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499 | Case 30 | Courses of Treatment | HR(+) HER2(+) Breast Cancer | 30.1. . Courses of Treatment. Neoadjuvant chemotherapy (#6 cycles of. docetaxel and carboplatin and trastuzumab. and pertuzumab) + Operation + Post-. operative radiation therapy.. 179. Pathology Report. Ductal Carcinoma In Situ. . 1. Post-chemotherapy status.. . 2. Size of tumor: 2.0 cm (ypTis).. . 3. Nuclear grade: high.. . 4. Necrosis: present.. . 5. Architectural pattern: papillary/micropapil. lary/cribriform/solid/comedo.. . 6. Surgical margins:. . (a) superior margin: 8 mm,. . (b) inferior margin: 7 mm,. . (c) medial margin: 15 mm,. . (d) lateral margin: (see note),. . (e) deep margin: 3 mm,. . (f) superficial margin: 7 mm.. . 7. Lymph nodes: no metastasis in three axillary. lymph nodes (ypN0(sn)) (sentinel LN: 0/3).. . 8. Microcalcification: present, tumoral.. . 9. Pathological TN category (AJCC 2017):. ypTisN0(sn).. Note: 1. The lateral margin of the lumpectomy. specimen (slide 4) is close to ductal carcinoma in. situ (3 mm) but this margin submitted for frozen. diagnosis (Fro 4) is free of tumor.. Result. Intensity Positive %. Estrogen. receptor. Strong (7/8). 3. 1/3–2/3. Progesterone. receptor. Intermediate. (5/8). 2. 10%-1/3. C-erbB2. Positive (3+). Ki-67. Positive in 9%. of tumor cells. S. Park et al.. 403. . . . HR(+) HER2(+) Breast Cancer. 404. a. b. . 31. |
506 | Case 30 | Important Radiologic | HR(+) HER2(+) Breast Cancer | Important Radiologic. Findings. 172 173 174 175 176 177. 178 |
511 | Case 30 | Patient History | HR(+) HER2(+) Breast Cancer | Patient History and Progress. Female/31 years old, pre-menopause.. Self-detected palpable mass lesion on outer. inner portion of right breast.. No family history.. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 30.2. |
500 | Case 30 | Courses of Treatment | HR(+) HER2(-) Breast Cancer | Courses of Treatment. Operation + Post-operative radiation ther. apy + Letrozole 2.5 mg/day.. Operation. Left breast conserving surgery, sentinel lymph. ponent: absent).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) superior margin: 15 mm.. . (b) inferior margin: 15 mm.. . (c) medial margin: 10 mm.. . (d) lateral margin: 15 mm.. . (e) deep margin: 3 mm.. . (f) superficial margin: 15 mm.. 6. Lymph nodes: no metastasis in one axillary. lymph node (pN0(i+)(sn)) (see note) (senti. nel LN: 0/1, non-sentinel LN: 0/0). 7. Arteriovenous invasion: absent.. 8. Lymphovascular. invasion:. present,. intratumoral.. 9. Tumor border: infiltrative.. . 10. Microcalcification: present, non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT1cN0(i+)(sn).. Note: 1. A few isolated tumor cells are. present only in the permanent section of Fro. 1 for immunohistochemical staining.. Result. Intensity. Positive %. Estrogen receptor. Strong (8/8). 3. >2/3. Progesterone receptor. Strong (7/8). 2. >2/3. C-erbB2. Negative (1+). Ki-67. Positive in 11% of tumor cells. Y. Kim et al. |
507 | Case 30 | Important Radiologic | HR(+) HER2(-) Breast Cancer | Important Radiologic. Findings. See Figs. 165, 166, 167 and 168.. 30.3. |
512 | Case 30 | Patient History | HR(+) HER2(-) Breast Cancer | s/p Left optic nerve palsy, hypertension, s/p. right rotator cuff tear operation.. 30.2. |
501 | Case 30 | Courses of Treatment | HR(−) HER2(+) Breast Cancer | 30.1. . Courses of Treatment. Neoadjuvant chemotherapy (#6 cycles of. docetaxel and carboplatin and trastuzumab and. pertuzumab) + Operation + Post-operative radia. tion therapy + Trastuzumab and pertuzumab.. 3. Histologic grade: not applicable.. 4. Intraductal component: absent.. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) superior margin: 10 mm,. . (b) inferior margin: (see note),. . (c) medial margin: 10 mm,. . (d) lateral margin: 10 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: 2 mm.. 7. Lymph nodes: no metastasis in three axillary. lymph nodes (ypN0(sn)) (sentinel LN: 0/3).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular invasion: absent.. . 10. Tumor border: infiltrative.. . 11. Microcalcification: present, tumoral.. . 12. Pathological TN category (AJCC 2017):. ypT1miN0(sn).. Note: 1. The inferior margin of the lumpec. tomy specimen (slide 5) is close to microinvasive. ductal carcinoma (2 mm) but this margin submit. ted for frozen diagnosis (Fro 2) 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. 19% of tumor. cells. a. b. . Y. Kwon et al.. 543. 31. |
508 | Case 30 | Important Radiologic | HR(−) HER2(+) Breast Cancer | Important Radiologic. Findings. 202 203. 204. HR(−) HER2(+) Breast Cancer. 540. . . Y. Kwon et al.. 541. 30.3. . After Neoadjuvant. Chemotherapy. 205 206. 207. 30.4. |
513 | Case 30 | Patient History | HR(−) HER2(+) Breast Cancer | Patient History and Progress. Female/41 years old, pre-menopause.. Self-detected palpable mass and nipple dis. charge on left breast.. No family history.. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 30.2. |
502 | Case 30 | Courses of Treatment | HR(−) HER2(−) Breast Cancer | 30.1. . Courses of Treatment. Neoadjuvant chemotherapy (#2 cycles of. doxorubicin and cyclophosphamide + #3. cycles of paclitaxel) + Operation + Adjuvant. capecitabine.. Operation. 224. Pathology Report. Invasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of tumor: 3.5 cm (ypT2).. 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 4/1HPF).. 4. Intraductal component: present, extratumoral. (5%) (nuclear grade: high, necrosis: absent,. architectural pattern: solid, extensive intra. ductal component: absent).. 5. Skin and nipple: no involvement of tumor.. 6. Surgical margins:. . (a) Deep margin: 1 mm from invasive ductal. carcinoma (slide 6).. . (b) Superficial margin: 2 mm.. . . . . HR(−) HER2(−) Breast Cancer. 684. . E. S. Lee et al.. 685. . . . 7. Lymph nodes: no metastasis in two axillary. lymph nodes (ypN0(sn)) (sentinel LN: 0/2).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular. invasion:. present,. intratumoral.. . 10. Tumor border: infiltrative.. . 11. Microcalcification:. present,. tumoral/. non-tumoral.. . 12. Pathological TN category (AJCC 2017):. ypT2N0(sn).. Result. Intensity. Positive. %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Equivocal (2+),. SISH (−). Ki-67. Positive in 86%. of tumor cells. HR(−) HER2(−) Breast Cancer. 686. . 31. |
509 | Case 30 | Important Radiologic | HR(−) HER2(−) Breast Cancer | Important Radiologic. Findings. 216 217. 218. . E. S. Lee et al.. 683. After Neoadjuvant. Chemotherapy. 219 220 221 222. 223. 30.3. |
514 | Case 30 | Patient History | HR(−) HER2(−) Breast Cancer | Patient History and Progress. Female/69 years old, post-menopause.. Self-detected palpable mass lesion on left. breast.. No family history.. h/o Tuberculosis, s/p thoracic vertebra com. pression fracture.. 30.2. |
503 | Case 30 | Courses of Treatment | Local Recurrence | 30.1. . Courses of Treatment. Right breast IDC → Operation → Adjuvant. therapy → Left breast recurrence (IDC).. Primary Treatment. 203 204 205. 206. . . . . Local Recurrence. 800. a. b. c. d. . Operation. 207. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 2.2 cm (pT2).. 2. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 5/10HPF).. 3. Intraductal component: present, intratu. moral/extratumoral (5%) (nuclear grade:. low, necrosis: present, architectural pattern:. cribriform/solid, extensive intraductal com. ponent: absent).. 4. Skin and nipple: no involvement of tumor.. 5. No involvement of skeletal muscle.. 6. Surgical margins:. . (a) Deep margin: 8 mm.. . (b) Superficial margin: 15 mm.. 7. Lymph nodes:. . (a) metastasis in 1 out of 5 axillary lymph. nodes (pN1a) (sentinel LN: 1/3, axillary. LN: 0/2).. . (b) perinodal extension: present.. . (c) size of metastatic carcinoma: 11 mm.. 8. Arteriovenous invasion: absent.. 9. Lymphovascular. invasion:. present,. peritumoral.. . 10. Tumor border: infiltrative.. . 11. Microcalcification: present, tumoral.. . 12. Pathologic stage (AJCC 2010): pT2N1a.. 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 11%. of tumor cells. Adjuvant Therapy. Anastrozole 1 mg/day for 4 years.. Y. Kim et al.. 801. Treatments After Recurrence. 208 209. 210. Operation. 211. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 0.9 cm (pT1b).. 2. Histologic grade: 2 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 1/3, 3/10HPF).. 3. Intraductal component: present, intratu. moral/extratumoral (50%) (nuclear grade:. high, necrosis: present, architectural pattern:. comedo, extensive intraductal component:. present).. 4. Skin and nipple: no involvement of tumor.. 5. Surgical margins:. . (a) Deep margin: 2 mm.. . (b) Superficial margin: 20 mm.. 6. Lymph nodes: no metastasis in one axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/1).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular invasion: absent.. . . . Local Recurrence. 802. a. b. c. d. . 9. Tumor border: infiltrative.. . 10. Microcalcification: absent.. . 11. Pathological TN category (AJCC 2017):. pT1bN0(sn).. Result. Intensity. Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Equivocal (2+). (SISH negative). Ki-67. Positive in 6%. of tumor cells. 31. |
515 | Case 30 | Patient History | Local Recurrence | Patient History and Progress. Female/89 years old, post-menopause.. Screen detected mass lesion on right breast 1. o’clock direction.. Outside result of biopsy: Invasive ductal. carcinoma.. No family history.. Hypertension, Hypothyroidism, s/p Cardiac. stent insertion (angina).. s/p Shoulder ligament rupture operation.. 30.2. |
504 | Case 30 | Courses of Treatment | Metastatic Breast Cancer | 30.1. . Courses of Treatment. Right breast cancer → Operation → Adjuvant. therapy → Bone metastasis.. 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. 5% of tumor. cells. Adjuvant Therapy. Tamoxifen 20 mg/day.. Treatments After Recurrence |
516 | Case 30 | Patient History | Metastatic Breast Cancer | Patient History and Progress. Female/50 years old, pre-menopause.. No family history.. Hepatitis B virus carrier, s/p myomectomy.. 30.2. |
517 | Case 31 | Courses of Treatment | Carcinoma In Situ | 31.1. . Courses of Treatment:. Operation. Operation. 146. 147. Pathology Report. Ductal carcinoma in situ, pathological TN cat. egory (AJCC 2017): pTis. . 1. Size of tumor: 2.0 cm (pTis).. . 2. Nuclear grade: low.. . 3. Necrosis: absent.. . 4. Architectural pattern: papillary/micropapil. lary/cribriform.. E. S. Lee et al.. 121. . . . 5. Skin: no involvement of tumor.. . 6. Surgical margins:. . (a) deep margin: 2 mm,. . (b) superficial margin: 2 mm.. . 7. Microcalcification:. present,. tumoral/non-. tumoral.. Result. Intensity Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Equivocal (2+). Ki-67. Positive in 3%. of tumor cells. Carcinoma In Situ. 122. a. b. d. e. . . . E. S. Lee et al.. 123. 32. |
524 | Case 31 | Important Radiologic | Carcinoma In Situ | Important Radiologic. Findings. 144. 145. 31.3. |
529 | Case 31 | Patient History | Carcinoma In Situ | Patient History and Progress. Female/31 years old, pre-menopause.. Screen detected calcification on left breast. 11 o’clock direction.. Outside result of mammotome biopsy: Ductal. carcinoma in situ.. No family history.. No comorbidities.. BRCA 1 and 2: Not detected.. 31.2. |
518 | Case 31 | Courses of Treatment | HR(+) HER2(+) Breast Cancer | 31.1. . 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.. 184. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 1.7 cm (pT1c).. S. Park et al.. micropapillary/comedo,. extensive. intra. ductal component: absent).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) superior margin: 10 mm,. . (b) inferior margin: 15 mm,. . (c) medial margin: 15 mm,. . (d) lateral margin: 10 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: 2 mm.. HR(+) HER2(+) Breast Cancer. 406. . . S. Park et al.. 407. 6. Lymph nodes:. . (a) metastasis in one out of two axillary. lymph nodes (pN1a(sn)) (sentinel LN:. 1/1, axillary LN: 0/1),. . (b) perinodal extension: present,. . (c) size of metastatic carcinoma: 8 mm.. 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):. pT1cN1a(sn).. . a. b. . HR(+) HER2(+) Breast Cancer. 408. 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 19%. of tumor cells. 32. |
525 | Case 31 | Important Radiologic | HR(+) HER2(+) Breast Cancer | Important Radiologic. Findings. 180 181 182. 183. 31.3. |
530 | Case 31 | Patient History | HR(+) HER2(+) Breast Cancer | Patient History and Progress. Female/69 years old, post-menopause.. Self-detected nipple retraction on left breast.. No family history.. Hypertension.. 31.2. |
519 | Case 31 | Courses of Treatment | HR(+) HER2(-) Breast Cancer | Courses of Treatment. Operation. +. Adjuvant. chemotherapy. (#4 cycles of docetaxel & . cyclophosphamide) +. Post-operative radiation therapy + Letrozole. 2.5 mg/day.. Operation. Right breast conserving surgery, sentinel lymph. . (c) medial margin: 10 mm.. . (d) lateral margin: 10 mm.. . (e) deep margin: <1 mm from invasive duc. tal carcinoma (slide 2).. . (f) superficial margin: 5 mm.. 6. Lymph nodes:. . (a) metastasis in one out of four axillary. lymph nodes (pN1a(sn)) (sentinel LN:. 1/1, axillary LN: 0/3). . (b) perinodal extension: present.. . (c) size of metastatic carcinoma: 10 mm.. 7. Arteriovenous invasion: absent.. 8. Lymphovascular. invasion:. present,. intratumoral.. 9. Tumor border: infiltrative.. . 10. Microcalcification: absent.. . 11. Pathological TN category (AJCC 2017):. pT2N1a(sn).. Result. Intensity. Positive %. Estrogen receptor. Strong (8/8). 3. >2/3. Progesterone receptor. Negative (1/8) IDC. Strong (8/8) DCIS. 1. 3. <1%. >2/3. C-erbB2. Equivocal (2+) (SISH negative). Ki-67. Positive in 43% of tumor cells. HR(+) HER2(−) Breast Cancer |
526 | Case 31 | Important Radiologic | HR(+) HER2(-) Breast Cancer | Important Radiologic. Findings. See Figs. 170, 171, 172 and 173.. 31.3. |
531 | Case 31 | Patient History | HR(+) HER2(-) Breast Cancer | niece.. S/P. Hysterectomy. and. salpingo-oophorectomy.. BRCA 1 exon 9-13 deletion, exon 2-6. deletion.. 31.2. |
520 | Case 31 | Courses of Treatment | HR(−) HER2(+) Breast Cancer | 31.1. . Operation. 213. 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:. 3/3, 5/HPF).. 3. Intraductal component: present, intratu. moral/extratumoral (50%) (nuclear grade:. high, necrosis: present, architectural pattern:. solid/comedo, extensive intraductal compo. nent: present).. Y. Kwon et al.. 545. a. b. . 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) superior margin: 10 mm,. . (b) inferior margin: 10 mm,. . (c) medial margin: 20 mm,. . (d) lateral margin: 15 mm,. . (e) deep margin: 2 mm,. . (f) 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):. pT2N0(sn).. HR(−) HER2(+) Breast Cancer. 546. . . 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. 32. |
527 | Case 31 | Important Radiologic | HR(−) HER2(+) Breast Cancer | Important Radiologic. Findings. 209 210 211. 212. . HR(−) HER2(+) Breast Cancer |
532 | Case 31 | Patient History | HR(−) HER2(+) Breast Cancer | Patient History and Progress. Female/74 years old, post-menopause.. Screen detected mass lesion on left breast 1. o’clock direction.. No family history.. Hypertension.. 31.2. |
521 | Case 31 | Courses of Treatment | HR(−) HER2(−) Breast Cancer | 31.1. . Courses of Treatment. Neoadjuvant chemotherapy (#4 cycles of. doxorubicin and cyclophosphamide + #4. cycles of docetaxel) + Operation + Post-. operative radiation therapy + Adjuvant. capecitabine.. Operation. 233. Pathology Report. Invasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of tumor: 0.9 cm (ypT1b).. 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 18/10HPF).. 4. Intraductal component: absent.. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) Superior margin: 38 mm.. . (b) Inferior margin: 21 mm.. . (c) Medial margin: 20 mm.. . (d) Lateral margin: 15 mm.. . (e) Deep margin: 6 mm.. . (f) Superficial margin: 22 mm.. 7. Lymph nodes: no metastasis in five axillary. lymph nodes (ypN0(sn)) (sentinel LN: 0/3,. non-sentinel LN: 0/2).. E. S. Lee et al.. 689. . . . . HR(−) HER2(−) Breast Cancer. 690. 8. Arteriovenous invasion: absent.. 9. Lymphovascular invasion: absent.. . 10. Tumor border: infiltrative.. . 11. Microcalcification: absent.. . 12. 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. Negative (0). Ki-67. Positive in 75%. of tumor cells. . . E. S. Lee et al.. 691. 32. |
528 | Case 31 | Important Radiologic | HR(−) HER2(−) Breast Cancer | Important Radiologic. Findings. 225 226 227. 228. E. S. Lee et al.. 687. . . . . HR(−) HER2(−) Breast Cancer. 688. . After Neoadjuvant. Chemotherapy. 229 230 231. 232. 31.3. |
533 | Case 31 | Patient History | HR(−) HER2(−) Breast Cancer | Patient History and Progress. Female/41 years old, pre-menopause.. Self-detected mass lesion on right breast.. No family history.. No comorbidities.. BRCA 1 and 2 mutation: Not detected, STK11. VUS (variant of uncertain).. 31.2. |
522 | Case 31 | Courses of Treatment | Local Recurrence | 31.1. . Courses of Treatment. Right breast Papillary carcinoma in situ→. Operation → Right breast recurrence (DCIS).. Primary Treatment. 212 213 214. 215. Operation. . . 216 217. 218. Pathology Report. <Right>. Y. Kim et al.. 803. . . . . . Papillary carcinoma in situ. . 1. Size of tumor: 5.0 cm (pTis).. . 2. Nuclear grade: low.. . 3. Necrosis: present.. . 4. Architectural pattern: papillary/cribriform.. . 5. Surgical margins:. . (a) Deep margin: <1 mm (slide 6).. . (b) Superficial margin: 0.08 mm (slide 2).. . 6. Lymph nodes: no metastasis in four axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/4).. . 7. Microcalcification: absent.. . 8. Pathologic stage (AJCC 2010): pTisN0(sn).. Result. Intensity. Positive %. Estrogen. receptor. Strong (7/8). 3. 1/3–2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Equivocal (2+). Ki-67. Positive in 26%. of tumor cells. <Left>. Local Recurrence. 804. . . Y. Kim et al.. 805. . . . 1. Intraductal papillomas, multiple, up to 0.8 cm. . 2. Sclerosing adenosis with microcalcification.. Treatments After Recurrence. 219. 220. Biopsy. Right 1 o’clock.. Ductal carcinoma in situ:. . 1. Nuclear grade: low.. . 2. Necrosis: absent.. . 3. Architectural pattern: papillary/cribriform.. . 4. Microcalcification: absent.. Local Recurrence. 806. . Closed follow-up due to rejection of surgical. treatment.. 32. |
534 | Case 31 | Patient History | Local Recurrence | Patient History and Progress. Female/49 years old, pre-menopause.. Screen detected mass lesion on right breast 1. o’clock direction.. No family history.. No comorbidities.. 31.2. |
523 | Case 31 | Courses of Treatment | Metastatic Breast Cancer | Courses of Treatment. Right breast cancer → Operation → Adjuvant. therapy → Lung metastasis.. Primary Treatment. receptor. Negative (0/8). 0. 0. C-erbB2. Negative (0). Ki-67. Positive in. 85% of tumor. cells. Adjuvant Therapy. Adjuvant chemotherapy #6 cycles (Fluorouracil. & Doxorubicin & Cyclophosphamide).. Post-operative radiation therapy to right breast.. Olaparib & placebo (clinical trial 0040, for. 1 year).. Operation. Nov. 2014 Bilateral salpingo-oophorectomy (due. to BRCA 1, positive for deleterious mutation).. Treatments After Recurrence |
535 | Case 31 | Patient History | Metastatic Breast Cancer | BRCA 1: positive for deleterious mutation.. S/p bilateral salpingo-oophorectomy.. 31.2. |
536 | Case 32 | Courses of Treatment | Carcinoma In Situ | 32.1. . Courses of Treatment. Operation + Postoperative radiation therapy.. Operation. 151. 152. Pathology Report. Ductal carcinoma in situ, pathological TN cat. egory (AJCC 2017): pTis. . 1. Size of tumor: 4.0 cm (pTis).. . 2. Nuclear grade: high.. . 3. Necrosis: present.. . 4. Architectural pattern: . micropapillary/cribri. form/comedo.. . 5. Skin: no involvement of tumor.. . 6. Surgical margins:. . (a) superior margin: 10 mm,. . (b) inferior margin: 10 mm,. . (c) medial margin: 40 mm,. . (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. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Equivocal. (2+). Ki-67. Positive in. 27% of tumor. cells. . |
543 | Case 32 | Important Radiologic | Carcinoma In Situ | Important Radiologic. Findings. 148 149. 150. 32.3. |
548 | Case 32 | Patient History | Carcinoma In Situ | Patient History and Progress. Female/72 years old, post-menopause.. Screen detected mass lesion on right breast. 8 o’clock direction.. Outside result of biopsy: Ductal carcinoma in. situ.. No family history.. No comorbidities.. 32.2. |
537 | Case 32 | Courses of Treatment | HR(+) HER2(+) Breast Cancer | 32.1. . Courses of Treatment. Neoadjuvant chemotherapy (#3 cycles of. docetaxel. and. trastuzumab. and. pertu. zumab) + Operation + Post-operative radia. tion therapy + Trastuzumab emtansine +. Letrozole 2.5 mg/day.. Operation:. Left. axillary. lymph. node. . dissection.. Pathology Report. Metastatic Ductal Carcinoma. . 1. Post-chemotherapy status.. . 2. metastasis in 7 out of 20 axillary lymph nodes. (axillary LN: 7/20).. . 3. perinodal extension: present.. . 4. size of metastatic carcinoma: 40 mm.. Result. Intensity. Positive. %. Estrogen. receptor. Intermediate. (5/8). 2. 10%-. 1/3. Progesterone. receptor. Negative (2/8). 1. <1%. C-erbB2. Positive (3+). Ki-67. Positive in 48%. of tumor cells. S. Park et al.. 409. . . HR(+) HER2(+) Breast Cancer |
544 | Case 32 | Important Radiologic | HR(+) HER2(+) Breast Cancer | Important Radiologic. Findings. 185 186 187 188. 189. 32.3. |
549 | Case 32 | Patient History | HR(+) HER2(+) Breast Cancer | Patient History and Progress. Female/74 years old, post-menopause.. Self-detected mass lesion on left axillary.. No family history.. S/P Tuberculosis, asthma.. 32.2. |
538 | Case 32 | Courses of Treatment | HR(+) HER2(-) Breast Cancer | Courses of Treatment. Operation + Post-operative radiation ther. apy + Letrozole 2.5 mg/day.. Operation. Right breast conserving surgery, sentinel lymph. ponent: absent).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) superior margin: 20 mm.. . (b) inferior margin: 40 mm.. . (c) medial margin: 15 mm.. . (d) lateral margin: 20 mm.. . (e) deep margin: 5 mm.. . (f) superficial margin: 10 mm.. 6. Lymph nodes: no metastasis in one axillary. lymph node (pN0(sn)) (sentinel LN: 0/1,. 11. Pathological TN category (AJCC 2017):. pT1cN0(sn).. Result. Intensity. Positive. %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative (0). Ki-67. Positive in 9% of. tumor cells. HR(+) HER2(−) Breast Cancer |
545 | Case 32 | Important Radiologic | HR(+) HER2(-) Breast Cancer | Important Radiologic. Findings. See Figs. 175, 176, 177 and 178.. 32.3. |
550 | Case 32 | Patient History | HR(+) HER2(-) Breast Cancer | o’clock direction.. No family history.. Hypertension, s/p bronchiectasis, s/p left hip. arthroplasty.. 32.2. |
539 | Case 32 | Courses of Treatment | HR(−) HER2(+) Breast Cancer | 32.1. . Courses of Treatment. Neoadjuvant chemotherapy (#5 cycles of. docetaxel and carboplatin and trastuzumab and. pertuzumab after followed #1 cycle of trastu. zumab and pertuzumab) + Operation + Post-. operative radiation therapy + Trastuzumab.. Operation. 220. Pathology Report. No residual tumor with stromal degeneration.. . 1. Post-chemotherapy status.. . 2. Lymph nodes: no metastasis in three axillary. lymph nodes (ypN0(sn)) (sentinel LN: 0/3).. Result. Intensity. Positive %. Estrogen. receptor. Negative. (2/8). 1. <1%. Progesterone. receptor. Negative. (2/8). 1. <1%. C-erbB2. Positive (3+). Ki-67. Positive in. 45% of tumor. cells. Y. Kwon et al.. 549. a. b. . 33. |
546 | Case 32 | Important Radiologic | HR(−) HER2(+) Breast Cancer | Important Radiologic. Findings. 214 215. 216. 32.3. . After Neoadjuvant. Chemotherapy. 217 218. 219. Y. Kwon et al.. 547. . . . . HR(−) HER2(+) Breast Cancer. 548. . . 32.4. |
551 | Case 32 | Patient History | HR(−) HER2(+) Breast Cancer | Patient History and Progress. Female/55 years old, post-menopause.. Screen detected mass lesion on right breast 8. o’clock direction.. No family history.. Hypertension, thyroid nodules.. 32.2. |
540 | Case 32 | Courses of Treatment | HR(−) HER2(−) Breast Cancer | 32.1. . Courses of Treatment. Neoadjuvant chemotherapy (#4 cycles of. doxorubicin and . cyclophosphamide + #4 cycles. of docetaxel) + Operation + Post-operative. radiation therapy + Adjuvant capecitabine.. . . . HR(−) HER2(−) Breast Cancer. 694. . . Operation. 242. Pathology Report. Invasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of tumor: 2.7 cm (ypT2).. 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 20/10HPF).. 4. Intraductal component: absent.. 5. Skin: dermal involvement of tumor.. E. S. Lee et al.. 695. 6. Nipple: no involvement of tumor.. 7. Surgical margins:. . (a) Deep margin: 22 mm.. . (b) Superficial margin: 7 mm.. 8. Lymph nodes: no metastasis in 14 axillary. lymph nodes (ypN0) (sentinel LN: 0/1, non-. sentinel LN: 0/13).. 9. Arteriovenous invasion: absent.. . 10. Lymphovascular invasion: absent.. . 11. Tumor border: infiltrative.. . 12. Microcalcification: absent.. . 13. Pathological TN category (AJCC 2017):. ypT2N0.. 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 75%. of tumor cells. 33. |
547 | Case 32 | Important Radiologic | HR(−) HER2(−) Breast Cancer | Important Radiologic. Findings. 234 235 236. 237. . HR(−) HER2(−) Breast Cancer. 692. . . . . . E. S. Lee et al.. 693. . After Neoadjuvant. Chemotherapy. 238 239 240. 241. 32.3. |
552 | Case 32 | Patient History | HR(−) HER2(−) Breast Cancer | Patient History and Progress. Female/49 years old, pre-menopause.. Self-detected mass lesion on left breast.. Family history of breast cancer, aunt and. cousin (paternal).. Family history of prostate cancer, father.. Hyperthyroidism.. BRCA 1 and 2 mutation: Not detected.. 32.2. |
541 | Case 32 | Courses of Treatment | Local Recurrence | 32.1. . Courses of Treatment. Right breast DCIS → Operation → Adjuvant. therapy → Right breast recurrence (tubular. carcinoma + DCIS).. Primary Treatment. Operation. Aug. 2014 Right breast wide excision (outside).. Pathology Report. Ductal carcinoma in situ involving intraductal. papilloma. . 1. Nuclear grade: low.. . 2. Necrosis: absent.. . 3. Architectural pattern: papillary/cribriform.. 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. 10.8% of tumor. cells. Adjuvant Therapy. Postoperative radiation therapy.. Tamoxifen 20 mg/day for 2 years.. Treatments After Recurrence. 221. 222. Operation. 223. Pathology Report. Tubular Carcinoma. 1. Post-lumpectomy status.. 2. Size of invasive component: 0.2 cm (rpT1a).. 3. Size of intraductal component: 1.0 cm.. 4. Histologic grade: 1/3 (tubule formation: 1/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 6/10HPF).. 5. Intraductal component: present, intratu. moral/extratumoral (90%) (nuclear grade:. low, necrosis: present, architectural pattern:. micropapillary/cribriform/comedo,. exten. sive intraductal component: present).. 6. Skin: no involvement of tumor.. Y. Kim et al.. 807. . . . . . 7. Surgical margins:. . (a) Superior margin: 10 mm.. . (b) Inferior margin: 10 mm.. . (c) Medial margin: <1 mm from tubular car. cinoma (slide 5).. . (d) Lateral margin: 10 mm.. . (e) Deep margin: 2 mm.. . (f) Superficial margin: 2 mm.. 8. Arteriovenous invasion: absent.. 9. Lymphovascular invasion: absent.. . 10. Tumor border: infiltrative.. . 11. Microcalcification:. present,. tumoral/. non-tumoral.. . 12. Pathological TN category (AJCC 2017):. rpT1a.. Result. Intensity. Positive %. Estrogen. receptor. Negative (2/8). 1. <1%. Progesterone. receptor. Negative (2/8). 1. <1%. C-erbB2. Negative (1+). Ki-67. Positive in 7%. of tumor cells. Operation. . 224. Local Recurrence. 808. a. b. . Pathology Report. Ductal Carcinoma In Situ, residual. . 1. Post-excision status.. . 2. Size of tumor: 0.2 cm.. . 3. Nuclear grade: low.. . 4. Necrosis: present.. . 5. Architectural pattern: cribriform/solid/comedo.. . 6. Surgical margins:. . (a) Nipple margin: (see note).. . (b) Deep margin: 3 mm.. . (c) Superficial margin: 2 mm.. . 7. Lymph nodes: no metastasis in one axillary. lymph node (pN0(sn)) (sentinel LN: 0/1).. . 8. Microcalcification: absent.. Note: 1. Atypical ductal hyperplasia is present. in the section of Fro 1.. 33. |
553 | Case 32 | Patient History | Local Recurrence | Patient History and Progress. Female/42 years old, pre-menopause.. Screen detected mass lesion on right breast. . 12 o’clock direction.. Outside result of lumpectomy: Ductal carci. noma in situ.. No family history.. No comorbidities.. BRCA 2 VUS (variant of uncertain).. 32.2. |
542 | Case 32 | Courses of Treatment | Metastatic Breast Cancer | Courses of Treatment. Left breast cancer → Operation → Adjuvant. therapy → Lung metastasis.. Primary Treatment. receptor. Intermediate. (4/7). 2. 10%–1/3. Progesterone. receptor. Strong (6/7). 3. 1/3–2/3–. C-erbB2. Positive (3+). Ki-67. Positive in. 20% of tumor. cells. Y. Kwon et al.. & Doxorubicin & Cyclophosphamide).. Post-operative radiation therapy to left breast. + Zoladex for 2 years + Tamoxifen 20 mg/day for. 5 years.. Treatments After Recurrence. 1/3–2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Positive (3+). Ki-67. Positive in. 14% of tumor. cells. Palliative Therapy. Palliative therapy # 37 cycles (Paclitaxel &. Trastuzumab).. Palliative therapy # 38 cycles (Trastuzumab) ~. Metastatic Breast Cancer |
554 | Case 32 | Patient History | Metastatic Breast Cancer | Patient History and Progress. Female/49 years old, peri-menopause.. No family history.. 32.2. |
555 | Case 33 | Courses of Treatment | Carcinoma In Situ | 33.1. . Courses of Treatment:. Operation. Operation. 155. 156. Pathology Report. <First 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: papillary/cribriform.. . 5. Skin: no involvement of tumor.. . 6. Surgical margins:. . (a) superior margin: 10 mm,. . (b) inferior margin: 10 mm,. . (c) medial margin: 5 mm,. . (d) lateral margin: positive (Fro 5) (see Note),. . (e) deep margin: 2 mm,. . (f) superficial margin: 2 mm.. . 7. Microcalcification:. present,. tumoral/non-. tumoral.. Note: 1. Ductal carcinoma in situ is present. only in the permanent section of Fro 5.. 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 tumor. cells. <Second operation>. Atypical ductal hyperplasia involving intra. ductal papilloma.. . 1. with a) foreign body reaction,. . 2. b) fat necrosis.. . (a) Post-excision status.. . . . . Carcinoma In Situ. 126. a. b. . a. b. . 34. |
562 | Case 33 | Important Radiologic | Carcinoma In Situ | Important Radiologic. Findings. 153. 154. 33.3. |
567 | Case 33 | Patient History | Carcinoma In Situ | Patient History and Progress. Female/68 years old, post-menopause.. Bloody nipple discharge from right breast.. No family history.. S/P Hysterectomy.. 33.2. |
556 | Case 33 | Courses of Treatment | HR(+) HER2(+) Breast Cancer | 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.. 194. Pathology Report. Invasive ductal carcinoma, histologic grade 2.. No residual tumor with stromal degeneration.. . 1. Post-chemotherapy status.. . 2. Lymph nodes: no metastasis in four axillary. lymph nodes (ypN0(sn)) (sentinel LN: 0/4).. Result. Intensity. Positive. %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Weak (3/8). 1. 1–10%. C-erbB2. Equivocal (2+). Ki-67. Positive in 46%. of tumor cells. SISH. Positive. HR(+) HER2(+) Breast Cancer. 413. . HR(+) HER2(+) Breast Cancer. 414. . a. b. . S. Park et al.. 415. 34. |
563 | Case 33 | Important Radiologic | HR(+) HER2(+) Breast Cancer | Important Radiologic. Findings. 190 191 192. 193. 33.3. |
568 | Case 33 | Patient History | HR(+) HER2(+) Breast Cancer | Self-detected palpable mass lesion on left. breast.. No family history.. No comorbidities.. 33.2. |
557 | Case 33 | Courses of Treatment | HR(+) HER2(-) Breast Cancer | Courses of Treatment. Operation + Post-operative radiation ther. apy + Tamoxifen 20 mg/day.. Y. Kim et al.. micropapillary/cribriform, extensive intra. ductal component: present).. 5. Skin: no involvement of tumor.. HR(+) HER2(−) Breast Cancer. . (e) deep margin: 3 mm.. . (f) superficial margin: 5 mm.. Y. Kim et al.. 279. 7. Lymph nodes: no metastasis in three axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/1,. axillary LN: 0/2). 8. Arteriovenous invasion: absent.. 9. Lymphovascular invasion: absent.. . 10. Tumor border: infiltrative.. . 11. Microcalcification: absent.. . 12. Pathological TN category (AJCC 2017):. pT1aN0(sn).. Result. Intensity. Positive. %. Estrogen. receptor. Strong (7/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative (1+). Ki-67. Positive in 5% of. tumor cells. 34. |
564 | Case 33 | Important Radiologic | HR(+) HER2(-) Breast Cancer | Important Radiologic. Findings. See Figs. 180, 181, 182, 183 and 184.. 33.3. |
569 | Case 33 | Patient History | HR(+) HER2(-) Breast Cancer | Restless legs.. 33.2. |
558 | Case 33 | Courses of Treatment | HR(−) HER2(+) Breast Cancer | 33.1. . tion therapy + Trastuzumab.. Operation. 228. Pathology Report. . 1. No residual tumor with foamy histiocytic. collection.. . (a) Post-chemotherapy status.. . (b) Lymph nodes: no metastasis in four axil. lary lymph nodes (ypN0(sn)) (sentinel. LN: 0/4).. . (c) Microcalcification:. present,. tumoral/. non-tumoral.. . (d) Related slides: C21-518.. . 2. Intraductal papilloma.. Result. Intensity. Positive %. Estrogen. receptor. Negative (2/8). 1. <1%. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in 22%. of tumor cells. 34. |
565 | Case 33 | Important Radiologic | HR(−) HER2(+) Breast Cancer | Important Radiologic. Findings. 221 222 223. 224. HR(−) HER2(+) Breast Cancer. . HR(−) HER2(+) Breast Cancer. 552. . 33.3. . After Neoadjuvant. Chemotherapy. 225 226. 227. Y. Kwon et al. |
570 | Case 33 | Patient History | HR(−) HER2(+) Breast Cancer | Patient History and Progress. Female/63 years old, post-menopause.. Self-detected palpable mass lesion on left. breast 2 o’clock direction.. No family history.. Hypertension, chronic kidney disease, ven. tricular premature contraction.. 33.2. |
559 | Case 33 | Courses of Treatment | HR(−) HER2(−) Breast Cancer | 33.1. . Courses of Treatment. Neoadjuvant chemotherapy (#4 cycles of. doxorubicin and cyclophosphamide + #4. cycles of docetaxel) + Operation + Post-. operative radiation therapy.. Operation. 251. Pathology Report. Atypical ductal hyperplasia, focal. . 1. Post-chemotherapy status.. . 2. Lymph nodes: no metastasis in one axillary. lymph node (ypN0(sn)) (sentinel LN: 0/1).. 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 61%. of tumor cells. E. S. Lee et al.. 697. . . . HR(−) HER2(−) Breast Cancer. 698. . . E. S. Lee et al.. 699. 34. |
566 | Case 33 | Important Radiologic | HR(−) HER2(−) Breast Cancer | Important Radiologic. Findings. 243 244 245. 246. . . HR(−) HER2(−) Breast Cancer. 696. . . . . After Neoadjuvant. Chemotherapy. 247 248 249. 250. 33.3. |
571 | Case 33 | Patient History | HR(−) HER2(−) Breast Cancer | Patient History and Progress. Female/52 years old, post-menopause.. Screen detected mass lesion on left breast 11. o’clock direction.. No family history.. s/p cervical cancer (stage 0).. BRCA 1 and 2 mutation: Not detected.. 33.2. |
560 | Case 33 | Courses of Treatment | Local Recurrence | 33.1. . Courses of Treatmaent. Left breast IDC → Neoadjuvant chemotherapy. → Operation → Adjuvant therapy → Left breast. recurrence (IDC).. Primary Treatment. 225 226 227. 228. Neoadjuvant Chemotherapy. Neoadjuvant chemotherapy #6 cycles of trastu. zumab and pertuzumab and docetaxel and. carboplatin.. Operation. . 229. Pathology Report. Invasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of tumor: 3.5 cm, 1.4 cm (ypT2(2)).. 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 30/10HPF).. 4. Intraductal component: present, extratumoral. (10%) (nuclear grade: high, necrosis: pres. ent, architectural pattern: micropapillary/. solid/comedo, extensive intraductal compo. nent: absent).. 5. Skin: no involvement of tumor.. Y. Kim et al.. 809. . . . . . 6. Surgical margins:. . (a) Superior margin: 30 mm.. . (b) Inferior margin: 6 mm.. . (c) Medial margin: 15 mm.. . (d) Lateral margin: (see note 1).. . (e) Deep margin: 6 mm.. . (f) Superficial margin: <1 mm from inva. sive ductal carcinoma (slide 12).. 7. Lymph nodes: no metastasis in 3 axillary. lymph nodes (ypN0(sn)) (sentinel LN: 0/3).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular. invasion:. present,. . intratumoral/peritumoral.. . 10. Tumor border: infiltrative.. . 11. Microcalcification: present, tumoral.. . 12. Pathological TN category (AJCC 2017):. ypT2(2)N0(sn).. Local Recurrence. 810. . . . Note: 1. The lateral margin of the lumpec. tomy specimen (slide 16) is close to ductal car. cinoma in situ (1.5 mm), but this margin. submitted for frozen diagnosis (Fro 7) 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 59%. of tumor cells. Adjuvant Therapy. Postoperative radiation therapy.. Trastuzumab for 1 year.. Treatments After Recurrence. 230. Operation. 231. Pathology Report. Invasive Ductal Carcinoma. 1. Post-lumpectomy status.. 2. Size of tumor: 1.8 cm (rpT1c).. 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 22/10HPF).. 4. Intraductal component: present, intratumoral. (5%) (nuclear grade: high, necrosis: absent,. architectural pattern: solid, extensive intra. ductal component: absent).. 5. Surgical margins:. . (a) Superior margin: 15 mm.. . (b) Inferior margin: positive for invasive. ductal carcinoma (slide 2).. . (c) Medial margin: 10 mm.. . (d) Lateral margin: positive for invasive. ductal carcinoma (slide 4).. . (e) Deep margin: 1 mm from invasive ductal. carcinoma (slide 3).. . (f) Superficial margin: 5 mm.. Y. Kim et al.. 811. a. b. . . 6. Arteriovenous invasion: absent.. 7. Lymphovascular invasion: absent.. 8. Tumor border: infiltrative.. 9. Microcalcification: present, tumoral.. . 10. Pathological TN category (AJCC 2017):. rpT1cNx.. 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 27%. of tumor cells. Operation. 232. Pathology Report. Lateral Margin. Invasive Ductal Carcinoma, residual. . 1. Post-lumpectomy and excision status.. . 2. Size of tumor: 0.6 cm.. . 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 22/10HPF).. . 4. Intraductal component: present, intratumoral. (20%) (nuclear grade: high, necrosis: absent,. architectural pattern: solid, extensive intra. ductal component: absent).. . 5. Surgical margins:. . (a) Lateral margin: (see note).. . 6. Vascular invasion: absent.. . 7. Lymphatic invasion: absent.. . 8. Tumor border: infiltrative.. . 9. Microcalcification: absent.. Inferior Margin. No residual tumor. . 1. Post-lumpectomy and excision status.. Note: The lateral margin of the lumpectomy. specimen (slide 4) is close to ductal carcinoma in. situ (4 mm), but this margin submitted for frozen. diagnosis (Fro 2) is free of tumor.. Adjuvant Therapy. Chemotherapy #14 cycles of T-DM1 (trastu. zumab emtansine).. Local Recurrence. 812. 34. |
572 | Case 33 | Patient History | Local Recurrence | Patient History and Progress. Female/45 years old, pre-menopause.. Screen detected mass lesion on upper inner. portion of left breast.. Outside result of biopsy: Invasive ductal. carcinoma.. Family history of breast cancer, mother at her. 50 years old.. S/P. Hysterectomy,. s/p. bilateral. breast. augmentation.. 33.2. |
561 | Case 33 | Courses of Treatment | Metastatic Breast Cancer | Courses of Treatment. Right breast cancer → Operation → Adjuvant. therapy → Bone metastasis.. Primary Treatment. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Intermediate. (5/8). 2. 10%–. 1/3. Result. Intensity. Positive %. C-erbB2. Equivocal (2+). Ki-67. Positive in 7%. of tumor cells. SISH. Positive. Adjuvant Therapy. Adjuvant chemotherapy #8 cycles (Doxorubicin. & cyclophosphamide #4 → Docetaxel #4).. Post-operative radiation therapy to right breast. +Tamoxifen 20 mg/day for 5 years.. Treatments After Recurrence. invasion.. Palliative Therapy. Radiation therapy to L-spine & T-spine & sacrum.. Palliative Capecitabine & lapatinib (Jul. 2021) ~. Y. Kwon et al. |
573 | Case 33 | Patient History | Metastatic Breast Cancer | |
574 | Case 34 | Courses of Treatment | Carcinoma In Situ | 34.1. . Courses of Treatment:. Operation. Operation. 161. 162. Pathology Report. <First 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: papillary/cribriform.. . 5. Surgical margins:. E. S. Lee et al.. 127. . . . . a. b. . Carcinoma In Situ. 128. a. b. . . (a) superior margin: 15 mm,. . (b) inferior margin: 30 mm,. . (c) medial margin: 15 mm,. . (d) lateral margin: 15 mm,. . (e) deep margin: 8 mm,. . (f) superficial margin: 8 mm.. . 6. Microcalcification: absent.. <Second operation>. Right.. 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. Surgical margins: positive for lobular carci. noma in situ at the nearest resection margin. (slide 1).. . 6. Microcalcification: absent.. E. S. Lee et al.. 129. . . Result. Intensity. Positive %. Estrogen. receptor. Weak (4/8). 1. 10%−1/3. Progesterone. receptor. Weak (4/8). 1. 10%−1/3. C-erbB2. Equivocal. (2+). Ki-67. Positive in. 3% of tumor. cells. Left.. Intraductal papilloma.. 35. |
581 | Case 34 | Important Radiologic | Carcinoma In Situ | Important Radiologic. Findings. 157 158 159. 160. 34.3. |
586 | Case 34 | Patient History | Carcinoma In Situ | Patient History and Progress. Female/53 years old, pre-menopause.. Screen detected mass lesion on upper outer of. right breast.. No family history.. S/P Total gastrectomy (gastric cancer), micro. papillary thyroid carcinoma (follow-up).. BRCA 1 and 2: Not examination.. 34.2. |
575 | Case 34 | Courses of Treatment | HR(+) HER2(+) Breast Cancer | 34.1. . Courses of Treatment. Neoadjuvant chemotherapy (#6 cycles of. docetaxel and carboplatin and trastuzumab. and pertuzumab) + Operation + Post-. operative radiation therapy + Trastuzumab. and Pertuzumab + Letrozole 2.5 mg/day.. 201. Pathology Report. Invasive ductal carcinoma, histologic grade 2.. No residual tumor with stromal degeneration. . 1. Post-chemotherapy status.. . 2. Lymph nodes: no metastasis in three axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/3).. Result. Intensity. Positive. %. Estrogen. receptor. Intermediate. (6/8). 3. 10%-. 1/3. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in 61%. of tumor cells. . HR(+) HER2(+) Breast Cancer. 416. . . . S. Park et al.. 417. . . . HR(+) HER2(+) Breast Cancer. 418. a. b. . 35. |
582 | Case 34 | Important Radiologic | HR(+) HER2(+) Breast Cancer | Important Radiologic. Findings. 195 196 197 198 199. 200. 34.3. |
587 | Case 34 | Patient History | HR(+) HER2(+) Breast Cancer | Patient History and Progress. Female/55 years old, post-menopause.. Self-detected palpable mass lesion on right. breast 9 o’clock direction.. No family history.. No comorbidities.. 34.2. |
576 | Case 34 | Courses of Treatment | HR(+) HER2(-) Breast Cancer | 34.1. . Courses of Treatment. Operation. Right nipple–areolar complex sparing mastec. tomy with immediate implant reconstruction,. sentinel lymph node biopsy, left nipple–areo. lar complex sparing mastectomy with immedi. ate implant reconstruction (Figs. 190, 191 and. 192).. Pathology Report. [Right]. 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:. noma in situ (slide 1).. . (b) superficial margin: 5 mm.. 6. Lymph nodes: no metastasis in one axillary. lymph node (pN0(sn)) (sentinel LN: 0/1). 7. Arteriovenous invasion: absent.. Y. Kim et al.. non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT1cN0(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 14%. of tumor cells. [Left]. Fibrocystic change.. 35. |
583 | Case 34 | Important Radiologic | HR(+) HER2(-) Breast Cancer | Important Radiologic. Findings. See Figs. 186, 187, 188 and 189.. 34.3. |
588 | Case 34 | Patient History | HR(+) HER2(-) Breast Cancer | Patient History and Progress. Female/43 years old, pre-menopause.. Screen for high risk for breast cancer.. Family history of breast cancer, mother.. Pancreatic cancer, maternal uncle.. No comorbidities.. BRCA 1 mutation carrier.. 34.2. |
577 | Case 34 | Courses of Treatment | HR(−) HER2(+) Breast Cancer | 34.1. . Courses of Treatment. Operation + Adjuvant chemotherapy (#4 cycles. of. doxorubicin. +. cyclophosphamide). +. Operation + Trastuzumab.. Operation. 233. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 1.5 cm (pT1c(Paget)).. 2. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 2/3, 11/10HPF).. 3. Intraductal component: absent.. 4. Nipple: Paget disease.. 5. Skin: no involvement of tumor.. Y. Kwon et al.. 557. a. b. . 6. Surgical margins: deep margin: 2 mm.. 7. Lymph nodes: no metastasis in one axillary. lymph node (pN0(sn)) (sentinel LN: 0/1).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular invasion: present, intratu. moral.. . 10. Tumor border: infiltrative.. . 11. Microcalcification: present, tumoral/non-. tumoral.. . 12. Pathological TN category (AJCC 2017):. pT1c(Paget)N0(sn).. HR(−) HER2(+) Breast Cancer. 558. . Result. Intensity. Positive %. Estrogen. receptor. Negative (2/8). 1. <1%. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in 25%. of tumor cells. 35. |
584 | Case 34 | Important Radiologic | HR(−) HER2(+) Breast Cancer | Important Radiologic. Findings. 229 230 231. 232. . HR(−) HER2(+) Breast Cancer. 556. . . . . 34.3. |
589 | Case 34 | Patient History | HR(−) HER2(+) Breast Cancer | Patient History and Progress. Female/54 years old, post-menopause.. Self-detected palpable mass lesion on left. breast.. No family history.. S/P. unilateral. salpingo-oophorectomy,. dyslipidemia.. HR(−) HER2(+) Breast Cancer. 554. a. b. . Y. Kwon et al.. 555. 34.2. |
578 | Case 34 | Courses of Treatment | HR(−) HER2(−) Breast Cancer | 34.1. . Courses of Treatment. Operation + Adjuvant chemotherapy (#1. cycles of docetaxel and cyclophosphamide,. stop d/t mucositis).. Operation. 255. Pathology Report. Invasive Ductal Carcinoma associated with. paraffinoma. 1. Size of tumor: 3.0 cm (pT2).. . . E. S. Lee et al.. 701. 2. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 2/3, 8/10HPF).. 3. Intraductal component: absent.. 4. Skin and nipple: no involvement of tumor.. 5. Surgical margins:. . (a) Deep margin: 10 mm.. . (b) Superficial margin: 21 mm.. 6. Lymph nodes: no metastasis in five axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/5).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular invasion: absent.. 9. Tumor border: infiltrative.. . 10. Microcalcification: absent.. . 11. 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. Negative (0). Ki-67. Positive in 23%. of tumor cells. 35. |
585 | Case 34 | Important Radiologic | HR(−) HER2(−) Breast Cancer | Important Radiologic. Findings. 252 253. 254. . . HR(−) HER2(−) Breast Cancer. 700. 34.3. |
590 | Case 34 | Patient History | HR(−) HER2(−) Breast Cancer | Patient History and Progress. Female/79 years old, post-menopause.. Screen detected mass lesion on left breast 12. o’clock direction.. No family history.. S/P paraffin injection, s/p appendectomy, s/p. hysterectomy, s/p hemicolectomy (colon cancer).. S/P radical total gastrostomy (advanced gas. tric cancer).. BRCA 1 and 2 mutation: Not detected,. BARD1 VUS (variant of uncertain).. 34.2. |
579 | Case 34 | Courses of Treatment | Local Recurrence | 34.1. . Courses of Treatment. Right breast IDC → Operation → Adjuvant. therapy → Right breast recurrence (IDC).. Primary Treatment. 233 234. 235. Operation. 236. Pathology Report. Invasive Ductal Carcinoma. 1. Size of invasive component: 0.7 cm (pT1b).. 2. Size of intraductal component: 1.0 cm.. 3. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 3/10HPF).. 4. Intraductal component: present, extratumoral. (60%) (nuclear grade: low, necrosis: present,. architectural pattern: papillary/cribriform,. extensive intraductal component: absent).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) Superior margin: 28 mm.. . (b) Inferior margin: 12 mm.. . (c) Medial margin: 10 mm.. . (d) Lateral margin: 30 mm.. . . . Y. Kim et al.. 813. a. b. . . . (e) Deep margin: <1 mm from ductal carci. noma in situ (slide 7).. . (f) Superficial margin: 13 mm.. 7. Arteriovenous invasion: absent.. 8. Lymphovascular invasion: absent.. 9. Tumor border: infiltrative.. . 10. Microcalcification: present, non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT1b.. Result. Intensity. Positive %. Estrogen. receptor. Intermediate. (6/8). 2. 1/3–2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Positive (3+). Ki-67. Positive in 53%. of tumor cells. Adjuvant Therapy. Postoperative radiation therapy.. Tamoxifen 20 mg/day for 1.8 years.. Treatments After Recurrence. 237. 238. Operation. . 239. Pathology Report. Invasive Ductal Carcinoma. 1. Post-lumpectomy status.. 2. Size of tumor: 2.1 cm, multifocal (rpT2).. 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 4/1HPF).. 4. Intraductal component: present, intratu. moral/extratumoral (50%) (nuclear grade:. high, necrosis: present, architectural pattern:. papillary/micropapillary/cribriform/solid/. comedo, extensive intraductal component:. present).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. Local Recurrence. 814. . (a) Deep margin: <1 mm from ductal carci. noma in situ (slides 1 and 3).. . (b) Superficial margin: positive for invasive. ductal carcinoma (slide 5).. 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):. rpT2.. Result. Intensity. Positive %. Estrogen. receptor. Strong (7/8). 2. >2/3. Progesterone. receptor. Strong (7/8). 3. 1/3–2/3. C-erbB2. Positive (3+). Ki-67. Positive in 51%. of tumor cells. Adjuvant Therapy. Adjuvant chemotherapy #4 cycles of doxorubicin. and cyclophosphamide.. Trastuzumab for 1 year.. Letrozole 2.5 mg/day.. . . Y. Kim et al.. 815. 35. |
591 | Case 34 | Patient History | Local Recurrence | Patient History and Progress. Female/47 years old, pre-menopause.. Screen detected microcalcification on upper. outer portion of right breast.. Family history of ovarian cancer mother.. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 34.2. |
580 | Case 34 | Courses of Treatment | Metastatic Breast Cancer | Courses of Treatment. Left breast cancer → Operation → Adjuvant. therapy → Right pleural, liver, right adrenal. gland, bone metastasis → Brain metastasis.. Primary Treatment. (0/8). 0. 0. Progesterone. receptor. Negative. (0/8). 0. 0. C-erbB2. Equivocal. (2+). Ki-67. Positive. in 46% of. tumor. cells. SISH. Positive. Adjuvant Therapy. Adjuvant chemotherapy #8 cycles (Doxorubicin. & cyclophosphamide #4 → Docetaxel & trastu. zumab #4).. Post-operative radiation therapy to left breast.. Concurrent Trastuzumab #13.. Treatments After Recurrence. Palliative Therapy. Radiation therapy to brain.. Palliative therapy #6 (Pertuzumab & trastu. zumab & Docetaxel) ~. 35. |
592 | Case 34 | Patient History | Metastatic Breast Cancer | No family history.. 34.2. |
593 | Case 35 | Courses of Treatment | Carcinoma In Situ | 35.1. . Courses of Treatment. Operation + Tamoxifen 20 mg/day for 5 years.. Operation. 165. 166. Pathology Report. Lobular carcinoma in situ, pathological TN. category (AJCC 2017): pTis. . 1. Size of tumor: 0.5 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: 5 mm,. . (b) inferior margin: 5 mm,. . (c) medial margin: 10 mm,. . (d) lateral margin: 10 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: 2 mm.. . 7. Microcalcification:. present,. tumoral/non-. tumoral.. Result. Intensity. Positive %. Estrogen. receptor. Strong (7/8). 3. 1/3–2/3. Progesterone. receptor. Strong (7/8). 3. 1/3–2/3. C-erbB2. Equivocal. (2+). Ki-67. Positive in. 2% of tumor. cells. Carcinoma In Situ. 130. a. b. . a. b. . . 36. |
600 | Case 35 | Important Radiologic | Carcinoma In Situ | Important Radiologic. Findings. 163. 164. 35.3. |
605 | Case 35 | Patient History | Carcinoma In Situ | Patient History and Progress. Female/59 years old, post-menopause.. Screen detected ductal dilatation on left breast. 12 o’clock direction.. No family history.. S/P Hysterectomy and bilateral salpingo-. oophorectomy, S/P total thyroidectomy (thyroid. cancer), hypertension.. 35.2. |
594 | Case 35 | Courses of Treatment | HR(+) HER2(+) Breast Cancer | 35.1. . Courses of Treatment. Neoadjuvant chemotherapy (#6 cycles of. docetaxel and carboplatin and trastuzumab. S. Park et al.. 209. 210. Pathology Report. Invasive ductal carcinoma, histologic grade 3.. No residual tumor with stromal degeneration.. . 1. Post-chemotherapy status.. . 2. Lymph nodes: no metastasis in seven axillary. lymph nodes (ypN0) (axillary LN (Fro 4): 0/4,. axillary LN: 0/3).. Result. Intensity Positive %. Estrogen. receptor. Intermediate. (5/8). 2. 10%-1/3. Progesterone. receptor. Intermediate. (6/8). 2. 10%-1/3. C-erbB2. Positive (3+). Ki-67. Positive in. 49% of tumor. cells. . S. Park et al.. 421. . HR(+) HER2(+) Breast Cancer. 422. . . . . . S. Park et al.. 423. a. b. . a. b. . HR(+) HER2(+) Breast Cancer. 424. 36. |
601 | Case 35 | Important Radiologic | HR(+) HER2(+) Breast Cancer | Important Radiologic. Findings. 202 203 204 205 206 207. 208. 35.3. |
606 | Case 35 | Patient History | HR(+) HER2(+) Breast Cancer | Patient History and Progress. Female/39 years old, pre-menopause.. Self-detected skin change and palpable mass. lesion on right breast 9:30 o’clock direction.. No family history.. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 35.2. |
595 | Case 35 | Courses of Treatment | HR(+) HER2(-) Breast Cancer | 35.1. . cribriform/solid/comedo, extensive intra. ductal component: present).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) superior margin: 15 mm.. . (b) inferior margin: 15 mm.. . (c) medial margin: 10 mm.. . (d) lateral margin: 10 mm.. . (e) deep margin: 2 mm.. . (f) superficial margin: 2 mm.. 7. Lymph nodes:. . (a) metastasis in two out of five axillary. lymph nodes (ypN1a(sn)) (sentinel LN:. 2/2, axillary LN: 0/3). HR(+) HER2(−) Breast Cancer. . 10. Tumor border: infiltrative.. . 11. Microcalcification:. present,. tumoral/. non-tumoral.. . 12. Pathological TN category (AJCC 2017):. ypT1cN1a(sn).. Result. Intensity. Positive %. Estrogen receptor. Strong (7/8). 2. >2/3. Progesterone receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative (1+). Ki-67. Positive in 8% of tumor cells. HR(+) HER2(−) Breast Cancer. 286. 36. |
602 | Case 35 | Important Radiologic | HR(+) HER2(-) Breast Cancer | Important Radiologic. Findings. See Figs. 193, 194, 195, 196 and 197.. Y. Kim et al. |
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