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Case 7 | HR(+) HER2(+) Breast Cancer | 7.1. . Courses of Treatment. Neoadjuvant chemotherapy (#6 cycles of. docetaxel and carboplatin and trastuzumab. and pertuzumab) + Operation + Post-. operative radiation therapy + Trastuzumab. emtansine + Tamoxifen 20 mg/day.. 42. 7.3.1. . Pathology Report. 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. . . . 4. Intraductal component: present, intratu. moral/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) superficial margin: 2 mm.. 7. Lymph nodes: no metastasis in 13 axillary. lymph nodes (ypN0) (sentinel LN: 0/3, axil. lary LN: 0/10).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular. invasion:. present,. intratumoral.. . 10. Tumor border: infiltrative.. . 11. Microcalcification:. present,. tumoral/. non-tumoral.. . 12. Pathological TN category (AJCC 2017):. ypT1cN0.. Note: 1. The inferior margin of the lumpec. tomy specimen (slide 7) is close to ductal carci. noma in situ (<1 mm) but this margin submitted. for frozen diagnosis (Fro 2) is free of tumor.. Result. Intensity. Positive. %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Positive (3+). Ki-67. Positive in 6% of. tumor cells. S. Park et al.. 321. . . HR(+) HER2(+) Breast Cancer. 322. F. ig. 40. 323. a. b. . 8. | Important Radiologic. Findings. 36 37 38 39 40. 41. 7.3. | Patient History and Progress. 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).. 7.2. |
Case 7 | HR(+) HER2(-) Breast Cancer | Courses of Treatment. Operation + Post-operative radiation ther. apy + Tamoxifen 20 mg/day.. 7.3.1. . Operation. Left breast conserving surgery, sentinel lymph. (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 carci. noma in situ (slide 9),. . (f) superficial 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: infiltrative.. . 11. Microcalcification:. 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 mar. gin submitted for frozen diagnosis (Fro 2) is. free of tumor.. Result. Intensity. Positive %. Estrogen receptor. Strong (7/8). 2. >2/3. Progesterone receptor. Intermediate (6/8). 2. 1/3–2/3. C-erbB2. Negative (1+). Ki-67. Positive in 5% of tumor cells. HR(+) HER2(−) Breast Cancer | Important Radiologic. Findings. See Figs. 31, 32, 32, 33, 34 and 35.. 7.3. | Depression.. 7.2. |
Case 7 | HR(−) HER2(+) Breast Cancer | 7.1. . Neoadjuvant chemotherapy (#6 cycles of. docetaxel and carboplatin and trastuzumab and. pertuzumab) + Operation + Post-operative radia. tion therapy.. 7.4.1. . Operation. 53. 7.4.2. . Pathology Report. No residual tumor with stromal degeneration.. . 1. Post-chemotherapy status.. . 2. Lymph nodes: no metastasis in two axillary. lymph nodes (ypN0(sn)) (sentinel LN: 0/2,. non-sentinel LN: 0/0).. Result. Intensity. Positive %. Estrogen. receptor. Negative (2/8). 1. <1%. Progesterone. receptor. Negative (2/8). 1. <1%. C-erbB2. Positive (3+). Ki-67. Positive in. 16% of tumor. cells. . HR(−) HER2(+) Breast Cancer. 456. 8. | Important Radiologic. Findings. 48. 49. . . HR(−) HER2(+) Breast Cancer. 454. 7.3. . After Neoadjuvant. Chemotherapy. 50 51. 52. | Patient History and Progress. Female/58 years old, post-menopause.. Screen detected mass lesion on upper outer. portion of left breast.. No family history.. S/P Nodules of vocal cord, operation.. 7.2. |
Case 7 | HR(−) HER2(−) Breast Cancer | 7.1. . Courses of Treatment. Neoadjuvant chemotherapy (#4 cycles of. doxorubicin and cyclophosphamide + #4. cycles of docetaxel) + Operation + Post-. operative radiation therapy + Adjuvant. capecitabine.. 7.3.1. . Operation. 51. 7.3.2. . Pathology Report. Metaplastic Carcinoma with sarcomatous. differentiation. 1. Post-chemotherapy status.. E. S. Lee et al.. 599. . . . HR(−) HER2(−) Breast Cancer. 600. . . . E. S. Lee et al.. 601. 2. Size of tumor: 4.2 cm (ypT2).. 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 22/10HPF).. 4. Intraductal component: present, intratumoral. (<5%) (nuclear grade: high, necrosis: pres. ent, architectural pattern: comedo, extensive. intraductal component: absent).. 5. Skin and nipple: no involvement of tumor.. 6. Surgical margins:. . (a) Deep margin: positive for metaplastic. carcinoma (slides 3 and 5).. . (b) Superficial margin: 11 mm.. 7. Lymph nodes: no metastasis in four axillary. lymph nodes (ypN0(sn)) (sentinel LN: 0/3,. non-sentinel LN: 0/1).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular. invasion:. present,. intratumoral.. . 10. Tumor border: infiltrative.. . 11. Microcalcification: present, non-tumoral.. . 12. Pathological TN category (AJCC 2017):. ypT2N0(sn).. Result. Intensity. Positive. %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Negative (0). Ki-67. Positive in 57%. of tumor cells. Lung metastasis.. Palliative chemotherapy (abraxane and. atezolizumab → gemcitabine and cisplatin).. 8. | Important Radiologic. Findings. 44 45. 46. HR(−) HER2(−) Breast Cancer. 598. . . . 7.2.1. . After Neoadjuvant. Chemotherapy. 47 48 49. 50. 7.3. | Patient History and Progress. Female/56 years old, post-menopause.. Self-detected palpable mass lesion on right. breast.. No family history.. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 7.2. |
Case 7 | Local Recurrence | 7.1. . Courses of Treatment. Left breast microinvasive ductal carci. noma + DCIS → Operation → Adjuvant therapy. → Right breast recurrence (DCIS).. 7.2.1. . Primary Treatment. 51 52. 53. Operation. . 54. Local Recurrence. 736. . . . . . . Pathology Report. Microinvasive Ductal Carcinoma. 1. Size of invasive component: <0.1 cm. (pT1mi).. 2. Size of intraductal component: 4.0 cm.. 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 3/HPF).. 4. Intraductal component: present, intratu. moral/extratumoral (99%) (nuclear grade:. high, necrosis: present, architectural pattern:. micropapillary/cribriform, extensive intra. ductal component: present).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) Superior margin: 5 mm.. . (b) Inferior margin: 15 mm.. . (c) Medial margin: 10 mm.. . (d) Lateral margin: positive for ductal carci. noma in situ (Fro 6) (see note).. . (e) Deep margin: 2 mm.. . (f) Superficial 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.. Y. Kim et al.. 737. . 10. Tumor border: infiltrative.. . 11. Microcalcification:. present,. tumoral/. non-tumoral.. . 12. Pathological TN category (AJCC 2017):. pT1miN0(sn).. Note: 1. Ductal carcinoma in situ is present. only in the permanent section of Fro 6.. Result. Intensity Positive %. Estrogen. receptor. Strong (7/8). 3. 1/3–2/3. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in 41%. of tumor cells. Operation. 55. Pathology Report. . 1. Ductal carcinoma in situ, residual.. . (a) Status post-lumpectomy status for micro. invasive ductal carcinoma (S19–2090).. . (b) Nuclear grade: high.. . (c) Necrosis: absent.. . (d) Architectural pattern: cribriform.. . (e) Microcalcification: absent.. . (f) Resection margin:. • Lateral: (see note).. . 2. Foreign body reaction with fat necrosis.. Note: The lateral margin of the wide excision. specimen (slide 1) is close to ductal carcinoma in. situ (<1 mm), but this margin submitted for fro. zen diagnosis (Fro 1) is free of tumor.. Adjuvant Therapy. Postoperative radiation therapy.. Tamoxifen 20 mg/day for 3 years.. 7.2.2. . Treatments After Recurrence. 56. 57. Operation. 58. Pathology Report. Papillary Carcinoma In Situ. . 1. Size of tumor: 0.8 cm (pTis).. . 2. Nuclear grade: low.. . 3. Necrosis: absent.. . 4. Architectural pattern: papillary/solid.. . . . . Local Recurrence. 738. a. b. . . 5. Skin: no involvement of tumor.. . 6. Surgical margins:. . (a) Superior margin: (see note 1).. . (b) Inferior margin: 10 mm.. . (c) Medial margin: 5 mm.. . (d) Lateral margin: 20 mm.. . (e) Deep margin: 2 mm.. . (f) Superficial margin: <1 mm from ductal. carcinoma in situ (slide 2).. . 7. Microcalcification:. present,. tumoral/. non-tumoral.. . 8. Pathological TN category (AJCC 2017): pTis.. Note: 1. The superior margin of the lumpec. tomy specimen (slide 3) is close to ductal carci. noma in situ (3 mm), but this margin submitted. for frozen diagnosis (Fro 1) is free of tumor.. Result. Intensity Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Negative (2/8). 1. <1%. C-erbB2. Equivocal (2+). Ki-67. Positive in 2%. of tumor cells. Adjuvant Therapy. Plan for tamoxifen for 5 years.. 8. | null | Patient History and Progress. Female/42 years old, pre-menopause.. Screen detected mass lesion on left breast. . 4 o’clock direction.. Family history of breast cancer, mother.. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 7.2. |
Case 7 | Metastatic Breast Cancer | Left breast cancer → Operation → Adjuvant. therapy → Ipsilateral breast and chest wall. recurrence → Chemotherapy → Progression on. the skin and contralateral axillary lymph. nodes.. 7.2.1. . Primary Treatment. Intensity. Positive %. Estrogen. receptor. Negative. (2/8). 1. <1%. Progesterone. receptor. Negative. (2/8). 1. <1%. C-erbB2. Positive. (3+). Result. Intensity. Positive %. Ki-67. Positive. in 43% of. tumor. cells. Adjuvant Therapy. Adjuvant chemotherapy #6 cycles (Cyclo. phosphamide & Methotrexate & Fluorouracil).. Post-operative radiation therapy.. 7.2.2. . Treatments After Recurrence. Abdominal Lymph Nodes Metastasis. Mar. 2021 CT abdomen & pelvis: r/o Enlarged. lymph node in Rt. external iliac chain and para. aortic area; cannot exclude pathologic lymph. node, such as metastasis or lymphoproliferative. disorder.. → Closed follow-up. | null | null |
Case 8 | Benign and Proliferative | 8.1. . Courses of Treatment. →2021-11-12 excision, Lt.. Benign and Proliferative Case Series. 26. . . . C. W. Lee et al.. 27. 8.3.1. . Pathology Report. Diagnosis. • Breast, left, excision:. –. – Atypical. ductal. hyperplasia. with. micro. calcification.. 9. | Important Radiologic. Findings. 12. 8.3. | Patient History and Progress. Female/54 years old, pre-menopause.. Screen detected microcalcification on upper. outer portion of left breast.. No family history.. No comorbidities.. 8.2. |
Case 8 | Carcinoma In Situ | 8.1. . Courses of Treatment. Operation + Postoperative radiation therapy. (right side) + Tamoxifen 20 mg/day for. 5 years.. 8.3.1. . Operation. 36. 37. 8.3.2. . Pathology Report. Right.. <First operation>. Ductal carcinoma in situ, pathological TN cat. egory (AJCC 2017): pTis. . 1. Size of tumor: 0.3 cm (pTis).. . 2. Nuclear grade: low.. . 3. Necrosis: absent.. . 4. Architectural pattern: papillary.. . 5. Surgical margins: positive (slide 2).. . 6. Microcalcification: present, non-tumoral.. . . E. S. Lee et al.. 69. . . Carcinoma In Situ. 70. . . . Result. Intensity. Positive %. Estrogen. receptor. Weak (4/8). 2. 1%–10%. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Equivocal. (2+). Ki-67. Positive in 2%. of tumor cells. <Second operation>. Atypical ductal hyperplasia involving intra. ductal papilloma.. . 1. Post-excision status.. Left.. Intraductal papilloma.. 9. | Important Radiologic. Findings. 34. 35. 8.3. | Patient History and Progress. Female/41 years old, pre-menopause.. Detected bloody discharge in left nipple.. No family history.. No comorbidities.. ATM VUS (variant of uncertain).. 8.2. |
Case 8 | HR(+) HER2(+) Breast Cancer | 8.1. . Courses of Treatment. Operation + Adjuvant chemotherapy (#4. cycles of doxorubicin and cyclophospha. mide). +. Post-operative. radiation. ther. apy + Trastuzumab + Letrozole 2.5 mg/day.. 47. 8.3.1. . Pathology Report. . 1. No residual tumor with foreign body. reaction.. . (a) Post-excision status.. . (b) Lymph nodes: no metastasis in one axil. lary lymph node (pN0(sn)) (sentinel LN:. 0/1).. . 2. Intraductal papilloma.. Result. Intensity. Positive. %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Weak (4/8). 2. 1–10%. C-erbB2. Positive (3+). Ki-67. Positive in 29%. of tumor cells. a. b. . HR(+) HER2(+) Breast Cancer. 326. 9. | Important Radiologic. Findings. 43 44 45. 46. . HR(+) HER2(+) Breast Cancer. 324. . . . S. Park et al.. 325. 8.3. | Patient History and Progress. 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.. 8.2. |
Case 8 | HR(+) HER2(-) Breast Cancer | Right nipple–areolar complex sparing mastec. tomy, sentinel lymph node biopsy, Left nipple–. areolar complex sparing mastectomy, sentinel. lymph node biopsy (Figs. 41 and 42).. 8.3.2. . Pathology Report. [Right]. Invasive Ductal Carcinoma. micropapillary/cribriform/solid/comedo,. extensive intraductal component: present).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) nipple margin: positive for ductal carci. noma in situ (Fro 2),. lymph nodes (pN0) (sentinel LN: 0/1, non-. sentinel LN: 0/6).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular. invasion:. present,. intratumoral.. . 10. Tumor border: infiltrative.. . 11. Microcalcification:. present,. tumoral/. non-tumoral.. . 12. Pathological TN category (AJCC 2017):. pT1cN0.. Result. Intensity. Positive. %. Estrogen. receptor. Strong (7/8). 2. >2/3. Progesterone. receptor. Strong (7/8). 2. >2/3. C-erbB2. Negative (1+). Ki-67. Positive in 26%. of tumor cells. [Left]. 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, intratu. moral/extratumoral (10%) (nuclear grade:. low, necrosis: absent, architectural pattern:. cribriform/solid, extensive intraductal com. ponent: absent).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) nipple margin: positive for ductal carci. noma 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, non-. sentinel LN: 0/5).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular invasion: absent.. 9. Tumor border: partly infiltrative.. . 10. Microcalcification: present, tumoral.. . 11. Pathological TN category (AJCC 2017):. pT1cN0.. Note: 1. Ductal carcinoma in situ is pres. ent only in the permanent section of Fro 1. Result. Intensity. Positive. %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative (0). Ki-67. Positive in 8% of. tumor cells. 9. | Important Radiologic. Findings. See Figs. 37, 38, 39 and 40. | o’clock and left breast 2 o’clock direction.. No family history.. No comorbidities.. BRCA 1 and 2 mutation: not detected.. 8.2. |
Case 8 | HR(−) HER2(+) Breast Cancer | 8.1. . 8.3.1. . Operation. . 58. 59. 8.3.2. . Pathology Report. Invasive Ductal Carcinoma. 1. Size of invasive component: 1.1 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:. 3/3, 5/HPF).. 4. Intraductal component: present, intratu. moral/extratumoral (60%) (nuclear grade:. high, necrosis: present, architectural pattern:. solid/comedo, extensive intraductal compo. nent: present).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) deep margin: 2 mm,. . (b) superficial margin: 2 mm.. 7. Lymph nodes: no metastasis in four axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/1,. axillary LN: 0/3).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular invasion: present, intratumoral.. . 10. Tumor border: infiltrative.. . 11. Microcalcification:. present,. tumoral/. non-tumoral.. . 12. Pathological TN category (AJCC 2017):. pT1cN0(sn).. Breast, right “accessary,” excision:. Mammary ducts and lobules in fibroadipose. tissue, suggestive of accessory breast.. Result. Intensity. Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in. 23% of tumor. cells. HR(−) HER2(+) Breast Cancer. 458. . . Y. Kwon et al.. 459. 9. | Important Radiologic. Findings. 54 55 56. 57. . . Y. Kwon et al. | Patient History and Progress. Female/53 years old, peri-menopause.. Screen detected microcalcification on right. breast 1 and 10 o’clock direction.. No family history.. No comorbidities.. 8.2. |
Case 8 | HR(−) HER2(−) Breast Cancer | 8.1. . Courses of Treatment. Neoadjuvant chemotherapy (#4 cycles of. doxorubicin and cyclophosphamide + #4. cycles of paclitaxel) + Operation + Post-. operative radiation therapy.. 8.3.1. . Operation. 58. 59. 8.3.2. . Pathology Report. <Right>. Microinvasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of invasive component: <0.1 cm. (ypT1mi).. 3. Size of in situ component: 1.0 cm.. 4. Histologic grade: not applicable.. 5. Intraductal component: present, extratumoral. (99%) (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: 5 mm.. . (b) Inferior margin: 5 mm.. . (c) Medial margin: 20 mm.. . (d) Lateral margin: (see note 1).. . (e) Deep margin: 5 mm.. . (f) Superficial margin: 5 mm.. 8. Lymph nodes: no metastasis in one axillary. lymph node (ypN0(sn)) (sentinel LN: 0/1).. 9. Arteriovenous invasion: absent.. . 10. Lymphovascular invasion: absent.. HR(−) HER2(−) Breast Cancer. 602. . . . E. S. Lee et al.. 603. . . . HR(−) HER2(−) Breast Cancer. 604. . . . E. S. Lee et al.. 605. . 11. Tumor border: infiltrative.. . 12. Microcalcification: present, non-tumoral.. . 13. Pathological TN category (AJCC 2017):. ypT1miN0(sn).. Note: 1. The lateral 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.. <Left>. 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: 10 mm.. . (d) Lateral margin: 10 mm.. . (e) Deep margin: 2 mm.. . (f) Superficial margin: 2 mm.. . 8. Microcalcification:. present,. tumoral/. non-tumoral.. . 9. Pathological TN category (AJCC 2017):. ypTis.. Result. Intensity. Positive. %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Negative (1+). Ki-67. Positive in 10%. of tumor cells. 9. | Important Radiologic. Findings. 52 53. 54. 8.2.1. . After Neoadjuvant. Chemotherapy. 55 56. 57. 8.3. | Patient History and Progress. Female/56 years old, peri-menopause.. Screen detected a mass lesion on right breast 7. o’clock direction and left breast 4 o’clock. direction.. No family history.. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 8.2. |
Case 8 | Local Recurrence | 8.1. . Courses of Treatment. Right breast IDC/Left breast intraductal papil. loma, sclerosing → Operation → Adjuvant ther. apy → Left breast recurrence (DCIS).. 8.2.1. . Primary Treatment. 59. 60. Operation. 61. 62. Pathology Report. <Right>. Y. Kim et al.. 739. . 1. Invasive Ductal Carcinoma involving scleros. ing adenosis.. . (a) Size of tumor: 1.5 cm (pT1c).. . (b) Histologic grade: 2/3 (tubule formation:. 3/3, nuclear pleomorphism: 2/3, mitotic. count: 1/3, 8/10HPF).. . (c) Intraductal component: present, intratu. moral/extratumoral (70%) (nuclear grade:. low, necrosis: present, architectural pat. tern: cribriform/solid, extensive intra. ductal component: present).. . (d) Skin: no involvement of tumor.. . (e) Surgical margins:. • Superior margin: 2 mm from ductal. carcinoma in situ (slide 7).. • Inferior margin: 2 mm from ductal car. cinoma in situ (slide MG4).. • Medial margin: 2 mm from invasive. ductal carcinoma (slide 6).. • Lateral margin: 2 mm from ductal car. cinoma in situ (slide 9).. • Deep margin: 2 mm.. • Superficial margin: 2 mm.. . (f) Arteriovenous invasion: absent.. . (g) Lymphovascular. invasion:. present,. intratumoral.. . (h) Tumor border: infiltrative.. . . . a. b. . . Local Recurrence. 740. a. b. . . . . . . (i) Microcalcification:. present,. tumoral/. non-tumoral.. . (j) Pathological TN category (AJCC 2017):. pT1c.. . 2. Intraductal papilloma.. . 3. Sclerosing adenosis with microcalcification.. Result. Intensity Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative. (1+) (IDC). Equivocal (2+). (DCIS). Ki-67. Positive in 24%. of tumor cells. <Left>. . 1. Intraductal papilloma with usual ductal. hyperplasia. . 2. Sclerosing adenosis with microcalcification.. Operation. Second Operation (Mar. 2021) Right axillary. lymph node sampling.. Pathology Report. No metastasis in eight axillary lymph nodes. (right sentinel LN: 0/2, right axillary LN: 0/6).. . 1. Post-excision status.. Adjuvant Therapy. Postoperative radiation therapy.. Tamoxifen 20 mg/day for 0.8 year.. 8.2.2. . Treatments After Recurrence. 63. 64. Y. Kim et al.. 741. a. b. . Operation. 65. Pathology Report. . 1. Ductal Carcinoma In Situ involving scleros. ing adenosis.. . (a) Size of tumor: 0.8 cm (pTis).. . (b) Nuclear grade: low.. . (c) Necrosis: absent.. . (d) Architectural pattern: micropapillary/. cribriform.. . (e) Surgical margins:. • Superior margin: <1 mm from ductal. carcinoma in situ (slide 2).. • Inferior margin: 10 mm.. • Medial margin: 5 mm.. • Lateral margin: 10 mm.. • Deep margin: 2 mm.. • Superficial margin: 2 mm.. . (f) Microcalcification:. present,. tumoral/. non-tumoral.. . 2. Intraductal papilloma with usual ductal. hyperplasia.. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Negative (2/8). 1. <1%. C-erbB2. Equivocal (2+). Ki-67. Positive in 1%. of tumor cells. Adjuvant Therapy. Plan for tamoxifen for 5 years.. 9. | null | Patient History and Progress. Female/48 years old, pre-menopause.. Screen detected mass lesion on right breast. . 12 o’clock direction and left 6 o’clock direction.. Family history of breast cancer, maternal aunt.. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 8.2. |
Case 8 | Metastatic Breast Cancer | Courses of Treatment. Left breast cancer → Operation → Adjuvant. therapy → Ipsilateral axillary lymph nodes. recurrence.. 8.2.1. . Primary Treatment. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (7/8). 3. 1/3–2/3. C-erbB2. Negative (0). Ki-67. Positive in. 61% of tumor. cells. Oncotype Dx RS Score: 18.. Adjuvant Therapy. Post-operative radiation therapy + Tamoxifen. 20 mg/day for 4.8 years.. 8.2.2. . Treatments After Recurrence. Ipsilateral Axillary Lymph Nodes. Recurrence. Progesterone. receptor. Strong (7/8). 3. 1/3–2/3. C-erbB2. Negative (0). Ki-67. Positive in. 29% of tumor. cells. Neoadjuvant Chemotherapy. Neoadjuvant. chemotherapy. #8. cycles. (Adriamycin & Cyclophosphamide #4 →. Docetaxel #4).. Operation. Sep. 2021 Left axillary lymph node dissection.. Pathology: No metastasis in twelve axillary | null | |
Case 9 | Benign and Proliferative | 9.1. . Courses of Treatment. → 2021-11-12 Excision, Rt.. 9.3.1. . Pathology Report. Diagnosis. • Breast, right, excision:. – | Important Radiologic. Findings. 13 14. 15. 9.3. | Patient History and Progress. Female/32 years old, pre-menopause.. Screen detected mass lesion on right breast. 8 o’clock direction.. Family history of breast cancer, mother and. maternal aunt.. No comorbidities.. 9.2. |
Case 9 | Carcinoma In Situ | 9.1. . Courses of Treatment. Operation + Tamoxifen 20 mg/day for 5 years.. 9.3.1. . Operation. 41. 42. E. S. Lee et al.. 71. . 9.3.2. . Pathology Report. Ductal carcinoma in situ, pathological TN cat. egory (AJCC 2017): pTisN0(sn). . 1. Size of tumor: 1.2 cm (pTis).. . 2. Nuclear grade: high.. . 3. Necrosis: present.. . 4. Architectural pattern: solid/comedo.. . 5. Skin: no involvement of tumor.. . 6. Surgical margins:. . (a) deep margin: 2 mm,. . (b) superficial margin: 2 mm.. . 7. Lymph nodes: no metastasis in one axillary. lymph node (pN0(sn)) (sentinel LN: 0/1)).. . 8. Microcalcification:. present,. tumoral/non-. tumoral.. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Equivocal. (2+). Ki-67. Positive in 9%. of tumor cells. Carcinoma In Situ. 72. . . 10. | Important Radiologic. Findings. 38 39. 40. 9.3. | Patient History and Progress. Female/50 years old, pre-menopause.. Screen detected microcalcification on inner. portion of left.. Outside result of biopsy: Ductal carcinoma in. situ, left.. Family history of breast cancer, maternal aunt.. No comorbidities.. BRCA 1 and 2 mutation: Not examination.. 9.2. |
Case 9 | HR(+) HER2(+) Breast Cancer | 9.1. . Courses of Treatment. Operation + Adjuvant chemotherapy (#4. cycles of doxorubicin and cyclophospha. mide). +. Post-operative. radiation. therapy + Trastuzumab.. 51. 9.3.1. . Pathology Report. 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, intratu. moral/extratumoral (30%) (nuclear grade:. high, necrosis: present, architectural pattern:. solid/comedo, extensive intraductal compo. nent: 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) superficial margin: 2 mm.. . S. Park et al.. 327. 6. Arteriovenous invasion: absent.. 7. Lymphovascular. invasion:. present,. intratumoral.. 8. Tumor border: infiltrative.. 9. Microcalcification:. present,. tumoral/. non-tumoral.. . 10. Pathological TN category (AJCC 2017):. pT1c.. Note: 1. The inferior margin of the lumpec. tomy specimen (slide 2) is close to ductal. . carcinoma in situ (3 mm) but this margin submit. ted 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. %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Positive (3+). Ki-67. Positive in 71%. of tumor cells. 10. | Important Radiologic. Findings. 48 49. 50. 9.3. | Patient History and Progress. 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).. 9.2. |
Case 9 | HR(+) HER2(-) Breast Cancer | 9.1. . Courses of Treatment. Operation. +. Adjuvant. chemotherapy. (#4 cycles of docetaxel & cyclophospha. mide). +. Post-operative. radiation. ther. apy + Tamoxifen 20 mg/day.. 9.3.1. . Operation. Left breast conserving surgery, sentinel lymph. moral/extratumoral (25%) (nuclear grade:. high, necrosis: present, architectural pattern:. solid/comedo, extensive intraductal compo. nent: 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) superficial 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. Microcalcification:. 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.. Result. Intensity. Positive. %. Estrogen. receptor. Strong (7/8). 2. >2/3. Progesterone. receptor. Weak (4/8). 2. 1–10%. C-erbB2. Equivocal (2+). (SISH negative). Ki-67. Positive in 23%. of tumor cells. HR(+) HER2(−) Breast Cancer | Important Radiologic. Findings. See Figs. 43, 44, 45 and 46.. 9.3. | Patient History and Progress. 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.. 9.2. |
Case 9 | HR(−) HER2(+) Breast Cancer | 9.1. . docetaxel and carboplatin and trastuzumab and. pertuzumab after followed #4 cycles of docetaxel. and. trastuzumab. and. . pertuzumab). +. Operation + Post-operative radiation ther. apy + Trastuzumab and pertuzumab.. 9.4.1. . Operation. 68. 9.4.2. . Pathology Report. . 1. No residual tumor with stromal fibrosis.. . (a) Post-chemotherapy status.. . (b) Lymph nodes: no metastasis in eight axillary. lymph nodes (ypN0) (sentinel LN: 0/8).. . 2. Atypical. ductal. hyperplasia. with. microcalcification.. Result. Intensity. Positive %. Estrogen. receptor. Negative (1/8). 1. <1%. Progesterone. receptor. Negative (2/8). 1. <1%. C-erbB2. Positive (3+). Ki-67. Positive in. 79% of tumor. cells. . Y. Kwon et al.. 465. 10. | Important Radiologic. Findings. 60 61 62. . . 9.3. . After Neoadjuvant. Chemotherapy. 64 65 66. 67. Y. Kwon et al. | Patient History and Progress. Female/51 years old, pre-menopause.. Screen detected mass lesion on left breast 2. o’clock direction.. No family history.. Hypothyroidism.. 9.2. |
Case 9 | HR(−) HER2(−) Breast Cancer | 9.1. . Courses of Treatment. Operation + adjuvant chemotherapy (#4. cycles of docetaxel and cyclophosphamide) +. Operation + Post-operative radiation therapy.. 9.3.1. . Operation. 65. 9.3.2. . Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 2.3 cm (pT2).. 2. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 8/HPF).. 3. Intraductal component: present, intratu. moral/extratumoral (10%) (nuclear grade:. high, necrosis: absent, architectural pattern:. solid, extensive 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: 10 mm.. . (e) Deep margin: <1 mm from invasive duc. tal carcinoma (slide 7).. . (f) Superficial margin: 2 mm.. 6. Lymph nodes: no metastasis in four axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/1,. non-sentinel LN: 0/2, intramammary LN:. 0/1).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular. invasion:. present,. intratumoral.. 9. Tumor border: infiltrative.. HR(−) HER2(−) Breast Cancer. 606. . . . E. S. Lee et al.. 607. . . Result. Intensity. Positive. %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Negative (1+). Ki-67. Positive in 87%. of tumor cells. <Lung>. . 1. Localized chronic granulomatous inflamma. tion with necrosis, suggestive of mycobacte. rial infection (see note).. . 2. Reactive hyperplasia in 5 regional lymph. nodes (LN #10: 0/2, LN #11: 0/3).. . 10. Microcalcification:. present,. tumoral/. non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT2N0(sn).. HR(−) HER2(−) Breast Cancer. 608. . . . 10. | Important Radiologic Findings. 60 61 62 63. 64. 9.3. | Patient History and Progress. Female/65 years old, post-menopause.. Screen detected mass lesion on right breast 10. o’clock direction.. No family history.. S/P right salpingectomy (due to ectopic. pregnancy).. 9.2. |
Case 9 | Local Recurrence | 9.1. . Courses of Treatment. Right breast mucinous carcinoma → Operation. → Adjuvant therapy → Left breast recurrence. (IDC + DCIS)/Right breast ADH.. 9.2.1. . Primary Treatment. 66 67. 68. Operation. . 69. Local Recurrence. 742. . . . . . Pathology Report. Mucinous Carcinoma. 1. Size of tumor: 1.5 cm (pT1c).. 2. Histologic grade: 1/3 (tubule formation: 2/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 7/10HPF).. 3. Intraductal component: absent.. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) Superior margin: 10 mm.. . (b) Inferior margin: 15 mm.. . (c) Medial margin: 15 mm.. . (d) Lateral margin: 20 mm.. . (e) Deep margin: 12 mm.. . (f) Superficial margin: 3 mm.. 6. Lymph nodes: no metastasis in one axillary. lymph node (pN0(sn)) (sentinel LN: 0/1).. 7. Vascular invasion: absent.. 8. Lymphatic invasion: absent.. 9. Tumor border: infiltrative.. Y. Kim et al.. 743. . 10. Microcalcification: absent.. . 11. Pathologic stage (AJCC 2010): pT1cN0(sn).. Result. Intensity Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative (0). Ki-67. Positive in 13%. of tumor cells. Adjuvant Therapy. Postoperative radiation therapy.. Tamoxifen 20 mg/day for 5 years.. 9.2.2. . Treatments After Recurrence. 70 71 72. 73. a. b. . a. b. . Operation. . 74. 75. Pathology Report. <Right>. Atypical ductal hyperplasia involving intra. ductal papilloma with marked cautery artifact.. <Left>. Ductal Carcinoma In Situ, residual. . 1. Size of tumor: up to 0.2 cm.. . 2. Nuclear grade: low.. . 3. Necrosis: absent.. . 4. Architectural pattern: micropapillary.. . 5. Skin: no involvement of tumor.. . 6. Surgical margins:. . (a) Superior margin: 15 mm.. . (b) Inferior margin: 5 mm.. . (c) Medial margin: 10 mm.. . (d) Lateral margin: 10 mm.. . (e) Deep margin: 5 mm.. . (f) Superficial margin: 1 mm from ductal. carcinoma in situ (slide 5).. . 7. Lymph nodes: no metastasis in one axillary. lymph node (pN0(sn)) (sentinel LN: 0/1). . 8. Microcalcification: present, tumoral.. Note: 1. In the previous biopsy specimen. (S21–18409), invasive ductal carcinoma mea. sures at least 0.5 cm in greatest dimension.. Result. Intensity Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative (1+). Ki-67. Positive in 8% of. tumor cells. Y. Kim et al.. 745. Adjuvant Therapy. Postoperative radiation therapy.. Letrozole 2.5 mg/day for 5 years with. goserelin.. 10. | null | Patient History and Progress. Female/51 years old, pre-menopause.. Screen detected mass lesion on right breast 12. o’clock direction.. Outside result of biopsy: Mucinous carcinoma.. Family history of colon cancer, father.. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 9.2. |
Case 9 | Metastatic Breast Cancer | . Courses of Treatment. Right breast cancer → Operation → Adjuvant. therapy → Ipsilateral axillary lymph nodes. recurrence.. 9.2.1. . Primary Treatment. Estrogen. receptor. Strong (7/8). 2. >2/3. Progesterone. receptor. Negative (2/8). 1. <1%. C-erbB2. Negative (0). Ki-67. Positive in. 23% of tumor. cells. Adjuvant Therapy. Post-operative radiation therapy + Letrozole. 2.5 mg/day for 1 year.. 9.2.2. . Treatments After Recurrence. Ipsilateral Axillary Lymph Nodes. Recurrence. See Figs. 29 and 30.. Aug. 2021 Left axillary lymph node biopsy.. Pathology: Metastatic ductal carcinoma.. Result. Intensity. Positive %. Estrogen. receptor. Negative. (2/8). 1. <1%. Progesterone. receptor. Negative. (0/8). 0. 0. C-erbB2. Negative (0). Ki-67. Positive in. 18% of tumor. Pathology: No metastasis in seven axillary. lymph nodes (right axillary lymph nodes: 0/7).. Radiotherapy. Post-operative radiation therapy (axillary and. subclavian area).. 10. | null | Patient History and Progress. Female/57 years old, post-menopause.. No family history.. S/p. Myomectomy. &. bilateral. salpingo-oophorectomy.. 9.2. |
Important Radiologic Findings | Benign and Proliferative | null | null | null |
Important Radiologic Findings | Carcinoma In Situ | null | null | null |
Important Radiologic Findings | HR(+) HER2(+) Breast Cancer | null | null | null |
Important Radiologic Findings | HR(+) HER2(-) Breast Cancer | null | null | null |
Important Radiologic Findings | HR(−) HER2(+) Breast Cancer | null | null | null |
Important Radiologic Findings | HR(−) HER2(−) Breast Cancer | null | null | null |
Important Radiologic Findings | Local Recurrence | null | null | null |
Important Radiologic Findings | Metastatic Breast Cancer | null | null | null |
Subsets and Splits