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404 | Case 26 | Important Radiologic | HR(+) HER2(+) Breast Cancer | Important Radiologic. Findings. 147 148 149 150 151. 152. . S. Park et al.. 387. 26.3. |
410 | Case 26 | Patient History | HR(+) HER2(+) Breast Cancer | Patient History and Progress. Female/61 years old, post-menopause.. Self-detected palpable mass lesion on right. breast 11 o’clock direction.. No family history.. S/P. Tuberculosis,. diabetes. mellitus,. dyslipidemia.. 26.2. |
397 | Case 26 | Courses of Treatment | HR(+) HER2(-) Breast Cancer | 26.1. . Courses of Treatment. Operation + Adjuvant chemotherapy (#4 cycles. of doxorubicin & cyclophosphamide) + Post-. operative radiation therapy + Tamoxifen. 20 mg/day.. Operation. Left breast conserving surgery, sentinel lymph. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) superior margin: 25 mm.. Y. Kim et al.. (f) superficial margin: 15 mm.. 6. Lymph nodes: no metastasis in two axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/2). 7. Arteriovenous invasion: absent.. 8. Lymphovascular invasion: absent.. 9. Tumor border: infiltrative.. . 10. Microcalcification:. present,. . tumoral/. non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT1cN0(sn).. Result. Intensity Positive %. Estrogen. receptor. Strong (7/8). 2. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative (0). Result. Intensity Positive %. Ki-67. Positive in 62%. of tumor cells. 27. |
405 | Case 26 | Important Radiologic | HR(+) HER2(-) Breast Cancer | Important Radiologic. Findings. See Figs. 145, 146, 147 and 148.. 26.3. |
411 | Case 26 | Patient History | HR(+) HER2(-) Breast Cancer | Patient History and Progress. Female/48 years old, pre-menopause.. Screen detected mass lesion on left breast 1. o’clock direction.. Family history of breast cancer, maternal aunt.. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 26.2. |
398 | Case 26 | Courses of Treatment | HR(−) HER2(+) Breast Cancer | 26.1. . Courses of Treatment. Operation + Adjuvant chemotherapy (#4 cycles. of doxorubicin + cyclophosphamide) + Post-. operative radiation therapy + Trastuzumab.. Operation. 184. Pathology Report. Invasive Ductal Carcinoma with medullary. pattern. 1. Size of tumor: 1.5 cm (pT1c).. 2. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 2/3, 12/10HPF).. 3. Intraductal component: present, intratu. moral/extratumoral (5%) (nuclear grade:. high, necrosis: absent, architectural pattern:. solid, extensive intraductal component:. absent).. HR(−) HER2(+) Breast Cancer. 530. . 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) superior margin: 20 mm,. . (b) inferior margin: 5 mm,. . (c) medial margin: 5 mm,. . (d) lateral margin: 5 mm,. . (e) deep margin: 2 mm,. . (f) 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:. present,. intratumoral.. 9. Tumor border: infiltrative.. . 10. Microcalcification:. present,. tumoral/. non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT1cN0(sn).. Result. Intensity. Positive %. Estrogen. receptor. Negative. (0/8). 0. 0. Progesterone. receptor. Negative. (2/8). 1. <1%. C-erbB2. Positive (3+). Ki-67. Positive in. 23% of. tumor cells. Y. Kwon et al.. 531. 27. |
406 | Case 26 | Important Radiologic | HR(−) HER2(+) Breast Cancer | Important Radiologic. Findings. 181 182. 183. Y. Kwon et al.. 529. . . . 26.3. |
412 | Case 26 | Patient History | HR(−) HER2(+) Breast Cancer | Patient History and Progress. Female/49 years old, pre-menopause.. Self-detected palpable mass lesion on right. breast 1 o’clock direction.. No family history.. No comorbidities.. 26.2. |
399 | Case 26 | Courses of Treatment | HR(−) HER2(−) Breast Cancer | 26.1. . Courses of Treatment. Neoadjuvant chemotherapy (#4 cycles of. doxorubicin and cyclophosphamide + #3. cycles of docetaxel + Trastuzumab) + Operati. on + Adjuvant capecitabine + Trastuzumab.. Operation. 193 194. 195. Pathology Report. <Right>. No residual tumor with stromal fibrosis. . 1. Post-chemotherapy status.. . 2. Lymph nodes: no metastasis in two axillary. lymph nodes (ypN0(sn)) (sentinel LN: 0/2).. <Left>. Invasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of tumor: 1.8 cm (ypT1c).. 3. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, <1/10HPF).. 4. Intraductal component: present, intratumoral. (60%) (nuclear grade: high, necrosis: absent,. architectural pattern: solid, extensive intra. ductal component: present).. 5. Surgical margins:. . (a) Deep margin: 1 mm from ductal carci. noma in situ (slide 3).. . (b) Superficial margin: 13 mm.. 6. Lymph nodes:. . (a) Metastasis in one out of eight axillary. lymph nodes (ypN1mi) (see note). (sentinel LN: 1/2, non-sentinel LN:. 0/6).. . (b) Perinodal extension: absent.. . (c) Size of metastatic carcinoma: 0.5 mm.. 7. Arteriovenous invasion: absent.. 8. Lymphovascular. invasion:. present,. intratumoral.. 9. Tumor border: infiltrative.. HR(−) HER2(−) Breast Cancer. 668. . . . . E. S. Lee et al.. 669. . . . . HR(−) HER2(−) Breast Cancer. 670. . 10. Microcalcification: present, non-tumoral.. . 11. Pathological TN category (AJCC 2017):. ypT1cN1mi.. Note: 1. Micrometastasis is present only in the. permanent section of Fro 3.. 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 1%. of tumor cells. . . . E. S. Lee et al.. 671. 27. |
407 | Case 26 | Important Radiologic | HR(−) HER2(−) Breast Cancer | Important Radiologic Findings. 186 187. 188. Breast, right, needle biopsy: Invasive ductal car. cinoma, histologic grade 3 with medullary pattern.. 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 51%. of tumor cells. Breast, left, needle biopsy: Invasive ductal. carcinoma, histologic grade 3.. Result. Intensity Positive %. Estrogen. receptor. Negative (2/8). 1. <1%. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Equivocal (2+). Ki-67. Positive in 39%. of tumor cells. SISH. Tumor. heterogeneity. After Neoadjuvant. Chemotherapy. 189 190 191. 192. 26.3. |
413 | Case 26 | Patient History | HR(−) HER2(−) Breast Cancer | Patient History and Progress. Female/53 years old, post-menopause.. Self-detected mass lesion on right breast.. Family history of breast cancer, grandmother.. Family history of ovarian cancer, sister.. S/P appendectomy, s/p bilateral salpingo-. oophorectomy, s/p left shoulder operation.. BRCA 1 mutation carrier.. 26.2. |
400 | Case 26 | Courses of Treatment | Local Recurrence | 26.1. . Courses of Treatment. Right breast DCIS→ Operation → Adjuvant. therapy → Right breast recurrence (IDC).. Primary Treatment. 170. 171. Local Recurrence. 786. a. b. . . Operation. 172. Pathology Report. Ductal Carcinoma In Situ. . 1. Post-excisional biopsy status.. . 2. Size of tumor: 2.0 cm, residual.. . 3. Nuclear grade: low.. . 4. Necrosis: absent.. . 5. Architectural. pattern:. cribriform. and. papillary.. . 6. Skin: no involvement of tumor.. . 7. Surgical margins:. . (a) Superior margin: 25 mm.. . (b) Inferior margin: 7 mm.. . (c) Medial margin: 30 mm.. . (d) Lateral margin: 20 mm.. . (e) Deep margin: 3 mm.. . (f) Superficial margin: 13 mm.. . 8. Microcalcification: absent.. Result. Intensity. Positive %. Estrogen. receptor. Strong (7/8). 2. >2/3. Progesterone. receptor. Strong (8/8). 2. >2/3. C-erbB2. Negative (0). Ki-67. Positive in 5%. of tumor cells. Adjuvant Therapy. Postoperative radiation therapy.. Treatments After Recurrence. 173. 174. Operation. . 175. Pathology Report. Invasive Ductal Carcinoma. 1. Post-lumpectomy status.. 2. Size of tumor: 1.2 cm (rpT1c).. 3. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 2/3, 11/10HPF).. Y. Kim et al.. 787. 4. Intraductal component: present, intratu. moral/extratumoral (10%) (nuclear grade:. low, necrosis: absent, architectural pattern:. cribriform, extensive intraductal component:. absent).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) Deep margin: 2 mm.. . (b) Superficial margin: 2 mm.. 7. Lymph nodes: not submitted.. 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):. rpT1c.. . . Local Recurrence. 788. . . Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 2. >2/3. Progesterone. receptor. Strong (8/8). 2. >2/3. C-erbB2. Negative (1+). Ki-67. Positive in 11%. of tumor cells. Adjuvant Therapy. Anastrozole 1 mg/day.. 27. |
414 | Case 26 | Patient History | Local Recurrence | Patient History and Progress. Female/40 years old, post-menopause.. Bloody nipple discharge from right breast.. Outside result of biopsy: Ductal carcinoma in. situ.. No family history.. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 26.2. |
401 | Case 26 | Courses of Treatment | Metastatic Breast Cancer | 26.1. . Courses of Treatment. Right breast cancer → Operation → Adjuvant. therapy → Stomach and bone metastasis.. Primary Treatment. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative (1+). Ki-67. Positive in. 29% of tumor. cells. Left> Invasive lobular carcinoma, stage. pT1c(m)N1mi.. Size of tumor: up to 1.5 cm, multiple, lymph. node: 2/7, size of metastatic carcinoma: 1.5 mm.. Result. Intensity Positive %. Estrogen. receptor. Strong (7/8). 2. >2/3. Progesterone. receptor. Strong (7/8). 3. 1/3–2/3. C-erbB2. Negative (0). Ki-67. Positive in. 17% of tumor. cells. Adjuvant Therapy. Adjuvant chemotherapy #8 cycles (Adriamycin. & Cyclophosphamide #4 → Docetaxel #4).. Post-operative radiation therapy +Tamoxifen. 20 mg/day for 5 years.. Treatments After Recurrence. See Figs. 93 and 94.. May 2018 Metastasis on stomach, bone.. Stomach biopsy Pathology: Metastatic ductal. carcinoma.. Result. Intensity. Positive %. Estrogen. receptor. Intermediate. (6/8). 2. 1/3–2/3. Progesterone. receptor. Strong (7/8). 3. 1/3–2/3. C-erbB2. Negative (0). Ki-67. Positive in. 8% of tumor. cells. Palliative Therapy. Bilateral salpingo-oophorectomy.. Letrozole 2.5 mg/day + Palbociclib~. Total gastrectomy.. Y. Kwon et al. |
415 | Case 26 | Patient History | Metastatic Breast Cancer | Patient History and Progress. Female/54 years old, post-menopause.. No family history.. S/p cholecystectomy, s/p total gastrectomy (gas. tric cancer), s/p bilateral salpingo-oophorectomy.. 26.2. |
416 | Case 27 | Courses of Treatment | Benign and Proliferative | 27.1. . Courses of Treatment. →2021-06-07 excision, Rt.. Pathology Report. Diagnosis. • Breast, right, excision:. –. – Intraductal papilloma with usual ductal. hyperplasia.. . C. W. Lee et al.. 51. © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023. E. S. Lee (ed.), A Practical Guide to Breast Cancer Treatment,. https://doi.org/10.1007/978-981-19-9044-1_3 |
424 | Case 27 | Important Radiologic | Benign and Proliferative | Important Radiologic. Findings. 53. 27.3. |
430 | Case 27 | Patient History | Benign and Proliferative | Patient History and Progress. Female/41 years old, pre-menopause.. Screen detected mass lesion on right breast 4. o’clock direction.. Outside result of biopsy: Papillary neoplasm.. No family history.. No comorbidities.. 27.2. |
417 | Case 27 | Courses of Treatment | Carcinoma In Situ | 27.1. . Courses of Treatment. Operation + Tamoxifen 20 mg/day for 5 years.. Operation. 126. 127. Pathology Report. Lobular carcinoma in situ, pathological TN. category (AJCC 2017): pTis. . 1. Size of tumor: 1.5 cm(pTis).. . 2. Nuclear grade: low.. Carcinoma In Situ. 113. . 3. Necrosis: absent.. . 4. Architectural pattern: solid.. . 5. Skin: no involvement of tumor.. . 6. Surgical margins:. . (a) superior margin: 50 mm,. . (b) inferior margin: (see Note 1),. . (c) medial margin: 5 mm,. . (d) lateral margin: 10 mm,. . (e) deep margin: positive for lobular carci. noma in situ (slide 1),. . (f) superficial margin: 5 mm.. . 7. Microcalcification: absent.. Note: 1. The inferior margin of the lumpec. tomy specimen (slide 4) is close to lobular. carcinoma in situ (<1 mm) but this margin. submitted for frozen diagnosis (Fro 2) is free. of tumor.. Result. Intensity. Positive %. Estrogen. receptor. Strong (7/8). 2. >2/3. Progesterone. receptor. Strong (7/8). 2. >2/3. C-erbB2. Negative (0). Ki-67. Positive in 2%. of tumor cells. 28. |
425 | Case 27 | Important Radiologic | Carcinoma In Situ | Important Radiologic. Findings. 123 124. 125. 27.3. |
431 | Case 27 | Patient History | Carcinoma In Situ | Patient History and Progress. Female/50 years old, pre-menopause.. Screen detected mass lesion on left breast. 2 o’clock direction.. Outside result of mammotome biopsy:. Lobular carcinoma in situ.. No family history.. 27.2. |
418 | Case 27 | Courses of Treatment | HR(+) HER2(+) Breast Cancer | 27.1. . Courses of Treatment. Neoadjuvant chemotherapy (#6 cycles of. docetaxel and carboplatin and trastuzumab. and pertuzumab) + Operation + Post-. operative. radiation. ther. apy + Trastuzumab + Tamoxifen 20 mg/day.. . 160. 161. Pathology Report. [Right].. . 1. Ductal carcinoma in situ involving sclerosing. adenosis.. . (a) Post-chemotherapy status.. . (b) Size of tumor: 0.3 cm (ypTis).. . (c) Nuclear grade: low.. . (d) Necrosis: absent.. . (e) Architectural pattern: cribriform/solid.. . (f) Skin: no involvement of tumor.. . (g) Surgical margins:. • superior margin: 10 mm,. • inferior margin: 20 mm,. • medial margin: 5 mm,. • lateral margin: 15 mm,. • deep margin: 5 mm,. • superficial margin: 5 mm.. . (h) Microcalcification: present, non-tumoral.. . (i) Pathological TN category (AJCC 2017):. ypTis.. . 2. Fibroadenoma.. Result. Intensity. Positive. %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Intermediate. (5/8). 2. 10%-. 1/3. C-erbB2. Negative (0). Ki-67. Positive in <1%. of tumor cells. [Left].. Invasive ductal carcinoma, histologic grade 2. with extensive intraductal component. . 1. No residual tumor with (1) necrotic detritus,. (2) foamy histiocytic collection.. . (a) Post-chemotherapy status. . (b) Lymph nodes: no metastasis in one axil. lary lymph node (ypN0(sn)) (sentinel LN:. 0/1). . (c) Microcalcification: present, non-tumoral. . 2. Sclerosing adenosis with microcalcification.. Result. Intensity. Positive. %. Estrogen. receptor. Strong (7/8). 3. 1/3–2/3. Progesterone. receptor. Weak (3/8). 1. 1–10%. C-erbB2. Positive (3+). Ki-67. Positive in 32%. of tumor cells. HR(+) HER2(+) Breast Cancer. 392. . . S. Park et al.. 393. . a. b. . HR(+) HER2(+) Breast Cancer. 394. a. b. . . 28. |
426 | Case 27 | Important Radiologic | HR(+) HER2(+) Breast Cancer | Important Radiologic. Findings. 155 156 157 158. 159. . S. Park et al.. 391. . . 27.3. |
432 | Case 27 | Patient History | HR(+) HER2(+) Breast Cancer | Patient History and Progress. Female/52 years old, peri-menopause.. Self-detected palpable mass lesion on left. breast 11 o’clock direction.. Family history of breast cancer, cousin. (maternal).. s/p Ovarian cyst excision.. BRCA 1 and 2 mutation: Not detected, NBN. VUS (variant of uncertain).. 27.2. |
419 | Case 27 | Courses of Treatment | HR(+) HER2(-) Breast Cancer | 27.1. . ductal component: present).. 4. Surgical margins:. . (a) superior margin: positive for ductal car. cinoma in situ (Fro 1) (see note 1).. . (b) inferior margin: 25 mm.. . (c) medial margin: (see note 2).. . (d) lateral margin: 15 mm.. . (e) deep margin: <1 mm from invasive duc. tal carcinoma (slide 7).. . (f) superficial margin: <1 mm from invasive. ductal carcinoma (slide 6).. 5. Lymph nodes: no metastasis in one axillary. lymph node (pN0(sn)) (sentinel LN: 0/1). 6. Arteriovenous invasion: absent.. 7. Lymphovascular invasion: absent.. 8. Tumor border: infiltrative.. 9. Microcalcification: present, tumoral.. . 10. Pathological TN category (AJCC 2017):. pT2N0(sn).. HR(+) HER2(−) Breast Cancer. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Intermediate. (6/8). 2. 1/3–2/3. C-erbB2. Negative (1+). Ki-67. Positive in 44%. of tumor cells. Y. Kim et al. |
427 | Case 27 | Important Radiologic | HR(+) HER2(-) Breast Cancer | Important Radiologic. Findings. See Figs. 150, 151, 152 and 153.. Y. Kim et al. |
433 | Case 27 | Patient History | HR(+) HER2(-) Breast Cancer | Patient History and Progress. Female/60 years old, post-menopause.. Screen detected mass lesion on left breast 10. o’clock direction.. No family history.. No comorbidities.. 27.2. |
420 | Case 27 | Courses of Treatment | HR(−) HER2(+) Breast Cancer | 27.1. . Courses of Treatment. Operation + Post-operative radiation ther. apy + Adjuvant paclitaxel and trastuzumab.. Operation. 188. Pathology Report. . 1. Invasive ductal carcinoma with medullary. pattern.. . (a) Size of tumor: 0.8 cm (pT1b).. . (b) Histologic grade: 3/3 (tubule formation:. 3/3, nuclear pleomorphism: 3/3, mitotic. count: 3/3, 4/HPF).. . (c) Intraductal component: present, intratu. moral/extratumoral (50%) (nuclear grade:. high, necrosis: absent, architectural pat. tern: solid, extensive intraductal compo. nent: present).. . (d) Skin: no involvement of tumor.. . (e) Surgical margins:. • superior margin: 5 mm,. • inferior margin: 20 mm,. • medial margin: 5 mm,. • lateral margin: 5 mm,. • deep margin: 1.5 mm from ductal car. cinoma in situ (slide 1),. • superficial margin: 2 mm.. . (f) Lymph nodes: no metastasis in one axil. lary lymph node (pN0(sn)) (sentinel LN:. 0/1).. . (g) Arteriovenous invasion: absent.. . (h) Lymphovascular. invasion:. present,. intratumoral.. a. b. . Y. Kwon et al.. 533. . (i) Tumor border: infiltrative.. . (j) Microcalcification:. present,. tumoral/. non-tumoral.. . (k) Pathological TN category (AJCC 2017):. pT1bN0(sn).. . 2. Intraductal papilloma with usual ductal. hyperplasia.. Result. Intensity. Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Equivocal(2+),. SISH(+). Ki-67. Positive in. 26% of tumor. cells. 28. |
428 | Case 27 | Important Radiologic | HR(−) HER2(+) Breast Cancer | Important Radiologic. Findings. 185 186. 187. . . . HR(−) HER2(+) Breast Cancer. 532. 27.3. |
434 | Case 27 | Patient History | HR(−) HER2(+) Breast Cancer | Patient History and Progress. Female/69 years old, post-menopause.. Screen detected mass lesion on right breast 9. o’clock direction.. Family history of breast cancer, sister.. Hypertension, dyslipidemia.. BRCA 1 and 2 mutation: Not examination.. 27.2. |
421 | Case 27 | Courses of Treatment | HR(−) HER2(−) Breast Cancer | 27.1. . Courses of Treatment. Neoadjuvant chemotherapy (#4 cycles of. doxorubicin and cyclophosphamide + #4. cycles of docetaxel) + Operation + Post-. operative radiation therapy + Adjuvant. capecitabine.. Operation. 203. Pathology Report. Invasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of tumor: 2.8 cm (ypT2).. 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 14/10HPF).. 4. Intraductal component: absent.. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) Superior margin: 5 mm.. . (b) Inferior margin: 5 mm.. . (c) Medial margin: 5 mm.. . (d) Lateral margin: 5 mm.. . (e) Deep margin: 2 mm.. . (f) Superficial margin: 2 mm.. 7. Lymph nodes: no metastasis in three axillary. lymph nodes (ypN0(i+)(sn)) (sentinel LN:. 0/2, axillary LN: 0/1).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular. invasion:. present,. intratumoral.. . 10. Tumor border: infiltrative.. . 11. Microcalcification:. present,. tumoral/. non-tumoral.. . 12. Pathological TN category (AJCC 2017):. ypT2N0(i+)(sn).. Note: 1. A few isolated tumor cells are present. only in the permanent section of Fro 6 for. . immunohistochemical staining.. HR(−) HER2(−) Breast Cancer. 674. . . . E. S. Lee et al.. 675. . . . 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 89%. of tumor cells. 28. |
429 | Case 27 | Important Radiologic | HR(−) HER2(−) Breast Cancer | Important Radiologic. Findings. 196 197 198. 199. . HR(−) HER2(−) Breast Cancer. 672. . . . . E. S. Lee et al.. 673. . After Neoadjuvant. Chemotherapy. 200 201. 202. 27.3. |
435 | Case 27 | Patient History | HR(−) HER2(−) Breast Cancer | Patient History and Progress. Female/36 years old, pre-menopause.. Self-detected palpable mass lesion on left. breast.. Family history of breast cancer, aunt. (maternal).. No comorbidities.. BRCA 1 and 2 mutation: Not detected,. RAD50 VUS (variant of uncertain).. 27.2. |
422 | Case 27 | Courses of Treatment | Local Recurrence | 27.1. . Courses of Treatment. Right breast tubular carcinoma → Operation. → Adjuvant therapy → Left breast recurrence. (IDC).. Primary Treatment. 176 177 178. 179. Operation. . 180. Pathology Report. Tubular Carcinoma. 1. Size of tumor: 1.5 cm (pT1c).. 2. Histologic grade: 1/3 (tubule formation: 1/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 2/10HPF).. Y. Kim et al.. 789. 3. Intraductal component: present, intratu. moral/extratumoral (5%) (nuclear grade:. low, necrosis: absent, architectural pattern:. cribriform, extensive intraductal component:. absent).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) Superior margin: 18 mm.. . (b) Inferior margin: 13 mm.. . (c) Medial margin: 10 mm.. . (d) Lateral margin: 10 mm.. . (e) Deep margin: 3 mm.. . (f) Superficial margin: 3 mm.. 6. Lymph nodes: no metastasis in one axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/1).. 7. Vascular invasion: absent.. 8. Lymphatic invasion: absent.. 9. Tumor border: infiltrative.. . 10. Microcalcification: present, tumoral.. . 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 (1+). Ki-67. Positive in 11%. of tumor cells. . . a. b. . Local Recurrence. 790. Adjuvant Therapy. Postoperative radiation therapy.. Tamoxifen 20 mg/day for 5 years.. Treatments After Recurrence. 181 182. 183. Operation. . 184. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 0.3 cm (pT1a).. 2. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 6/10HPF).. 3. Intraductal component: present, intratu. moral/extratumoral (50%) (nuclear grade:. low, necrosis: absent, architectural pattern:. micropapillary/cribriform, extensive intra. ductal component: present).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) Superior margin: 10 mm.. . (b) Inferior margin: positive for invasive. ductal carcinoma (Fro 7) (see note).. . (c) Medial margin: 10 mm.. . (d) Lateral margin: 10 mm.. . (e) Deep margin: <1 mm from ductal carci. noma in situ (slide 1).. . (f) Superficial margin: 2 mm.. 6. Lymph nodes: no metastasis in two axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/2).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular invasion: absent.. 9. Tumor border: infiltrative.. . 10. Microcalcification:. present,. tumoral/. non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT1aN0(sn).. Note: 1. Invasive ductal carcinoma is focally. present only in the permanent section of Fro 7.. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Intermediate. (6/8). 3. 10%-1/3. C-erbB2. Negative (1+). Ki-67. Positive in 2%. of tumor cells. . . . . Y. Kim et al.. 791. a. b. . . . Operation. Second Operation (Dec. 2021) Left breast wide. excision.. Pathology Report. Atypical ductal hyperplasia. . 1. Post-lumpectomy status.. Adjuvant Therapy. Postoperative radiation therapy.. 28. |
436 | Case 27 | Patient History | Local Recurrence | Patient History and Progress. Female/57 years old, post-menopause.. Screen detected mass lesion on right breast 1. o’clock direction.. Outside result of biopsy: Invasive ductal. carcinoma.. Family history of breast cancer, younger. sister.. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 27.2. |
423 | Case 27 | Courses of Treatment | Metastatic Breast Cancer | Courses of Treatment. Left breast cancer → Operation → Adjuvant. therapy. →. Right. shoulder. soft. tissue. metastasis.. Primary Treatment. Estrogen. receptor. Strong (6/7). 3. 1/3–2/3. Progesterone. receptor. Weak (2/7). 1. <10%. C-erbB2. Equivocal. (2+). Ki-67. Positive in. 15% of tumor. cells. FISH. Negative. Adjuvant Therapy. Adjuvant chemotherapy #8 cycles (Adriamycin. & Cyclophosphamide #4 → Docetaxel #4).. Post-operative radiation therapy + Letrozole. 2.5 mg/day for 1 year → Tamoxifen 20 mg/day. for 1 year.. Jun. 2021 Right shoulder soft tissue biopsy.. Pathology: Metastatic ductal carcinoma.. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Weak (3/8). 1. 1–10%. C-erbB2. Negative (1+). Ki-67. Positive in. 6% of tumor. cells. Palliative Therapy. Clinical trial enrolled (SAR439859/placebo +. Letrozole/placebo+ Palbociclib)~. 28. |
437 | Case 27 | Patient History | Metastatic Breast Cancer | 27.2. |
438 | Case 28 | Courses of Treatment | Carcinoma In Situ | 28.1. . Courses of Treatment. Operation + Tamoxifen 20 mg/day for 5 years.. Operation. 131. 132. Pathology Report. Lobular carcinoma in situ, pathological TN. category (AJCC 2017): pTis. . 1. Size of tumor: 0.7 cm (pTis).. . 2. Nuclear grade: low.. . 3. Necrosis: absent.. . 4. Architectural pattern: solid.. . 5. Skin: No involvement of tumor.. . 6. Surgical margins:. . (a) superior margin: (see Note),. . (b) inferior margin: 25 mm,. . (c) medial margin: 10 mm,. . (d) lateral margin: 20 mm,. . (e) deep margin: 5 mm,. . (f) superficial margin: 2 mm.. . 7. Microcalcification: absent.. Note: 1. The superior margin of the. lumpectomy specimen (slide 1) is close to. lobular carcinoma in situ (1 mm) but this mar. gin submitted for frozen diagnosis (Fro 1) is. free of tumor.. Result. Intensity. Positive %. Estrogen. receptor. Intermediate. (6/8). 1. >2/3. Progesterone. receptor. Strong (7/8). 2. >2/3. C-erbB2. Negative (1+). Ki-67. Positive in 6%. of tumor cells. . Carcinoma In Situ. . 29. |
445 | Case 28 | Important Radiologic | Carcinoma In Situ | Important Radiologic. Findings. 128 129. 130. 28.3. |
450 | Case 28 | Patient History | Carcinoma In Situ | Patient History and Progress. Female/50 years old, pre-menopause.. Screen detected microcalcification on upper. outer portion of right breast.. Outside result of stereotactic excisional. biopsy: Lobular carcinoma in situ.. No family history.. No comorbidities.. 28.2. |
439 | Case 28 | Courses of Treatment | HR(+) HER2(+) Breast Cancer | 28.1. . Courses of Treatment. Operation + Adjuvant chemotherapy (#3. cycles of doxorubicin and cyclophospha. mide). +. Post-operative. radiation. ther. apy + Trastuzumab + Tamoxifen 20 mg/day.. 166. Pathology Report. . 1. Invasive Ductal Carcinoma.. . (a) Size of invasive component: 1.6 cm. (pT1c).. . (b) Size of intraductal component: 3.0 cm.. S. Park et al.. 395. . . . HR(+) HER2(+) Breast Cancer. 396. a. b. . . (c) Histologic grade: 3/3 (tubule formation:. 3/3, nuclear pleomorphism: 3/3, mitotic. count: 3/3, 3/HPF).. . (d) Intraductal component: present, intratu. moral/extratumoral (50%) (nuclear grade:. high, necrosis: present, architectural pat. tern: solid/comedo, extensive intraductal. component: present).. . (e) Skin: no involvement of tumor.. . (f) Surgical margins:. • superior margin: 10 mm,. • inferior margin: 10 mm,. • medial margin: 5 mm,. • lateral margin: 5 mm,. • deep margin: 2 mm,. • superficial margin: 2 mm.. . (g) Lymph nodes: no metastasis in two axil. lary lymph nodes (pN0(sn)) (sentinel LN:. 0/2).. . (h) Arteriovenous invasion: absent.. . (i) Lymphovascular. invasion:. present,. intratumoral.. . (j) Tumor border: infiltrative.. . (k) Microcalcification:. present,. tumoral/. non-tumoral.. . (l) Pathological TN category (AJCC 2017):. pT1cN0(sn).. . 2. Intraductal papilloma with usual ductal. hyperplasia.. 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 44%. of tumor cells. SISH. Positive. S. Park et al.. 397. 29. |
446 | Case 28 | Important Radiologic | HR(+) HER2(+) Breast Cancer | Important Radiologic. Findings. 162 163 164. 165. 28.3. |
451 | Case 28 | Patient History | HR(+) HER2(+) Breast Cancer | Patient History and Progress. Female/47 years old, pre-menopause.. Self-detected palpable mass lesion on right. breast 6 o’clock direction.. No family history.. Hepatitis B carrier.. 28.2. |
440 | Case 28 | Courses of Treatment | HR(+) HER2(-) Breast Cancer | . Courses of Treatment. Operation + Post-operative radiation ther. apy + Letrozole 2.5 mg/day with palbociclib. 100 mg/day.. Operation. Right breast conserving surgery, sentinel lymph. ponent: absent).. 4. Skin: no involvement of tumor.. HR(+) HER2(−) Breast Cancer. . (e) deep margin: 5 mm.. . (f) superficial margin: 2 mm.. 6. Lymph nodes:. . (a) metastasis in two out of two axillary. lymph nodes (pN1a(sn)) (see note) (sen. tinel LN: 1/1, axillary LN: 1/1). . (b) perinodal extension: present.. . (c) size of metastatic carcinoma: 6 mm.. 7. Arteriovenous invasion: absent.. 8. Lymphovascular. invasion:. present,. intratumoral.. 9. Tumor border: infiltrative.. . 10. Microcalcification: present, tumoral.. . 11. Pathological TN category (AJCC 2017):. pT2N1a(sn).. Note: 1. Micrometastasis is present only. in the permanent section of Fro 1.. Result. Intensity. Positive %. Estrogen receptor. Strong (8/8). 3. >2/3. Progesterone receptor. Intermediate (6/8). 2. 1/3–2/3. C-erbB2. Negative (1+). Ki-67. Positive in 9% of tumor cells. Y. Kim et al. |
447 | Case 28 | Important Radiologic | HR(+) HER2(-) Breast Cancer | Important Radiologic. Findings. See Figs. 155, 156, 157 and 158.. 28.3. |
452 | Case 28 | Patient History | HR(+) HER2(-) Breast Cancer | Patient History and Progress. Female/72 years old, post-menopause.. Screen detected mass lesion on right breast 8. o’clock direction.. No family history.. S/p cholecystectomy, hypertension.. 28.2. |
441 | Case 28 | Courses of Treatment | HR(−) HER2(+) Breast Cancer | 28.1. . docetaxel and carboplatin and trastuzumab and. pertuzumab) + Operation + Post-operative radia. tion therapy + Trastuzumab and pertuzumab.. Operation. 196. Pathology Report. Ductal Carcinoma In Situ. 1. Post-chemotherapy status.. 2. Size of tumor: 0.2 cm (ypTis).. 3. Nuclear grade: high.. 4. Necrosis: absent.. 5. Architectural pattern: solid.. 6. Skin: no involvement of tumor.. 7. Surgical margins:. . (a) superior margin: 20 mm,. . (b) inferior margin: 10 mm,. . (c) medial margin: 30 mm,. . (d) lateral margin: 5 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: 2 mm.. 8. Lymph nodes: no metastasis in three axillary. lymph nodes (ypN0(sn)) (sentinel LN: 0/3).. 9. Microcalcification:. present,. tumoral/. non-tumoral.. . 10. Pathological TN category (AJCC 2017):. ypTisN0(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 38%. of tumor cells. . Y. Kwon et al.. 537. 29. |
448 | Case 28 | Important Radiologic | HR(−) HER2(+) Breast Cancer | Important Radiologic. Findings. 189 190 191. 192. . HR(−) HER2(+) Breast Cancer. 534. . . . F. ig. 192. Chemotherapy. 193 194. 195. . . |
453 | Case 28 | Patient History | HR(−) HER2(+) Breast Cancer | 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.. 28.2. |
442 | Case 28 | Courses of Treatment | HR(−) HER2(−) Breast Cancer | 28.1. . Courses of Treatment. Operation + Post-operative radiation therapy. (Adjuvant chemotherapy refuse).. Operation. 207. Pathology Report. Malignant Adenomyoepithelioma (Epithelial-. Myoepithelial Carcinoma). 1. Size of tumor: 2.0 cm (pT1c).. HR(−) HER2(−) Breast Cancer. 676. . . . . E. S. Lee et al.. 677. . 2. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 3/3, 23/10HPF).. 3. Intraductal component: absent.. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) Superior margin: 10 mm.. . (b) Inferior margin: 10 mm.. . (c) Medial margin: 15 mm.. . (d) Lateral margin: 25 mm.. . (e) Deep margin: 9 mm.. . (f) Superficial margin: <1 mm from. epithelial-. myoepithelial. carcinoma. (slides 2 and 7).. 6. Arteriovenous invasion: absent.. 7. Lymphovascular invasion: absent.. 8. Tumor border: pushing.. 9. Microcalcification: present, non-tumoral.. . 10. Pathological TN category (AJCC 2017):. pT1c.. 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 18%. of tumor cells. 29. |
449 | Case 28 | Important Radiologic | HR(−) HER2(−) Breast Cancer | Important Radiologic Findings. 204 205. 206. 28.3. |
454 | Case 28 | Patient History | HR(−) HER2(−) Breast Cancer | Patient History and Progress. Female/57 years old, post-menopause.. Self-detected palpable mass lesion on right.. No family history.. S/P. right. neck. excision. (due. to. lymphadenitis).. 28.2. |
443 | Case 28 | Courses of Treatment | Local Recurrence | 28.1. . Courses of Treatment. Left breast DCIS → Operation → Adjuvant. therapy → Left breast recurrence (microinva. sive ductal carcinoma).. Primary Treatment. 185 186 187. 188. Local Recurrence. 792. . . . . Operation. . 189. Pathology Report. Ductal carcinoma in situ. 1. Post mammotome biopsy status.. 2. Size of tumor: 2.0 cm, residual (pTis).. 3. Nuclear grade: high.. 4. Necrosis: present.. 5. Architectural pattern: solid and comedo.. 6. Skin: no involvement of tumor.. 7. 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.. 8. Lymph nodes: no metastasis in 3 axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/3,. axillary LN: 0/0).. Y. Kim et al.. 793. . . 9. Microcalcification:. present,. tumoral/. non-tumoral.. . 10. Pathologic staging: pTisN0(sn).. Result. Intensity. Positive %. Estrogen. receptor. Negative (0/7). 0. 0. Progesterone. receptor. Negative (0/7). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in 10%. of tumor cells. Adjuvant Therapy. Postoperative radiation therapy.. Treatments After Recurrence. 190 191. 192. Operation. . 193. Local Recurrence. 794. Pathology Report. Microinvasive Ductal Carcinoma. 1. Size of tumor: 0.1 cm (pTis).. 2. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, not identified).. 3. Intraductal component: present, intratu. moral/extratumoral (90%) (nuclear grade:. high, necrosis: present, architectural pattern:. comedo, cribriform, and solid, extensive. intraductal component: absent/present).. 4. Skin: no involvement of tumor.. 5. Surgical margins: (deep margin: 1 mm from. ductal carcinoma in situ).. 6. Vascular invasion: absent.. 7. Lymphatic invasion: absent.. 8. Tumor border: infiltrative.. 9. Microcalcification:. present,. tumoral/. non-tumoral.. . 10. Pathologic stage (AJCC 2010): pTisNx.. Result. Intensity. Positive %. Estrogen. receptor. Strong (7/7). 3. >2/3. Progesterone. receptor. Strong (7/7). 3. >2/3. C-erbB2. Positive (2+). Ki-67. Positive in 25%. of tumor cells. . . . a. b. . Y. Kim et al.. 795. Adjuvant Therapy. Tamoxifen 20 mg/day for 6.5 years with. goserelin.. 29. |
455 | Case 28 | Patient History | Local Recurrence | Patient History and Progress. Female/50 years old, pre-menopause.. Screen detected mass lesion on left breast 2. o’clock direction.. Outside result of mammotome excision:. Ductal carcinoma in situ.. No family history.. No comorbidities.. 28.2. |
444 | Case 28 | Courses of Treatment | Metastatic Breast Cancer | 28.1. . Courses of Treatment. Right breast cancer → Operation → Adjuvant. therapy. →. Right. shoulder. soft. tissue. metastasis.. Primary Treatment. receptor. Strong (7/8). 2. >2/3. Progesterone. receptor. Strong (7/8). 2. >2/3. C-erbB2. Negative (1+). Ki-67. Positive in 7%. of tumor cells. Adjuvant Therapy. Post-operative radiation therapy + Tamoxifen. 20 mg/day.. Treatments After Recurrence. >2/3. Progesterone. receptor. Weak (3/8). 2. <1%. C-erbB2. Negative (1+). Ki-67. Positive in. 6% of tumor. Apr. 2020 Left axillary lymph node sampling and. bilateral salpingo-oophorectomy.. Pathology: Metastatic ductal carcinoma in one. out of three axillary lymph nodes.. Size of metastatic carcinoma: 6 mm.. Result. Intensity. Positive %. Estrogen. receptor. Intermediate. (5/8). 2. 10–1/3. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Negative (1+). Ki-67. Positive in 1%. of tumor cells. Adjuvant Therapy. Post-operative radiation therapy (axilla).. Liver Metastasis. May 2020 Liver MRI: r/o liver metastasis. |
456 | Case 28 | Patient History | Metastatic Breast Cancer | Patient History and Progress. Female/51 years old, post-menopause.. No family history.. BRCA 1 & 2 mutation: Not detected, ATM. VUS (variant of uncertain).. Metastatic Breast Cancer. 908. 28.2. |
457 | Case 29 | Courses of Treatment | Carcinoma In Situ | 29.1. . Courses of Treatment. Operation + Adjuvant chemotherapy #4 cycles. (Doxorubicin and Cyclophosphamide) + Postope. rative radiation therapy (both) + Letrozole. 2.5 mg/day for 5 years.. Operation. 136. 137. Pathology Report. Right.. Lobular carcinoma in situ, pathological TN. category (AJCC 2017): pTis. . 1. Size of tumor: 2.5 cm (pTis).. . 2. Nuclear grade: low.. . 3. Necrosis: absent.. . 4. Architectural pattern: solid.. . 5. Surgical margins:. . (a) superior margin: (see Note 1),. . (b) inferior margin: (see Note 2),. . (c) medial margin: 5 mm,. . (d) lateral margin: positive for lobular carci. noma in situ (Fro 4) (see Note 3),. . (e) deep margin: <1 mm from lobular carci. noma in situ (slides 4 and 5),. . (f) superficial margin: 3 mm.. . 6. Microcalcification:. present,. tumoral/. non-tumoral.. Note: 1. The superior margin of the. lumpectomy specimen (slide 2) is close to. lobular carcinoma in situ (3 mm) but this mar. gin submitted for frozen diagnosis (Fro 1) is. free of tumor.. 2. The inferior margin of the lumpectomy. specimen (slide 4) is close to lobular car. cinoma in situ (<1 mm) but this margin. submitted for frozen diagnosis (Fro 2) is. free of tumor.. 3. Lobular carcinoma in situ is present only in. the permanent section of Fro 4.. Carcinoma In Situ. 116. . . E. S. Lee et al.. 117. a. b. c. d. . . Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Intermediate. (5/8). 3. 1%–10%. C-erbB2. Negative. (1+). Ki-67. Positive in. 1% of tumor. cells. Left.. Invasive ductal carcinoma, pathological TN. category (AJCC 2017): pT1cN0(sn). . 1. Size of tumor: 1.5 cm (pT1c).. . 2. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 2/3, 11/10HPF).. . 3. Intraductal component: present, intratumoral. (20%) (nuclear grade: low, necrosis: present,. architectural pattern: micropapillary/cribri. form/solid/comedo,. extensive. intraductal. component: absent).. . 4. Surgical margins:. . (a) superior margin: 20 mm,. . (b) inferior margin: 15 mm,. . (c) medial margin: 10 mm,. . (d) lateral margin: 10 mm,. . (e) deep margin: 8 mm,. . (f) superficial margin: 10 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,. intratumoral.. . 8. Tumor border: infiltrative.. . 9. Microcalcification: present, non-tumoral.. Result. Intensity Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Negative (2/8). 1. <1%. C-erbB2. Negative (1+). Ki-67. Positive in 17%. of tumor cells. Carcinoma In Situ. 118. 30. |
464 | Case 29 | Important Radiologic | Carcinoma In Situ | Important Radiologic. Findings. 133 134. 135. 29.3. |
469 | Case 29 | Patient History | Carcinoma In Situ | Patient History and Progress. Female/50 years old, post-menopause.. Screen detected mass lesion on left breast. 2 o’clock direction.. Outside result of biopsy: Left breast 2 o’clock,. invasive ductal carcinoma.. No family history.. No comorbidities.. BRCA 1 and 2 mutation: Not detected, MSH6. VUS (variant of uncertain).. 29.2. |
458 | Case 29 | Courses of Treatment | HR(+) HER2(+) Breast Cancer | 29.1. . Courses of Treatment. Operation + Adjuvant chemotherapy (#4. cycles of docetaxel and cyclophosphamide and. trastuzumab) + Post-operative radiation ther. apy + Trastuzumab + Letrozole 2.5 mg/day.. 171. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 2.1 cm (pT2).. 2. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 2/3, 11/10 HPF).. 3. Intraductal component: present, intratu. moral/extratumoral (5%) (nuclear grade:. low, necrosis: absent, architectural pattern:. papillary/cribriform/solid, extensive intra. ductal component: 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: 4 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: <1 mm from invasive. ductal carcinoma (slide 4).. 6. Lymph nodes: no metastasis in three axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/3).. a. b. . HR(+) HER2(+) Breast Cancer. 400. 7. Arteriovenous invasion: absent.. 8. Lymphovascular. invasion:. present,. intratumoral.. 9. Tumor border: infiltrative.. . 10. Microcalcification:. present,. . tumoral/. non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT2N0(sn).. Result. Intensity. Positive. %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (7/8). 3. 1/3–2/3. C-erbB2. Positive (3+). Ki-67. Positive in 28%. of tumor cells. 30. |
465 | Case 29 | Important Radiologic | HR(+) HER2(+) Breast Cancer | Important Radiologic. Findings. 167 168 169. 29.3. |
470 | Case 29 | Patient History | HR(+) HER2(+) Breast Cancer | Patient History and Progress. Female/80 years old, post-menopause.. Self-detected mass lesion on right breast 8. o’clock direction.. No family history.. Hypertension, dyslipidemia, s/p tympano. plasty.. 29.2. |
459 | Case 29 | Courses of Treatment | HR(+) HER2(-) Breast Cancer | Courses of Treatment. Operation + Post-operative radiation ther. apy + Letrozole 2.5 mg/day.. Y. Kim et al.. 265. Operation. Left breast conserving surgery, sentinel lymph. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) superior margin: 20 mm.. . (b) inferior margin: 10 mm.. . (c) medial margin: 15 mm.. . (d) lateral margin: 15 mm.. . (e) deep margin: 10 mm.. . (f) superficial margin: 5 mm.. 6. Lymph nodes: no metastasis in two axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/2,. non-sentinel LN: 0/0). 7. Arteriovenous invasion: absent.. 8. Lymphovascular invasion: absent.. 9. Tumor border: infiltrative.. . 10. Microcalcification: present, non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT1bN0(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 4% of |
466 | Case 29 | Important Radiologic | HR(+) HER2(-) Breast Cancer | Important Radiologic. Findings. See Figs. 160, 161, 162 and 163.. 29.3. |
471 | Case 29 | Patient History | HR(+) HER2(-) Breast Cancer | S/P hysterectomy, hypertension, s/p left cere. bral infarction, s/p transient ischemic attack.. 29.2. |
460 | Case 29 | Courses of Treatment | HR(−) HER2(+) Breast Cancer | 29.1. . Courses of Treatment. Operation (adjuvant chemotherapy refuse).. Operation. 200. 201. Pathology Report. Microinvasive Ductal Carcinoma. 1. Size of invasive component: <0.1 cm (pT1mi).. 2. Size of intraductal component: 5.0 cm.. 3. Histologic grade: not applicable.. 4. Intraductal component: present, intratu. moral/extratumoral (99%) (nuclear grade:. high, necrosis: present, architectural pattern:. micropapillary/cribriform/comedo,. exten. sive intraductal component: present).. 5. Skin: no involvement of tumor.. 6. Surgical margins: (see Note 1).. . (a) deep margin: 2 mm,. . (b) superficial margin: 2 mm.. 7. Lymph nodes: no metastasis in two axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/2,. axillary LN: 0/0).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular invasion: absent.. . 10. Tumor border: infiltrative.. . 11. Microcalcification:. present,. tumoral/. non-tumoral.. . 12. Pathological TN category (AJCC 2017):. pT1miN0(sn).. Breast, left nipple, excision: Ductal carcinoma. in situ (see Note 2).. Breast, left nipple margin, excision: Ductal. carcinoma in situ (see Note 2).. Note: 1. The lateral border of the mastectomy. specimen (slide MG8) is close to ductal carci. noma in situ (<1 mm).. 2. The nipple margin separately submitted for. permanent diagnosis (slides B&C) is positive for. ductal carcinoma in situ but this margin submit. ted for frozen diagnosis (Fro 9) is free of tumor.. 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. 29% of tumor. cells. . Y. Kwon et al.. 539. a. b. . . . 30. |
467 | Case 29 | Important Radiologic | HR(−) HER2(+) Breast Cancer | Important Radiologic. Findings. 197 198. 199. . . . . HR(−) HER2(+) Breast Cancer. 538. 29.3. |
472 | Case 29 | Patient History | HR(−) HER2(+) Breast Cancer | Patient History and Progress. Female/39 years old, pre-menopause.. Self-detected palpable mass lesion on upper. outer portion of left breast.. No family history.. S/P Left salpingo-oophorectomy.. BRCA 1 and 2 mutation: Not detected.. 29.2. |
461 | Case 29 | Courses of Treatment | HR(−) HER2(−) Breast Cancer | 29.1. . Courses of Treatment. Neoadjuvant chemotherapy (#4 cycles of doxo. rubicin and cyclophosphamide + #4 cycles of. docetaxel) + Operation + Post-operative radia. tion therapy + Adjuvant capecitabine.. Operation. 215. Pathology Report. Microinvasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of tumor: <0.1 cm (ypT1mi).. 3. Histologic grade: not applicable.. 4. Intraductal component: absent.. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) Superior margin: 10 mm.. . (b) Inferior margin: 10 mm.. . (c) Medial margin: 10 mm.. . (d) Lateral margin: 10 mm.. . (e) Deep margin: 2 mm.. . (f) Superficial margin: 2 mm.. 7. Lymph nodes: no metastasis in six axillary. lymph nodes (ypN0) (sentinel LN: 0/3, non-. sentinel LN: 0/3).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular invasion: absent.. . 10. Tumor border: infiltrative.. . 11. Microcalcification: present, tumoral/non-. tumoral.. . 12. Pathological TN category (AJCC 2017):. ypT1miN0.. 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 43%. of tumor cells. E. S. Lee et al.. 681. . . . . . HR(−) HER2(−) Breast Cancer. 682. 30. |
468 | Case 29 | Important Radiologic | HR(−) HER2(−) Breast Cancer | Important Radiologic Findings. 208 209 210. 211. . E. S. Lee et al.. 679. . . . . HR(−) HER2(−) Breast Cancer. 680. . After Neoadjuvant. Chemotherapy. 212 213. 214. 29.3. |
473 | Case 29 | Patient History | HR(−) HER2(−) Breast Cancer | Patient History and Progress. Female/27 years old, pre-menopause.. Self-detected mass lesion on left breast.. No family history.. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. HR(−) HER2(−) Breast Cancer. 678. 29.2. |
462 | Case 29 | Courses of Treatment | Local Recurrence | 29.1. . Courses of Treatment. Left breast IDC→ Operation → Adjuvant ther. apy → Left breast recurrence (IDC).. Primary Treatment. 194 195 196. 197. Operation. . 198. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 3.0 cm (pT2).. . . . . Local Recurrence. 796. 2. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 2/3, 12/10HPF).. 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: <1 mm from invasive duc. tal carcinoma (slide 2).. . (b) Superficial margin: <1 mm from ductal. carcinoma in situ (slide 9).. . . Y. Kim et al.. 797. 6. Lymph nodes: no metastasis in one axillary. lymph node (pN0(sn)) (sentinel LN: 0/1).. 7. Arteriovenous invasion: absent.. 8. Extensive lymphovascular invasion: present,. intratumoral/peritumoral.. 9. Tumor border: infiltrative.. . 10. Microcalcification:. present,. tumoral/. non-tumoral.. . 11. Pathologic stage (AJCC 2010): pT2N0(sn).. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Negative (2/8). 1. <1%. C-erbB2. Equivocal (2+). (SISH negative). Ki-67. Positive in 11%. of tumor cells. Adjuvant Therapy. Adjuvant chemotherapy #4 cycles of cyclophos. phamide and docetaxel.. Tamoxifen 20 mg/day for 3.6 years.. Treatments After Recurrence. 199. 200. Operation. . 201. 202. Pathology Report. <Right>. Fibrocystic change.. <Left>. Invasive Ductal Carcinoma. 1. Post-nipple-sparing mastectomy status.. 2. Size of tumor: 2.0 cm and 1.8 cm (rpT1c(2)).. 3. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 2/3, 11/10HPF).. 4. Intraductal component: absent.. 5. Skin: dermal involvement of tumor.. 6. Surgical margins:. . (a) Deep margin: positive for invasive. . ductal carcinoma (slide 1).. . (b) Superficial margin: 2 mm.. 7. Lymph nodes: no metastasis in one axillary. lymph node (rpN0(sn)) (sentinel LN: 0/1).. . . Local Recurrence. 798. a. b. c. d. . a. b. . 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):. rpT1cN0(sn).. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Negative (2/8). 1. <1%. C-erbB2. Equivocal (2+). (SISH negative). Ki-67. Positive in 2%. of tumor cells. Y. Kim et al.. 799. Adjuvant Therapy. Postoperative radiation therapy.. Letrozole 2.5 mg/day.. 30. |
474 | Case 29 | Patient History | Local Recurrence | Patient History and Progress. Female/46 years old, pre-menopause.. Screen detected mass lesion on left breast 7:30. o’clock direction.. Outside result of biopsy: (1) Invasive ductal. carcinoma, (2) Atypical ductal hyperplasia.. Family history of breast cancer, mother.. Asthma.. BRCA 1 VUS (variant of uncertain).. 29.2. |
463 | Case 29 | Courses of Treatment | Metastatic Breast Cancer | Courses of Treatment. Right breast cancer → Neoadjuvant chemother. apy → Operation → Adjuvant therapy → Lung. metastasis.. Primary Treatment. receptor. Strong. (6/7). 3. 1/3–2/3. Progesterone. receptor. Strong. (6/7). 3. 1/3–2/3. C-erbB2. Negative. (1+). Ki-67. N.A. Clinical stage: cT3N1M0.. Operation. Oct. 2007 Right total mastectomy, axillary lymph. node dissection.. Pathology: Invasive ductal carcinoma, stage. ypT2N0.. Size of tumor: 2.5 cm, lymph node: 0/6.. Result. Intensity. Positive %. Estrogen. receptor. Strong (6/7). 3. 1/3–2/3. Progesterone. receptor. Weak (2/7). 1. <10%. C-erbB2. Negative. (1+). Ki-67. Positive in. 5% of tumor. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative (0). Ki-67. Positive in. 15% of. tumor cells. Aug. 2021 Chest CT:. LN enlargement, right interlobar and right. lower paratracheal, metastasis.. Bronchovascular bundle thickening in RUL. and centrilobular nodules in RLL, lymphangitic. metastasis.. Palliative Therapy. Letrozole 2.5 mg/day + (ribociclib #1→ palboci. clib~) + zoladex~. Y. Kwon et al.. 911. 30. |
475 | Case 29 | Patient History | Metastatic Breast Cancer | |
476 | Case 3 | Courses of Treatment | Benign and Proliferative | 3.1. . Courses of Treatment. → 2021-12-10 Excision, Rt.. C. W. Lee et al.. 21. . . . . 3.3.1. . Pathology Report. Diagnosis. • Breast, right, excision:. –. – Intraductal papilloma.. 4. |
484 | Case 3 | Important Radiologic | Benign and Proliferative | Important Radiologic. Findings. 4. 5. 3.3. |
490 | Case 3 | Patient History | Benign and Proliferative | Patient History and Progress. Female/72 years old, post-menopause.. Screen detected nodular lesion on right breast. 9 o’clock direction.. No family history.. Hypertension.. 3.2. |
477 | Case 3 | Courses of Treatment | Carcinoma In Situ | Courses of Treatment. Operation + Tamoxifen 20 mg/day for 5 years.. 3.3.1. . Operation. 13. 14. 3.3.2. . Pathology Report. <First operation>. Lobular carcinoma in situ. . 1. Size of tumor: 0.3 cm.. . 2. Nuclear grade: low.. . 3. Necrosis: absent.. . 4. Architectural pattern: solid.. . 5. Surgical margins:. . (a) superior margin: <1 mm (slide 3),. . (b) inferior margin: 5 mm,. . (c) medial margin: positive (slide 4),. . (d) lateral margin: 5 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: 2 mm.. . 6. Microcalcification:. present,. tumoral/non-. tumoral.. Result. Intensity. Positive %. Estrogen. receptor. Strong (7/8). 3. 1/3–2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative (1+). Ki-67. Positive in 5%. of tumor cells. <Second operation>. E. S. Lee et al.. 57. . . Carcinoma In Situ. 58. Lobular carcinoma in situ. . 1. Post-excision status.. . 2. Size of tumor: 0.3 cm, residual.. . 3. Nuclear grade: low.. . 4. Necrosis: absent.. . 5. Architectural pattern: solid.. . 6. Surgical margins:. . (a) Superior margin: 5 mm.. . (b) Inferior margin: 5 mm.. . (c) Medial margin: 5 mm.. . (d) Lateral margin: 5 mm.. . (e) Deep margin: 2 mm.. . (f) Superficial margin: 2 mm.. . 7. Microcalcification: present, non-tumoral.. 4. |
485 | Case 3 | Important Radiologic | Carcinoma In Situ | 3.1. . Important Radiologic. Findings. 11. 12. 3.3. |
491 | Case 3 | Patient History | Carcinoma In Situ | Patient History and Progress. Female/41 years old, pre-menopause.. Screen detected microcalcifications on right. breast upper outer.. Outside result of biopsy: Right 10 o’clock. 1.. Usual ductal hyperplasia, 2. duct ectasia.. No family history.. S/P Hallux valgus operation.. 3.2. |
478 | Case 3 | Courses of Treatment | HR(+) HER2(+) Breast Cancer | 3.1. . Courses of Treatment. Operation + Adjuvant chemotherapy (#4. cycles of doxorubicin and cyclophospha. mide). +. Post-operative. radiation. ther. apy + Trastuzumab + Letrozole 2.5 mg/day.. . . S. Park et al.. 307. . 18. 3.3.1. . Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 1.8 cm (pT1c).. 2. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 2/3, 10/10 HPF).. 3. Intraductal component: present, intratu. moral/extratumoral (10%) (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: (see note),. . (c) medial margin: 5 mm,. . (d) lateral margin: 10 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: 4 mm.. HR(+) HER2(+) Breast Cancer. 308. 6. Lymph nodes: no metastasis in one axillary. lymph node (pN0(sn)) (sentinel LN: 0/1).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular invasion: absent.. 9. Tumor border: infiltrative.. . 10. Microcalcification:. present,. tumoral/. non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT1cN0(sn).. Note: 1. The inferior margin of the lumpec. tomy specimen (slides 3 and 4) is close to ductal. carcinoma in situ (2 mm) but this margin submit. ted 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. Equivocal (2+). Ki-67. Positive in 43%. of tumor cells. SISH. Positive. . . S. Park et al.. 309. a. b. . 4. |
486 | Case 3 | Important Radiologic | HR(+) HER2(+) Breast Cancer | Important Radiologic. Findings. 13 14 15 16. 17. 3.3. |
492 | Case 3 | Patient History | HR(+) HER2(+) Breast Cancer | Patient History and Progress. Female/58 years old, post-menopause.. Screen detected mass lesion on right breast 7. o’clock direction.. No family history.. Dyslipidemia.. 3.2. |
479 | Case 3 | Courses of Treatment | HR(+) HER2(-) Breast Cancer | Courses of Treatment. Operation + Post-operative radiation ther. apy + Letrozole 2.5 mg/day.. Y. Kim et al.. moral/extratumoral (5%) (nuclear grade:. low, necrosis: absent, architectural pattern:. cribriform, extensive intraductal component:. absent).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) superior margin: 10 mm,. . (b) inferior margin: 20 mm,. . (c) medial margin: 10 mm,. . (d) lateral margin: 10 mm (see note 1),. . (e) deep margin: 2 mm,. . (f) superficial margin: 2 mm.. 6. Lymph nodes: no metastasis in three axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/1,. non-sentinel LN: 0/2).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular. invasion:. present,. intratumoral.. 9. Tumor border: infiltrative.. . 10. Microcalcification:. present,. tumoral/. non-tumoral.. Breast, right subareolar:. Invasive Ductal Carcinoma. 1. Size of tumor: 1.1 cm (pT1c).. 2. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 2/3, 11/10 HPF).. 3. Intraductal component: present, intratu. moral/extratumoral (10%) (nuclear grade:. low, necrosis: absent, architectural pattern:. cribriform, extensive intraductal component:. absent).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) superior margin: 10 mm,. . (b) inferior margin: (see note 2),. . (c) medial margin: 10 mm,. . (d) lateral margin: 10 mm,. . (e) deep margin: 1 mm from invasive ductal. carcinoma (slide 9),. . (f) superficial margin: 2 mm.. 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):. pT1cN0(sn).. Result. Intensity. Positive %. Estrogen receptor. Strong (7/8). 2. >2/3. Progesterone receptor. Weak (3/8). 1. 1–10%. C-erbB2. Negative (1+). Ki-67. Positive in 4% of tumor cells. Y. Kim et al. |
487 | Case 3 | Important Radiologic | HR(+) HER2(-) Breast Cancer | Important Radiologic. Findings. See Figs. 10, 11, 12 and 13.. 3.3. |
493 | Case 3 | Patient History | HR(+) HER2(-) Breast Cancer | No family history.. L-spine disc herniation.. 3.2. |
480 | Case 3 | Courses of Treatment | HR(−) HER2(+) Breast Cancer | 3.1. . Courses of Treatment. Palliative chemotherapy (#7 cycles of docetaxel. and. trastuzumab. and. pertuzumab). +. Operation. +. Post-operative. radiation. ther. apy + Palliative trastuzumab and pertuzumab.. 3.4.1. . Operation. 26. 3.4.2. . Pathology Report. 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: 12 mm,. . (b) inferior margin: (see note),. . (c) medial margin: 10 mm,. . (d) lateral margin: 20 mm,. . (e) deep margin: 10 mm,. . (f) superficial margin: 12 mm.. 8. Lymph nodes: no metastasis in four axillary. lymph nodes (ypN0(sn)) (sentinel LN: 0/4).. 9. Arteriovenous invasion: absent.. . 10. Lymphovascular invasion: absent.. . 11. Tumor border: pushing.. . 12. Microcalcification:. present,. tumoral/. non-tumoral.. . 13. Pathological TN category (AJCC 2017):. ypTisN0(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. 14% of tumor. cells. . . . HR(−) HER2(+) Breast Cancer. 442. 4. |
488 | Case 3 | Important Radiologic | HR(−) HER2(+) Breast Cancer | Important Radiologic. Findings. 18 19 20. 21. . HR(−) HER2(+) Breast Cancer. 438. . . . Y. Kwon et al.. 439. F. i. g. . 21. . . . . . . . 3.3. . After Neoadjuvant. Chemotherapy. 22 23 24. 25. Y. Kwon et al.. 441. 3.4. |
494 | Case 3 | Patient History | HR(−) HER2(+) Breast Cancer | Patient History and Progress. Female/61 years old, post-menopause.. Self-detected nipple retraction on right breast.. Family history of breast cancer, cousin. (maternal).. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 3.2. |
481 | Case 3 | Courses of Treatment | HR(−) HER2(−) Breast Cancer | 3.1. . Courses of Treatment. Operation + operation, Transfer.. 3.3.1. . Operation. 20. 3.3.2. . Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 2.3 cm (pT2).. 2. Histologic grade: 3/3 (tubule formation: 2/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 82/10HPF).. 3. Intraductal component: present, extratumoral. (30%) (nuclear grade: high, necrosis: pres. ent, architectural pattern: solid/comedo,. extensive intraductal component: present).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) superior margin: (see note),. . (b) inferior margin: positive for ductal carci. noma in situ (Fro 5),. E. S. Lee et al.. 583. . . . . . . HR(−) HER2(−) Breast Cancer. 584. . . . . . (c) medial margin: positive for ductal carci. noma in situ (Fro 6),. . (d) lateral margin: 5 mm,. . (e) deep margin: <1 mm from ductal carci. noma in situ (slide 11),. . (f) superficial margin: 5 mm.. 6. Lymph nodes: no metastasis in three axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/3,. non-sentinel LN: 0/0).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular. invasion:. present,. intratumoral.. E. S. Lee et al.. 585. . 9. Tumor border: infiltrative.. . 10. Microcalcification: present, tumoral.. . 11. Pathological TN category (AJCC 2017):. pT2N0(sn).. Breast, left 2 o’clock, lumpectomy:. Invasive Ductal Carcinoma. 1. Size of invasive component: 0.2 cm.. 2. Size of intraductal component: 2.0 cm.. 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 2/3, 13/10HPF).. 4. Intraductal component: present, intratu. moral/extratumoral (90%) (nuclear grade:. high, necrosis: present, architectural pattern:. solid/comedo, extensive intraductal compo. nent: present).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) Superior margin: 5 mm.. . (b) Inferior margin: positive for ductal car. cinoma in situ (slide 21).. . (c) Medial margin: 5 mm.. . (d) Lateral margin: <1 mm from ductal car. cinoma in situ (slide 22).. . (e) Deep margin: <1 mm from ductal carci. noma in situ (slide 21).. . (f) Superficial margin: 1 mm from ductal. carcinoma in situ (slide 18).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular invasion: absent.. 9. Tumor border: infiltrative.. . 10. Microcalcification: present, non-tumoral.. Note: 1. The superior margin of the. lumpectomy specimen (slide 1) is positive for. ductal carcinoma in situ, but this margin sub. mitted for frozen diagnosis (Fro 4) is free of. tumor.. 21. 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 53%. of tumor cells. 4. |
489 | Case 3 | Important Radiologic | HR(−) HER2(−) Breast Cancer | Important Radiologic. Findings. 16 17 18. 19. 3.3. |
495 | Case 3 | Patient History | HR(−) HER2(−) Breast Cancer | Patient History and Progress. Female/41 years old, pre-menopause.. Screen detected mass lesion on left breast 3. o’clock direction.. No family history.. No comorbidities.. 3.2. |
482 | Case 3 | Courses of Treatment | Local Recurrence | 3.1. . Courses of Treatment. Left breast IDC + DCIS → Operation → Left. breast recurrence (DCIS).. 14. 15. 3.2.1. . Operation. 16. 3.2.2. . Pathology Report. Ductal Carcinoma In Situ. . 1. Size of tumor: 1.5 cm.. . 2. Nuclear grade: high.. . 3. Necrosis: present.. . 4. Architectural pattern: solid/comedo.. . 5. Surgical margins:. . (a) Superior margin: 2 mm (slide 6).. . (b) Inferior margin: 1.5 mm (slide 6).. . (c) Medial margin: 10 mm.. . (d) Lateral margin: <1 mm (slide 7).. . (e) Deep margin: 2 mm.. . 6. Microcalcification:. present,. tumoral/. non-tumoral.. Result. Intensity. Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (2/8). 1. <1%. C-erbB2. Positive (3+). Ki-67. Positive in 35%. of tumor cells. Y. Kim et al.. 723. a. b. . a. b. c. d. . 3.2.3. . Operation. 17. 3.2.4. . Pathology Report. Invasive Ductal Carcinoma. 1. Post-excision status.. 2. Size of invasive component: 0.2 cm (pT1a).. 3. Size of intraductal component: 3.5 cm.. 4. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 1/3, <1/10HPF).. 5. Intraductal component: present, extratumoral. (99%) (nuclear grade: high, necrosis: pres. ent, architectural pattern: micropapillary/. cribriform/solid/comedo, extensive intra. ductal component: present).. Local Recurrence. 724. 6. Skin: no involvement of tumor.. 7. Surgical margins:. . (a) Superior margin: (see note 1).. . (b) Inferior margin: (see note 2).. . (c) Medial margin: 15 mm.. . (d) Lateral margin: (see note 3).. . (e) Deep margin: <1 mm from ductal carci. noma in situ (slide 14).. . (f) Superficial margin: 2 mm.. 8. Arteriovenous invasion: absent.. 9. Lymphovascular invasion: absent.. . 10. Tumor border: infiltrative.. . 11. Microcalcification: present, tumoral.. . 12. Pathological TN category (AJCC 2017): pT1a.. 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 65%. of tumor cells. 3.3. . Treatments After Recurrence. 18 19. 20. 3.3.1. . Operation. . 21. 3.3.2. . Pathology Report. Ductal Carcinoma In Situ. 1. Post-excision status.. 2. Size of tumor: 1.5 cm (rpTis).. 3. Nuclear grade: high.. 4. Necrosis: present.. 5. Architectural pattern: micropapillary.. 6. Skin: no involvement of tumor.. 7. Surgical margins:. . (a) Deep margin: 2 mm.. . (b) Superficial margin: 2 mm.. 8. Lymph nodes: no metastasis in one axillary. lymph node (pN0(sn)) (sentinel LN:0/1).. . . . Y. Kim et al.. 725. . 9. Microcalcification:. present,. tumoral/. non-tumoral.. . 10. Pathological TN category (AJCC 2017):. rpTisN0(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 19%. of tumor cells. 4. |
496 | Case 3 | Patient History | Local Recurrence | Patient History and Progress. Female/47 years old, pre-menopause.. Screen detected microcalcification on upper. portion of left breast.. Family history of colon cancer, father.. No comorbidities.. 3.2. |
483 | Case 3 | Courses of Treatment | Metastatic Breast Cancer | Courses of Treatment. Left. breast. cancer. →. Neoadjuvant. Chemotherapy → Operation → Adjuvant therapy. → Bone, lung, and brain metastasis.. 3.2.1. . Primary Treatment. Docetaxel #4).. Operation. Mar. 2018 Left modified radical mastectomy.. Pathology: Invasive ductal carcinoma, stage. ypT2N1.. Size of tumor: 2.7 * 2.4 cm, lymph node: 2/5,. size of metastatic carcinoma: 4 mm.. Metastatic Breast Cancer. Estrogen. receptor. Negative. (0/8). 0. 0. Progesterone. receptor. Negative. (0/8). 0. 0. C-erbB2. Negative. (1+). Ki-67. Positive. in 26% of. tumor. cells. Adjuvant Therapy. Post-operative radiation therapy +adjuvant che. motherapy (Xeloda).. 3.2.2. . Treatments After Recurrence. Bone metastasis → Lung metastasis → Brain. metastasis → Progression.. Palliative Therapy. Apr. 2020 Bone scan: multiple bone metastasis in. right T2-5, T7 and left 4th–5th ribs.. → Nab-paclitaxel/atezolizumab #7 cycles:. Progressive disease on pleural nodule.. → Xeloda #7 cycles: Progressive disease on. brain → Whole brain radiation therapy.. → Gemcitabine #2 cycles: Progressive disease. on pleural effusion.. → Eribulin #2 cycles: Progressive disease on. pleural effusion.. → Vinorelbine/carboplatin #3 cycles: clini. cally progressive disease.. See Figs. 9, 10, 11, and 12.. Y. Kwon et al. |
497 | Case 3 | Patient History | Metastatic Breast Cancer | |
498 | Case 30 | Courses of Treatment | Carcinoma In Situ | 30.1. . Courses of Treatment. Operation + Postoperative Radiation therapy.. Operation. 142. 143. Pathology Report. Ductal carcinoma in situ, pathological TN cat. egory (AJCC 2017): pTisN0(sn). . 1. Size of tumor: 2.0 cm (pTis).. . 2. Nuclear grade: high.. . 3. Necrosis: present.. . 4. Architectural pattern: micropapillary/cribri. form/solid/comedo.. . 5. Skin: no involvement of tumor.. . 6. Surgical margins:. . (a) nipple margin: positive for ductal carci. noma in situ (Fro 4),. . (b) subareolar margin: positive for ductal car. cinoma in situ (Fro 1),. . (c) deep margin: 2 mm,. . (d) 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.. . Carcinoma In Situ. 120. . . Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Intermediate. (5/8). 2. 10%−1/3. C-erbB2. Positive (3+). Ki-67. Positive in. 11% of tumor. cells. 31. |
505 | Case 30 | Important Radiologic | Carcinoma In Situ | Important Radiologic. Findings. 138 139 140. 141. 30.3. |
510 | Case 30 | Patient History | Carcinoma In Situ | Patient History and Progress. Female/60 years old, post-menopause.. Screen detected mass and microcalcification. on left breast 10 o’clock direction.. Outside result of biopsy: Ductal carcinoma in. situ.. No family history.. Claustrophobia, hypertension.. 30.2. |
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