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199 | Case 18 | Courses of Treatment | Carcinoma In Situ | 18.1. . Courses of Treatment. Operation + Postoperative radiation therapy.. Operation. 83. 84. Pathology Report. Ductal carcinoma in situ, pathological TN cat. egory (AJCC 2017): pTis. . 1. Size of tumor: 1.1 cm (pTis).. . 2. Nuclear grade: low.. . 3. Necrosis: present.. . 4. Architectural pattern: micropapillary/cribri. form/solid.. . 5. Surgical margins:. . (a) superior margin: 20 mm,. . (b) inferior margin: (see Note 1),. . (c) medial margin: 5 mm,. . (d) lateral margin: (see Note 2),. . (e) deep margin: 2 mm,. . (f) superficial margin: 5 mm.. . 6. Microcalcification: present, non-tumoral.. Note: 1. The inferior margin of the lumpec. tomy specimen (slide 5) is close to ductal car. cinoma in situ (2 mm) but this margin submitted. for frozen diagnosis (Fro 3) is free of tumor.. 2. The lateral margin of the lumpectomy spec. imen (slide 6) is close to ductal carcinoma in situ. (2 mm) but this margin submitted for frozen. diagnosis (Fro 7) 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. Negative (1+). Ki-67. Positive in 5%. of tumor cells. . . E. S. Lee et al.. 91. . . . 19. |
207 | Case 18 | Important Radiologic | Carcinoma In Situ | Important Radiologic. Findings. 81. 82. 18.3. |
213 | Case 18 | Patient History | Carcinoma In Situ | Patient History and Progress. Female/64 years old, post-menopause.. Screen detected mass lesion on right breast. 8 o’clock direction.. Outside result of biopsy:. Right breast 8 o’clock, atypical intraductal. papillary neoplasm, favor ductal carcinoma in. situ.. No family history.. Hypertension, diabetes mellitus.. 18.2. |
200 | Case 18 | Courses of Treatment | HR(+) HER2(+) Breast Cancer | 18.1. . Courses of Treatment. Operation + Adjuvant chemotherapy (#4. cycles of doxorubicin and cyclophosphamide. followed by #4 cycles of docetaxel and trastu. zumab) + Post-operative radiation ther. apy + Trastuzumab + Letrozole 2.5 mg/day. with goserelin.. 99. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: up to 3.0 cm, multifocal. (pT2(Paget)).. . . HR(+) HER2(+) Breast Cancer. 356. . 2. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 23/10 HPF).. 3. Intraductal component: present, intratu. moral/extratumoral (20%) (nuclear grade:. high, necrosis: present, architectural pattern:. 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 carci. noma in situ (slide 3),. . (f) superficial 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: infiltrative.. . 11. Microcalcification:. present,. tumoral/. non-tumoral.. . 12. Pathological TN category (AJCC 2017):. pT2(Paget)N1a(sn).. Note: 1. The inferior margin of the lumpec. tomy specimen (slide 3) is close to ductal carci. noma 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 immunohis. tochemical staining.. 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 77%. of tumor cells. S. Park et al.. 357. . . HR(+) HER2(+) Breast Cancer. 358. a. b. . 19. |
208 | Case 18 | Important Radiologic | HR(+) HER2(+) Breast Cancer | Important Radiologic. Findings. 95 96 97. 98. 18.3. |
214 | Case 18 | Patient History | HR(+) HER2(+) Breast Cancer | Patient History and Progress. 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.. 18.2. |
201 | Case 18 | Courses of Treatment | HR(+) HER2(-) Breast Cancer | Courses of Treatment. Operation (1st & 2nd, Aug. 2010) + Post-. operative radiation therapy + Tamoxifen. 20 mg/day.. Operation (3rd, Jan. 2021) + Adjuvant che. motherapy (docetaxel & cyclophosphamide) +. Letrozole 2.5 mg/day.. Operation (1st, Aug. 2010). comedo.. . 5. Surgical margins:. . (a) superior margin: 30 mm.. . (b) inferior margin: positive (slide 3).. . (c) medial margin: 10 mm.. . (d) lateral margin: 10 mm.. . (e) deep margin: 2 mm.. . 6. Microcalcification:. present,. tumoral/. non-tumoral.. . 7. Pathologic stage (AJCC 2010): pTis.. Flat Epithelial Atypia. • With microcalcification.. Result. Intensity. Positive. %. Estrogen. receptor. Strong (7/7). 3. >2/3. Progesterone. receptor. Strong (6/7). 3. 1/3–2/3. C-erbB2. Equivocal (2+). Ki-67. Positive in 1% of. tumor cells. Operation (2nd, Aug. 2010). Left breast conserving surgery, sentinel lymph. with microcalcification.. Operation (3rd, Jan. 2021). Left total mastectomy, sentinel lymph node. biopsy, right total mastectomy (Figs. 99 and 100).. Pathology Report. [Right]. . 1. Fibroadenoma. . 2. Sclerosing adenosis with microcalcification.. [Left]. Invasive Ductal Carcinoma. 1. Post-lumpectomy status.. 2. Size of tumor: 2.0 cm (rpT1c).. Y. Kim et al.. . (a) deep margin: 3 mm.. . (b) superficial 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, intratu. moral/peritumoral.. . 10. Tumor border: infiltrative.. . 11. Microcalcification: present, tumoral.. . 12. Pathological TN category (AJCC 2017):. rpT1cN0(sn).. Result. Intensity. Positive %. Estrogen receptor. Strong (8/8). 3. >2/3. Progesterone receptor. Intermediate (5/8). 3. 1–10%. C-erbB2. Negative (0). Ki-67. Positive in 8% of tumor cells. Y. Kim et al. |
209 | Case 18 | Important Radiologic | HR(+) HER2(-) Breast Cancer | Important Radiologic. Findings. See Figs. 89, 90, 91, 92, 93, 94, 95 and 96.. 18.3. |
215 | Case 18 | Patient History | HR(+) HER2(-) Breast Cancer | S/P unilateral salpingo-oophorectomy, s/p. hysterectomy, Hypertension.. 18.2. |
202 | Case 18 | Courses of Treatment | HR(−) HER2(+) Breast Cancer | 18.1. . Courses of Treatment. Neoadjuvant chemotherapy (#6 cycles of. docetaxel and carboplatin and trastuzumab and. pertuzumab) + Operation + Post-operative radia. tion therapy + Trastuzumab.. . Y. Kwon et al.. 503. 3/3, 3/1HPF).. 4. Intraductal component: absent.. 5. Surgical margins:. . (a) superior margin: 40 mm,. . (b) inferior margin: 15 mm,. . (c) medial margin: 10 mm,. . (d) lateral margin: 15 mm,. . (e) deep margin: 5 mm,. . (f) superficial margin: 8 mm.. 6. Lymph nodes: no metastasis in two axillary. lymph nodes (ypN0(sn)) (sentinel LN: 0/1,. axillary LN: 0/1).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular. invasion:. present,. intratumoral.. HR(−) HER2(+) Breast Cancer. 504. a. b. . 9. Tumor border: infiltrative.. . 10. Microcalcification: present, non-tumoral.. . 11. Pathological TN category (AJCC 2017):. ypT1bN0(sn).. 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. 41% of tumor. cells. 19. |
210 | Case 18 | Important Radiologic | HR(−) HER2(+) Breast Cancer | Important Radiologic. Findings. 127 128 129. 130. . Y. Kwon et al.. 501. . . . HR(−) HER2(+) Breast Cancer. 502. 18.3. . After Neoadjuvant. Chemotherapy. 131 132 133. 134. 18.4. |
216 | Case 18 | Patient History | HR(−) HER2(+) Breast Cancer | Patient History and Progress. Female/61 years old, post-menopause.. Self-detected bloody discharge on nipple of. left breast.. No family history.. S/p hysterectomy.. 18.2. |
203 | Case 18 | Courses of Treatment | HR(−) HER2(−) Breast Cancer | 18.1. . Courses of Treatment. Neoadjuvant chemotherapy (#4 cycles of. doxorubicin and cyclophosphamide + #4. cycles of paclitaxel) + Operation + Post-. operative radiation therapy + Adjuvant. capecitabine.. Operation. 130. Pathology Report. . 1. Invasive Ductal Carcinoma.. . (a) Post-chemotherapy status.. . (b) Size of tumor: 0.7 cm (ypT1b).. . (c) Histologic grade: 3/3 (tubule formation:. 3/3, nuclear pleomorphism: 3/3, mitotic. count: 3/3, 95/10HPF).. . (d) Intraductal component: absent.. . (e) Skin and nipple: no involvement of tumor.. . (f) Surgical margins:. • Superior margin: 20 mm.. • Inferior margin: 20 mm.. • Medial margin: 10 mm.. • Lateral margin: 10 mm.. • Deep margin: 1.5 mm from invasive. ductal carcinoma (slide 2).. • Superficial margin: 15 mm.. . (g) Lymph nodes: no metastasis in three axillary. lymph nodes (ypN0(sn)) (sentinel LN: 0/3).. . (h) Arteriovenous invasion: absent.. . (i) Lymphovascular invasion: absent.. . (j) Tumor border: infiltrative.. . (k) Microcalcification: present, non-tumoral.. . (l) Pathological TN category (AJCC 2017):. ypT1bN0(sn).. . 2. Sclerosing adenosis with microcalcification.. Note: 1. A few isolated tumor cells are present. only in the permanent section of Fro 7 for immu. nohistochemical staining.. 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 63%. of tumor cells. E. S. Lee et al.. 637. . HR(−) HER2(−) Breast Cancer. 638. . . . . . . E. S. Lee et al.. 639. . . . HR(−) HER2(−) Breast Cancer. 640. 19. |
211 | Case 18 | Important Radiologic | HR(−) HER2(−) Breast Cancer | Important Radiologic Findings. 123 124. 125. After Neoadjuvant. Chemotherapy. 126 127 128. 129. 18.3. |
217 | Case 18 | Patient History | HR(−) HER2(−) Breast Cancer | Patient History and Progress. Female/57 years old, post-menopause.. Self-detected palpable mass lesion and skin. change on left breast.. Family history of breast cancer, aunt. (paternal).. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 18.2. |
204 | Case 18 | Courses of Treatment | Local Recurrence | 18.1. . Courses of Treatment. Left breast IDC→ Operation → Adjuvant. . therapy → Right breast recurrence (IDC).. Primary Treatment. Operation. May 2001 Left modified radical mastectomy. (outside).. Pathology Report. Invasive Ductal Carcinoma. . 1. Size of tumor: 3.0 cm (pT2).. . 2. Lymph nodes: two metastases in 24 axillary. lymph nodes (pN1) (sentinel LN: 0/2, axillary. LN: 0/2, intramammary LN: 0/1).. . 3. Pathological TN category: pT2N1.. Result. Intensity. Positive %. Estrogen. receptor. Negative. 0. 0. Progesterone. receptor. Negative. 0. 0. C-erbB2. Negative (0). Ki-67. Positive in 70%. of tumor cells. Adjuvant Therapy. Adjuvant chemotherapy #4 cycles of doxorubicin. and cyclophosphamide followed by #4 cycles of. docetaxel.. Treatments After Recurrence. 129 130. 131. . . Local Recurrence. 768. Operation. 132. Pathology Report. Invasive Ductal Carcinoma. 1. Post left mastectomy status.. 2. Size of tumor: 1.6 cm (pT1c).. 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 12/HPF).. 4. Intraductal component: present, intratu. moral/extratumoral (30%) (nuclear grade:. high, necrosis: present, architectural pattern:. micropapillary/comedo,. extensive. intra. ductal component: present).. 5. Nipple: involvement of lactiferous duct.. 6. Skin: no involvement of tumor.. 7. Surgical margins:. . (a) Deep margin: 2 mm.. . (b) Superficial margin: 2 mm.. 8. Lymph nodes:. . . Y. Kim et al.. 769. . (a) Metastasis in one out of four axillary. lymph nodes (pN1mi(sn)) (sentinel LN:. 1/3, non-sentinel LN: 0/1).. . (b) Perinodal extension: absent.. . (c) Size of metastatic carcinoma: 0.8 mm.. 9. Arteriovenous invasion: absent.. . 10. Lymphovascular. invasion:. present,. intratumoral.. . 11. Tumor border: infiltrative.. . 12. Microcalcification:. present,. tumoral/. non-tumoral.. . 13. Pathological TN category (AJCC 2017):. pT1cN1mi(sn).. 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 80%. of tumor cells. Adjuvant Therapy. Anastrozole 1 mg/day (stop d/t low compliance).. 19. |
218 | Case 18 | Patient History | Local Recurrence | Patient History and Progress. Female/71 years old, post-menopause.. Screen detected mass lesion on right breast.. No family history.. Diabetes mellitus, Grave’s disease.. BRCA 2 mutation carrier.. 18.2. |
205 | Case 18 | Courses of Treatment | Metastatic Breast Cancer | 18.1. . Courses of Treatment. Left breast cancer → Operation → Ipsilateral. chest wall recurrence → Neoadjuvant chemo. therapy → operation → targeted therapy →. Ipsilateral lymph node recurrence.. Primary Treatment. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in. 23% of tumor. cells. Treatments After Recurrence. See Figs. 58 and 59.. Nov. 2018 Muscle, left breast biopsy.. Pathology: Invasive ductal carcinoma, clini. cally recurrent.. Metastatic Breast Cancer. receptor. Intermediate. (5/8). 3. 1–10%. C-erbB2. Positive (3+). Ki-67. Positive in. 39% of tumor. cells. Neoadjuvant Chemotherapy. Chemotherapy. #3. cycle. (Docetaxel. &. Trastuzumab + Pertuzumab).. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Negative (2/8). 1. <1%. C-erbB2. Equivocal (2+). Ki-67. Positive in. 34% of tumor. cells. Adjuvant Therapy. Trastuzumab + Pertuzumab.. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Equivocal (2+). Ki-67. Positive in. 25% of tumor. cells. SISH. Positive. Operation. Jan. 2020 Left axillary lymph node dissection.. Pathology: Metastatic ductal carcinoma in. three out of eight axillary lymph nodes.. Y. Kwon et al.. 891. Size of metastatic carcinoma: 20 mm.. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Negative (2/8). 1. <1%. C-erbB2. Positive (3+). Ki-67. Positive in 30%. of tumor cells. Adjuvant Therapy. Post-operative radiation therapy + Letrozole. 2.5 mg/day~. 19. |
219 | Case 18 | Patient History | Metastatic Breast Cancer | Patient History and Progress. Female/64 years old, post-menopause.. No family history.. Hypertension, diabetes mellitus.. 18.2. |
220 | Case 19 | Courses of Treatment | Benign and Proliferative | 19.1. . Courses of Treatment. →2021-08-03 excision, Lt.. Pathology Report. Diagnosis. • Breast, left 1 o’clock, excision:. –. – Fibroadenoma.. –. – Intraductal papilloma with usual ductal. hyperplasia.. • Breast, left 8 o’clock, excision:. –. – Intraductal papilloma with (1) usual ductal. hyperplasia, (2) microcalcification.. 20. |
228 | Case 19 | Important Radiologic | Benign and Proliferative | Important Radiologic. Findings. 34 35. 36. Benign and Proliferative Case Series. 40. . . . C. W. Lee et al.. 41. 19.3. |
234 | Case 19 | Patient History | Benign and Proliferative | Patient History and Progress. Female/42 years old, pre-menopause.. Screen detected mass lesion on left breast. 8 o’clock direction.. Outside result of biopsy: papillary neoplasm.. No family history.. No comorbidities.. 19.2. |
221 | Case 19 | Courses of Treatment | Carcinoma In Situ | 19.1. . Courses of Treatment:. Operation. Operation. . 89. 90. Carcinoma In Situ. 92. Pathology Report. Right.. Ductal carcinoma in situ. . 1. Post-mammotome status.. . 2. Size of tumor: 0.3 cm, residual.. . 3. Nuclear grade: high.. . 4. Necrosis: absent.. . 5. Architectural pattern: cribriform/solid.. . 6. Skin and nipple: no involvement of tumor.. . 7. Surgical margins:. . (a) deep margin: 5 mm,. . (b) superficial margin: <1 mm from ductal. carcinoma in situ (slide 11).. . 8. Lymph nodes: no metastasis in two axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/2).. . 9. Microcalcification: present, tumoral.. Left.. Ductal carcinoma in situ, pathological TN cat. egory (AJCC 2017): pTisN0(sn). . 1. Size of tumor: 6.0 cm (pTis).. . 2. Nuclear grade: low.. . 3. Necrosis: absent.. . 4. Architectural pattern: micropapillary/cribri. form/solid.. . 5. Skin and nipple: no involvement of tumor.. . 6. Surgical margins: (see note).. . (a) deep margin: 1 mm from ductal carci. noma in situ (slide 4),. . (b) superficial margin: <1 mm from ductal. carcinoma in situ (slide 8).. . 7. Lymph nodes: no metastasis in three axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/3).. . 8. Microcalcification: present, tumoral.. Note: 1. Atypical ductal hyperplasia is pres. ent only in the permanent section of Fro 3.. 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. 14% of tumor. cells. . . . E. S. Lee et al.. 93. . . . Carcinoma In Situ. 94. . E. S. Lee et al.. 95. . 20. |
229 | Case 19 | Important Radiologic | Carcinoma In Situ | Important Radiologic. Findings. 85 86 87. 88. 19.3. |
235 | Case 19 | Patient History | Carcinoma In Situ | Patient History and Progress. Female/48 years old, pre-menopause.. Screen detected diffuse non-mass lesions on. upper, central, and lower portion of left breast.. Screen detected microcalcification on inner. subareolar of right breast.. Outside result of excisional biopsy: bilateral. ductal carcinoma in situ.. No family history.. S/P L-spine operation.. BRCA 1 and 2 mutation: Not detected.. 19.2. |
222 | Case 19 | Courses of Treatment | HR(+) HER2(+) Breast Cancer | 19.1. . Courses of Treatment. Neoadjuvant chemotherapy (#6 cycles of. docetaxel and carboplatin and trastuzumab. and pertuzumab) + Operation + Post-. operative radiation therapy + Trastuzumab +. Letrozole 2.5 mg/day.. 105. Pathology Report. Invasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of tumor: 1.5 cm (ypT1c).. S. Park et al.. 359. . . 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:. . (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) superficial 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: infiltrative.. . 11. Microcalcification: present, non-tumoral.. . 12. Pathological TN category (AJCC 2017):. ypT1cN0(sn).. Result. Intensity. Positive. %. Estrogen. receptor. Intermediate. (6/8). 2. 1/3–2/3. Progesterone. receptor. Negative (2/8). 1. <1%. C-erbB2. Positive (3+). Ki-67. Positive in 3% of. tumor cells. HR(+) HER2(+) Breast Cancer. 360. . . . S. Park et al.. 361. a. b. . 20. |
230 | Case 19 | Important Radiologic | HR(+) HER2(+) Breast Cancer | Important Radiologic. Findings. 100 101 102 103. 104. 19.3. |
236 | Case 19 | Patient History | HR(+) HER2(+) Breast Cancer | Patient History and Progress. 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.. 19.2. |
223 | Case 19 | Courses of Treatment | HR(+) HER2(-) Breast Cancer | Courses of Treatment. Operation + Tamoxifen 20 mg/day with leup. rolide acetate.. Operation. Left nipple–areolar complex sparing mastectomy. with immediate implant reconstruction, sentinel. lymph node biopsy (Figs. 106 and 107).. Pathology Report. 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, intratu. moral/extratumoral (20%) (nuclear grade:. low, necrosis: present, architectural pattern:. cribriform/solid/comedo, extensive intra. ductal component: present).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) deep margin: 2 mm.. . (b) superficial margin: 2 mm.. HR(+) HER2(−) Breast Cancer. . 10. Microcalcification:. present,. tumoral/. non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT1c(2)N0(sn).. Result. Intensity. Positive. %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Equivocal (2+). (SISH negative). Ki-67. Positive in 9% of. tumor cells. Y. Kim et al. |
231 | Case 19 | Important Radiologic | HR(+) HER2(-) Breast Cancer | Important Radiologic. Findings. See Figs. 101, 102, 103, 104 and 105.. 19.3. |
237 | Case 19 | Patient History | HR(+) HER2(-) Breast Cancer | No comorbidities.. 19.2. |
224 | Case 19 | Courses of Treatment | HR(−) HER2(+) Breast Cancer | 19.1. . Operation. 140. Pathology Report. 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:. 12/3, 2/10HPF).. 3. Intraductal component: present, extratumoral. (5%) (nuclear grade: high, necrosis: present,. architectural pattern: solid/comedo, exten. sive intraductal component: absent).. 4. Surgical margins:. . (a) superior margin: 10 mm,. . (b) inferior margin: 20 mm,. . (c) medial margin: 10 mm,. . (d) lateral margin: 10 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: 5 mm.. 5. Lymph nodes: no metastasis in two axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/2).. 6. Arteriovenous invasion: absent.. 7. Lymphovascular. invasion:. present,. peritumoral.. 8. Tumor border: infiltrative.. 9. Microcalcification:. present,. tumoral/. non-tumoral.. . 10. Pathological TN category (AJCC 2017):. pT2N0(sn).. 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 39%. of tumor cells. . . . Y. Kwon et al.. 507. a. b. . 20. |
232 | Case 19 | Important Radiologic | HR(−) HER2(+) Breast Cancer | Important Radiologic. Findings. 136 137 138. 139 |
238 | Case 19 | Patient History | HR(−) HER2(+) Breast Cancer | Patient History and Progress. Female/52 years old, pre-menopause.. Self-detected palpable mass lesion on left. breast 1 and 2 o’clock direction.. No family history.. Hepatitis B virus carrier, liver cirrhosis.. Y. Kwon et al.. 505. 19.2. |
225 | Case 19 | Courses of Treatment | HR(−) HER2(−) Breast Cancer | 19.1. . Courses of Treatment. Operation + adjuvant chemotherapy (#4. cycles of doxorubicin and cyclophospha. mide + #3 cycles of paclitaxel-stop d/t drug-. induced. pneumonitis). +. Post-operative. radiation therapy.. Operation. 134. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 2.2 cm (pT2).. 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 (20%) (nuclear grade:. high, necrosis: present, architectural pattern:. solid/comedo, extensive intraductal compo. nent: absent).. 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: 10 mm.. . (e) Deep margin: 2 mm.. . (f) Superficial margin: 2 mm.. 6. Arteriovenous invasion: absent.. 7. Lymphovascular invasion: absent.. 8. Tumor border: infiltrative.. 9. Microcalcification: present, tumoral/non-. tumoral.. . 10. Pathological TN category (AJCC 2017):. pT2Nx.. 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 91%. of tumor cells. E. S. Lee et al.. 641. . . . HR(−) HER2(−) Breast Cancer. 642. . 20. |
233 | Case 19 | Important Radiologic | HR(−) HER2(−) Breast Cancer | Important Radiologic Findings. 131 132. 133. 19.3. |
239 | Case 19 | Patient History | HR(−) HER2(−) Breast Cancer | Patient History and Progress. Female/63 years old, post-menopause.. Screen detected mass lesion on right breast 10. o’clock direction.. No family history.. Hepatitis B virus carrier, h/o Tuberculosis.. 19.2. |
226 | Case 19 | Courses of Treatment | Local Recurrence | 19.1. . Courses of Treatment. Left breast IDC → Adjuvant therapy.. Primary Treatment. 133 134 135 136. 137. Neoadjuvant Chemotherapy. Neoadjuvant chemotherapy #4 cycles of doxoru. bicin and cyclophosphamide followed by. #4 cycles of docetaxel and trastuzumab.. Operation. . . 138. 139. Pathology Report. <Right>. Complex. sclerosing. lesion. with. microcalcification.. <Left>. Invasive Ductal Carcinoma, associated with. complex sclerosing lesion. 1. Post-chemotherapy status.. 2. Size of invasion component: 1.3 cm. (ypT1c(m)).. 3. Size of intraductal component: 1.6 cm.. . Local Recurrence. 770. architectural pattern: micropapillary/cribri. form, extensive intraductal component:. present).. 6. Skin: no involvement of tumor.. 7. Surgical margins:. . (a) Superior margin: 15 mm.. . (b) Inferior margin: 4 mm.. . (c) Medial margin: (see NOTE 1).. . (d) Lateral margin: 50 mm.. . (e) Deep margin: 7 mm.. . (f) Superficial margin: 14 mm.. Y. Kim et al.. 771. 8. Lymph nodes:. . (a) Metastasis in two out of eight axillary. lymph nodes (ypN1a(sn)) (sentinel LN:. 2/2, axillary LN: 0/6).. . (b) Perinodal extension: present.. . (c) Size of metastatic carcinoma: 3 mm.. 9. Arteriovenous invasion: absent.. . 10. Lymphovascular. invasion:. present,. peritumoral.. . 11. Tumor border: infiltrative.. . 12. Microcalcification:. present,. tumoral/. non-tumoral.. . 13. Pathologic stage (AJCC 2010): ypT1c(m). N1a(sn).. . a. b. . a. b. . Local Recurrence. 772. Note 1: The medial margin of the lumpectomy. specimen (slide 4) is <1 mm from invasive ductal. carcinoma, but this margin submitted for frozen. diagnosis (Fro 6) is free of tumor.. Result. Intensity. Positive %. Estrogen. receptor. Weak (4/8). 2. 1–10%. Progesterone. receptor. Weak (4/8). 2. 1–10%. C-erbB2. Positive (3+). Ki-67. Positive in 1%. of tumor cells. Adjuvant Therapy. Postoperative radiation therapy.. Trastuzumab for 1 year.. Tamoxifen 20 mg/day for 5 years.. 20. |
240 | Case 19 | Patient History | Local Recurrence | Patient History and Progress. Female/52 years old, pre-menopause.. Screen detected mass lesion on right breast. subareolar area and left breast subareolar area.. No family history.. Hypertension.. 19.2. |
227 | Case 19 | Courses of Treatment | Metastatic Breast Cancer | 19.1. . Courses of Treatment. Right breast cancer → Operation → Adjuvant. therapy → Ipsilateral axillary lymph node. recurrence → Operation → Endocrine therapy. → Progressive disease.. Primary Treatment. Positive %. Estrogen. receptor. Strong (7/8). 3. 1/3–2/3. Progesterone. receptor. Strong (7/8). 3. 1/3–2/3. C-erbB2. Negative (0). Ki-67. Positive in. 26% of. tumor cells. Adjuvant Therapy. Adjuvant chemotherapy #8 cycles (Adriamycin. & Cyclophosphamide #4 → Docetaxel #4).. Post-operative radiation therapy + Tamoxifen. 20 mg/day for 3.8 years.. Treatments After Recurrence. Progesterone. receptor. Weak (4/8). 2. 1–10%. C-erbB2. Negative (0). Ki-67. Positive in. 6% of tumor. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Intermediate. (5/8). 2. 10%–1/3. C-erbB2. Negative (1+). Ki-67. Positive in 7%. of tumor cells. Adjuvant Therapy. Letrozole 2.5 mg/day for 0.75 year → Progressive. disease.. See Figs. 64 and 65.. Mar. 2022 Right axillary lymph node biopsy.. Pathology: Metastatic ductal carcinoma.. Result. Intensity. Positive %. Estrogen. receptor. Weak (3/8). 1. 1–10%. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Negative (1+). Ki-67. Positive in. 11% of tumor. cells. Palliative Chemotherapy |
241 | Case 19 | Patient History | Metastatic Breast Cancer | Patient History and Progress. Female/45 years old, post-menopause.. No family history.. S/p bilateral salpingo-oophorectomy.. 19.2. |
242 | Case 2 | Courses of Treatment | Benign and Proliferative | 2.1. . Courses of Treatment. → 2022-02-14 Excision, Lt.. 2.3.1. . Pathology Report. • Breast, left, excision:. –. – Atypical ductal hyperplasia with micro. -. calcification.. –. – Intraductal papilloma with usual ductal. hyperplasia.. 3. |
250 | Case 2 | Important Radiologic | Benign and Proliferative | Important Radiologic. Findings. 3. 2.3. |
256 | Case 2 | Patient History | Benign and Proliferative | Patient History and Progress. Female/47 years old, pre-menopause.. Screen detected mass lesion on left breast. 2 o’clock direction.. Outside result of biopsy: Intraductal papilloma.. No family history.. No comorbidities.. 2.2. |
243 | Case 2 | Courses of Treatment | Carcinoma In Situ | 2.1. |
251 | Case 2 | Important Radiologic | Carcinoma In Situ | Important Radiologic. Findings. 7. 8. 2.3. . Course of Treatment:. Operation. 2.3.1. . Operation. 9. 10. 2.3.2. . Pathology Report. Lobular carcinoma in situ. . 1. Size of tumor: 0.2 cm2.. . 2. Nuclear grade: low.. . 3. Necrosis: absent.. . 4. Architectural pattern: solid.. . 5. Surgical margin: 2 mm from nearest margin.. . . E. S. Lee et al.. 55. . a. b. . Carcinoma In Situ. 56. . . . 3. |
257 | Case 2 | Patient History | Carcinoma In Situ | Patient History and Progress. Female/47 years old, pre-menopause.. Nipple discharge on left breast.. Family history of breast cancer, mother and. sister, aunt, cousin sister.. Thrombocytopenia (Follow-up at outside. hospital).. BRCA 2 VUS (variant of uncertain).. 2.2. |
244 | Case 2 | Courses of Treatment | HR(+) HER2(+) Breast Cancer | 2.1. . 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.. 12. 2.3.1. . Pathology Report. . 1. Microinvasive ductal carcinoma.. . (a) Post-chemotherapy status.. . (b) Size of tumor: <0.1 cm (ypT1mi).. HR(+) HER2(+) Breast Cancer. 304. . . . S. Park et al.. 305. . (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 microin. vasive ductal carcinoma (Fro 6),. • inferior margin: 30 mm,. • medial margin: >10 mm,. • lateral margin: >10 mm,. • deep margin: 2 mm,. • superficial margin: 2 mm.. . a. b. . . HR(+) HER2(+) Breast Cancer. 306. . (g) Lymph nodes: no metastasis in two axil. lary lymph nodes (ypN0(sn)) (sentinel. LN: 0/2).. . (h) Arteriovenous invasion: absent.. . (i) Lymphovascular invasion: absent.. . (j) Tumor border: infiltrative.. . (k) Microcalcification:. present,. tumoral/. non-tumoral.. . (l) Pathological TN category (AJCC 2017):. ypT1miN0(sn).. . (m) Related slides:. . 2. Sclerosing adenosis with microcalcification.. Result. Intensity. Positive. %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Equivocal (2+). Ki-67. Positive in 2% of. tumor cells. 3. |
252 | Case 2 | Important Radiologic | HR(+) HER2(+) Breast Cancer | Important Radiologic. Findings. 8 9 10. 11. 2.3. |
258 | Case 2 | Patient History | HR(+) HER2(+) Breast Cancer | Patient History and Progress. 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.. 2.2. |
245 | Case 2 | Courses of Treatment | HR(+) HER2(-) Breast Cancer | Courses of Treatment. Operation + Post-operative radiation ther. apy + Anastrozole 1 mg/day.. 2.3.1. . Operation. Left breast conserving surgery, sentinel lymph. 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) superficial 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: infiltrative.. . 10. Microcalcification:. present,. tumoral/. non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT1bN0(sn).. Y. Kim et al. |
253 | Case 2 | Important Radiologic | HR(+) HER2(-) Breast Cancer | Important Radiologic. Findings. See Figs. 5, 6, 7 and 8.. HR(+) HER2(−) Breast Cancer. 3. >2/3. C-erbB2. Negative (0). Ki-67. Positive in 5% of tumor cells. 2.3. |
259 | Case 2 | Patient History | HR(+) HER2(-) Breast Cancer | Hepatitis B virus carrier, dyslipidemia.. 2.2. |
246 | Case 2 | Courses of Treatment | HR(−) HER2(+) Breast Cancer | 2.1. . Courses of Treatment. Neoadjuvant chemotherapy (#2 cycles of. docetaxel and carboplatin and trastuzumab and. pertuzumab + #4 cycles of docetaxel and trastu. zumab and pertuzumab) + Operation + Post-. operative radiation therapy + Trastuzumab. emtansine.. 2.4.1. . Operation. 17. 2.4.2. . Pathology Report. Invasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of invasive component: 0.6 cm, multifo. cal (pT1b).. 3. Size of intraductal component: 3.0 cm.. 4. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 2/3, 10/10HPF).. 5. Intraductal component: present, extratumoral. (80%) (nuclear grade: high, necrosis: pres. ent, architectural pattern: solid/comedo,. extensive intraductal component: present).. 6. Skin: no involvement of tumor.. 7. Surgical margins:. . (a) subareolar margin: positive for ductal. carcinoma in situ (Fro 6),. . (b) superior margin: 10 mm,. . (c) inferior margin: positive for ductal carci. noma in situ (Fro 3) (see note),. . (d) medial margin: 5 mm,. . (e) lateral margin: (see note),. . (f) deep margin: (see note),. . (g) superficial margin: <1 mm from ductal. carcinoma in situ (slide 7).. . Y. Kwon et al.. 437. 8. Lymph nodes: no metastasis in two axillary. lymph nodes (ypN0(sn)) (sentinel LN: 0/2).. 9. Arteriovenous invasion: absent.. . 10. Lymphovascular invasion: absent.. . 11. Tumor border: infiltrative.. . 12. Microcalcification: present, non-tumoral.. . 13. Pathological TN category (AJCC 2017):. ypT1bN0(sn).. 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. 79% of. tumor cells. 3. |
254 | Case 2 | Important Radiologic | HR(−) HER2(+) Breast Cancer | Important Radiologic Findings. 9 10 11. 434. 2.3. . After Neoadjuvant. Chemotherapy. 13 14 15. 16. . Y. Kwon et al.. 435. . . . . HR(−) HER2(+) Breast Cancer. 436. 2.4. |
260 | Case 2 | Patient History | HR(−) HER2(+) Breast Cancer | Patient History and Progress. Female/68 years old, post-menopause.. A self-detected skin change and nipple retrac. tion on left breast.. No family history.. Hypothyroidism.. 2.2. |
247 | Case 2 | Courses of Treatment | HR(−) HER2(−) Breast Cancer | 2.1. . Courses of Treatment. Neoadjuvant chemotherapy (#4 cycles of. doxorubicin and cyclophosphamide + #4. cycles of docetaxel) + Operation + Post-. operative radiation therapy.. 2.3.1. . Operation. 15. 2.3.2. . Pathology Report. No residual tumor with stromal fibrosis. . 1. Post-chemotherapy status.. . 2. Lymph nodes:. . (a) No metastasis in ten axillary lymph node. (ypN0) (sentinel LN: 0/3, non-sentinel. LN: 0/7).. Result. Intensity. Positive. %. Estrogen. receptor. Negative (2/8). 1. <1%. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Equivocal (2+). SISH (−). Ki-67. Positive in 67%. of tumor cells. E. S. Lee et al.. 581. . . . HR(−) HER2(−) Breast Cancer. 582. . . 3. |
255 | Case 2 | Important Radiologic | HR(−) HER2(−) Breast Cancer | Important Radiologic. Findings. 8 9 10. 11. E. S. Lee et al.. 579. . . . HR(−) HER2(−) Breast Cancer. 580. . 2.2.1. . After Neoadjuvant. Chemotherapy. 12 13. 14. 2.3. |
261 | Case 2 | Patient History | HR(−) HER2(−) Breast Cancer | Patient History and Progress. Female/49 years old, pre-menopause.. Self-detected palpable mass lesion on right. breast.. No family history.. No comorbidities.. 2.2. |
248 | Case 2 | Courses of Treatment | Local Recurrence | 2.1. . Courses of Treatment. Left breast IDC → Operation → Adjuvant. . therapy → Left breast recurrence (IDC).. 2.2.1. . Primary Treatment. 10. Operation. Nov. 2008 Left breast conserving surgery, senti. nel lymph node biopsy (outside).. Pathology Report. Invasive Ductal Carcinoma. . 1. Size of tumor: 0.4 cm (pT1a).. . 2. Lymph nodes: no metastasis in three axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/3).. . 3. Pathologic stage (AJCC 2010): pT1aN0(sn).. Result. Intensity. Positive %. Estrogen. receptor. Negative. Progesterone. receptor. Negative. C-erbB2. Positive. Adjuvant Therapy. Postoperative radiation therapy.. Y. Kim et al.. 721. . . . 2.2.2. . Treatments After Recurrence. 11. 12. Operation. . 13. Pathology Report. Invasive Ductal Carcinoma, clinically recurrent. 1. Post-lumpectomy status.. 2. Size of tumor: 0.8 cm (rpT1b).. 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 27/10HPF).. 4. Intraductal component: absent, extratumoral. (20%) (nuclear grade: high, necrosis: absent,. architectural pattern: micropapillary/cribri. form, extensive intraductal component: absent).. 5. Surgical margins:. . (a) Deep margin: 1.5 mm.. . (b) Superficial margin: 7 mm.. 6. Lymph nodes: no metastasis in one axillary. lymph node (rpN0(sn)) (sentinel LN: 0/1).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular invasion: absent.. 9. Tumor border: infiltrative.. . 10. Microcalcification: present, tumoral.. . 11. Pathologic stage (AJCC 2017): rpT1bN0(sn).. Local Recurrence. 722. . . . 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 50%. of tumor cells. Adjuvant Therapy. Adjuvant chemotherapy #4 cycles of docetaxel. with concurrent trastuzumab for 2 years.. 3. |
262 | Case 2 | Patient History | Local Recurrence | Patient History and Progress. Female/54 years old, peri-menopause.. Screen detected mass lesion on left breast. . 2 o’clock direction.. No family history.. No comorbidities.. 2.2. |
249 | Case 2 | Courses of Treatment | Metastatic Breast Cancer | Courses of Treatment. Right breast cancer → Operation + Adjuvant. therapy → Lung metastasis → Palliative therapy. → Progression on rib and lung → Palliative. therapy → Progression on liver → Palliative. therapy.. 2.2.1. . Primary Treatment. Radiologic Finding. Estrogen. receptor. Strong (6/7). 2. >2/3. Progesterone. receptor. Negative (0/7). 0. 0. C-erbB2. Negative (0). Ki-67. Positive in 15%. of tumor cells. Adjuvant Therapy. Post-operative radiation therapy + Tamoxifen. 20 mg/day for 2.5 years.. Letrozole 2.5 mg/day for 1 year: stop due to. skin rash → Change to Tamoxifen 20 mg/day for. 1.5 years.. Metastatic Breast Cancer. Treatments After Recurrence. Lung Metastasis. Letrozole 2.5 mg/day for 3 years → Progressive. disease on right 8th rib, lung.. Sep. 2017 CT chest r/o lung metastasis.. See Figs. 5 and 6.. Operation. Apr. 2019 Right upper lobe lung wedge. resection.. Pathology: Metastatic ductal carcinoma from. breast.. Size of tumor: 0.9 × 0.7 × 0.5 cm.. Radiation Therapy. Radiation therapy to Right 8th rib.. Progression on Liver. Fulvestrant 250 mg 1/month + Palbociclib. 100 mg/day: Progressive disease on liver →. Exemestane 25 mg/day + Everolimus 5 mg/day. → Palliative chemotherapy (weekly Paclitaxel #6. cycles): Progressive disease on liver →. Doxorubicin & Cyclophosphamide. |
263 | Case 20 | Courses of Treatment | Benign and Proliferative | 20.1. . Courses of Treatment. →2021-05-10 excision, Lt.. Pathology Report. Diagnosis. • Breast, left, excision:. –. – Atypical ductal hyperplasia.. –. – Fibrocystic change with microcalcification.. 21. |
271 | Case 20 | Important Radiologic | Benign and Proliferative | Important Radiologic. Findings. 37. 38. . Benign and Proliferative Case Series. 42. . 20.3. |
277 | Case 20 | Patient History | Benign and Proliferative | Patient History and Progress. Female/44 years old, pre-menopause.. Screen detected microcalcification on upper. outer portion of left breast.. Family history of breast cancer, sister.. No comorbidities.. 20.2. |
264 | Case 20 | Courses of Treatment | Carcinoma In Situ | 20.1. . Courses of Treatment. First Operation + Tamoxifen 20 mg/day for. 4 months.. Second Operation.. Carcinoma In Situ. 96. . . . Operation. First operation: Breast conserving surgery, senti. nel lymph node biopsy (left).. Second operation: Skin sparing mastectomy. with latissimus dorsi flap reconstruction (left).. Third operation: Excision (right).. 93. 94. Pathology Report. Left.. <First operation>. Invasive ductal Carcinoma, pathologic stage. (AJCC 2010): pT1aN0(sn). 1. Size of invasive component: 0.5 cm (pT1a).. 2. Size of intraductal component: 4.0 cm.. 3. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 5/10HPF).. 4. Intraductal component: present, intratumoral/. extratumoral (90%) (nuclear grade: low,. necrosis: absent, architectural pattern: solid. and papillary, extensive intraductal compo. nent: present).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) superior margin: 3 mm from atypical. ductal hyperplasia (slide 1),. . (b) inferior margin: (see Note 1),. . (c) medial margin: (see Note 2),. . (d) lateral margin: 40 mm,. . (e) deep margin: positive for ductal carci. noma in situ (slide 9),. . (f) superficial margin: 3 mm.. 7. Lymph nodes: no metastasis in seven axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/7,. axillary LN: 0/0).. 8. Vascular invasion: absent.. 9. Lymphatic invasion: absent.. . 10. Tumor border: pushing.. . 11. Microcalcification: present, non-tumoral.. Note: 1. Atypical ductal hyperplasia is. present only in the permanent section of Fro. 3. The inferior margin of the lumpectomy. specimen (slides 2, 5, 7, 9, and 11) is positive. for ductal carcinoma in site 2. The medial. margin of the lumpectomy specimen (slide. 3) is close to ductal carcinoma in situ (1 mm). but this margin submitted for frozen diagno. sis (Fro 4) 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. Negative (1+). Ki-67. Positive in. 29% of tumor. cells. <Second operation>. E. S. Lee et al.. 97. . . Carcinoma In Situ. 98. . 1. Atypical ductal hyperplasia, focal.. . (a) Post-lumpectomy status.. . 2. No residual tumor with foreign body reaction.. Right.. <Third operation>. Ductal carcinoma in situ, pathological TN cat. egory (AJCC 2017): pTis. . 1. Size of tumor: 0.5 cm (pTis).. . 2. Nuclear grade: low.. . 3. Necrosis: absent.. . 4. Architectural. pattern:. micropapillary/. cribriform.. . 5. Skin: no involvement of tumor.. . 6. Surgical margins:. . (a) superior margin: 10 mm,. . (b) inferior margin: 10 mm,. . (c) medial margin: <1 mm from ductal carci. noma in situ (slide 6),. . (d) lateral margin: 5 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: 2 mm.. . 7. Microcalcification:. present,. tumoral/non-. tumoral.. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (7/8). 3. >2/3. C-erbB2. Negative (0). Ki-67. Positive in. <1% of. tumor cells. <Fourth operation>. No residual tumor with foreign body reaction.. . 1. Post-excision status.. 21. |
272 | Case 20 | Important Radiologic | Carcinoma In Situ | Important Radiologic. Findings. 91. 92. 20.3. |
278 | Case 20 | Patient History | Carcinoma In Situ | Patient History and Progress. Female/48 years old, pre-menopause.. Screen detected mass lesion on left breast 3. o’clock direction at first visit.. Pain on right breast at second visit.. No family history.. No comorbidities.. NGS: negative.. 20.2. |
265 | Case 20 | Courses of Treatment | HR(+) HER2(+) Breast Cancer | 20.1. . Courses of Treatment. Operation + Adjuvant chemotherapy (#4. cycles of doxorubicin and cyclophosphamide. followed by #11 cycles of weekly pacli. taxel). +. Post-operative. radiation. ther. apy + Trastuzumab + Letrozole 2.5 mg/day.. 110. Pathology Report. Invasive Ductal Carcinoma. 1. Post-mammotome excision status.. 2. Size of tumor: 2.1 cm (pT2).. HR(+) HER2(+) Breast Cancer. 362. . . 3. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 2/3, 10/10 HPF).. 4. Intraductal component: absent.. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) superior margin: 5 mm,. . (b) inferior margin: 6 mm,. . (c) medial margin: 5 mm,. . (d) lateral margin: 5 mm,. . (e) deep margin: 4 mm,. . (f) superficial margin: 6 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: infiltrative.. . 11. Microcalcification: present, tumoral.. . 12. Pathological TN category (AJCC 2017):. pT2N0(sn).. Result. Intensity. Positive. %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in 15%. of tumor cells. S. Park et al.. 363. . . HR(+) HER2(+) Breast Cancer. 364. a. b. . 21. |
273 | Case 20 | Important Radiologic | HR(+) HER2(+) Breast Cancer | Important Radiologic. Findings. 106 107 108. 109. 20.3. |
279 | Case 20 | Patient History | HR(+) HER2(+) Breast Cancer | Patient History and Progress. Female/75 years old, post-menopause.. Screen detected mass lesion on right breast 8. o’clock direction.. No family history.. Asthma (follow-up).. 20.2. |
266 | Case 20 | Courses of Treatment | HR(+) HER2(-) Breast Cancer | Courses of Treatment. Operation + Post-operative radiation ther. apy + Tamoxifen 20 mg/day.. Operation. Left breast conserving surgery, sentinel lymph. 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.. . 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.. Y. Kim et al.. 2. 1/3–2/3. C-erbB2. Equivocal (2+). Ki-67. Positive in 21% of tumor cells. SISH. Negative. HR(+) HER2(−) Breast Cancer. 238. 21. |
274 | Case 20 | Important Radiologic | HR(+) HER2(-) Breast Cancer | Important Radiologic. Findings. See Figs. 108, 109, 110, 111 and 112.. 20.3. |
280 | Case 20 | Patient History | HR(+) HER2(-) Breast Cancer | o’clock direction.. No family history.. S/P Tuberculosis, S/P duodenal adenoma. excision.. 20.2. |
267 | Case 20 | Courses of Treatment | HR(−) HER2(+) Breast Cancer | 20.1. . Courses of Treatment. Neoadjuvant chemotherapy (#6 cycles of. docetaxel and carboplatin and trastuzumab and. pertuzumab) + Operation + Post-operative radia. tion therapy + Trastuzumab.. Operation. 147. Pathology Report. 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, intratu. moral/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) superficial 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.. a. b. . Y. Kwon et al.. 511. 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):. ypT1cN1a(sn).. 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. 45% of. tumor cells. 21. |
275 | Case 20 | Important Radiologic | HR(−) HER2(+) Breast Cancer | Important Radiologic. Findings. 141 142. 143. HR(−) HER2(+) Breast Cancer. 508. . . . Y. Kwon et al.. 509. 20.3. . After Neoadjuvant. Chemotherapy. 144 145. 146. . . . HR(−) HER2(+) Breast Cancer. 510. 20.4. |
281 | Case 20 | Patient History | HR(−) HER2(+) Breast Cancer | Patient History and Progress. 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.. 20.2. |
268 | Case 20 | Courses of Treatment | HR(−) HER2(−) Breast Cancer | 20.1. . Courses of Treatment. Neoadjuvant chemotherapy (#4 cycles of. doxorubicin and cyclophosphamide + #4. cycles of docetaxel) + Operation + Post-. operative radiation therapy.. Operation. 143. Pathology Report. No residual tumor with stromal fibrosis. E. S. Lee et al.. 645. . . . HR(−) HER2(−) Breast Cancer. 646. . 1. Post-chemotherapy status.. . 2. Lymph nodes: no metastasis in seven axillary. lymph nodes (ypN0) (sentinel LN: 0/1, non-. sentinel LN: 0/6).. . 3. Microcalcification:. present,. tumoral/. non-tumoral.. 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 46%. of tumor cells. . . E. S. Lee et al.. 647. 21. |
276 | Case 20 | Important Radiologic | HR(−) HER2(−) Breast Cancer | Important Radiologic. Findings. 135 136 137. 138. E. S. Lee et al.. 643. . . . . HR(−) HER2(−) Breast Cancer. 644. . After Neoadjuvant. Chemotherapy. 139 140 141. 142. 20.3. |
282 | Case 20 | Patient History | HR(−) HER2(−) Breast Cancer | Patient History and Progress. 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).. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 20.2. |
269 | Case 20 | Courses of Treatment | Local Recurrence | 20.1. . Courses of Treatment. Right breast DCIS → Operation → Adjuvant. therapy → Right breast recurrence (microinva. sive ductal carcinoma).. Primary Treatment. 140. Operation. Jul. 2017 Right breast conserving surgery, senti. nel lymph node biopsy (outside).. Pathology Report. Ductal Carcinoma In Situ. 1. Size of tumor: 1.2 cm.. 2. Nuclear grade: high.. 3. Necrosis: present, central.. 4. Architectural pattern: comedo.. 5. Skin: no involvement of tumor.. 6. Surgical margins: uninvolved by DCIS dis. tance from closest margin: 2 mm (specify. margin: 9H).. 7. Lymph nodes: no metastasis in five lymph. nodes (pN0(sn)).. 8. Lymphovascular invasion: not identified.. 9. Perineural invasion: not identified.. . 10. Pathological TN category: pTisN0.. Result. Intensity. Positive %. Estrogen. receptor. Negative. 0. 0. Progesterone. receptor. Negative. 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in 35%. of tumor cells. . . Y. Kim et al.. 773. Adjuvant Therapy. Postoperative radiation therapy.. Treatments After Recurrence. 141 142. 143. Operation. . 144. 145. Pathology Report. . 1. Microinvasive Ductal Carcinoma. . (a) Size of invasive component: <0.1 cm. (pT1mi).. . (b) Size of in situ component: 1.5 cm.. . (c) Histologic grade: not applicable.. . (d) Intraductal component: present, intratu. moral/extratumoral (99%) (nuclear grade:. high, necrosis: present, architectural pat. tern: micropapillary/cribriform/solid/com. edo, extensive intraductal component:. present).. . (e) Surgical margins:. • Deep margin: 3 mm.. • Superficial margin: 8 mm.. . (f) Lymph nodes: no metastasis in three axil. lary lymph nodes (pN0(sn)) (sentinel LN:. 0/3).. . (g) Arteriovenous invasion: absent.. . . . Local Recurrence. 774. . a. b. . . (h) Lymphovascular invasion: absent.. . (i) Tumor border: infiltrative.. . (j) Microcalcification:. present,. tumoral/. non-tumoral.. . (k) Pathological TN category (AJCC 2017):. pT1miN0(sn).. . (l) Related slides: none.. . 2. Fibroadenoma.. Result. Intensity. Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Weak (3/8). 2. <1%. C-erbB2. Positive (3+). Ki-67. Positive in 23%. of tumor cells. 21. |
283 | Case 20 | Patient History | Local Recurrence | Patient History and Progress. Female/41 years old, pre-menopause.. Screen detected mass lesion on right breast 12. o’clock direction.. Outside result of biopsy: Ductal carcinoma in. situ.. No family history.. s/p Right breast conserving surgery (Breast. cancer), s/p parotidectomy, Panic disorder.. BRCA 1 VUS (variant of uncertain), APC,. and MSH2 VUS.. 20.2. |
270 | Case 20 | Courses of Treatment | Metastatic Breast Cancer | Courses of Treatment. Left breast cancer → Operation → Adjuvant. therapy → Ipsilateral axillary lymph node. recurrence.. Primary Treatment. Operation. Sep. 1998 Left breast conserving surgery, axil. lary lymph node dissection.. Pathology: Invasive ductal carcinoma, stage. pT1aN0.. Size of tumor: N.A, lymph node: 0/16.. Result. Intensity. Positive %. Estrogen. receptor. Positive. N.A. N.A. Progesterone. receptor. Positive. N.A. N.A. C-erbB2. N.A. Ki-67. N.A. Adjuvant Therapy. Adjuvant. chemotherapy. #3. cycles. (Cyclophosphamide. &. Methotrexate. &. Fluorouracil).. Post-operative radiation therapy +Tamoxifen. 20 mg/day for 0.5 year.. Treatments After Recurrence. 3. >2/3. Progesterone. receptor. Intermediate. (6/8). 2. 1/3–2/3. C-erbB2. Negative (0). Ki-67. Positive in 32%. of tumor cells. Neoadjuvant Chemotherapy. Neoadjuvant. chemotherapy. #6. cycles. (Adriamycin & Cyclophosphamide #4 →. Docetaxel #2).. Estrogen. receptor. Strong. (8/8). 3. >2/3. Progesterone. receptor. Weak (3/8). 1. 1–10%. C-erbB2. Negative. (0). Ki-67. Positive in. 12% of |
284 | Case 20 | Patient History | Metastatic Breast Cancer | Family history of breast cancer, maternal. cousin.. BRCA 1 & 2 mutation: Not detected.. 20.2. |
285 | Case 21 | Courses of Treatment | Benign and Proliferative | 21.1. . Courses of Treatment. →2021-07-07 excision, both.. Pathology Report. Diagnosis. • Breast, left, excision:. –. – Intraductal papilloma.. –. – Sclerosing. adenosis. with. microcal-. cification.. Diagnosis. • Breast, right, excision:. –. – Intraductal papilloma.. –. – Sclerosing adenosis with microcalcification.. C. W. Lee et al.. 43. . . . Benign and Proliferative Case Series. 44. 22. |
293 | Case 21 | Important Radiologic | Benign and Proliferative | Important Radiologic. Findings. 39 40. 41. 21.3. |
299 | Case 21 | Patient History | Benign and Proliferative | Patient History and Progress. Female/42 years old, pre-menopause.. Screen detected mass lesion on right breast 7. o’clock direction and left 1 o’clock direction.. Outside result of biopsy: both papillary. neoplasm.. No family history.. s/p Right breast mammotome biopsy (result:. fibroadenoma).. 21.2. |
286 | Case 21 | Courses of Treatment | Carcinoma In Situ | 21.1. . Courses of Treatment. Operation + Postoperative radiation therapy +. Tamoxifen 20 mg/day for 5 years.. . . E. S. Lee et al.. 99. Operation. 98. 99. Pathology Report. Ductal carcinoma in situ, pathological TN cat. egory (AJCC 2017): pTisN0 (sn). . 1. Size of tumor: 3.0 cm (pTis).. . 2. Nuclear grade: low.. . 3. Necrosis: absent.. . 4. Architectural pattern: papillary/micropapil. lary/cribriform/solid.. . 5. Skin: no involvement of tumor.. . 6. Surgical margins:. . (a) superior margin: 20 mm,. . (b) inferior margin: (see Note 1),. . (c) medial margin: (see Note 2),. . (d) lateral margin: 20 mm,. . (e) deep margin: <1 mm from ductal carci. noma in situ (slides 2 and 6),. . (f) superficial margin: <1 mm from ductal. carcinoma in situ (slide 3).. . 7. Lymph nodes: no metastasis in two axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/2).. . 8. Microcalcification:. present,. . tumoral/non-. tumoral.. Note: 1. The inferior margin of the lumpec. tomy specimen (slide 9) is positive for ductal. carcinoma in situ but this margin submitted. for frozen diagnosis (Fro 2) is free of tumor.. 2. The medial margin of the lumpectomy speci. men (slide 4) is close to ductal carcinoma in. situ (2 mm) and atypical ductal hyperplasia is. present only in the permanent section of Fro 3.. 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 5%. of tumor cells. . . Carcinoma In Situ. 100. . . 22. |
294 | Case 21 | Important Radiologic | Carcinoma In Situ | Important Radiologic. Findings. 95 96. 97. 21.3. |
300 | Case 21 | Patient History | Carcinoma In Situ | Patient History and Progress. Female/37 years old, pre-menopause.. Screen detected mass lesion on right breast. 9 o’clock direction.. Outside result of biopsy: Right 9 o’clock, duc. tal carcinoma in situ.. No family history.. Thyroid papillary carcinoma: follow-up at. outside hospital.. BRCA 1 and 2: not detected, POLE VUS. (variant of uncertain).. 21.2. |
287 | Case 21 | Courses of Treatment | HR(+) HER2(+) Breast Cancer | 21.1. . Courses of Treatment. Neoadjuvant chemotherapy (#6 cycles of. docetaxel and carboplatin and trastuzumab. and pertuzumab) + Operation + Post-. operative radiation therapy + Letrozole. 2.5 mg/day.. 117. 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, 1/10 HPF).. S. Park et al.. 365. . . 4. Intraductal component: present, intratu. moral/extratumoral (20%) (nuclear grade:. low, necrosis: absent, architectural pattern:. micropapillary/cribriform, extensive intra. ductal component: absent).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) superior margin: 25 mm,. . (b) inferior margin: 50 mm,. . (c) medial margin: 10 mm,. . (d) lateral margin: 20 mm,. . (e) deep margin: 15 mm,. . (f) superficial margin: 10 mm.. 7. Lymph nodes: no metastasis in one axillary. lymph node (ypN0(sn)) (sentinel LN: 0/1).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular invasion: present, intratu. moral/peritumoral.. . 10. Tumor border: infiltrative.. . 11. Microcalcification:. present,. tumoral/. non-tumoral.. . 12. Pathological TN category (AJCC 2017):. ypT1cN0(sn).. Result. Intensity. Positive. %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Weak (4/8). 2. 1–10%. C-erbB2. Equivocal (2+). Ki-67. Positive in 1% of. tumor cells. SISH. Positive. HR(+) HER2(+) Breast Cancer. 366. . S. Park et al.. 367. . F. ig. 115. HR(+) HER2(+) Breast Cancer. 368. a. b. . 22. |
295 | Case 21 | Important Radiologic | HR(+) HER2(+) Breast Cancer | Important Radiologic. Findings. 111 112 113 114 115. 116. 21.3. |
301 | Case 21 | Patient History | HR(+) HER2(+) Breast Cancer | Patient History and Progress. Female/69 years old, post-menopause.. Screen detected mass lesion on right breast 6. o’clock direction.. Family history of breast cancer, paternal aunt,. cousin (paternal).. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 21.2. |
288 | Case 21 | Courses of Treatment | HR(+) HER2(-) Breast Cancer | 21.1. . Courses of Treatment. Operation + Post-operative radiation ther. apy + Letrozole 2.5 mg/day.. Operation (1st, Dec. 2020). nent: 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) superficial margin: 2 mm.. 6. Arteriovenous invasion: absent.. 7. Lymphovascular. invasion:. present,. intratumoral.. Positive. %. Estrogen. receptor. Intermediate. (6/8). 3. 10%–. 1/3. Progesterone. receptor. Strong (7/8). 3. 1/3–2/3. C-erbB2. Negative (0). Ki-67. Positive in 2% of. tumor cells. HR(+) HER2(−) Breast Cancer |
296 | Case 21 | Important Radiologic | HR(+) HER2(-) Breast Cancer | Important Radiologic. Findings. See Figs. 114, 115, 116 and 117.. 21.3. |
302 | Case 21 | Patient History | HR(+) HER2(-) Breast Cancer | Patient History and Progress. Female/78 years old, post-menopause.. Screen detected mass lesion on left breast 12. o’clock direction.. No family history.. Hypertension, s/p hysterectomy.. 21.2. |
289 | Case 21 | Courses of Treatment | HR(−) HER2(+) Breast Cancer | 21.1. . Operation. 156. Pathology Report. 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.. Y. Kwon et al.. 515. a. b. . 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) superficial 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: infiltrative.. . 10. Microcalcification: present, non-tumoral.. . 11. Pathological TN category (AJCC 2017):. ypT1bN0(sn).. 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. 39% of tumor. cells. HR(−) HER2(+) Breast Cancer. 516. 22. |
297 | Case 21 | Important Radiologic | HR(−) HER2(+) Breast Cancer | Important Radiologic. Findings. 148 149 150. 151. . HR(−) HER2(+) Breast Cancer. 512. . . . . Y. Kwon et al.. 513. 21.3. . After Neoadjuvant. Chemotherapy. 152 153 154. 155. . HR(−) HER2(+) Breast Cancer |
303 | Case 21 | Patient History | HR(−) HER2(+) Breast Cancer | Patient History and Progress. Female/55 years old, pre-menopause.. Self-detected palpable mass lesion on right. breast.. No family history.. S/P Tuberculosis.. 21.2. |
290 | Case 21 | Courses of Treatment | HR(−) HER2(−) Breast Cancer | 21.1. . Courses of Treatment. Neoadjuvant chemotherapy (#4 cycles of. doxorubicin and cyclophosphamide + #4. cycles of docetaxel) + Operation + Post-. operative radiation therapy + Letrozole. 2.5 mg + Adjuvant capecitabine.. Operation. 152. Pathology Report. 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, intratu. moral/extratumoral (>95%) (nuclear grade:. high, necrosis: present, architectural pattern:. cribriform/solid/comedo, extensive intra. ductal component: present).. 6. Skin: no involvement of tumor.. 7. Surgical margins:. HR(−) HER2(−) Breast Cancer. 650. . . . . . (a) Superior margin: positive for ductal car. cinoma 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) Superficial margin: <1 mm from inva. sive 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: infiltrative.. . 12. Microcalcification: 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.. Result. Intensity. Positive %. Estrogen. receptor. Weak (3/8). 1. 1–10%. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Negative (0). Ki-67. Positive in 52%. of tumor cells. E. S. Lee et al.. 651. . . 22. |