal carcinoma in situ (<1 mm) but this margin
submitted for frozen diagnosis (Fro 13) is free of
tumor.
[Left Breast].
1. Invasive Ductal Carcinoma.
(a) Size of tumor: 1.4 cm (pT1c).
(b) Histologic grade: 2/3 (tubule formation:
3/3, nuclear pleomorphism: 2/3, mitotic
count: 1/3, 4/10 HPF).
(c) Intraductal component: present, intratumoral/extratumoral (5%) (nuclear grade:
low, necrosis: absent, architectural pattern: cribriform, extensive intraductal
component: absent).
(d) Skin: no involvement of tumor.
(b) Nuclear grade: low.
(c) Necrosis: present.
(d) Architectural pattern: solid/comedo.
(e) Surgical margins: (see note).
(f) Lymph nodes: not submitted (pNx).
(g) Microcalcifcation: absent.
(h) Pathological TN category (AJCC 2017):
pTisNx.
2. Fibrocystic change. (e) Surgical margins:
• nipple margin: positive for ductal carcinoma in situ (Fro 3) (see note),
• deep margin: 27 mm,
• superfcial margin: <1 mm from invasive ductal carcinoma (slide 2).
(f) Lymph nodes: no metastasis in three axillary lymph nodes (pN0(sn)) (sentinel LN:
0/3).
(g) Arteriovenous invasion: absent.
(h) Lymphovascular invasion: absent.
(i) Tumor border: infltrative.(j) Microcalcifcation: present, tumoral.
(k) Pathological TN category (AJCC 2017):
pT1cN0(sn).
2. Fibroadenoma.
Note: 1. Ductal carcinoma in situ is present
only in the permanent section of Fro 3.
|
HR(+) HER2(+) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 18
|
Female/38 years old, pre-menopause.
Self-detected palpable mass lesion on portion
of outer half of left breast.
No family history.
Lumbar spine disc.
BRCA 1 and 2 mutation: Not examination.
|
Report 1: Left mammography (Apr. 2021): regional fnelinear microcalcifcations with architectural distortion at outer breast. Report 2: Left breast US (Apr. 2021): an irregular
hypoechoic mass with microcalcifcations
(US-CNB = IDC). Microcalcifcations in subareolar ducts
(white arrow). An axillary lymph node with loss of fatty
hilum . Report 3: Breast MRI (Apr. 2021): an irregular enhancing mass in the left breast (white arrow). Mild enhancement of the
left nipple. Report 4: Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left axilla.
| null |
Operation + Adjuvant chemotherapy (#4
cycles of doxorubicin and cyclophosphamide
followed by #4 cycles of docetaxel and trastuzumab) + Post-operative radiation therapy + Trastuzumab + Letrozole 2.5 mg/day
with goserelin.
Operation: Left breast conserving surgery,
sentinel lymph node biopsy. (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on
each direction
|
Invasive Ductal Carcinoma
1. Size of tumor: up to 3.0 cm, multifocal
(pT2(Paget)). papillary/solid/comedo, extensive intraductal
component: absent).
4. Nipple: Paget’s disease.
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) superior margin: 12 mm,
(b) inferior margin: (see Note 1),
(c) medial margin: 15 mm,
(d) lateral margin: 8 mm,
(e) deep margin: <1 mm from ductal carcinoma in situ (slide 3),
(f) superfcial margin: <2 mm from invasive
ductal carcinoma (slide 13).
7. Lymph nodes:
(a) metastasis in three out of four axillary
lymph nodes (pN1a(sn)) (see Note 2)
(sentinel LN: 3/4),
(b) perinodal extension: present,
(c) size of metastatic carcinoma: 4 mm.
8. Arteriovenous invasion: absent.
9. Lymphovascular invasion: present,
peritumoral.
10. Tumor border: infltrative.
11. Microcalcifcation: present, tumoral/
non-tumoral.
12. Pathological TN category (AJCC 2017):
pT2(Paget)N1a(sn).
Note: 1. The inferior margin of the lumpectomy specimen (slide 3) is close to ductal carcinoma in situ (<1 mm) but this margin submitted
for frozen diagnosis (Fro 8 and 9) is free of tumor.
2. A few isolated tumor cells are present only
in the permanent section of Fro 5 for immunohistochemical staining. 2. Histologic grade: 3/3 (tubule formation: 3/3,
nuclear pleomorphism: 3/3, mitotic count:
3/3, 23/10 HPF).
3. Intraductal component: present, intratumoral/extratumoral (20%) (nuclear grade:
high, necrosis: present, architectural pattern:
|
HR(+) HER2(+) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 19
|
Female/71 years old, post-menopause.
Self-detected palpable mass lesion on left
breast 11 o’clock direction.
No family history.
Hypertension, dyslipidemia, s/p
appendectomy.
|
Report 1: Left mammography (Nov. 2020): an irregular
mass at upper inner quadrant. Report 2: Left breast US (Nov. 2020): an irregular
hypoechoic mass. US-CNB = IDC. Report 3: Breast MRI (Nov. 2020): an irregular enhancing mass in the left breast. Report 4: Post-NAC breast MRI (Apr. 2021): decreased
size of the tumor after NAC. Report 5: Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left axilla.
| null |
Neoadjuvant chemotherapy (#6 cycles of
docetaxel and carboplatin and trastuzumab
and pertuzumab) + Operation + Postoperative radiation therapy + Trastuzumab +
Letrozole 2.5 mg/day.
Operation: Left breast conserving surgery,
sentinel lymph node biopsy
|
Invasive Ductal Carcinoma
1. Post-chemotherapy status.
2. Size of tumor: 1.5 cm (ypT1c). (a) superior margin: 20 mm,
(b) inferior margin: 20 mm,
(c) medial margin: 25 mm,
(d) lateral margin: 10 mm,
(e) deep margin: 13 mm,
(f) superfcial margin: 18 mm.
7. Lymph nodes: no metastasis in one axillary
lymph node (ypN0(sn)) (sentinel LN: 0/0,
sentinel LN #2: 0/1).
8. Arteriovenous invasion: absent.
9. Lymphovascular invasion: absent.
10. Tumor border: infltrative.
11. Microcalcifcation: present, non-tumoral.
12. Pathological TN category (AJCC 2017):
ypT1cN0(sn). 3. Histologic grade: 3/3 (tubule formation: 3/3,
nuclear pleomorphism: 3/3, mitotic count:
2/3, 10/10 HPF).
4. Intraductal component: absent.
5. Skin: no involvement of tumor.
6. Surgical margins:
|
HR(+) HER2(+) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 20
|
Female/49 years old, pre-menopause.
Screen detected mass lesion on left breast 2
o’clock direction.
No family history.
S/P Tuberculosis, S/P duodenal adenoma
excision.
|
Report 1:Left mammography (Nov. 2020): an irregular
mass at upper outer quadrant. Report 2:Left breast US (Nov. 2020): an irregular mass
with non-parallel orientation. US-CNB = IDC, Report 3:Breast MRI (Nov. 2021): an irregular enhancing mass in the left breast. Report 4:1 Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left axilla. Reprt 5:Breast MRI for routine surveillance (Oct. 2021): No abnormal fnding in both breasts.
| null |
Operation + Post-operative radiation therapy + Tamoxifen 20 mg/day.
Operation
Left breast conserving surgery, sentinel lymph
node biopsy. (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on each direction
|
Invasive Ductal Carcinoma
1. Size of tumor: 0.9 cm (pT1b).
2. Histologic grade: 1/3 (tubule formation: 2/3,
nuclear pleomorphism: 2/3, mitotic count:
1/3, 1/10 HPF).
3. Intraductal component: present, intratumoral/extratumoral (40%) (nuclear grade:
low, necrosis: absent, architectural pattern:
micropapillary/cribriform/solid/comedo,
extensive intraductal component: present).
4. Skin: no involvement of tumor.
5. Surgical margins:
(a) superior margin: 15 mm.
(b) inferior margin: 20 mm.
(c) medial margin: 15 mm.
(d) lateral margin: 5 mm.
(e) deep margin: 5 mm.
(f) superfcial margin: 3 mm. 6. Lymph nodes: no metastasis in six axillary
lymph nodes (pN0(sn)) (sentinel LN: 0/3,
non-sentinel LN: 0/3).
7. Arteriovenous invasion: absent.
8. Lymphovascular invasion: absent.
9. Tumor border: infltrative.
10. Microcalcifcation: present, tumoral/
non-tumoral.
11. Pathological TN category (AJCC 2017):
pT1bN0(sn).
Note: 1. Atypical ductal hyperplasia is
present in the permanent section of Fro 1.
|
HR(+) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 21
|
Female/78 years old, post-menopause.
Screen detected mass lesion on left breast 12
o’clock direction.
No family history.
Hypertension, s/p hysterectomy.
|
Report 1:Left CC mammography (June 2019, Nov.
2020): negative fnding in 2019. A new mass at the central
breast in 2020. Report 2:Left breast US (Nov. 2020): a hypoechoic mass
with microlobulated margins at 12 o’clock direction.
Outside US-CNB = DCIS, Report 3:Breast MRI (Nov. 2020): an irregular enhancing mass in the left breast. Report 4:Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left lateral breast.
| null |
Invasive Ductal Carcinoma
1. Size of tumor: 1.2 cm (pT1c).
2. Histologic grade: 2/3 (tubule formation: 3/3,
nuclear pleomorphism: 2/3, mitotic count:
2/3, 11/10 HPF).
3. Intraductal component: present, intratumoral/extratumoral (20%) (nuclear grade:
low, necrosis: present, architectural pattern:
solid/comedo, extensive intraductal component: absent).
4. Skin: no involvement of tumor.
5. Surgical margins:
(a) superior margin: 5 mm.
(b) inferior margin: 20 mm.
(c) medial margin: 10 mm.
(d) lateral margin: 20 mm.
(e) deep margin: 2 mm.
(f) superfcial margin: 2 mm.
6. Arteriovenous invasion: absent.
7. Lymphovascular invasion: present,
intratumoral.
8. Tumor border: infltrative. 9. Microcalcifcation: present, tumoral/
non-tumoral.
10. Pathological TN category (AJCC 2017):
pT1c. Left sentinel lymph node biopsy
|
No metastasis in two axillary lymph nodes
1. Post-lumpectomy status.
|
HR(+) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 22
|
Female/61 years old, post-menopause.
Screen detected mass lesion on entire left
breast.
No family history.
Diabetes mellitus, Spinal stenosis.
|
Report 1: Mammography (June 2020): global asymmetry with edema in the left breast. Report 2:Left breast US (July 2020): irregular hypoechoic lesion with posterior acoustic shadowing involving the
entire left breast (partly shown). US-CNB = IDC, Report 3:Breast MRI (Aug. 2020): diffuse non-mass enhancement with involvement of the skin. Enlarged lymph nodes
at the left axilla (black arrow). Report 4:Post-NAC breast MRI (Dec. 2020): slightly decreased tumor burden in the left breast. Report 5:Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left axilla. Report 6:Breast MRI for routine surveillance (July 2021): no abnormal fnding in right breast and anterior left chest
wall.
| null |
Neoadjuvant chemotherapy (#4 cycles of
doxorubicin & cyclophosphamide followed by
#4 cycles of docetaxel) + Operation + Postoperative radiation therapy + Letrozole
2.5 mg/day.
22.3.1 Operation
Left modifed radical mastectomy (a) Gross pathology of mastectomy specimen. (b, c and d) The margins get marked and sliced with different
colors on each direction
|
Invasive Micropapillary Carcinoma
1. Post-chemotherapy status.
2. Size of tumor: 11.0 cm (ypT3).
3. Histologic grade: 2/3 (tubule formation: 3/3,
nuclear pleomorphism: 2/3, mitotic count:
1/3, 2/10HPF).
4. Intraductal component: absent.
5. Skin and nipple: dermal involvement of
tumor.
6. Surgical margins:
(a) deep margin: positive for invasive carcinoma (slide 1).
(b) superfcial margin: positive for invasive
carcinoma (slide 4).
7. Lymph nodes:
(a) metastasis in nine out of nine axillary
lymph nodes (ypN2a).
(b) perinodal extension: present.
(c) size of metastatic carcinoma: 6 mm.
8. Arteriovenous invasion: present,
peritumoral.
9. Lymphovascular invasion: present,
peritumoral.
10. Tumor border: infltrative.
|
HR(+) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 23
|
Female/53 years old, post-menopause.
Screen detected mass lesion on right breast 7
o’clock direction.
Family history of breast cancer, younger
sister.
Diabetes mellitus, s/p right thyroidectomy
(thyroid cancer), s/p cholecystectomy, s/p
hysterectomy.
BRCA 1 and 2 mutation: Not detected.
|
Report 1:Right mammography (July 2020): an irregular
mass with microcalcifcations at lower center. Another
oval mass at the upper outer quadrant (black arrow).
Multiple enlarged lymph nodes at the right axilla (white
arrows). Report 2:Right breast US (July 2020): an irregular
hypoechoic mass with microcalcifcations at lower center
(white arrows, US-CNB = IDC). Another oval isoechoic
mass at the upper outer quadrant (black arrow), Report 3:Breast MRI (July 2020): an irregular enhancing mass in the right breast (white arrow). Enlarged lymph node
at the right axilla (black arrow). Report 4:Post-NAC breast MRI (Dec. 2020): Decreased
size of the tumor after NAC. Report 5: Lymphoscintigraphy shows visualized sentinel
lymph nodes in the right axilla.
| null |
Neoadjuvant chemotherapy (#4 cycles of
doxorubicin & cyclophosphamide followed by
#4 cycles of docetaxel) + Operation + Postoperative radiation therapy + Letrozole
2.5 mg/day.
Operation
Right breast conserving surgery, sentinel lymph
node biopsy (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors
on each direction.
|
1. Microinvasive ductal carcinoma
(a) Post-chemotherapy status.
(b) Size of invasive component: <0.1 cm
(ypT1mi).
(c) Size of intraductal component: 1.5 cm.
(d) Histologic grade: 3/3 (tubule formation:
3/3, nuclear pleomorphism: 3/3, mitotic
count: 2/3, 10/10 HPF)
(e) Intraductal component: present, intratumoral/extratumoral (99%) (nuclear
grade: high, necrosis: present, architectural pattern: solid/comedo, extensive
intraductal component: present).
(f) Skin: no involvement of tumor.
(g) Surgical margins:
• superior margin: 10 mm.
• inferior margin: (see note).
• medial margin: 5 mm.
• lateral margin: 10 mm.• deep margin: <1 mm from ductal carcinoma in situ (slide 1).
• superfcial margin: 5 mm.
(h) Lymph nodes: no metastasis in three
axillary lymph nodes (ypN0(sn)) (sentinel LN: 0/1, axillary LN: 0/2)
(i) Arteriovenous invasion: absent.
(j) Lymphovascular invasion: absent.
(k) Tumor border: infltrative.
(l) Microcalcifcation: present, tumoral/
non-tumoral.
(m) Pathological TN category (AJCC 2017):
ypT1miN0(sn).
2. Intraductal papilloma with usual ductal
hyperplasia.
3. Fibroadenoma.
4. Complex sclerosing lesion.
Note: 1. The inferior margin of the lumpectomy specimen (slide 7) is close to ductal carcinoma in situ (2 mm) but this margin
submitted for frozen diagnosis (Fro 4) is free
of tumor.
|
HR(+) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
Case 24
|
Female/45 years old, pre-menopause.
Screen detected mass lesion on right breast 9
o’clock direction and right axillary LN.
No family history.
No comorbidities.
|
Report 1:Breast MRI (July 2020): an irregular enhancing
mass in the right breast (white arrow). Enlarged lymph
node at the right axilla (black arrow). Report 2:Right breast US (June 2020): an irregular mass with microcalcifcations at outer center (white arrow,
US-CNB = IDC). Another irregular mass at the lower outer quadrant (black arrow), Report 3:Breast MRI (June 2020): two irregular enhancing masses in the right breast. Multiple enlarged lymph nodes
at the right axilla (circle, US-CNB = Metastatic ductal carcinoma). Report 4:Post-NAC breast MRI (Jan. 2021): decreased size of the tumors and lymph nodes after NAC. Report 5: Lymphoscintigraphy shows visualized sentinel
lymph nodes in the right axilla.
| null |
Neoadjuvant chemotherapy (#4 cycles of
doxorubicin & cyclophosphamide followed by
#4 cycles of docetaxel) & letrozole 2.5 mg/day
with leuprolide acetate + Operation + Postoperative radiation therapy.
Operation (1st, Jan. 2021)
Right breast conserving surgery, axillary lymph
node dissection 7 (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors
on each direction
|
Invasive Ductal Carcinoma
1. Post-chemotherapy status.
2. Size of tumor: 2.0 cm (ypT1c).
3. Histologic grade: 2/3 (tubule formation: 3/3,
nuclear pleomorphism: 2/3, mitotic count:
1/3, 1/10 HPF)
4. Intraductal component: present, intratumoral/
extratumoral (5%) (nuclear grade: low, necrosis: absent, architectural pattern: solid, extensive intraductal component: absent).
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) superior margin: positive for ductal carcinoma in situ (Fro 1) (see note).
(b) inferior margin: 10 mm.
(c) medial margin: 10 mm. (d) lateral margin: positive for invasive ductal carcinoma (Fro 4).
(e) deep margin: 5 mm.
(f) superfcial margin: 3 mm.
7. Lymph nodes:
(a) metastasis in fve out of twelve axillary
lymph nodes (ypN2a) (sentinel LN: 3/3,
axillary LN: 2/9)
(b) perinodal extension: present.
(c) size of metastatic carcinoma: 6 mm.
8. Arteriovenous invasion: absent.
9. Lymphovascular invasion: present,
intratumoral.
10. Tumor border: infltrative.
11. Microcalcifcation: present, tumoral/
non-tumoral.
12. Pathological TN category (AJCC 2017):
ypT1cN2a. Operation (2nd, Feb. 2021)
Right breast wide excision
|
HR(+) HER2(−) Breast Cancer
|
Cluster 2: Invasive Breast Cancer Subtypes
|
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