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607 | Case 35 | Patient History | HR(+) HER2(-) Breast Cancer | Patient History and Progress. Female/48 years old, pre-menopause.. Screen detected mass lesion on left breast 4. o’clock direction.. Family history of breast cancer, maternal aunt.. No comorbidities.. BRCA 1 and 2 mutation: no examination.. 35.2. |
596 | Case 35 | Courses of Treatment | HR(−) HER2(+) Breast Cancer | 35.1. . Courses of Treatment. Neoadjuvant chemotherapy (#5 cycles of. docetaxel. and. trastuzumab. and. pertu. zumab) + Operation + Post-operative radiation. therapy + Trastuzumab and pertuzumab.. Operation. 242. Pathology Report. Microinvasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of invasive component: <0.1 cm. (ypT1mi).. 3. Size of intraductal component: 0.8 cm.. 4. Histologic grade: not applicable.. . HR(−) HER2(+) Breast Cancer. 562. moral/extratumoral (99%) (nuclear grade:. low, necrosis: present, architectural pattern:. solid/comedo, extensive intraductal compo. nent: present).. 6. Skin: no involvement of tumor.. 7. Surgical margins:. . (a) superior margin: 5 mm,. . (b) inferior margin: 20 mm,. . (c) medial margin: positive for microinva. sive ductal carcinoma (Fro 3) (see note),. . (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. Arteriovenous invasion: absent.. . 10. Lymphovascular invasion: absent.. . 11. Tumor border: infiltrative.. . 12. Microcalcification:. present,. tumoral/. non-tumoral.. . 13. Pathological TN category (AJCC 2017):. ypT1miN0(sn).. Note: 1. Microinvasive ductal carcinoma is. focally present only in the permanent section of. Fro 3.. 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. 48% of. tumor cells. 36. |
603 | Case 35 | Important Radiologic | HR(−) HER2(+) Breast Cancer | Important Radiologic. Findings. 234 235 236. 237. Y. Kwon et al.. 559. . . . HR(−) HER2(+) Breast Cancer. 560. . . Y. Kwon et al.. 561. 35.3. . After Neoadjuvant. Chemotherapy. 238 239 240. 241. 35.4. |
608 | Case 35 | Patient History | HR(−) HER2(+) Breast Cancer | Patient History and Progress. Female/73 years old, post-menopause.. Self-detected palpable mass lesion on right. breast.. Family history of breast cancer, cousin. (maternal).. s/p cholecystectomy, s/p unilateral salpingo-. oophorectomy, hypertension, diabetes mellitus.. BRCA 1 and 2 mutation: Not detected.. 35.2. |
597 | Case 35 | Courses of Treatment | HR(−) HER2(−) Breast Cancer | 35.1. . Courses of Treatment. Operation. +. Adjuvant. chemotherapy. (#4 cycles of doxorubicin and cyclophospha. mide) + Post-operative radiation therapy.. Operation. 259. Pathology Report. Invasive Ductal Carcinoma with apocrine. differentiation. 1. Size of tumor: 1.1 cm (pT1c).. 2. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 2/3, 6/10HPF).. 3. Intraductal component: present, extratumoral. (10%) (nuclear grade: high, necrosis: pres. ent, architectural pattern: cribriform/solid/. comedo, extensive intraductal component:. absent).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) Superior margin: 8 mm.. . (b) Inferior margin: 13 mm.. . (c) Medial margin: (see note).. . (d) Lateral margin: 15 mm.. . (e) Deep margin: 2 mm.. . (f) Superficial margin: 15 mm.. 6. Arteriovenous invasion: absent.. 7. Lymphovascular invasion: absent.. 8. Tumor border: infiltrative.. 9. Microcalcification:. present,. tumoral/. non-tumoral.. . 10. Pathological TN category (AJCC 2017):. pT1cNx.. Note: 1. The medial margin of the lumpec. tomy specimen (slide 5) is close to ductal carci. noma in situ (2 mm), but this margin submitted. for frozen diagnosis (Fro 3) is free of tumor.. 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 7% of. tumor cells. HR(−) HER2(−) Breast Cancer. 702. . . . . E. S. Lee et al.. 703. . 36. |
604 | Case 35 | Important Radiologic | HR(−) HER2(−) Breast Cancer | Important Radiologic Findings. 256 257. 258. 35.3. |
609 | Case 35 | Patient History | HR(−) HER2(−) Breast Cancer | Patient History and Progress. Female/75 years old, post-menopause.. Screen detected mass lesion on left breast 2. o’clock direction.. No family history.. Hypertension, Hyperlipidemia, s/p hysterec. tomy, arrhythmia (s/p operation).. 35.2. |
598 | Case 35 | Courses of Treatment | Local Recurrence | 35.1. . Courses of Treatment. Right breast IDC → Neoadjuvant chemotherapy. → Operation → Adjuvant therapy → Right. breast recurrence (DCIS).. Primary Treatment. Operation. First Operation (Aug. 2004) Left breast conserv. ing surgery, sentinel lymph node biopsy.. Pathology Report. Invasive Ductal Carcinoma. 1. Size of invasive carcinoma: 0.4 cm (pT1a).. 2. Size of intraductal carcinoma: 4 cm.. 3. Histologic grade: 2/3 (tubule formation: 2/3,. nuclear pleomorphism: 2/3, mitotic count: 2/3).. 4. Ductal carcinoma in situ: present, intratu. moral/extratumoral (95%) (nuclear grade:. low, necrosis: present, architectural pattern:. cribriform and comedo, extensive intraductal. component: present).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) Superior margin: 20 mm.. . (b) Inferior margin: (see note).. . (c) Medial margin: 20 mm.. . (d) Lateral margin: 10 mm.. . (e) Deep margin: 10 mm.. 7. Lymph nodes: no metastasis in 3 axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/3,. axillary LN: 0/0).. 8. Vascular invasion: absent.. 9. Lymphatic invasion: absent.. . 10. Tumor border: infiltrative.. . 11. Microcalcification: present, tumoral.. . 12. Pathologic staging: pT1aN0(sn).. Note: Ductal carcinoma in situ is noted only in. the permanent section of nipple margin (Fro 4). and inferior margin (Fro 5).. Result. Intensity Positive %. Estrogen. receptor. Strong (6/7). 3. 1/3–2/3. Progesterone. receptor. Intermediate. (5/7). 2. 1/3–2/3. C-erbB2. Negative (1+). Ki-67. Positive in 5%. of tumor cells. Operation. Second Operation (Sep. 2004) Left breast wide. excision.. Pathology Report. No residual carcinoma with foreign body. reaction.. . 1. Post-lumpectomy status.. Adjuvant Therapy. Postoperative radiation therapy.. Tamoxifen 20 mg/day for 2 years.. Treatments After Recurrence. 240. 241. Local Recurrence. 816. Operation. . 242. 243. Pathology Report. . 1. Ductal Carcinoma In Situ. . (a) Size of tumor: 2.0 cm (pTis).. . (b) Nuclear grade: low.. . (c) Necrosis: absent.. . (d) Architectural pattern: cribriform.. . (e) Surgical margins:. • Deep margin: 7 mm.. • Superficial margin: 6 mm.. . (f) Microcalcification:. present,. tumoral/. non-tumoral.. . (g) Pathologic stage (AJCC 2010): pTisNx.. . 2. Sclerosing adenosis.. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (7/8). 3. 1/3–2/3. C-erbB2. Equivocal (2+). Ki-67. Positive in 17%. of tumor cells. . . . Y. Kim et al.. 817. . . Adjuvant Therapy. Tamoxifen. 20. mg/day. for. 0.3. year. (self-cessation).. 36. |
610 | Case 35 | Patient History | Local Recurrence | Patient History and Progress. Female/53 years old, peri-menopause.. Screen detected mass lesion on left breast. subareola.. No family history.. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 35.2. |
599 | Case 35 | Courses of Treatment | Metastatic Breast Cancer | 35.1. . Courses of Treatment. Right breast cancer → Operation → Adjuvant. therapy → Bone metastasis.. Primary Treatment. Strong (8/8). 3. >2/3. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Negative (1+). Ki-67. Positive in. 16% of tumor. cells. Oncotype Dx test: 23 (Recurrence Score).. Adjuvant Therapy. Post-operative radiation therapy to right breast. zoladex for 2 years +Tamoxifen 20 mg/day for. 5 years.. Treatments After Recurrence. See Figs. 112 and 113.. Sep. 2017 PET-CT: R/o metastasis to C2. vertebra.. Palliative Therapy. Bilateral salpingo-oophorectomy.. Radiation therapy to C-spine + Letrozole &. Palbociclib & zometa (2017-11-03~).. Metastatic Breast Cancer |
611 | Case 35 | Patient History | Metastatic Breast Cancer | Patient History and Progress. Female/51 years old, pre-menopause.. No family history.. S/p. hysterectomy. &. Left. salpingo-. oophorectomy (benign), s/p total hip replacement. arthroplasty.. 35.2. |
612 | Case 36 | Courses of Treatment | Carcinoma In Situ | 36.1. . Courses of Treatment:. Operation. Operation. 169. 170. Pathology Report. Lobular carcinoma in situ. . 1. Size of tumor: 0.5 cm.. . 2. Nuclear grade: low.. . 3. Necrosis: absent.. . 4. Architectural pattern: solid.. . 5. Skin: no involvement of tumor.. . 6. Surgical margins:. . (a) superior margin: 10 mm,. . (b) inferior margin: 5 mm,. E. S. Lee et al.. 131. . . a. b. . . Carcinoma In Situ. 132. . (c) medial margin: 20 mm,. . (d) lateral margin: 10 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: 2 mm.. . 7. Microcalcification:. present,. tumoral/non-. tumoral.. 37. |
619 | Case 36 | Important Radiologic | Carcinoma In Situ | Important Radiologic. Findings. 167. 168. 36.3. |
624 | Case 36 | Patient History | Carcinoma In Situ | Patient History and Progress. Female/47 years old, pre-menopause.. Screen detected mass lesion on right breast. 11 o’clock direction.. No family history.. No comorbidities.. 36.2. |
613 | Case 36 | Courses of Treatment | HR(+) HER2(+) Breast Cancer | 36.1. . Courses of Treatment. Operation + Adjuvant chemotherapy (#4. cycles of docetaxel and cyclophosphamide and. trastuzumab) + Post-operative radiation ther. apy + Trastuzumab + Tamoxifen 20 mg/day.. 215. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 1.5 cm (pT1c).. 2. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. b. . 3. Intraductal component: present, intratu. moral/extratumoral (5%) (nuclear grade:. high, necrosis: absent, architectural pattern:. solid, extensive intraductal component:. absent).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) superior margin: 10 mm,. . (b) inferior margin: 10 mm,. . (c) medial margin: 5 mm,. . (d) lateral margin: 5 mm,. . (e) deep margin: <1 mm from invasive duc. tal carcinoma (slide 2),. . (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):. pT1cN0(sn).. Result. Intensity. Positive. %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Weak (3/8). 2. <1%. C-erbB2. Equivocal (2+). Ki-67. Positive in 54%. of tumor cells. SISH. Tumor. heterogeneity. S. Park et al.. 427. © 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_7 |
620 | Case 36 | Important Radiologic | HR(+) HER2(+) Breast Cancer | Important Radiologic. Findings. 211 212 213. 214. 36.3. |
625 | Case 36 | Patient History | HR(+) HER2(+) Breast Cancer | Patient History and Progress. Female/42 years old, pre-menopause.. Self-detected palpable mass lesion on left. breast 5:30 o’clock direction.. No family history.. S/P Right pneumonectomy (lung cancer).. BRCA 1 and 2 mutation: Not examination.. 36.2. |
614 | Case 36 | Courses of Treatment | HR(+) HER2(-) Breast Cancer | 36.1. . Courses of Treatment. Operation + Post-operative radiation ther. apy + Tamoxifen 20 mg/day.. Operation. Right breast conserving surgery, sentinel lymph. micropapillary/cribri. form, extensive intraductal component:. present).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) superior margin: 10 mm.. . (b) inferior margin: 25 mm.. . (c) medial margin: 10 mm.. . (d) lateral margin: 20 mm.. . (e) deep margin: <1 mm from invasive duc. tal carcinoma (slide 1).. . (f) superficial margin: 5 mm.. 6. Lymph nodes: no metastasis in two axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/1,. non-sentinel LN: 0/1). pT1bN0(sn).. 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. Negative (1+). Ki-67. Positive in 9% of. tumor cells. HR(+) HER2(−) Breast Cancer |
621 | Case 36 | Important Radiologic | HR(+) HER2(-) Breast Cancer | Important Radiologic. Findings. See Figs. 199, 200, 201, 202 and 203.. 36.3. |
626 | Case 36 | Patient History | HR(+) HER2(-) Breast Cancer | Patient History and Progress. Female/50 years old, pre-menopause.. Screen detected mass lesion on right breast 10. o’clock direction.. No family history.. s/p endometrial curettage.. 36.2. |
615 | Case 36 | Courses of Treatment | HR(−) HER2(+) Breast Cancer | 36.1. . Courses of Treatment. Neoadjuvant chemotherapy (#6 cycles of. docetaxel and carboplatin and trastuzumab. and pertuzumab) + Operation + Post-. operative radiation therapy + Trastuzumab.. 245. 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.. . 2. Intraductal papilloma.. 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. 22% of. tumor cells. Y. Kwon et al.. 565. F. i. g. 243. (mSUV = 1.3). HR(−) HER2(+) Breast Cancer. 566. . . 37. |
622 | Case 36 | Important Radiologic | HR(−) HER2(+) Breast Cancer | Important Radiologic. Findings. 243. 244. 36.3. |
627 | Case 36 | Patient History | HR(−) HER2(+) Breast Cancer | Patient History and Progress. Female/63 years old, post-menopause.. Screen detected mass lesion on left breast 2. o’clock direction.. No family history.. Hypertension, chronic renal failure, ventricu. lar premature contraction.. S/P cholecystectomy (due to stone).. 36.2. |
616 | Case 36 | Courses of Treatment | HR(−) HER2(−) Breast Cancer | 36.1. . Courses of Treatment. Neoadjuvant chemotherapy (#4 cycles of. doxorubicin and . cyclophosphamide + #4 cycles. of docetaxel) + Operation + Post-operative. radiation therapy.. Operation. 267. Pathology Report. . 1. No residual tumor with foamy histiocytic. collection.. . (a) Post-chemotherapy status.. . (b) Lymph nodes: no metastasis in two axil. lary lymph nodes (ypN0(sn)) (sentinel. LN: 0/2).. . (c) Related slides: S21–10541, S21–10544.. . 2. Adenomyoepithelial. hyperplasia. with. microcalcification.. 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 66%. of tumor cells. E. S. Lee et al.. 707. . . . HR(−) HER2(−) Breast Cancer. 708. 37. |
623 | Case 36 | Important Radiologic | HR(−) HER2(−) Breast Cancer | Important Radiologic Findings. 260 261 262. 263. HR(−) HER2(−) Breast Cancer. 704. . . . . E. S. Lee et al.. 705. . HR(−) HER2(−) Breast Cancer. 706. . After Neoadjuvant Chemotherapy. 264 265. 266. 36.3. |
628 | Case 36 | Patient History | HR(−) HER2(−) Breast Cancer | Patient History and Progress. Female/46 years old, pre-menopause.. Self-detected palpable mass lesion on left. axillary.. Family history of breast cancer, aunt. (maternal).. Hepatitis B virus carrier.. BRCA 1 and 2 mutation: Not detected, RET. VUS (variant of uncertain).. 36.2. |
617 | Case 36 | Courses of Treatment | Local Recurrence | 36.1. . Courses of Treatment. Right breast DCIS → Operation → Left breast. recurrence (DCIS).. Primary Treatment. 244. Operation. 245. Pathology Report. Ductal Carcinoma In Situ. . 1. Post mammotome biopsy status.. Local Recurrence. 818. . a. b. . . 2. Size of tumor: 0.2 cm, residual.. . 3. Nuclear grade: low.. . 4. Necrosis: absent/present.. . 5. Architectural pattern: cribriform.. . 6. Surgical margins:. . (a) Superior margin: (see note).. . (b) Inferior margin: 7 mm.. . (c) Medial margin: 4 mm from ductal carci. noma in situ.. . (d) Lateral margin: 8 mm.. . (e) Deep margin: 2 mm.. . (f) Superficial margin: 2 mm.. . 7. Microcalcification: absent.. Note: 1. The superior margin of the lumpec. tomy specimen (slide 4) is close to ductal carci. noma in situ (<1 mm), but this margin submitted. for frozen diagnosis (Fro 1) is free of tumor.. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative (1+). Ki-67. Positive in 29%. of tumor cells. Treatments After Recurrence. 246. Operation. 247. 248. Pathology Report. Ductal Carcinoma In Situ. . 1. Size of tumor: 3.5 cm (pTis).. . 2. Nuclear grade: low.. . 3. Necrosis: absent.. . 4. Architectural pattern: papillary/cribriform/. solid.. . 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.. . 8. Pathological TN category (AJCC 2017): pTis.. Axillary Tail: Ductal Carcinoma In Situ. . 1. Size of tumor: 0.3 cm.. . 2. Nuclear grade: low.. . 3. Necrosis: absent.. . 4. Architectural pattern: cribriform.. . 5. Surgical margin: involvement of superficial. margin.. Y. Kim et al.. 819. . a. b. . 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 51%. of tumor cells. Adjuvant Therapy. Tamoxifen 20 mg/day for 5 years.. 37. |
629 | Case 36 | Patient History | Local Recurrence | Patient History and Progress. Female/48 years old, pre-menopause.. Screen detected mass lesion on right breast 10. o’clock direction.. Outside result of biopsy: Papillary carcinoma. in situ.. No family history.. s/p bilateral breast augmentation.. BRCA 1 and 2 mutation: Not detected.. 36.2. |
618 | Case 36 | Courses of Treatment | Metastatic Breast Cancer | Courses of Treatment. Right breast cancer → Operation → Adjuvant. therapy → Lung metastasis.. Primary Treatment. Estrogen. receptor. Strong (7/7). 3. >2/3. Progesterone. receptor. Intermediate. (5/7). 2. 1/3–2/3. Result. Intensity. Positive %. C-erbB2. Equivocal. (2+). Ki-67. Positive in. 10% of tumor. cells. SISH. Negative. Adjuvant Therapy. Adjuvant chemotherapy #8 cycles (Doxorubicin. & cyclophosphamide #4 → Docetaxel #4).. Post-operation radiation to right breast +. Tamoxifen 20 mg/day for 5 years.. Treatments After Recurrence. Strong (8/8). 3. >2/3. Progesterone. receptor. Intermediate. (6/8). 2. 1/3–2/3. C-erbB2. Negative (0). Ki-67. Positive in. 22% of tumor. cells. Palliative Therapy. Clinical trial: Capecitabine #19: Progressive. disease.. Nov. 2018 Bilateral salpingo-oophorectomy.. Palliative therapy: Letrozole +Palbociclib. (Dec. 2018) ~. 37. |
630 | Case 36 | Patient History | Metastatic Breast Cancer | mellitus.. 36.2. |
631 | Case 37 | Courses of Treatment | Carcinoma In Situ | 37.1. . Courses of Treatment:. Operation. Operation. 173. 174. Pathology Report. Lobular carcinoma in situ. . 1. Size of tumor: 2.0 cm.. . 2. Nuclear grade: low.. . 3. Necrosis: absent.. . 4. Architectural pattern: solid.. . 5. Skin: no involvement of tumor.. . 6. Surgical margins:. . (a) superior margin: positive (Fro 1),. . (b) inferior margin: 4 mm,. . (c) medial margin: positive (Fro 3),. . (d) lateral margin: positive (Fro 4),. . (e) deep margin: <1 mm (slide 6),. . (f) superficial margin: 10 mm.. . 7. Microcalcification: absent.. Result. Intensity. Positive %. Estrogen. receptor. Weak (4/8). 2. 1–10%. Progesterone. receptor. Weak (4/8). 2. 1–10%. C-erbB2. Negative (1+). Ki-67. Positive in 8%. of tumor cells. . E. S. Lee et al.. 133. . a. b. . a. b. . . Carcinoma In Situ. 134. 38. |
637 | Case 37 | Important Radiologic | Carcinoma In Situ | Important Radiologic. Findings. 171. 172. 37.3. |
641 | Case 37 | Patient History | Carcinoma In Situ | Patient History and Progress. Female/46 years old, pre-menopause.. Screen detected mass lesion on left breast. 12 o’clock direction.. Outside result of biopsy: Lobular carcinoma. in situ.. No family history.. No comorbidities.. 37.2. |
632 | Case 37 | Courses of Treatment | HR(+) HER2(-) Breast Cancer | Courses of Treatment. Operation + Adjuvant chemotherapy (#4. cycles of docetaxel & cyclophosphamide) +. Post-operative radiation therapy + Tamoxifen. 20 mg/day.. Operation. Left breast conserving surgery, sentinel lymph. ductal component: present).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) superior margin: 10 mm.. . (b) inferior margin: 15 mm.. . (c) medial margin: 10 mm.. . (d) lateral margin: (see note).. . (e) deep margin: 4 mm.. . (f) superficial margin: <1 mm from ductal. 10. Microcalcification:. present,. tumoral/. non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT2N0(sn).. Note: 1. The lateral margin of the lumpec. tomy specimen (slide 6) is close to ductal. carcinoma in situ (<1 mm) but this margin. submitted for frozen diagnosis (Fro 9) is free. of tumor.. Y. Kim et al.. 3. 10%–1/3. C-erbB2. Negative (1+) IDC. Positive (3+) DCIS. Ki-67. Positive in 47% of tumor cells. 38. |
638 | Case 37 | Important Radiologic | HR(+) HER2(-) Breast Cancer | Important Radiologic. Findings. See Figs. 205, 206, 207 and 208.. 37.3. |
642 | Case 37 | Patient History | HR(+) HER2(-) Breast Cancer | 4–5 o’clock direction.. No family history.. Hypertension,. s/p. Lumbar. spine. disc. operation.. 37.2. |
633 | Case 37 | Courses of Treatment | HR(−) HER2(+) Breast Cancer | 37.1. . Courses of Treatment. Neoadjuvant chemotherapy (#6 cycles of. docetaxel and carboplatin and trastuzumab. and pertuzumab) + Operation + Post-. operative radiation therapy + Trastuzumab.. 253. Pathology Report. Ductal Carcinoma In Situ. 1. Post-chemotherapy status.. 2. Size of tumor: 0.5 cm (ypTis).. 3. Nuclear grade: high.. 4. Necrosis: present.. 5. Architectural pattern: solid/comedo.. 6. Skin: no involvement of tumor.. 7. Surgical margins:. . (a) superior margin: 10 mm,. . (b) inferior margin: 10 mm,. . (c) medial margin: 30 mm,. HR(−) HER2(+) Breast Cancer. 570. . . (d) lateral margin: 20 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: 2 mm.. 8. Lymph nodes: no metastasis in two axillary. lymph nodes (ypN0(sn)) (sentinel LN: 0/2).. 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. 39% of tumor. cells. 38. |
639 | Case 37 | Important Radiologic | HR(−) HER2(+) Breast Cancer | Important Radiologic. Findings. 246 247. 248. Y. Kwon et al.. 567. . . . HR(−) HER2(+) Breast Cancer. 568. 37.3. . After Neoadjuvant. Chemotherapy. 249 250 251. 252. . Y. Kwon et al.. 569. . . . 37.4. |
643 | Case 37 | Patient History | HR(−) HER2(+) Breast Cancer | Patient History and Progress. Female/63 years old, post-menopause.. Self-detected nipple discharge on left breast.. No family history.. S/P Total hysterectomy, s/p right lung lobec. tomy (benign), diabetes mellitus.. 37.2. |
634 | Case 37 | Courses of Treatment | HR(−) HER2(−) Breast Cancer | 37.1. . Courses of Treatment. Neoadjuvant chemotherapy (#4 cycles of. doxorubicin and cyclophosphamide + #4. cycles of docetaxel) + Operation + Post-. operative radiation therapy + Adjuvant. capecitabine.. Operation. 276. Pathology Report. Invasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of invasive component: up to 0.3 cm,. multifocal (ypT1a).. 3. Size of intraductal component: 2.0 cm.. 4. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 2/3, 3/HPF).. 5. Intraductal component: present, intratu. moral/extratumoral (80%) (nuclear grade:. high, necrosis: present, architectural pattern:. papillary/micropapillary/cribriform/solid/. comedo, extensive intraductal component:. absent/present).. 6. Skin: no involvement of tumor.. 7. Surgical margins:. . (a) Superior margin: 20 mm.. . (b) Inferior margin: 5 mm.. . (c) Medial margin: (see note).. . (d) Lateral margin: 5 mm.. . (e) Deep margin: 2 mm.. . (f) Superficial margin: 2 mm.. 8. Lymph nodes:. . (a) metastasis in two out of six axillary lymph. nodes (ypN1a) (sentinel LN: 1/1, axillary. LN: 0/4, intramammary LN: 1/1),. . (b) perinodal extension: present,. . (c) size of metastatic carcinoma: 4 mm.. 9. Arteriovenous invasion: absent.. HR(−) HER2(−) Breast Cancer. 710. . . . . E. S. Lee et al.. 711. . 10. Lymphovascular invasion: present, intratu. moral/peritumoral.. . 11. Tumor border: infiltrative.. . 12. Microcalcification:. present,. tumoral/. non-tumoral.. . 13. Pathological TN category (AJCC 2017):. ypT1aN1a.. Result. Intensity. Positive %. Estrogen. receptor. Weak (3/8). 1. 1%–10%. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Negative (1+). Ki-67. Positive in 29%. of tumor cells. . . HR(−) HER2(−) Breast Cancer. 712. 38. |
640 | Case 37 | Important Radiologic | HR(−) HER2(−) Breast Cancer | Important Radiologic. Findings. 268 269 270. 271. . . . . . E. S. Lee et al.. 709. . After Neoadjuvant. Chemotherapy. 272 273 274. 275. 37.3. |
644 | Case 37 | Patient History | HR(−) HER2(−) Breast Cancer | Patient History and Progress. Female/46 years old, pre-menopause.. Self-detected palpable mass lesion on right breast.. Family history of breast cancer, aunt (maternal).. s/p myomectomy.. BRCA 1 and 2 mutation: Not detected.. 37.2. |
635 | Case 37 | Courses of Treatment | Local Recurrence | 37.1. . Courses of Treatment. Left breast DCIS→ Operation → Adjuvant ther. apy → Left breast recurrence (DCIS).. Primary Treatment. 249 250. 251. Operation. 252. Local Recurrence. 820. Pathology Report. Ductal Carcinoma In Situ. . 1. Size of tumor: 3.0 cm (pTis).. . 2. Nuclear grade: low.. . 3. Necrosis: present.. . 4. Architectural pattern: micropapillary/cribri. form/comedo.. . 5. Skin: no involvement of tumor.. . 6. Surgical margins:. . (a) Nipple margin: positive for atypical duc. tal hyperplasia (Fro 1) (see note 1).. . (b) Superior margin: (see note 2).. . (c) Inferior margin: 20 mm.. . (d) Medial margin: 5 mm.. . (e) Lateral margin: 15 mm.. . (f) Deep margin: 2 mm.. . (g) Superficial margin: 2 mm.. . 7. Microcalcification:. present,. tumoral/. non-tumoral.. . 8. Pathologic stage (AJCC 2010): pTis.. Note: 1. Atypical ductal hyperplasia is present. only in the permanent section of Fro 1.. 2. The superior margin of the lumpectomy. specimen (slide 1) is positive for ductal carci. noma in situ, but this margin submitted for frozen. Result. Intensity. Positive %. Estrogen. receptor. Intermediate. (6/8). 2. 1/3–2/3. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in 36%. of tumor cells. Adjuvant Therapy. Postoperative radiation therapy.. Tamoxifen 20 mg/day for 5 years.. Treatments After Recurrence. 253. 254. Operation. 255. Pathology Report. Ductal Carcinoma In Situ. . 1. Post-lumpectomy status.. . 2. Size of tumor: 0.5 cm (rpTis).. . 3. Nuclear grade: high.. . 4. Necrosis: absent.. . 5. Architectural. pattern:. micropapillary/. cribriform.. . 6. Skin and nipple: Paget’s disease.. . 7. 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.. Local Recurrence. 822. . . . 8. Microcalcification:. present,. tumoral/. non-tumoral.. . 9. Pathological TN category (AJCC 2017):. rpTis(Paget).. 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 58%. of tumor cells. 38. |
645 | Case 37 | Patient History | Local Recurrence | Patient History and Progress. Female/43 years old, pre-menopause.. Screen detected mass lesion on left breast 7. o’clock direction.. Outside result of biopsy: ductal carcinoma in. situ.. No family history.. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 37.2. |
636 | Case 37 | Courses of Treatment | Metastatic Breast Cancer | 37.1. . Courses of Treatment. Right breast cancer → Operation → Adjuvant. therapy → Lung metastasis.. Primary Treatment. Estrogen. receptor. Intermediate. (6/8). 2. 1/3–2/3. Progesterone. receptor. Intermediate. (6/8). 2. 1/3–2/3. C-erbB2. Positive (3+). Ki-67. Positive in. 27% of tumor. cells. Metastatic Breast Cancer. 920. Adjuvant Therapy. Adjuvant chemotherapy #8 cycles (Doxorubicin. & cyclophosphamide #4 → Docetaxel & trastu. zumab #4).. Post-operative radiation therapy to right. breast.. Concurrent Trastuzumab # 4 + Tamoxifen. 20 mg/day for 85 days.. Treatments After Recurrence. See Figs. 117 and 118.. Feb. 2014 PET>R/O metastasis to lung, lymph. node, and right pleural effusion.. Palliative Therapy. Palliative therapy: Letrozole & trastuzumab (Feb. |
646 | Case 37 | Patient History | Metastatic Breast Cancer | Patient History and Progress. Female/59 years old, post-menopause.. No family history.. Hypertension, s/p right vertebral artery, tran. sient ischemic attack.. 37.2. |
647 | Case 38 | Courses of Treatment | Carcinoma In Situ | 38.1. . Courses of Treatment. Neoadjuvant chemotherapy #6 cycles (Docetaxel. and. Carboplatin. and. Trastuzumab. and. Pertuzumab) + Operation + Postoperative radia. tion therapy + Tamoxifen 20 mg/day for 5 years. + Trastuzumab for 1 year.. Operation. 180. 181. Pathology Report. Right.. Lobular carcinoma in situ. . 1. Post-chemotherapy status.. . 2. Size of tumor: 1.5 cm.. . 3. Nuclear grade: low.. . 4. Necrosis: absent.. . 5. Architectural pattern: solid.. . 6. Surgical margins:. . (a) superior margin: (see note),. . (b) inferior margin: 4 mm,. . (c) medial margin: 20 mm,. . (d) lateral margin: (see note),. . (e) deep margin: <1 mm (MG2),. . (f) superficial margin: 2 mm.. . 7. Microcalcification: present, non-tumoral.. Note: 1. The superior and lateral margins of. the lumpectomy specimen (slides MG1and 5). are close to lobular carcinoma in situ (1 mm). but these margins submitted for frozen diagno. sis (Fro 1 and Fro 4) are free of tumor.. Left.. Ductal carcinoma in situ. . 1. Post-chemotherapy status.. . 2. Size of tumor: up to 0.5 cm (ypTis).. . 3. Nuclear grade: high.. . 4. Necrosis: present.. . 5. Architectural pattern: papillary/cribriform/. solid/comedo.. . 6. Skin: no involvement of tumor.. . 7. Surgical margins:. . (a) superior margin: 17 mm,. . (b) inferior margin: 10 mm,. . . . E. S. Lee et al.. 135. . . . . . a. b. . Carcinoma In Situ. 136. a. b. c. d. . . . (c) medial margin: 40 mm,. . (d) lateral margin: 10 mm,. . (e) deep margin: 3 mm,. . (f) superficial margin: 14 mm.. . 8. Lymph nodes: no metastasis in five axillary. lymph nodes (ypN0(sn)) (sentinel LN: 0/5).. . 9. Microcalcification: present.. 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. 15% of tumor. cells. 39. |
653 | Case 38 | Important Radiologic | Carcinoma In Situ | Important Radiologic. Findings. 175 176 177 178. 179. 38.3. |
657 | Case 38 | Patient History | Carcinoma In Situ | Patient History and Progress. Female/51 years old, pre-menopause.. Screen detected mass and microcalcification. on upper outer left breast.. No family history.. No comorbidities.. BRCA 1 and 2 mutation: Not detected, POLE. VUS (variant of uncertain).. 38.2. |
648 | Case 38 | Courses of Treatment | HR(+) HER2(-) Breast Cancer | 38.1. . Courses of Treatment. Operation + Post-operative radiation ther. apy + Letrozole 2.5 mg/day.. HR(+) HER2(−) Breast Cancer. extensive intraductal component: present).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) superior margin: 20 mm.. . (b) inferior margin: 7 mm.. . (c) medial margin: 15 mm.. . (d) lateral margin: 10 mm.. . (e) deep margin: 2 mm.. . (f) superficial margin: 5 mm.. 7. Lymph nodes: no metastasis in one axillary. lymph node (pN0(sn)) (sentinel LN: 0/1). Y. Kim et al.. %. Estrogen. receptor. Strong (7/8). 2. >2/3. Progesterone. receptor. Weak (3/8). 1. 1–10%. C-erbB2. Negative (1+). Ki-67. Positive in 19%. of tumor cells. HR(+) HER2(−) Breast Cancer |
654 | Case 38 | Important Radiologic | HR(+) HER2(-) Breast Cancer | Important Radiologic. Findings. See Figs. 210, 211, 212, 213 and 214.. 38.3. |
658 | Case 38 | Patient History | HR(+) HER2(-) Breast Cancer | Patient History and Progress. Female/57 years old, post-menopause.. Screen detected mass lesion on left breast 2. o’clock direction.. No family history.. Diabetes mellitus, dyslipidemia, s/p cataract. operation.. 38.2. |
649 | Case 38 | Courses of Treatment | HR(−) HER2(+) Breast Cancer | 38.1. . Courses of Treatment. Operation + Adjuvant chemotherapy (#4. cycles of docetaxel and cyclophosphamide) +. Post-operative. radiation. therapy. +. Trastuzumab.. 258. Y. Kwon et al.. 571. . . . HR(−) HER2(+) Breast Cancer. 3. Intraductal component: present, intratu. moral/extratumoral (60%) (nuclear grade:. high, necrosis: present, architectural pattern:. cribriform/solid/comedo, extensive intra. ductal component: present).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) superior margin: 10 mm,. . (b) inferior margin: 15 mm,. . (c) medial margin: 5 mm,. . (d) lateral margin: 10 mm,. . (e) deep margin: 10 mm,. . (f) superficial margin: 7 mm.. Y. Kwon et al.. 573. 6. Lymph nodes: no metastasis in nine axillary. lymph nodes (pN0) (sentinel LN: 0/4, axil. lary LN: 0/5).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular invasion: absent.. 9. Tumor border: infiltrative.. . 10. Microcalcification: present, non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT1cN0.. 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. HR(−) HER2(+) Breast Cancer. 575 |
655 | Case 38 | Important Radiologic | HR(−) HER2(+) Breast Cancer | Important Radiologic. Findings. 254 255 256. 257. 38.3. |
659 | Case 38 | Patient History | HR(−) HER2(+) Breast Cancer | Patient History and Progress. Female/55 years old, post-menopause.. Self-detected palpable mass lesion on right. breast.. Family history of breast cancer, sister.. Dyslipidemia.. BRCA 1 and 2 mutation: Not detected,. MUTYH. and. RAD50 VUS. (variant. of. uncertain).. 38.2. |
650 | Case 38 | Courses of Treatment | HR(−) HER2(−) Breast Cancer | 38.1. . Courses of Treatment. Neoadjuvant chemotherapy (#4 cycles of. doxorubicin and cyclophosphamide + #4. cycles of docetaxel) + Operation + Post-. operative radiation therapy.. Operation. . 285. 286. Pathology Report. No residual tumor with stromal degeneration. . 1. Post-chemotherapy status.. . 2. Lymph nodes: no metastasis in one axillary. lymph node (ypN0(sn)) (sentinel LN: 0/1).. . 3. Microcalcification: present.. 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 62%. of tumor cells. HR(−) HER2(−) Breast Cancer. 714. . . . E. S. Lee et al.. 715. . . HR(−) HER2(−) Breast Cancer. 716. . E. S. Lee et al.. 717 |
656 | Case 38 | Important Radiologic | HR(−) HER2(−) Breast Cancer | Important Radiologic. Findings. 277 278 279. 280. . . . . E. S. Lee et al.. 713. . After Neoadjuvant. Chemotherapy. 281 282 283. 284. 38.3. |
660 | Case 38 | Patient History | HR(−) HER2(−) Breast Cancer | Patient History and Progress. Female/52 years old, post-menopause.. Self-detected palpable mass lesion on right. breast.. No family history.. s/p bilateral salpingo-oophorectomy.. BRCA 1 mutation carrier.. 38.2. |
651 | Case 38 | Courses of Treatment | Local Recurrence | 38.1. . Courses of Treatment. Right breast IDC→ Operation → Adjuvant ther. apy → Right breast DCIS.. Primary Treatment. Operation. Jun. 2012 Right breast conserving surgery, senti. nel lymph node biopsy (outside).. Pathology Report. Invasive Ductal Carcinoma. . 1. Size of tumor: 0.9 cm (pT1b).. . 2. Lymph nodes: no metastasis in four axillary. lymph nodes (pN0(sn)).. . 3. Pathological TN category: pT1bN0.. Result. Intensity. Positive %. Estrogen. receptor. Positive (6/8). Progesterone. receptor. Positive (6/8). C-erbB2. Equivocal (2+). Adjuvant Therapy. Adjuvant chemotherapy #6 cycles of cyclophos. phamide and methotrexate and fluorouracil.. Postoperative radiation therapy.. Tamoxifen 20 mg/day for 5 years.. Treatments After Recurrence. 256. Operation. 257. Pathology Report. Ductal Carcinoma In Situ. . 1. Size of tumor: 0.3 cm (pTis).. . 2. Nuclear grade: low.. . 3. Necrosis: absent.. . 4. Architectural pattern: cribriform/solid.. . 5. Skin: no involvement of tumor.. . 6. Surgical margins:. . (a) Superior margin: 5 mm.. . (b) Inferior margin: 2 mm (slides 3 and 4).. . . . Local Recurrence. 824. . (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.. . 8. Pathological TN category (AJCC 2017): pTis.. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative (1+). Ki-67. Positive in 8%. of tumor cells. Adjuvant Therapy. Postoperative radiation therapy.. Tamoxifen 20 mg/day.. 39. |
661 | Case 38 | Patient History | Local Recurrence | Patient History and Progress. Female/47 years old, pre-menopause.. Screen detected mass lesion on right breast 12. o’clock direction.. Outside result of Lumpectomy: Invasive duc. tal carcinoma.. No family history.. Y. Kim et al.. 823. 38.2. |
652 | Case 38 | Courses of Treatment | Metastatic Breast Cancer | Courses of Treatment. Both breasts cancer → Operation → Adjuvant. therapy → Liver metastasis.. Primary Treatment. See Figs. 119 and 120.. Operation. Dec. 2008 Bilateral breast conserving surgery,. axillary lymph node dissection.. Pathology:. Right breast> Invasive ductal carcinoma, stage. pT2N2a, size of tumor: 4.5 cm, lymph node: 6/9. (12 mm).. Result. Intensity Positive %. Estrogen. receptor. Weak(2/7). 1. <10%. Progesterone. receptor. Negative. (0/7). 0. 0. Result. Intensity Positive %. C-erbB2. Positive. (3+). Ki-67. Positive in. 15% of. tumor cells. Left breast> Ductal carcinoma in situ, stage. pTisN0, size of tumor: 2.0 cm, lymph node: 0/7.. Metastatic Breast Cancer. receptor. Negative (0/7). 0. 0. C-erbB2. Positive(3+). Ki-67. Positive in 5%. of tumor cells. Adjuvant Therapy. Adjuvant chemotherapy #8 cycles (Doxorubicin. & cyclophosphamide #4 → Docetaxel #4).. Post-operative radiation therapy to right breast. & supraclavicular lymph node + Letrozole for. 5 years, concurrent Trastuzumab #18.. Treatments After Recurrence |
662 | Case 38 | Patient History | Metastatic Breast Cancer | |
663 | Case 39 | Courses of Treatment | Carcinoma In Situ | 39.1. . Courses of Treatment. Operation + Tamoxifen 20 mg/day for 6 months.. Operation. 184. 185. Pathology Report. Lobular carcinoma in situ. . 1. Size of tumor: 2.0 cm.. . 2. Nuclear grade: low.. . 3. Necrosis: absent.. E. S. Lee et al.. 137. . 4. Architectural pattern: solid.. . 5. Skin: no involvement of tumor.. . 6. Surgical margins:. . (a) superior margin: <1 mm (slide 2),. . (b) inferior margin: <1 mm (slide 5),. . (c) medial margin: 1 mm (slide 4),. . (d) lateral margin: <1 mm (slide 6),. . (e) deep margin: <1 mm (slide 3),. . (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 (8/8). 3. >2/3. C-erbB2. Negative (1+). Ki-67. Positive in 6%. of tumor cells. . . a. b. . Carcinoma In Situ. 138. a. b. . . . . . 40. |
667 | Case 39 | Important Radiologic | Carcinoma In Situ | Important Radiologic. Findings. 182. 183. 39.3. |
669 | Case 39 | Patient History | Carcinoma In Situ | Patient History and Progress. Female/47 years old, pre-menopause.. Screen detected mass lesion on right breast 12. o’clock direction.. Outside result of biopsy: lobular carcinoma in. situ.. No family history.. Hypertension.. 39.2. |
664 | Case 39 | Courses of Treatment | HR(+) HER2(-) Breast Cancer | Courses of Treatment. Operation. +. Adjuvant. chemotherapy. (#4 cycles of docetaxel & cyclophospha. mide) + Tamoxifen 20 mg/day.. Operation. Right nipple–areolar complex sparing mastec. tomy with immediate implant reconstruction, left. breast mass excision (Figs. 220, 221 and 222).. Pathology Report. [Right]. Invasive Lobular Carcinoma. 1. Size of tumor: 2.5 cm (pT2).. Y. Kim et al.. 295. 2. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 6/10 HPF). 3. In situ component: present, intratumoral/. extratumoral (70%).. 4. Skin: no involvement of tumor.. 5. Surgical margins: (see note).. . (a) deep margin: <1 mm from invasive lobu. lar carcinoma (slides 1 and 9).. . (b) superficial margin: <1 mm from invasive. lobular carcinoma (slide 1).. 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):. pT2N0(sn).. Note: 1. Lobular carcinoma in situ is pres. ent only in the permanent sections of Fro 9. and Fro 10.. 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 5% of. tumor cells. [Left] |
668 | Case 39 | Important Radiologic | HR(+) HER2(-) Breast Cancer | Important Radiologic. Findings. See Figs. 216, 217, 218 and 219.. 39.3. |
670 | Case 39 | Patient History | HR(+) HER2(-) Breast Cancer | No comorbidities.. 39.2. |
665 | Case 39 | Courses of Treatment | Local Recurrence | 39.1. . Courses of Treatment. Left breast IDC→ Operation → Adjuvant ther. apy → Left breast recurrence (IDC).. Primary Treatment. 258 259 260. 261. Operation. 262. Pathology Report. Invasive Ductal Carcinoma. 1. Size of invasive tumor: 3 cm (pT2).. 2. Size of intraductal component: 4.5 cm.. 3. Histologic grade: 1/3 (tubule formation: 3/3,. nuclear pleomorphism: 1/3, mitotic count:. 1/3, 7/10HPF).. 4. Intraductal component: present, intratu. moral/extratumoral (30%) (nuclear grade:. low, necrosis: absent, architectural pattern:. cribriform, extensive intraductal component:. present).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . . . Y. Kim et al.. 825. . . . Local Recurrence. 826. . (a) Deep margin: 13 mm.. . (b) Superficial margin: 16 mm.. 7. Lymph nodes:. . (a) Metastasis in 1 out of 10 axillary lymph. nodes (pN1mi) (sentinel LN: 1/3, axil. lary LN: 0/7).. . (b) Perinodal extension: absent.. . (c) Size of metastatic carcinoma: 2 mm.. 8. Vascular invasion: absent.. 9. Lymphatic invasion: absent.. . 10. Tumor border: infiltrative.. . 11. Microcalcification: absent.. . 12. Pathologic stage (AJCC 2010): pT2N1mi.. 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 26%. of tumor cells. Adjuvant Therapy. Tamoxifen 20 mg/day for 2.6 years with. goserelin.. Treatments after Recurrence. 263. 264. Operation. 265. Pathology Report. Invasive Ductal Carcinoma. 1. Post-nipple-sparing mastectomy status.. 2. Size of tumor: 0.3 cm, residual (see note).. 3. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 7/10HPF).. 4. Intraductal component: present, intratu. moral/extratumoral (10%) (nuclear grade:. low, necrosis: absent, architectural pattern:. cribriform, extensive intraductal component:. absent).. 5. Skin and nipple: no involvement of tumor.. 6. Surgical margins:. . (a) Superior margin: 10 mm.. . (b) Inferior margin: 5 mm.. . (c) Medial margin: 20 mm.. . (d) Lateral margin: 5 mm.. . (e) Deep margin: 2 mm.. . (f) Superficial margin: 2 mm.. 7. Arteriovenous invasion: absent.. 8. Lymphovascular. invasion:. present,. intratumoral.. 9. Tumor border: infiltrative.. . 10. Microcalcification:. present,. tumoral/. non-tumoral.. Note: 1. In the previous biopsy specimen. (S18–12629), invasive ductal carcinoma mea. sures at least 0.4 cm in greatest dimension.. . . Y. Kim et al.. 827. . . Result. Intensity. Positive %. Estrogen. receptor. Intermediate. (5/8). 2. 10%-1/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative (1+). Ki-67. Positive in 14%. of tumor cells. Adjuvant Therapy. Postoperative radiation therapy.. Letrozole 2.5 mg/day for 5 years.. 40. |
671 | Case 39 | Patient History | Local Recurrence | Patient History and Progress. Female/42 years old, post-menopause.. Bloody discharge from left nipple.. No family history.. 39.2. |
666 | Case 39 | Courses of Treatment | Metastatic Breast Cancer | Courses of Treatment. Right breast cancer → Neoadjuvant chemother. apy → Operation → Adjuvant therapy → Left. breast and lung metastasis.. Primary Treatment. Estrogen. receptor. Negative(0/7). 0. 0. Progesterone. receptor. Negative(0/7). 0. 0. C-erbB2. Equivocal (2+). Ki-67. Positive in. 10% of tumor. cells. SISH. Negative. Adjuvant Therapy. Post-operative radiation to right breast.. Treatments After Recurrence. (0/8). 0. 0. Progesterone. receptor. Negative(0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in. 43% of tumor. cells |
672 | Case 39 | Patient History | Metastatic Breast Cancer | Patient History and Progress. Female/51 years old, peri-menopause.. No family history.. BRCA 1 & 2 mutation: Not detected.. Hepatitis B virus carrier, hypertension.. 39.2. |
673 | Case 4 | Courses of Treatment | Benign and Proliferative | 4.1. . Courses of Treatment. → 2021-12-14 Excision, Lt.. Benign and Proliferative Case Series. 22. . 4.3.1. . Pathology Report. Diagnosis. • Breast, left, excision:. –. – Intraductal papilloma.. 5. |
681 | Case 4 | Important Radiologic | Benign and Proliferative | Important Radiologic. Findings. 6. 4.3. |
687 | Case 4 | Patient History | Benign and Proliferative | Patient History and Progress. Female/60 years old, post-menopause.. Screen detected mass lesion on left breast. 12 o’clock direction.. Family history of pancreatic cancer, mother.. Hypertension, dyslipidemia (taking medication).. 4.2. |
674 | Case 4 | Courses of Treatment | Carcinoma In Situ | 4.1. . Courses of Treatment. Operation + Postoperative radiation therapy (left. side) + Tamoxifen 20 mg/day for 5 years.. 4.3.1. . Operation. 19. 20. 4.3.2. . Pathology Report. Right.. <First operation>. Lobular carcinoma in situ. . 1. Size of tumor: 0.2 cm.. . 2. Nuclear grade: low.. . 3. Necrosis: absent.. . 4. Architectural pattern: solid.. . 5. Surgical margins:. . (a) superior margin: 5 mm,. . (b) inferior margin: 5 mm,. . . (d) lateral margin: 10 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: 2 mm.. . 6. Microcalcification:. present,. tumoral/. non-tumoral.. <Second operation>. Lobular carcinoma in situ. . 1. Post-excision status.. . 2. Size of tumor: 0.2 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,. . . . . . . Carcinoma In Situ. 60. d. . (c) medial margin: 10 mm,. . (d) lateral margin: 30 mm (see Note 1),. . (e) deep margin: 10 mm,. . (f) superficial margin: 5 mm.. . 7. Microcalcification: present, non-tumoral.. Note: 1. Atypical ductal hyperplasia is pres. ent only in the permanent section of Frozen 10.. Left.. <First operation>. E. S. Lee et al.. 61. Ductal carcinoma in situ, pathological TN cat. egory (AJCC 2017): pTis. . 1. Size of tumor: 0.5 cm (pTis).. . 2. Nuclear grade: low.. . 3. Necrosis: absent.. . 4. Architectural. pattern:. micropapillary/. cribriform.. . 5. 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.. . 6. Microcalcification:. present,. tumoral/non-. tumoral.. 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. <Second operation>. Ductal carcinoma in situ. . 1. Post-excision status.. . 2. Size of tumor: 0.4 cm, residual.. . 3. Nuclear grade: low.. . 4. Necrosis: absent.. . 5. Architectural. pattern:. micropapillary/. cribriform.. . 6. Surgical margins:. . (a) superior margin: 5 mm (see Note 1),. . (b) inferior margin: 5 mm,. . (c) medial margin: (see Note 2),. . (d) lateral margin: 30 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: 2 mm.. . 7. Microcalcification: present, tumoral.. Note: 1. Atypical ductal hyperplasia is. present only in the permanent section of Fro 1. 2. The medial margin of the lumpectomy. specimen (slide 4) is close to ductal carci. noma in situ (2 mm) but this margin submit. ted for frozen diagnosis (Fro 3) is free of. tumor. F. i. g. . 20_1 |
682 | Case 4 | Important Radiologic | Carcinoma In Situ | Important Radiologic. Findings. 15 16 17. 18. 4.3. |
688 | Case 4 | Patient History | Carcinoma In Situ | Patient History and Progress. Female/46 years old, pre-menopause.. Self-detected palpable mass on right breast 8. and 9 o’clock direction.. No family history.. No comorbidities.. BRCA 1 and 2: No detected mutation,. RAD51C VUS (variant of uncertain).. 4.2. |
675 | Case 4 | Courses of Treatment | HR(+) HER2(+) Breast Cancer | 4.1. . Courses of Treatment. Operation + Adjuvant chemotherapy (#4. cycles of doxorubicin and cyclophospha. mide). +. Post-operative. radiation. ther. apy + Letrozole 2.5 mg/day.. 23. 4.3.1. . Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 0.6 cm (pT1b).. 2. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 2/3, 10/10 HPF).. HR(+) HER2(+) Breast Cancer. 310. . . . 3. Intraductal component: present, extratumoral. (50%) (nuclear grade: high, necrosis: pres. ent, architectural pattern: micropapillary/. cribriform/comedo, extensive intraductal. component: present).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) superior margin: 10 mm,. . (b) inferior margin: 5 mm,. . (c) medial margin: 15 mm,. . (d) lateral margin: 25 mm,. . (e) deep margin: 1.5 mm from ductal carci. noma in situ (slide 3),. . (f) superficial margin: 8 mm.. 6. Lymph nodes: no metastasis in two axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/2).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular invasion: absent.. 9. Tumor border: infiltrative.. . 10. Microcalcification:. present,. tumoral/. non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT1bN0(sn).. Result. Intensity. Positive. %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Intermediate. (5/8). 2. 10% to. 1/3. C-erbB2. Positive (3+). Ki-67. Positive in 27%. of tumor cells. S. Park et al.. 311. . . HR(+) HER2(+) Breast Cancer. 312. a. b. . 5. |
683 | Case 4 | Important Radiologic | HR(+) HER2(+) Breast Cancer | Important Radiologic. Findings. 19 20 21. 22. 4.3. |
689 | Case 4 | Patient History | HR(+) HER2(+) Breast Cancer | Patient History and Progress. Female/56 years old, post-menopause.. Screen detected mass lesion on right breast 12. o’clock direction.. No family history.. S/P Thyroid radiofrequency ablation.. 4.2. |
676 | Case 4 | Courses of Treatment | HR(+) HER2(-) Breast Cancer | 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: 10 mm,. . (d) lateral margin: 15 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: 2 mm.. 6. Lymph nodes:. . (a) metastasis in one out of five axillary. lymph nodes (pN1a(sn)) (sentinel LN:. 1/1, axillary LN: 0/4),. . (b) perinodal extension: present,. . (c) size of metastatic carcinoma: 23 mm.. 7. Arteriovenous invasion: absent.. 8. Lymphovascular. invasion:. present,. intratumoral.. 9. Tumor border: infiltrative.. . 10. Microcalcification:. present,. tumoral/. non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT1cN1a(sn).. Result. Intensity. Positive %. Estrogen receptor. Strong (8/8). 3. >2/3. Progesterone receptor. Negative (0/8). 0. 0. C-erbB2. Equivocal (2+) (SISH negative). Ki-67. Positive in 6% of tumor cells. Y. Kim et al. |
684 | Case 4 | Important Radiologic | HR(+) HER2(-) Breast Cancer | Important Radiologic. Findings. See Figs. 15, 16, 17 and 18.. HR(+) HER2(−) Breast Cancer |
690 | Case 4 | Patient History | HR(+) HER2(-) Breast Cancer | Dyslipidemia.. 4.2. |
677 | Case 4 | Courses of Treatment | HR(−) HER2(+) Breast Cancer | 4.1. . Courses of Treatment. Neoadjuvant chemotherapy (#6 cycles of. docetaxel and carboplatin and trastuzumab and. pertuzumab) + Operation + Post-operative radia. tion therapy.. 4.4.1. . Operation. 35. 4.4.2. . Pathology Report. . 1. No residual tumor with stromal fibrosis.. . (a) Post-chemotherapy status.. . (b) Lymph nodes: no metastasis in nine axil. lary lymph nodes (ypN0) (sentinel LN:. 0/4, non-sentinel LN: 0/5).. . 2. Fibroadenomatous change.. Note: Histologic mapping has been done.. 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 35%. of tumor cells. . HR(−) HER2(+) Breast Cancer. 446. . 5. |
685 | Case 4 | Important Radiologic | HR(−) HER2(+) Breast Cancer | Important Radiologic. Findings. 27 28 29. 30. . Y. Kwon et al.. 443. . . . F. ig. 30. 34. . . . . . . Y. Kwon et al.. 445. 4.4. |
691 | Case 4 | Patient History | HR(−) HER2(+) Breast Cancer | Patient History and Progress. Female/58 years old, post-menopause.. Self-detected mass lesion on left breast 3:30. o’clock direction.. No family history.. No comorbidities.. 4.2. |
678 | Case 4 | Courses of Treatment | HR(−) HER2(−) Breast Cancer | 4.1. . Courses of Treatment. Operation + adjuvant chemotherapy (#4 cycles. of docetaxel and cyclophosphamide) + Post-. operative radiation therapy.. 4.3.1. . Operation. 26. 4.3.2. . Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 1.5 cm (pT1c).. 2. Histologic grade: 3/3 (tubule formation: 2/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 40/10HPF).. 3. Intraductal component: absent.. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) Superior margin: 16 mm.. . (b) Inferior margin: 20 mm.. . (c) Medial margin: 18 mm.. . (d) Lateral margin: 26 mm.. . (e) Deep margin: 6 mm.. . (f) Superficial margin: 8 mm.. 6. Lymph nodes: no metastasis in one axillary. lymph node (pN0(sn)) (sentinel LN: 0/1).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular invasion: absent.. 9. Tumor border: infiltrative.. . 10. Microcalcification: present, non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT1cN0(sn).. 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 25%. of tumor cells. HR(−) HER2(−) Breast Cancer. 588. . 5. |
686 | Case 4 | Important Radiologic | HR(−) HER2(−) Breast Cancer | Important Radiologic. Findings. 22 23 24. 25. HR(−) HER2(−) Breast Cancer. 586. . . . E. S. Lee et al.. 587. . 4.3. |
692 | Case 4 | Patient History | HR(−) HER2(−) Breast Cancer | Patient History and Progress. Female/52 years old, post-menopause.. Self-detected palpable mass lesion on left. breast 1–2 o’clock direction.. No family history.. Hyperthyroidism.. 4.2. |
679 | Case 4 | Courses of Treatment | Local Recurrence | 4.1. . Courses of Treatment. Left breast Invasive cribriform carcinoma →. Operation → Adjuvant therapy → Left chest. wall recurrence (IDC).. 4.2.1. . Primary Treatment. 22 23. 24. Operation. . 25. 26. Pathology Report. Invasive Cribriform Carcinoma. 1. Size of invasive component: 1.5 cm and. 0.5 cm (pT1c).. 2. Size of intraductal component: 7.0 cm.. Local Recurrence. 726. . . . . 3. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 6/10HPF).. 4. Intraductal component: present, intratu. moral/extratumoral (90%) (nuclear grade:. low, necrosis: present, architectural pattern:. papillary/cribriform/solid/comedo, extensive. intraductal component: present).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) Deep margin: <1 mm from ductal carci. noma in situ (slides 4 and 15).. . (b) Superficial margin: positive for ductal. carcinoma in situ (slides 5 and 10).. 7. Lymph nodes: no metastasis in two axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/2). 8. Arteriovenous invasion: absent.. 9. Lymphovascular invasion: absent.. . 10. Tumor border: infiltrative.. . 11. Microcalcification: present, tumoral.. . 12. Pathologic stage (AJCC 2010): pT1c(m). N0(sn).. Y. Kim et al.. 727. a. b. c. d. . . Invasive Lobular Carcinoma. . 1. Size of tumor: 0.4 cm.. . 2. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 2/10HPF).. . 3. In situ component: present, extratumoral (30%).. . 4. Arteriovenous invasion: absent.. . 5. Lymphovascular invasion: absent.. . 6. Tumor border: infiltrative.. 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 18%. of tumor cells. Adjuvant Therapy. Tamoxifen 20 mg/day for 1.2 years.. 4.2.2. . Treatments After Recurrence. 27. 28. Operation. 29. Pathology Report. Invasive Ductal Carcinoma. 1. Post-nipple-sparing mastectomy status.. 2. Size of tumor: 0.7 cm (rpT1b).. Local Recurrence. 728. . . . 3. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 2/10HPF).. 4. Intraductal component: present, intratumoral. (10%) (nuclear grade: low, necrosis: present,. architectural pattern: cribriform/comedo,. extensive intraductal component: absent).. 5. Skin and nipple: no involvement of tumor.. 6. Surgical margins: deep margin: 3 mm.. 7. Arteriovenous invasion: absent.. 8. Lymphovascular invasion: absent.. 9. Tumor border: infiltrative.. . 10. Microcalcification: present, tumoral.. . 11. Pathological TN category (AJCC 2017):. rpT1b.. 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 15%. of tumor cells. Adjuvant Therapy. Plan for tamoxifen with goserelin.. 5. |
693 | Case 4 | Patient History | Local Recurrence | Patient History and Progress. Female/41 years old, pre-menopause.. Screen detected mass lesion on left breast 1. and 2 o’clock direction.. Outside result of biopsy: Ductal carcinoma in. situ.. No family history.. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 4.2. |
680 | Case 4 | Courses of Treatment | Metastatic Breast Cancer | Courses of Treatment. Right breast cancer → Operation → Adjuvant. therapy → Left breast and pleural effusion. recurrence.. 4.2.1. . Primary Treatment. Operation. Oct. 2008 Right breast conserving surgery, axil. lary lymph node dissection.. Pathology: Invasive ductal carcinoma, stage. T1(m)N1 (2/25).. Size of tumor: 1.7 * 1.5 * 1 cm and. 0.5 * 0.4 cm, lymph node: 2/25, size of metastatic. carcinoma: 19 mm.. Result. Intensity. Positive %. Estrogen. receptor. Positive. N.A.. N.A.. Progesterone. receptor. Positive. N.A.. N.A.. C-erbB2. Negative (1+). Ki-67. Positive in. 63.51% of. tumor cells. Adjuvant Therapy. Adjuvant chemotherapy #6 cycles → Post-. operative radiation therapy + Tamoxifen 20 mg/. day for 5 years.. 4.2.2. . Treatments After Recurrence. Left breast and pleural effusion recurrence.. 0. Progesterone. receptor. Negative. (0/8). 0. 0. C-erbB2. Negative (0). Ki-67. Positive in. 74% of. tumor cells. Clinical. stage:. cT4N3M1. (pleural. effusion).. Palliative Chemotherapy. Palliative chemotherapy #12 cycles (paclitaxel. #12 & Cisplatin #9): controlled disease.. Palliative Operation. Feb. 2022 Left total mastectomy, sentinel lymph. node biopsy (palliative operation).. Pathology: No residual tumor with foamy his. tiocytic collection.. . 1. Post-chemotherapy status. . 2. Lymph nodes: no metastasis in one axillary. lymph node (pN0(sn)). (sentinel LN: 0/1). Palliative radiation therapy.. Post-operative radiation therapy. |
694 | Case 4 | Patient History | Metastatic Breast Cancer | BRCA 1 mutation: detected.. s/p Appendectomy, s/p myomectomy.. 4.2. |
695 | Case 40 | Courses of Treatment | Carcinoma In Situ | 40.1. . Courses of Treatment:. Operation. Operation. 189. 190. Pathology Report. Lobular carcinoma in situ. . 1. Post-stereotactic excision status.. . 2. Size of tumor: 1.0 cm, residual.. . 3. Nuclear grade: low.. E. S. Lee et al.. 139. . 4. Necrosis: absent.. . 5. Architectural pattern: solid.. . 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: 20 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: 2 mm.. . 8. Microcalcification:. present,. tumoral/non-. tumoral.. . a. b. . a. b. . Carcinoma In Situ. 140. . . . Result. Intensity. Positive %. Estrogen. receptor. Strong (7/8). 3. 1/3–2/3. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Equivocal (2+). Ki-67. Positive in 1%. of tumor cells. 41. |
698 | Case 40 | Important Radiologic | Carcinoma In Situ | Important Radiologic. Findings. 186 187. 188. 40.3. |
699 | Case 40 | Patient History | Carcinoma In Situ | Patient History and Progress. Female/47 years old, post-menopause.. Screen detected mass and microcalcification. on right breast 10 o’clock direction.. No family history.. No comorbidities.. 40.2. |
696 | Case 40 | Courses of Treatment | Local Recurrence | 40.1. . Courses of Treatment. Right breast DCIS→ Operation → Right breast. recurrence (microinvasive ductal carcinoma).. Primary Treatment. 266. Local Recurrence. 828. . . Operation. 267. Pathology Report. Ductal Carcinoma In Situ. . 1. Size of tumor: 0.3 cm (pTis).. . 2. Nuclear grade: low.. . 3. Necrosis: absent.. . 4. Architectural pattern: solid/cribriform.. . 5. Surgical margins:. . (a) Superior margin: 7 mm.. . (b) Inferior margin: 6 mm.. . (c) Medial margin: 1 mm from ductal carci. noma in situ (slide 1).. . (d) Lateral margin: 45 mm.. . (e) Deep margin: <1 mm from ductal carci. noma in situ (slide 1).. . 6. Microcalcification:. present,. tumor/. non-tumor.. . 7. Pathologic stage (AJCC 2010): pTisNx.. Result. Intensity. Positive %. Estrogen. receptor. Intermediate. (6/8). 2. 1/3–2/3. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in 25%. of tumor cells. Treatments After Recurrence. 268 269. 270. Operation. . 271. Pathology Report. Microinvasive Ductal Carcinoma. 1. Size of invasive component: <0.1 cm. (pT1mi).. 2. Size of intraductal component: 0.6 cm.. Y. Kim et al.. 829. . . . . Local Recurrence. 830. 3. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 6/10HPF).. 4. Intraductal component: present, intratu. moral/extratumoral (99%) (nuclear grade:. low, necrosis: present, architectural pattern:. cribriform/solid/comedo, extensive intra. ductal component: present).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) Deep margin: 2 mm.. . (b) Superficial margin: 2 mm.. 7. Lymph nodes: no metastasis in one axillary. lymph node (pN0(sn)) (sentinel LN: 0/1).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular invasion: absent.. . 10. Tumor border: infiltrative.. . 11. Microcalcification:. present,. tumoral/. non-tumoral.. . 12. Pathologic stage (AJCC 2010): pT1miN0(sn).. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Equivocal (2+). Ki-67. Positive in 22%. of tumor cells. Adjuvant Therapy. Anastrozole 1 mg/day for 3.3 years, then tamoxi. fen 20 mg/day.. 41. |
700 | Case 40 | Patient History | Local Recurrence | Patient History and Progress. Female/60 years old, post-menopause.. Screen detected mass lesion on right breast 12. o’clock and 9 o’clock direction.. Outside result of biopsy: right breast 12. o’clock, Atypical ductal hyperplasia.. Right breast 9:30 o’clock, Fibrocystic change.. Family history of breast cancer, older sister. and younger sister.. Hepatitis C virus carrier, Facet Joint Syndrome. lumbosacral region, Dyspnea disorder.. BRCA 1 VUS (variant of uncertain).. 40.2. |
697 | Case 40 | Courses of Treatment | Metastatic Breast Cancer | Courses of Treatment. Right breast cancer → Neoadjuvant chemother. apy → Operation → Adjuvant therapy → Lung. metastasis.. Primary Treatment. 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative (0). Ki-67. Positive in. 76% of tumor. cells. Neoadjuvant Chemotherapy. Neoadjuvant chemotherapy #8 cycles (Doxorubicin. & cyclophosphamide #4 → Docetaxel #4).. Y. Kwon et al.. 925. Operation. Apr. 2015 Right breast conserving surgery, axil. lary lymph node dissection.. Pathology: Invasive ductal carcinoma, stage. ypT1cN1mi.. Size of tumor: 1.4 cm, lymph node 2/9 (2 mm).. Adjuvant Therapy. Post-operative radiation to right breast +. Tamoxifen 20 mg/day for 2 years.. Treatments After Recurrence |
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