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811 | Case 7 | Patient History | Carcinoma In Situ | Patient History and Progress. Female/48 years old, pre-menopause.. Screen detected mass lesion on right breast 1. and 9 o’clock direction.. Outside result of mammotome excision:. Right breast 1 o’clock, DCIS.. Right breast 9 o’clock, intraductal papilloma. with atypical ductal hyperplasia.. No family history.. No comorbidities.. 7.2. |
798 | Case 7 | Courses of Treatment | HR(+) HER2(+) Breast Cancer | 7.1. . Courses of Treatment. Neoadjuvant chemotherapy (#6 cycles of. docetaxel and carboplatin and trastuzumab. and pertuzumab) + Operation + Post-. operative radiation therapy + Trastuzumab. emtansine + Tamoxifen 20 mg/day.. 42. 7.3.1. . Pathology Report. Invasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of tumor: 1.1 cm (ypT1c).. 3. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 6/10 HPF).. HR(+) HER2(+) Breast Cancer. 320. . . . 4. Intraductal component: present, intratu. moral/extratumoral (30%) (nuclear grade:. high, necrosis: absent, architectural pattern:. solid, extensive intraductal component:. present).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) superior margin: 10 mm,. . (b) inferior margin: (see note),. . (c) medial margin: 10 mm,. . (d) lateral margin: 5 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: 2 mm.. 7. Lymph nodes: no metastasis in 13 axillary. lymph nodes (ypN0) (sentinel LN: 0/3, axil. lary LN: 0/10).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular. invasion:. present,. intratumoral.. . 10. Tumor border: infiltrative.. . 11. Microcalcification:. present,. tumoral/. non-tumoral.. . 12. Pathological TN category (AJCC 2017):. ypT1cN0.. Note: 1. The inferior margin of the lumpec. tomy specimen (slide 7) is close to ductal carci. noma in situ (<1 mm) but this margin submitted. for frozen diagnosis (Fro 2) is free of tumor.. Result. Intensity. Positive. %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Positive (3+). Ki-67. Positive in 6% of. tumor cells. S. Park et al.. 321. . . HR(+) HER2(+) Breast Cancer. 322. F. ig. 40. 323. a. b. . 8. |
806 | Case 7 | Important Radiologic | HR(+) HER2(+) Breast Cancer | Important Radiologic. Findings. 36 37 38 39 40. 41. 7.3. |
812 | Case 7 | Patient History | HR(+) HER2(+) Breast Cancer | Patient History and Progress. Female/50 years old, pre-menopause.. Screen detected mass lesion on left breast 3. o’clock direction.. No family history.. Paroxysmal supraventricular tachycardia, s/p. atrial septal defect closure.. S/P thyroid lobectomy (thyroid cancer).. 7.2. |
799 | Case 7 | Courses of Treatment | HR(+) HER2(-) Breast Cancer | Courses of Treatment. Operation + Post-operative radiation ther. apy + Tamoxifen 20 mg/day.. 7.3.1. . Operation. Left breast conserving surgery, sentinel lymph. (a) superior margin: 10 mm,. . (b) inferior margin: (see note),. . (c) medial margin: 10 mm,. . (d) lateral margin: 5 mm,. . (e) deep margin: <1 mm from ductal carci. noma in situ (slide 9),. . (f) superficial margin: 2 mm.. 7. Lymph nodes: no metastasis in six axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/2,. non-sentinel LN: 0/4).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular. invasion:. present,. intratumoral.. . 10. Tumor border: infiltrative.. . 11. Microcalcification:. present,. tumoral/. non-tumoral.. . 12. Pathological TN category (AJCC 2017):. pT1cN0(sn).. Note: 1. The inferior margin of the. lumpectomy specimen (slide 2) is close to. ductal carcinoma in situ (3 mm) but this mar. gin submitted for frozen diagnosis (Fro 2) is. free of tumor.. Result. Intensity. Positive %. Estrogen receptor. Strong (7/8). 2. >2/3. Progesterone receptor. Intermediate (6/8). 2. 1/3–2/3. C-erbB2. Negative (1+). Ki-67. Positive in 5% of tumor cells. HR(+) HER2(−) Breast Cancer |
807 | Case 7 | Important Radiologic | HR(+) HER2(-) Breast Cancer | Important Radiologic. Findings. See Figs. 31, 32, 32, 33, 34 and 35.. 7.3. |
813 | Case 7 | Patient History | HR(+) HER2(-) Breast Cancer | Depression.. 7.2. |
800 | Case 7 | Courses of Treatment | HR(−) HER2(+) Breast Cancer | 7.1. . Neoadjuvant chemotherapy (#6 cycles of. docetaxel and carboplatin and trastuzumab and. pertuzumab) + Operation + Post-operative radia. tion therapy.. 7.4.1. . Operation. 53. 7.4.2. . Pathology Report. No residual tumor with stromal degeneration.. . 1. Post-chemotherapy status.. . 2. Lymph nodes: no metastasis in two axillary. lymph nodes (ypN0(sn)) (sentinel LN: 0/2,. non-sentinel LN: 0/0).. Result. Intensity. Positive %. Estrogen. receptor. Negative (2/8). 1. <1%. Progesterone. receptor. Negative (2/8). 1. <1%. C-erbB2. Positive (3+). Ki-67. Positive in. 16% of tumor. cells. . HR(−) HER2(+) Breast Cancer. 456. 8. |
808 | Case 7 | Important Radiologic | HR(−) HER2(+) Breast Cancer | Important Radiologic. Findings. 48. 49. . . HR(−) HER2(+) Breast Cancer. 454. 7.3. . After Neoadjuvant. Chemotherapy. 50 51. 52. |
814 | Case 7 | Patient History | HR(−) HER2(+) Breast Cancer | Patient History and Progress. Female/58 years old, post-menopause.. Screen detected mass lesion on upper outer. portion of left breast.. No family history.. S/P Nodules of vocal cord, operation.. 7.2. |
801 | Case 7 | Courses of Treatment | HR(−) HER2(−) Breast Cancer | 7.1. . Courses of Treatment. Neoadjuvant chemotherapy (#4 cycles of. doxorubicin and cyclophosphamide + #4. cycles of docetaxel) + Operation + Post-. operative radiation therapy + Adjuvant. capecitabine.. 7.3.1. . Operation. 51. 7.3.2. . Pathology Report. Metaplastic Carcinoma with sarcomatous. differentiation. 1. Post-chemotherapy status.. E. S. Lee et al.. 599. . . . HR(−) HER2(−) Breast Cancer. 600. . . . E. S. Lee et al.. 601. 2. Size of tumor: 4.2 cm (ypT2).. 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 22/10HPF).. 4. Intraductal component: present, intratumoral. (<5%) (nuclear grade: high, necrosis: pres. ent, architectural pattern: comedo, extensive. intraductal component: absent).. 5. Skin and nipple: no involvement of tumor.. 6. Surgical margins:. . (a) Deep margin: positive for metaplastic. carcinoma (slides 3 and 5).. . (b) Superficial margin: 11 mm.. 7. Lymph nodes: no metastasis in four axillary. lymph nodes (ypN0(sn)) (sentinel LN: 0/3,. non-sentinel LN: 0/1).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular. invasion:. present,. intratumoral.. . 10. Tumor border: infiltrative.. . 11. Microcalcification: present, non-tumoral.. . 12. Pathological TN category (AJCC 2017):. ypT2N0(sn).. Result. Intensity. Positive. %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Negative (0). Ki-67. Positive in 57%. of tumor cells. Lung metastasis.. Palliative chemotherapy (abraxane and. atezolizumab → gemcitabine and cisplatin).. 8. |
809 | Case 7 | Important Radiologic | HR(−) HER2(−) Breast Cancer | Important Radiologic. Findings. 44 45. 46. HR(−) HER2(−) Breast Cancer. 598. . . . 7.2.1. . After Neoadjuvant. Chemotherapy. 47 48 49. 50. 7.3. |
815 | Case 7 | Patient History | HR(−) HER2(−) Breast Cancer | Patient History and Progress. Female/56 years old, post-menopause.. Self-detected palpable mass lesion on right. breast.. No family history.. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 7.2. |
802 | Case 7 | Courses of Treatment | Local Recurrence | 7.1. . Courses of Treatment. Left breast microinvasive ductal carci. noma + DCIS → Operation → Adjuvant therapy. → Right breast recurrence (DCIS).. 7.2.1. . Primary Treatment. 51 52. 53. Operation. . 54. Local Recurrence. 736. . . . . . . Pathology Report. Microinvasive Ductal Carcinoma. 1. Size of invasive component: <0.1 cm. (pT1mi).. 2. Size of intraductal component: 4.0 cm.. 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 3/HPF).. 4. Intraductal component: present, intratu. moral/extratumoral (99%) (nuclear grade:. high, necrosis: present, architectural pattern:. micropapillary/cribriform, extensive intra. ductal component: present).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) Superior margin: 5 mm.. . (b) Inferior margin: 15 mm.. . (c) Medial margin: 10 mm.. . (d) Lateral margin: positive for ductal carci. noma in situ (Fro 6) (see note).. . (e) Deep margin: 2 mm.. . (f) Superficial margin: 2 mm.. 7. Lymph nodes: no metastasis in one axillary. lymph node (pN0(sn)) (sentinel LN: 0/1).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular invasion: absent.. Y. Kim et al.. 737. . 10. Tumor border: infiltrative.. . 11. Microcalcification:. present,. tumoral/. non-tumoral.. . 12. Pathological TN category (AJCC 2017):. pT1miN0(sn).. Note: 1. Ductal carcinoma in situ is present. only in the permanent section of Fro 6.. Result. Intensity Positive %. Estrogen. receptor. Strong (7/8). 3. 1/3–2/3. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in 41%. of tumor cells. Operation. 55. Pathology Report. . 1. Ductal carcinoma in situ, residual.. . (a) Status post-lumpectomy status for micro. invasive ductal carcinoma (S19–2090).. . (b) Nuclear grade: high.. . (c) Necrosis: absent.. . (d) Architectural pattern: cribriform.. . (e) Microcalcification: absent.. . (f) Resection margin:. • Lateral: (see note).. . 2. Foreign body reaction with fat necrosis.. Note: The lateral margin of the wide excision. specimen (slide 1) is close to ductal carcinoma in. situ (<1 mm), but this margin submitted for fro. zen diagnosis (Fro 1) is free of tumor.. Adjuvant Therapy. Postoperative radiation therapy.. Tamoxifen 20 mg/day for 3 years.. 7.2.2. . Treatments After Recurrence. 56. 57. Operation. 58. Pathology Report. Papillary Carcinoma In Situ. . 1. Size of tumor: 0.8 cm (pTis).. . 2. Nuclear grade: low.. . 3. Necrosis: absent.. . 4. Architectural pattern: papillary/solid.. . . . . Local Recurrence. 738. a. b. . . 5. Skin: no involvement of tumor.. . 6. Surgical margins:. . (a) Superior margin: (see note 1).. . (b) Inferior margin: 10 mm.. . (c) Medial margin: 5 mm.. . (d) Lateral margin: 20 mm.. . (e) Deep margin: 2 mm.. . (f) Superficial margin: <1 mm from ductal. carcinoma in situ (slide 2).. . 7. Microcalcification:. present,. tumoral/. non-tumoral.. . 8. Pathological TN category (AJCC 2017): pTis.. Note: 1. The superior margin of the lumpec. tomy specimen (slide 3) is close to ductal carci. noma in situ (3 mm), but this margin submitted. for frozen diagnosis (Fro 1) is free of tumor.. Result. Intensity Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Negative (2/8). 1. <1%. C-erbB2. Equivocal (2+). Ki-67. Positive in 2%. of tumor cells. Adjuvant Therapy. Plan for tamoxifen for 5 years.. 8. |
816 | Case 7 | Patient History | Local Recurrence | Patient History and Progress. Female/42 years old, pre-menopause.. Screen detected mass lesion on left breast. . 4 o’clock direction.. Family history of breast cancer, mother.. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 7.2. |
803 | Case 7 | Courses of Treatment | Metastatic Breast Cancer | Left breast cancer → Operation → Adjuvant. therapy → Ipsilateral breast and chest wall. recurrence → Chemotherapy → Progression on. the skin and contralateral axillary lymph. nodes.. 7.2.1. . Primary Treatment. Intensity. Positive %. Estrogen. receptor. Negative. (2/8). 1. <1%. Progesterone. receptor. Negative. (2/8). 1. <1%. C-erbB2. Positive. (3+). Result. Intensity. Positive %. Ki-67. Positive. in 43% of. tumor. cells. Adjuvant Therapy. Adjuvant chemotherapy #6 cycles (Cyclo. phosphamide & Methotrexate & Fluorouracil).. Post-operative radiation therapy.. 7.2.2. . Treatments After Recurrence. Abdominal Lymph Nodes Metastasis. Mar. 2021 CT abdomen & pelvis: r/o Enlarged. lymph node in Rt. external iliac chain and para. aortic area; cannot exclude pathologic lymph. node, such as metastasis or lymphoproliferative. disorder.. → Closed follow-up. |
817 | Case 8 | Courses of Treatment | Benign and Proliferative | 8.1. . Courses of Treatment. →2021-11-12 excision, Lt.. Benign and Proliferative Case Series. 26. . . . C. W. Lee et al.. 27. 8.3.1. . Pathology Report. Diagnosis. • Breast, left, excision:. –. – Atypical. ductal. hyperplasia. with. micro. calcification.. 9. |
825 | Case 8 | Important Radiologic | Benign and Proliferative | Important Radiologic. Findings. 12. 8.3. |
831 | Case 8 | Patient History | Benign and Proliferative | Patient History and Progress. Female/54 years old, pre-menopause.. Screen detected microcalcification on upper. outer portion of left breast.. No family history.. No comorbidities.. 8.2. |
818 | Case 8 | Courses of Treatment | Carcinoma In Situ | 8.1. . Courses of Treatment. Operation + Postoperative radiation therapy. (right side) + Tamoxifen 20 mg/day for. 5 years.. 8.3.1. . Operation. 36. 37. 8.3.2. . Pathology Report. Right.. <First operation>. Ductal carcinoma in situ, pathological TN cat. egory (AJCC 2017): pTis. . 1. Size of tumor: 0.3 cm (pTis).. . 2. Nuclear grade: low.. . 3. Necrosis: absent.. . 4. Architectural pattern: papillary.. . 5. Surgical margins: positive (slide 2).. . 6. Microcalcification: present, non-tumoral.. . . E. S. Lee et al.. 69. . . Carcinoma In Situ. 70. . . . Result. Intensity. Positive %. Estrogen. receptor. Weak (4/8). 2. 1%–10%. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Equivocal. (2+). Ki-67. Positive in 2%. of tumor cells. <Second operation>. Atypical ductal hyperplasia involving intra. ductal papilloma.. . 1. Post-excision status.. Left.. Intraductal papilloma.. 9. |
826 | Case 8 | Important Radiologic | Carcinoma In Situ | Important Radiologic. Findings. 34. 35. 8.3. |
832 | Case 8 | Patient History | Carcinoma In Situ | Patient History and Progress. Female/41 years old, pre-menopause.. Detected bloody discharge in left nipple.. No family history.. No comorbidities.. ATM VUS (variant of uncertain).. 8.2. |
819 | Case 8 | Courses of Treatment | HR(+) HER2(+) Breast Cancer | 8.1. . Courses of Treatment. Operation + Adjuvant chemotherapy (#4. cycles of doxorubicin and cyclophospha. mide). +. Post-operative. radiation. ther. apy + Trastuzumab + Letrozole 2.5 mg/day.. 47. 8.3.1. . Pathology Report. . 1. No residual tumor with foreign body. reaction.. . (a) Post-excision status.. . (b) Lymph nodes: no metastasis in one axil. lary lymph node (pN0(sn)) (sentinel LN:. 0/1).. . 2. Intraductal papilloma.. Result. Intensity. Positive. %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Weak (4/8). 2. 1–10%. C-erbB2. Positive (3+). Ki-67. Positive in 29%. of tumor cells. a. b. . HR(+) HER2(+) Breast Cancer. 326. 9. |
827 | Case 8 | Important Radiologic | HR(+) HER2(+) Breast Cancer | Important Radiologic. Findings. 43 44 45. 46. . HR(+) HER2(+) Breast Cancer. 324. . . . S. Park et al.. 325. 8.3. |
833 | Case 8 | Patient History | HR(+) HER2(+) Breast Cancer | Patient History and Progress. Female/61 years old, post-menopause.. Screen detected mass lesion on right breast 9. o’clock direction.. No family history.. Hypertension,. s/p. cholecystectomy,. arrhythmia.. 8.2. |
820 | Case 8 | Courses of Treatment | HR(+) HER2(-) Breast Cancer | Right nipple–areolar complex sparing mastec. tomy, sentinel lymph node biopsy, Left nipple–. areolar complex sparing mastectomy, sentinel. lymph node biopsy (Figs. 41 and 42).. 8.3.2. . Pathology Report. [Right]. Invasive Ductal Carcinoma. micropapillary/cribriform/solid/comedo,. extensive intraductal component: present).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) nipple margin: positive for ductal carci. noma in situ (Fro 2),. lymph nodes (pN0) (sentinel LN: 0/1, non-. sentinel LN: 0/6).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular. invasion:. present,. intratumoral.. . 10. Tumor border: infiltrative.. . 11. Microcalcification:. present,. tumoral/. non-tumoral.. . 12. Pathological TN category (AJCC 2017):. pT1cN0.. Result. Intensity. Positive. %. Estrogen. receptor. Strong (7/8). 2. >2/3. Progesterone. receptor. Strong (7/8). 2. >2/3. C-erbB2. Negative (1+). Ki-67. Positive in 26%. of tumor cells. [Left]. Invasive Ductal Carcinoma. 1. Size of tumor: 1.5 cm (pT1c).. 2. Histologic grade: 2/3 (tubule formation: 2/3,. nuclear pleomorphism: 2/3, mitotic count:. 2/3, 17/10 HPF).. 3. Intraductal component: present, intratu. moral/extratumoral (10%) (nuclear grade:. low, necrosis: absent, architectural pattern:. cribriform/solid, extensive intraductal com. ponent: absent).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) nipple margin: positive for ductal carci. noma in situ (Fro 1) (see note),. . (b) deep margin: 1 mm from invasive ductal. carcinoma (slide 1).. 6. Lymph nodes: no metastasis in eight axillary. lymph nodes (pN0) (sentinel LN: 0/3, non-. sentinel LN: 0/5).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular invasion: absent.. 9. Tumor border: partly infiltrative.. . 10. Microcalcification: present, tumoral.. . 11. Pathological TN category (AJCC 2017):. pT1cN0.. Note: 1. Ductal carcinoma in situ is pres. ent only in the permanent section of Fro 1. Result. Intensity. Positive. %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative (0). Ki-67. Positive in 8% of. tumor cells. 9. |
828 | Case 8 | Important Radiologic | HR(+) HER2(-) Breast Cancer | Important Radiologic. Findings. See Figs. 37, 38, 39 and 40. |
834 | Case 8 | Patient History | HR(+) HER2(-) Breast Cancer | o’clock and left breast 2 o’clock direction.. No family history.. No comorbidities.. BRCA 1 and 2 mutation: not detected.. 8.2. |
821 | Case 8 | Courses of Treatment | HR(−) HER2(+) Breast Cancer | 8.1. . 8.3.1. . Operation. . 58. 59. 8.3.2. . Pathology Report. Invasive Ductal Carcinoma. 1. Size of invasive component: 1.1 cm (pT1c).. 2. Size of intraductal component: 3.0 cm.. 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 5/HPF).. 4. Intraductal component: present, intratu. moral/extratumoral (60%) (nuclear grade:. high, necrosis: present, architectural pattern:. solid/comedo, extensive intraductal compo. nent: present).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) deep margin: 2 mm,. . (b) superficial margin: 2 mm.. 7. Lymph nodes: no metastasis in four axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/1,. axillary LN: 0/3).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular invasion: present, intratumoral.. . 10. Tumor border: infiltrative.. . 11. Microcalcification:. present,. tumoral/. non-tumoral.. . 12. Pathological TN category (AJCC 2017):. pT1cN0(sn).. Breast, right “accessary,” excision:. Mammary ducts and lobules in fibroadipose. tissue, suggestive of accessory breast.. Result. Intensity. Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in. 23% of tumor. cells. HR(−) HER2(+) Breast Cancer. 458. . . Y. Kwon et al.. 459. 9. |
829 | Case 8 | Important Radiologic | HR(−) HER2(+) Breast Cancer | Important Radiologic. Findings. 54 55 56. 57. . . Y. Kwon et al. |
835 | Case 8 | Patient History | HR(−) HER2(+) Breast Cancer | Patient History and Progress. Female/53 years old, peri-menopause.. Screen detected microcalcification on right. breast 1 and 10 o’clock direction.. No family history.. No comorbidities.. 8.2. |
822 | Case 8 | Courses of Treatment | HR(−) HER2(−) Breast Cancer | 8.1. . Courses of Treatment. Neoadjuvant chemotherapy (#4 cycles of. doxorubicin and cyclophosphamide + #4. cycles of paclitaxel) + Operation + Post-. operative radiation therapy.. 8.3.1. . Operation. 58. 59. 8.3.2. . Pathology Report. <Right>. Microinvasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of invasive component: <0.1 cm. (ypT1mi).. 3. Size of in situ component: 1.0 cm.. 4. Histologic grade: not applicable.. 5. Intraductal component: present, extratumoral. (99%) (nuclear grade: high, necrosis: present,. architectural pattern: . cribriform/solid/comedo,. extensive intraductal component: present).. 6. Skin: no involvement of tumor.. 7. Surgical margins:. . (a) Superior margin: 5 mm.. . (b) Inferior margin: 5 mm.. . (c) Medial margin: 20 mm.. . (d) Lateral margin: (see note 1).. . (e) Deep margin: 5 mm.. . (f) Superficial margin: 5 mm.. 8. Lymph nodes: no metastasis in one axillary. lymph node (ypN0(sn)) (sentinel LN: 0/1).. 9. Arteriovenous invasion: absent.. . 10. Lymphovascular invasion: absent.. HR(−) HER2(−) Breast Cancer. 602. . . . E. S. Lee et al.. 603. . . . HR(−) HER2(−) Breast Cancer. 604. . . . E. S. Lee et al.. 605. . 11. Tumor border: infiltrative.. . 12. Microcalcification: present, non-tumoral.. . 13. Pathological TN category (AJCC 2017):. ypT1miN0(sn).. Note: 1. The lateral margin of the lumpectomy. specimen (slide 7) is close to ductal carcinoma in. situ (2 mm), but this margin submitted for frozen. diagnosis (Fro 4) is free of tumor.. <Left>. Ductal Carcinoma In Situ. . 1. Post-chemotherapy status.. . 2. Size of tumor: 0.2 cm (ypTis).. . 3. Nuclear grade: high.. . 4. Necrosis: absent.. . 5. Architectural pattern: solid.. . 6. Skin: no involvement of tumor.. . 7. Surgical margins:. . (a) Superior margin: 20 mm.. . (b) Inferior margin: 10 mm.. . (c) Medial margin: 10 mm.. . (d) Lateral margin: 10 mm.. . (e) Deep margin: 2 mm.. . (f) Superficial margin: 2 mm.. . 8. Microcalcification:. present,. tumoral/. non-tumoral.. . 9. Pathological TN category (AJCC 2017):. ypTis.. Result. Intensity. Positive. %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Negative (1+). Ki-67. Positive in 10%. of tumor cells. 9. |
830 | Case 8 | Important Radiologic | HR(−) HER2(−) Breast Cancer | Important Radiologic. Findings. 52 53. 54. 8.2.1. . After Neoadjuvant. Chemotherapy. 55 56. 57. 8.3. |
836 | Case 8 | Patient History | HR(−) HER2(−) Breast Cancer | Patient History and Progress. Female/56 years old, peri-menopause.. Screen detected a mass lesion on right breast 7. o’clock direction and left breast 4 o’clock. direction.. No family history.. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 8.2. |
823 | Case 8 | Courses of Treatment | Local Recurrence | 8.1. . Courses of Treatment. Right breast IDC/Left breast intraductal papil. loma, sclerosing → Operation → Adjuvant ther. apy → Left breast recurrence (DCIS).. 8.2.1. . Primary Treatment. 59. 60. Operation. 61. 62. Pathology Report. <Right>. Y. Kim et al.. 739. . 1. Invasive Ductal Carcinoma involving scleros. ing adenosis.. . (a) Size of tumor: 1.5 cm (pT1c).. . (b) Histologic grade: 2/3 (tubule formation:. 3/3, nuclear pleomorphism: 2/3, mitotic. count: 1/3, 8/10HPF).. . (c) Intraductal component: present, intratu. moral/extratumoral (70%) (nuclear grade:. low, necrosis: present, architectural pat. tern: cribriform/solid, extensive intra. ductal component: present).. . (d) Skin: no involvement of tumor.. . (e) Surgical margins:. • Superior margin: 2 mm from ductal. carcinoma in situ (slide 7).. • Inferior margin: 2 mm from ductal car. cinoma in situ (slide MG4).. • Medial margin: 2 mm from invasive. ductal carcinoma (slide 6).. • Lateral margin: 2 mm from ductal car. cinoma in situ (slide 9).. • Deep margin: 2 mm.. • Superficial margin: 2 mm.. . (f) Arteriovenous invasion: absent.. . (g) Lymphovascular. invasion:. present,. intratumoral.. . (h) Tumor border: infiltrative.. . . . a. b. . . Local Recurrence. 740. a. b. . . . . . . (i) Microcalcification:. present,. tumoral/. non-tumoral.. . (j) Pathological TN category (AJCC 2017):. pT1c.. . 2. Intraductal papilloma.. . 3. Sclerosing adenosis with microcalcification.. Result. Intensity Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative. (1+) (IDC). Equivocal (2+). (DCIS). Ki-67. Positive in 24%. of tumor cells. <Left>. . 1. Intraductal papilloma with usual ductal. hyperplasia. . 2. Sclerosing adenosis with microcalcification.. Operation. Second Operation (Mar. 2021) Right axillary. lymph node sampling.. Pathology Report. No metastasis in eight axillary lymph nodes. (right sentinel LN: 0/2, right axillary LN: 0/6).. . 1. Post-excision status.. Adjuvant Therapy. Postoperative radiation therapy.. Tamoxifen 20 mg/day for 0.8 year.. 8.2.2. . Treatments After Recurrence. 63. 64. Y. Kim et al.. 741. a. b. . Operation. 65. Pathology Report. . 1. Ductal Carcinoma In Situ involving scleros. ing adenosis.. . (a) Size of tumor: 0.8 cm (pTis).. . (b) Nuclear grade: low.. . (c) Necrosis: absent.. . (d) Architectural pattern: micropapillary/. cribriform.. . (e) Surgical margins:. • Superior margin: <1 mm from ductal. carcinoma in situ (slide 2).. • Inferior margin: 10 mm.. • Medial margin: 5 mm.. • Lateral margin: 10 mm.. • Deep margin: 2 mm.. • Superficial margin: 2 mm.. . (f) Microcalcification:. present,. tumoral/. non-tumoral.. . 2. Intraductal papilloma with usual ductal. hyperplasia.. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Negative (2/8). 1. <1%. C-erbB2. Equivocal (2+). Ki-67. Positive in 1%. of tumor cells. Adjuvant Therapy. Plan for tamoxifen for 5 years.. 9. |
837 | Case 8 | Patient History | Local Recurrence | Patient History and Progress. Female/48 years old, pre-menopause.. Screen detected mass lesion on right breast. . 12 o’clock direction and left 6 o’clock direction.. Family history of breast cancer, maternal aunt.. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 8.2. |
824 | Case 8 | Courses of Treatment | Metastatic Breast Cancer | Courses of Treatment. Left breast cancer → Operation → Adjuvant. therapy → Ipsilateral axillary lymph nodes. recurrence.. 8.2.1. . Primary Treatment. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (7/8). 3. 1/3–2/3. C-erbB2. Negative (0). Ki-67. Positive in. 61% of tumor. cells. Oncotype Dx RS Score: 18.. Adjuvant Therapy. Post-operative radiation therapy + Tamoxifen. 20 mg/day for 4.8 years.. 8.2.2. . Treatments After Recurrence. Ipsilateral Axillary Lymph Nodes. Recurrence. Progesterone. receptor. Strong (7/8). 3. 1/3–2/3. C-erbB2. Negative (0). Ki-67. Positive in. 29% of tumor. cells. Neoadjuvant Chemotherapy. Neoadjuvant. chemotherapy. #8. cycles. (Adriamycin & Cyclophosphamide #4 →. Docetaxel #4).. Operation. Sep. 2021 Left axillary lymph node dissection.. Pathology: No metastasis in twelve axillary |
838 | Case 8 | Patient History | Metastatic Breast Cancer | |
839 | Case 9 | Courses of Treatment | Benign and Proliferative | 9.1. . Courses of Treatment. → 2021-11-12 Excision, Rt.. 9.3.1. . Pathology Report. Diagnosis. • Breast, right, excision:. – |
847 | Case 9 | Important Radiologic | Benign and Proliferative | Important Radiologic. Findings. 13 14. 15. 9.3. |
853 | Case 9 | Patient History | Benign and Proliferative | Patient History and Progress. Female/32 years old, pre-menopause.. Screen detected mass lesion on right breast. 8 o’clock direction.. Family history of breast cancer, mother and. maternal aunt.. No comorbidities.. 9.2. |
840 | Case 9 | Courses of Treatment | Carcinoma In Situ | 9.1. . Courses of Treatment. Operation + Tamoxifen 20 mg/day for 5 years.. 9.3.1. . Operation. 41. 42. E. S. Lee et al.. 71. . 9.3.2. . Pathology Report. Ductal carcinoma in situ, pathological TN cat. egory (AJCC 2017): pTisN0(sn). . 1. Size of tumor: 1.2 cm (pTis).. . 2. Nuclear grade: high.. . 3. Necrosis: present.. . 4. Architectural pattern: solid/comedo.. . 5. Skin: no involvement of tumor.. . 6. Surgical margins:. . (a) deep margin: 2 mm,. . (b) superficial margin: 2 mm.. . 7. Lymph nodes: no metastasis in one axillary. lymph node (pN0(sn)) (sentinel LN: 0/1)).. . 8. Microcalcification:. present,. tumoral/non-. tumoral.. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Equivocal. (2+). Ki-67. Positive in 9%. of tumor cells. Carcinoma In Situ. 72. . . 10. |
848 | Case 9 | Important Radiologic | Carcinoma In Situ | Important Radiologic. Findings. 38 39. 40. 9.3. |
854 | Case 9 | Patient History | Carcinoma In Situ | Patient History and Progress. Female/50 years old, pre-menopause.. Screen detected microcalcification on inner. portion of left.. Outside result of biopsy: Ductal carcinoma in. situ, left.. Family history of breast cancer, maternal aunt.. No comorbidities.. BRCA 1 and 2 mutation: Not examination.. 9.2. |
841 | Case 9 | Courses of Treatment | HR(+) HER2(+) Breast Cancer | 9.1. . Courses of Treatment. Operation + Adjuvant chemotherapy (#4. cycles of doxorubicin and cyclophospha. mide). +. Post-operative. radiation. therapy + Trastuzumab.. 51. 9.3.1. . Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 1.3 cm (pT1c).. 2. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 4/HPF).. 3. Intraductal component: present, intratu. moral/extratumoral (30%) (nuclear grade:. high, necrosis: present, architectural pattern:. solid/comedo, extensive intraductal compo. nent: present).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) superior margin: 5 mm,. . (b) inferior margin: (see Note 1),. . (c) medial margin: (see Note 2),. . (d) lateral margin: 10 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: 2 mm.. . S. Park et al.. 327. 6. Arteriovenous invasion: absent.. 7. Lymphovascular. invasion:. present,. intratumoral.. 8. Tumor border: infiltrative.. 9. Microcalcification:. present,. tumoral/. non-tumoral.. . 10. Pathological TN category (AJCC 2017):. pT1c.. Note: 1. The inferior margin of the lumpec. tomy specimen (slide 2) is close to ductal. . carcinoma in situ (3 mm) but this margin submit. ted for frozen diagnosis (Fro 4) is free of tumor.. 2. The medial margin of the lumpectomy. specimen (slide 5) is close to ductal carcinoma in. %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Positive (3+). Ki-67. Positive in 71%. of tumor cells. 10. |
849 | Case 9 | Important Radiologic | HR(+) HER2(+) Breast Cancer | Important Radiologic. Findings. 48 49. 50. 9.3. |
855 | Case 9 | Patient History | HR(+) HER2(+) Breast Cancer | Patient History and Progress. Female/44 years old, pre-menopause.. Screen detected mass lesion on left breast 7. o’clock direction.. Family history of breast cancer, two sisters.. Family history of pancreatic cancer, mother.. No other history of disease, operation, or. medication.. BRCA 1 and 2 mutation: Not detected,. RAD50 VUS (variant of uncertain).. 9.2. |
842 | Case 9 | Courses of Treatment | HR(+) HER2(-) Breast Cancer | 9.1. . Courses of Treatment. Operation. +. Adjuvant. chemotherapy. (#4 cycles of docetaxel & cyclophospha. mide). +. Post-operative. radiation. ther. apy + Tamoxifen 20 mg/day.. 9.3.1. . Operation. Left breast conserving surgery, sentinel lymph. moral/extratumoral (25%) (nuclear grade:. high, necrosis: present, architectural pattern:. solid/comedo, extensive intraductal compo. nent: present).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) superior margin: (see note),. . (b) inferior margin: 22 m,. . (c) medial margin: 1 mm,. . (d) lateral margin: 18 mm,. . (e) deep margin: 3 mm,. . (f) superficial margin: positive for ductal. carcinoma in situ (slide 9).. 6. Lymph nodes: no metastasis in two axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/2).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular. invasion:. present,. peritumoral.. 9. Tumor border: pushing.. . 10. Microcalcification:. present,. tumoral/. non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT2N0(sn).. Intraductal Papilloma with Usual Ductal. Hyperplasia. Note: 1. The superior margin of the lumpectomy. specimen (slide 1) is close to ductal carcinoma. in situ (<1 mm) but this margin submitted for. frozen diagnosis (Fro 3) is free of tumor.. Result. Intensity. Positive. %. Estrogen. receptor. Strong (7/8). 2. >2/3. Progesterone. receptor. Weak (4/8). 2. 1–10%. C-erbB2. Equivocal (2+). (SISH negative). Ki-67. Positive in 23%. of tumor cells. HR(+) HER2(−) Breast Cancer |
850 | Case 9 | Important Radiologic | HR(+) HER2(-) Breast Cancer | Important Radiologic. Findings. See Figs. 43, 44, 45 and 46.. 9.3. |
856 | Case 9 | Patient History | HR(+) HER2(-) Breast Cancer | Patient History and Progress. Female/55 years old, pre-menopause.. Self-detected palpable mass lesion on left. breast 11 o’clock direction.. Family history of Prostate cancer, paternal. uncle.. No comorbidities.. 9.2. |
843 | Case 9 | Courses of Treatment | HR(−) HER2(+) Breast Cancer | 9.1. . docetaxel and carboplatin and trastuzumab and. pertuzumab after followed #4 cycles of docetaxel. and. trastuzumab. and. . pertuzumab). +. Operation + Post-operative radiation ther. apy + Trastuzumab and pertuzumab.. 9.4.1. . Operation. 68. 9.4.2. . Pathology Report. . 1. No residual tumor with stromal fibrosis.. . (a) Post-chemotherapy status.. . (b) Lymph nodes: no metastasis in eight axillary. lymph nodes (ypN0) (sentinel LN: 0/8).. . 2. Atypical. ductal. hyperplasia. with. microcalcification.. Result. Intensity. Positive %. Estrogen. receptor. Negative (1/8). 1. <1%. Progesterone. receptor. Negative (2/8). 1. <1%. C-erbB2. Positive (3+). Ki-67. Positive in. 79% of tumor. cells. . Y. Kwon et al.. 465. 10. |
851 | Case 9 | Important Radiologic | HR(−) HER2(+) Breast Cancer | Important Radiologic. Findings. 60 61 62. . . 9.3. . After Neoadjuvant. Chemotherapy. 64 65 66. 67. Y. Kwon et al. |
857 | Case 9 | Patient History | HR(−) HER2(+) Breast Cancer | Patient History and Progress. Female/51 years old, pre-menopause.. Screen detected mass lesion on left breast 2. o’clock direction.. No family history.. Hypothyroidism.. 9.2. |
844 | Case 9 | Courses of Treatment | HR(−) HER2(−) Breast Cancer | 9.1. . Courses of Treatment. Operation + adjuvant chemotherapy (#4. cycles of docetaxel and cyclophosphamide) +. Operation + Post-operative radiation therapy.. 9.3.1. . Operation. 65. 9.3.2. . Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 2.3 cm (pT2).. 2. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 8/HPF).. 3. Intraductal component: present, intratu. moral/extratumoral (10%) (nuclear grade:. high, necrosis: absent, architectural pattern:. solid, extensive intraductal component:. absent).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) Superior margin: 10 mm.. . (b) Inferior margin: 10 mm.. . (c) Medial margin: 5 mm.. . (d) Lateral margin: 10 mm.. . (e) Deep margin: <1 mm from invasive duc. tal carcinoma (slide 7).. . (f) Superficial margin: 2 mm.. 6. Lymph nodes: no metastasis in four axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/1,. non-sentinel LN: 0/2, intramammary LN:. 0/1).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular. invasion:. present,. intratumoral.. 9. Tumor border: infiltrative.. HR(−) HER2(−) Breast Cancer. 606. . . . E. S. Lee et al.. 607. . . Result. Intensity. Positive. %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Negative (1+). Ki-67. Positive in 87%. of tumor cells. <Lung>. . 1. Localized chronic granulomatous inflamma. tion with necrosis, suggestive of mycobacte. rial infection (see note).. . 2. Reactive hyperplasia in 5 regional lymph. nodes (LN #10: 0/2, LN #11: 0/3).. . 10. Microcalcification:. present,. tumoral/. non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT2N0(sn).. HR(−) HER2(−) Breast Cancer. 608. . . . 10. |
852 | Case 9 | Important Radiologic | HR(−) HER2(−) Breast Cancer | Important Radiologic Findings. 60 61 62 63. 64. 9.3. |
858 | Case 9 | Patient History | HR(−) HER2(−) Breast Cancer | Patient History and Progress. Female/65 years old, post-menopause.. Screen detected mass lesion on right breast 10. o’clock direction.. No family history.. S/P right salpingectomy (due to ectopic. pregnancy).. 9.2. |
845 | Case 9 | Courses of Treatment | Local Recurrence | 9.1. . Courses of Treatment. Right breast mucinous carcinoma → Operation. → Adjuvant therapy → Left breast recurrence. (IDC + DCIS)/Right breast ADH.. 9.2.1. . Primary Treatment. 66 67. 68. Operation. . 69. Local Recurrence. 742. . . . . . Pathology Report. Mucinous Carcinoma. 1. Size of tumor: 1.5 cm (pT1c).. 2. Histologic grade: 1/3 (tubule formation: 2/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 7/10HPF).. 3. Intraductal component: absent.. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) Superior margin: 10 mm.. . (b) Inferior margin: 15 mm.. . (c) Medial margin: 15 mm.. . (d) Lateral margin: 20 mm.. . (e) Deep margin: 12 mm.. . (f) Superficial margin: 3 mm.. 6. Lymph nodes: no metastasis in one axillary. lymph node (pN0(sn)) (sentinel LN: 0/1).. 7. Vascular invasion: absent.. 8. Lymphatic invasion: absent.. 9. Tumor border: infiltrative.. Y. Kim et al.. 743. . 10. Microcalcification: absent.. . 11. Pathologic stage (AJCC 2010): pT1cN0(sn).. Result. Intensity Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative (0). Ki-67. Positive in 13%. of tumor cells. Adjuvant Therapy. Postoperative radiation therapy.. Tamoxifen 20 mg/day for 5 years.. 9.2.2. . Treatments After Recurrence. 70 71 72. 73. a. b. . a. b. . Operation. . 74. 75. Pathology Report. <Right>. Atypical ductal hyperplasia involving intra. ductal papilloma with marked cautery artifact.. <Left>. Ductal Carcinoma In Situ, residual. . 1. Size of tumor: up to 0.2 cm.. . 2. Nuclear grade: low.. . 3. Necrosis: absent.. . 4. Architectural pattern: micropapillary.. . 5. Skin: no involvement of tumor.. . 6. Surgical margins:. . (a) Superior margin: 15 mm.. . (b) Inferior margin: 5 mm.. . (c) Medial margin: 10 mm.. . (d) Lateral margin: 10 mm.. . (e) Deep margin: 5 mm.. . (f) Superficial margin: 1 mm from ductal. carcinoma in situ (slide 5).. . 7. Lymph nodes: no metastasis in one axillary. lymph node (pN0(sn)) (sentinel LN: 0/1). . 8. Microcalcification: present, tumoral.. Note: 1. In the previous biopsy specimen. (S21–18409), invasive ductal carcinoma mea. sures at least 0.5 cm in greatest dimension.. Result. Intensity Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative (1+). Ki-67. Positive in 8% of. tumor cells. Y. Kim et al.. 745. Adjuvant Therapy. Postoperative radiation therapy.. Letrozole 2.5 mg/day for 5 years with. goserelin.. 10. |
859 | Case 9 | Patient History | Local Recurrence | Patient History and Progress. Female/51 years old, pre-menopause.. Screen detected mass lesion on right breast 12. o’clock direction.. Outside result of biopsy: Mucinous carcinoma.. Family history of colon cancer, father.. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 9.2. |
846 | Case 9 | Courses of Treatment | Metastatic Breast Cancer | . Courses of Treatment. Right breast cancer → Operation → Adjuvant. therapy → Ipsilateral axillary lymph nodes. recurrence.. 9.2.1. . Primary Treatment. Estrogen. receptor. Strong (7/8). 2. >2/3. Progesterone. receptor. Negative (2/8). 1. <1%. C-erbB2. Negative (0). Ki-67. Positive in. 23% of tumor. cells. Adjuvant Therapy. Post-operative radiation therapy + Letrozole. 2.5 mg/day for 1 year.. 9.2.2. . Treatments After Recurrence. Ipsilateral Axillary Lymph Nodes. Recurrence. See Figs. 29 and 30.. Aug. 2021 Left axillary lymph node biopsy.. Pathology: Metastatic ductal carcinoma.. Result. Intensity. Positive %. Estrogen. receptor. Negative. (2/8). 1. <1%. Progesterone. receptor. Negative. (0/8). 0. 0. C-erbB2. Negative (0). Ki-67. Positive in. 18% of tumor. Pathology: No metastasis in seven axillary. lymph nodes (right axillary lymph nodes: 0/7).. Radiotherapy. Post-operative radiation therapy (axillary and. subclavian area).. 10. |
860 | Case 9 | Patient History | Metastatic Breast Cancer | Patient History and Progress. Female/57 years old, post-menopause.. No family history.. S/p. Myomectomy. &. bilateral. salpingo-oophorectomy.. 9.2. |
861 | Important Radiologic Findings | Important Radiologic Findings | Benign and Proliferative | – Atypical ductal hyperplasia, focal.Fig. 13. Fig. 13 Mammography. shows no discernable. abnormality. Benign and Proliferative Case Series. 28. 10. . 10.1. . Patient History and Progress. Female/33 years old, pre-menopause. |
862 | Important Radiologic Findings | Important Radiologic Findings | Carcinoma In Situ | 52Fig. 2. Fig. 2 MRI revealed. regional heterogeneous. non-mass enhancement. in the left upper inner. breast. a. b. . . 1.3. . (c) medical margin: 10 mm,Fig. 15. Fig. 15 Mammogram. shows no suspicious. mass in both breasts,. except 1 cm sized. circumscribed iso-dense. nodule in right upper. outer breast, pre-. mammary fat layer. (white arrow). E. S. Lee et al.. 59. Fig. 20 (a–d) Gross pathology of right breast excision. specimen (first operation). (e, f) Gross pathology of right. breast wide excision specimen (second operation). (g, h). Gross pathology of left breast excision specimen (first. operation). (i, j) Gross pathology of left breast wide exci. sion specimen (second operation). a. c. e. f. b. Fig. 20 (continued). Carcinoma In Situ. 62. . . 5. . 5.1. . Patient History and Progress. Female/52 years old, pre-menopause.. Fig. 45. Fig. 45 MRI shows. focal heterogeneous. non-mass enhancement. . . 7. Lymph nodes: no metastasis in one axillary. lymph node (pN0(sn)) (sentinel LN: 0/1).. . 8. Microcalcification:. present,. tumoral/non-. Fig. 53. Fig. 53 MRI shows. round homogeneous. enhancing nodule at the. corresponding area of. the mass on US. Carcinoma In Situ. 78Fig. 54. Fig. 54 Lymphoscintigraphy. shows visualized sentinel lymph. node in left axilla. . E. S. Lee et al.. 79. . . 13. . 13.1. Fig. 65. Fig. 65 MRI shows. focal clumped non-mass. enhancement at the. corresponding area of. the microcalcifications. on mammography. . Pathology Report. Ductal carcinoma in situ, pathological TN cat. egory (AJCC 2017): pTisN0(sn). 1. Size of tumor: 4.0 cm (pTis).. 86Fig. 72. Fig. 72 Asymmetric. enhancement and. thickening were shown. in left nipple–areolar. complex. . . . E. S. Lee et al.. 87. . Fig. 101. Fig. 101 MRI shows. asymmetric strong. enhancement and. thickening of left. nipple–areolar complex. . Carcinoma In Situ. 102. . . . 105Fig. 109. Fig. 109 Asymmetry. was only seen on one. view, the mediolateral. oblique view. . . Pathology Report. Lobular carcinoma in situ, pathological TN. category (AJCC 2017): pTis. . 1. Size of tumor: 1.3 cm (pTis).. 112Fig. 125. Fig. 125 MRI. demonstrates an. enhancing residual mass. in the left breast. a. b. . a. b. . E. S. Lee et al.. 114Fig. 129. Fig. 129 Biopsy clip. (white arrow) was. inserted after stereotactic. VAB. On MRI, note an. artifact related to the. VAB and inserted clip. (black arrow)Fig. 130. Fig. 130 MRI. demonstrates mild BPE. without definite. abnormality. a. b. . E. S. Lee et al.. 115. a. b. Fig. 133. Fig. 133 MRI of a. woman with known left. breast cancer. MRI. shows an enhancing. malignant mass in the. left breast (black arrow).. An enhancing focus was. seen in the right breast. (white arrow). a. b. Fig. 139. Fig. 139 US. demonstrates. hypoechoic lesions with. echogenic calcifications. E. S. Lee et al.. 119. . c. d. . . Fig. 150. Fig. 150 MRI demonstrates an irregular enhancing mass. Carcinoma In Situ. 124. a. b. . . E. S. Lee et al.. 125. 33. |
863 | Important Radiologic Findings | Important Radiologic Findings | HR(+) HER2(+) Breast Cancer | HR(+) HER2(+) Breast Cancer. Soojin Park, Ran Song, Yunju Kim, Bo Hwa Choi,. Eun Sook Lee, Chan Wha Lee, and Eun-Gyeong Lee. 1. Fig. 5 PET-CT shows. (a) a hypermetabolic. mass in the left lower. outer breast. (mSUV = 9.9) and (b). hypermetabolic lymph. node in the left axilla. level I (mSUV = 3.7). . S. Park et al.. 303. Fig. 32 PET-CT shows. (a) a hypermetabolic. mass in the left upper. outer breast. (mSUV = 4.8) and (b). there was no enlarged. hypermetabolic lymph. node in the left axilla. HR(+) HER2(+) Breast Cancer. 318. . Fig. 40 PET-CT shows. (a) a hypermetabolic. mass in the left outer. breast (mSUV = 8.6). and (b) mild. hypermetabolic enlarged. lymph nodes with fatty. hilum in the left axilla. level I–II (mSUV = 2.3). . S. Park et al.. Fig. 50. Fig. 50 Breast MRI (Jan. 2021): an irregular enhancing mass in the left breast. HR(+) HER2(+) Breast Cancer. 328. a. b. . situ (<1 mm) but this margin submitted for frozen. diagnosis (Fro 4) is free of tumor.. Result. Intensity. Positive. Fig. 55 PET-CT shows. (a) a hypermetabolic. mass in the left breast. (mSUV = 12.4) and (b). hypermetabolic lymph. nodes in the left axilla. level I–II, left internal. mammary area, and (c). left supraclavicular. fossa. (d) A. hypermetabolic mass. Fig. 115 PET-CT. shows (a) focal. hypermetabolic mass in. the subareolar area of. the right breast. (mSUV = 4.3) and (b). mild hypermetabolic. lymph node in the right. axilla level I. (mSUV = 0.9). . Fig. 130 PET-CT. shows (a) a. hypermetabolic mass in. the left lower inner. breast (mSUV = 7.7). and (b) multiple. hypermetabolic lymph. nodes in the left axilla. level I–III and (c) left. internal mammary area. . Fig. 137 PET-CT. shows (a) a. hypermetabolic mass in. the right breast. (mSUV = 13.7) and (b). small lymph nodes. without significant. hypermetabolism in the. right axilla. . S. Park et al.. 383Fig. 6.141. Fig. 6.141 (continued). . . (i) Tumor border: infiltrative.. . (j) Microcalcification: present, tumoral.. . (k) Pathological TN category (AJCC 2017):. pT1cN0(sn).. . 2. Intraductal papilloma with (1) usual ductal. 388Fig. 150. Fig. 150 PET-CT. shows a hypermetabolic. mass in the right upper. outer breast. (mSUV = 14.3). . . 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 25/10 HPF).. 4. Intraductal component: present, intratu. 170Fig. 167. Fig. 167 Right. mammography (May. 2021): an irregular mass. at lower outer quadrant. HR(+) HER2(+) Breast Cancer. 398. . . . S. Park et al.. 399. 401Fig. 172. Fig. 172 Right. mammography (May. 2021): a focal. asymmetry at upper. inner quadrant. HR(+) HER2(+) Breast Cancer. 402. . . . S. Park et al.. 405Fig. 180. Fig. 180 Left. mammography (June. 2021): an irregular mass. with spiculated margins. at upper outer quadrant. 2. Histologic grade: 2/3 (tubule formation: 2/3,. nuclear pleomorphism: 3/3, mitotic count:. 2/3, 11/10 HPF).. 3. Intraductal component: present, intratu. moral/extratumoral (20%) (nuclear grade:. high, necrosis: present, architectural pattern:. 410Fig. 187. Fig. 187 Breast MRI. (Mar. 2021): enlarged. lymph nodes at the. axilla. No abnormal. finding in both breasts. . S. Park et al.. 411Fig. 189. Fig. 189 Breast MRI. for routine surveillance. (May 2022): no. abnormal finding in both. breasts and axillae. 33. . 33.1. . Patient History and Progress. Female/50 years old, pre-menopause.. 412Fig. 190. Fig. 190 Left. mammography (Jan.. 2021): a focal. asymmetry with. microcalcifications at. the subareolar area. (white arrow). Enlarged. lymph nodes at the. axilla (black arrow). . S. Park et al.. 419Fig. 202. Fig. 202 Right. mammography (Jan.. 2021): an irregular mass. with fine pleomorphic. microcalcifications at. upper outer quadrant. HR(+) HER2(+) Breast Cancer. 420. and pertuzumab) + Operation + Post-. operative radiation therapy + Trastuzumab +. Tamoxifen 20 mg/day.. 3/3, 5/HPF).Fig. 211. Fig. 211 Left. mammography (May. 2021): negative finding. S. Park et al.. 425. . . . HR(+) HER2(+) Breast Cancer. 426. a |
864 | Important Radiologic Findings | Important Radiologic Findings | HR(+) HER2(-) Breast Cancer | biopsy (Fig. 4).. 1.3.2. . Pathology Report. Invasive Ductal Carcinoma. Associated. with. encapsulated. papillary. carcinoma.. 1. Size of tumor: 2.5 cm (pT2).. tumor cellsFig. 1 [BB:51.259;245.417;246.379;658.808]. Fig. 1 Left mammography (Nov. 2020): an irregular. mass with nipple retraction at subareolar areaFig. 2 [BB:51.366;55.874;453.200;201.315]. Fig. 2 Left breast US (Dec. 2020): a hypervascular irregular mass at subareolar area. US-CNB = IDCFig. 3. Fig. 3 Lymphoscintigraphy shows visualized sentinel. lymph nodes in the left axilla. Y. Kim et al.. 175. F. i. g. 4 [BB:51.298;225.990;453.269;658.808]. Fig. 4 (a) Gross pathology of mastectomy specimen. (b, c) The margins get marked and sliced with different colors on. each direction. 2. . 2.1. . Patient History and Progress. Female/61 years old, post-menopause.. Screen detected mass lesion on left breast 2. o’clock direction.. No family history.. 176Fig. 5 [BB:51.259;324.143;246.379;658.808]. Fig. 5 Left CC mammography (Oct. 2018, Sept. 2020):. negative finding in 2018. A developing asymmetry at. outer breast in 2020Fig. 6. Fig. 6 Left breast US (Nov. 2020): a hypoechoic mass at. upper outer quadrant. US-CNB = IDC. Result. Intensity. Positive %. Estrogen receptor. Strong (8/8). 3. >2/3. Progesterone receptor. Strong (8/8). node biopsy (Fig. 9).. 2.3.2. . Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 0.8 cm (pT1b).. 2. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 2/3, 11/10 HPF).. 3. Intraductal component: present, intratu. moral/extratumoral (20%) (nuclear grade:. 177Fig. 7 [BB:153.542;343.325;453.543;658.808]. Fig. 7 Breast MRI. (Dec. 2020): an irregular. enhancing mass in the. left breastFig. 8. Fig. 8 Lymphoscintigraphy shows visualized sentinel. lymph nodes in the left axilla. HR(+) HER2(−) Breast Cancer. 178Fig. 9 [BB:71.350;391.495;433.216;658.808]. a. b. Fig. 9 (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on. each directionFig. 10 [BB:263.535;111.200;441.543;345.344]. Fig. 10 Right mammography (Nov. 2020): two irregular. masses at subareolar area (white arrow) and upper outer. quadrant (black arrow). 3. . 3.1. . Patient History and Progress. Female/78 years old, post-menopause.. Screen detected mass lesion on right breast 10. o’clock direction.. 179Fig. 11 [BB:51.306;528.968;453.261;658.808]. Fig. 11 Right breast US (Nov. 2020): two irregular masses at subareolar area (white arrow, US-CNB = IDC) and upper. outer quadrant (black arrow, US-CNB = IDC)Fig. 12 [BB:51.283;174.205;453.284;478.000]. Fig. 12 Breast MRI (Dec. 2020): two irregular enhancing masses at subareolar area (white arrow) and upper outer. quadrant (black arrow) of right breast. HR(+) HER2(−) Breast Cancer. 180Fig. 13. Fig. 13 Lymphoscintigraphy shows faintly visualized. sentinel lymph nodes in the right axilla. 3.3.1. . Operation. Right breast conserving surgery, sentinel lymph. node biopsy (Fig. 14).. 3.3.2. . Pathology Report. Breast, right 10 o’clock:. Invasive Ductal Carcinoma. 1. Size of tumor: 0.9 cm.. 2. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 2/3, 11/10 HPF).. 3. Intraductal component: present, intratu. 181Fig. 14 [BB:51.281;226.048;454.531;658.808]. a. bFig. 14 [BB:51.281;226.048;454.531;658.808]. c. d. Fig. 14 (a) Gross pathology of lumpectomy specimen (10 o’ clock direction). (c) Gross pathology of lumpectomy. specimen (subareolar area). (b, d) The margins get marked and sliced with different colors on each direction. 4. . 4.1. . Patient History and Progress. Female/57 years old, post-menopause.. Screen detected mass lesion on right breast 10. o’clock direction.. No family history.. 182Fig. 15 [BB:51.259;239.246;246.379;658.808]. Fig. 15 Right mammography (Nov. 2020): a focal asym. metry at upper outer quadrant. 4.3. . Courses of Treatment. Operation + Post-operative radiation ther. apy + Letrozole 2.5 mg/day.. 4.3.1. . Operation. Right breast conserving surgery, sentinel lymph. node biopsy (Fig. 19).. 4.3.2. . Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 1.8 cm (pT1c).. 2. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 2/3, 17/10 HPF).. 3. Intraductal component: present, intratu. moral/extratumoral (10%) (nuclear grade:. 183Fig. 16 [BB:51.366;485.768;453.200;658.808]. Fig. 16 Right breast US (Dec. 2020): an irregular hypoechoic mass at upper outer quadrant (white arrow,. US-CNB = IDC). An enlarged lymph node at the right axillary fossa (black arrow)Fig. 17 [BB:51.284;112.816;453.283;435.065]. Fig. 17 Breast MRI (Dec. 2020): an irregular enhancing mass in the right breast (white arrow) and an enlarged lymph. node at the right axillary fossa (black arrow). HR(+) HER2(−) Breast Cancer. 184Fig. 18. Fig. 18 Lymphoscintigraphy shows visualized sentinel. lymph nodes in the right axillaFig. 19 [BB:51.314;167.485;453.253;464.500]. a. b. Fig. 19 (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on. each direction. Y. Kim et al.. 185. 5. . 5.1. . Patient History and Progress. Female/58 years old, post-menopause.. Screen detected mass lesion on right breast 4. node biopsy (Fig. 24).. 5.3.2. . Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 2.1 cm (pT2).. 2. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 2/3, 14/10 HPF).. 3. Intraductal component: present, intratu. moral/extratumoral (20%) (nuclear grade:. 6. Lymph nodes:Fig. 20 [BB:51.259;100.578;246.379;450.931]. Fig. 20 Right mammography (Nov. 2020): a focal asym. metry with fine pleomorphic microcalcifications at lower. inner quadrantFig. 21. Fig. 21 Right breast US (Dec. 2020): an irregular. hypoechoic mass. US-CNB = IDC with mucinous. component. HR(+) HER2(−) Breast Cancer. 186Fig. 22 [BB:153.543;383.333;453.544;658.808]. Fig. 22 Breast MRI. (Dec. 2020): a focal. non-mass enhancement. in the right breastFig. 23. Fig. 23 Lymphoscintigraphy shows visualized sentinel. lymph nodes in the right axilla. Result. Intensity. Positive %. Estrogen receptor. Strong (7/8). 2. >2/3. Progesterone receptor. Negative (2/8). 187Fig. 24 [BB:51.307;359.662;453.260;658.078]. a. b. Fig. 24 (a) Gross pathology of lumpectomy specimen (black arrow). (b) The margins get marked and sliced with dif. ferent colors on each directionFig. 25. Fig. 25 Gross pathology of breast wide excision. specimen. 5.3.3. . Operation (2nd, Jan. 2021). Right breast wide excision (Fig. 25).. 5.3.4. . Pathology Report. Invasive Ductal Carcinoma. . 1. Post-lumpectomy status.. . 2. Size of tumor: 0.2 cm, residual.. . 3. Histologic grade: 2/3 (tubule formation: 3/3,. node biopsy (Fig. 30).. 6.3.2. . Pathology Report. Invasive Ductal Carcinoma. 1. Size of invasive component: 1.8 cm (pT1c).. 2. Size of intraductal component: 4.0 cm.. 3. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 2/3, 11/10 HPF).. 4. Intraductal component: present, intratu. 7. Lymph nodes:Fig. 26 [BB:51.259;70.988;246.379;455.250]. Fig. 26 Right mammography (Oct. 2020): a spiculated. mass with microcalcifications at upper inner quadrantFig. 27. Fig. 27 Right breast US (Oct. 2020): an irregular. hypoechoic mass (white arrow, US-CNB = IDC) with. adjacent smaller masses (not shown). Y. Kim et al.. 189Fig. 28 [BB:153.542;367.733;453.543;658.808]. Fig. 28 Breast MRI. (Nov. 2020): an irregular. enhancing mass (white. arrow) with adjacent. satellite lesions (black. arrows) in the right. breastFig. 29. Fig. 29 Lymphoscintigraphy shows visualized sentinel. lymph nodes in the right axilla. . (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: 7 mm.. 8. Arteriovenous invasion: absent.. 190Fig. 30 [BB:51.314;361.793;453.253;658.808]. a. b. Fig. 30 (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on. each direction. 7. . 7.1. . Patient History and Progress. Female/42 years old, pre-menopause.. Screen detected mass lesion on left breast 2:30. and 3 o’clock direction.. No family history.. node biopsy (Fig. 36).. 7.3.2. . Pathology Report. Mucinous Carcinoma. 1. Size of invasive component: 1.8 cm (pT1c).. 2. Size of intraductal component: 3.0 cm.. 3. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 6/10 HPF).. Y. Kim et al.. 191Fig. 31 [BB:51.259;249.966;246.379;658.808]. Fig. 31 Left mammography (Nov. 2020): an irregular. palpable mass (white arrow) and another smaller mass. (black arrow) at upper outer quadrantFig. 32. Fig. 32 Left breast US (Nov. 2020): an irregular mass. (white arrow, US-CNB = Mucinous carcinoma) with adja. cent smaller masses (black arrows). 4. Intraductal component: present, intratu. moral/extratumoral (60%) (nuclear grade:. low, necrosis: absent, architectural pattern:. micropapillary/cribriform, extensive intra. ductal component: present).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . 192Fig. 33 [BB:51.280;330.033;453.287;658.808]. Fig. 33 Breast MRI (Nov. 2020): an enhancing mass (white arrow) with increased T2 signal intensity (black arrow) in. the left breastFig. 34. Fig. 34 Lymphoscintigraphy shows visualized sentinel. lymph nodes in the left axilla. Y. Kim et al.. 193Fig. 35. Fig. 35 Breast MRI for routine surveillance (Aug. 2021): no abnormal finding in both breastsFig. 36 [BB:51.307;176.273;453.260;473.250]. a. b. Fig. 36 (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on. each direction. HR(+) HER2(−) Breast Cancer. 194. 8. . 8.1. . Patient History and Progress. Female/46 years old, pre-menopause.. Screen detected mass lesion on right breast 12. Fig. 37 Both mammography (Nov. 2020): irregular mass at upper inner quadrant of the right breast (white arrow) and. upper outer quadrant of the left breast (black arrow)Fig. 37 [BB:55.877;195.405;448.690;537.000]. Y. Kim et al.. 195Fig. 38 [BB:51.366;498.968;453.200;658.808]. Fig. 38 Both breast US (Nov. 2020): irregular masses at upper inner quadrant of the right breast (white arrow) and. upper outer quadrant of the left breast (black arrow). Both US-CNB = IDCFig. 39 [BB:51.283;132.357;453.284;449.078]. Fig. 39 Breast MRI (Nov. 2020): irregular enhancing masses in both breasts. HR(+) HER2(−) Breast Cancer. 196. 8.3. . Courses of Treatment. Operation + Post-operative radiation ther. apy + Tamoxifen 20 mg/day.. 8.3.1. . Operation. 1. Size of invasive component: 1.5 cm (pT1c).Fig. 40. Fig. 40 Lymphoscintigraphy shows visualized sentinel. lymph nodes in both axillaFig. 41 [BB:51.315;147.568;453.253;446.000]. a. b. Fig. 41 (a) Gross pathology of right mastectomy specimen. (b, c) The margins get marked and sliced with different. colors on each direction. Y. Kim et al.. 197. 2. Size of intraductal component: 3.5 cm.. 3. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 2/3, 18/10 HPF).. 4. Intraductal component: present, intratu. moral/extratumoral (60%) (nuclear grade:. low, necrosis: present, architectural pattern:. Fig. 41_1 [BB:51.024;525.848;250.704;658.808]. Fig. 41 (continued). F. i. g. 42 [BB:51.367;211.885;453.200;478.000]. Fig. 42 (a) Gross pathology of left mastectomy specimen. (b, c) The margins get marked and sliced with different. colors on each direction. HR(+) HER2(−) Breast Cancer. 198. . (b) deep margin: <1 mm from ductal carci. noma in situ (slide 3),. . (c) superficial margin: <1 mm from ductal. carcinoma in situ (slide 5).. 7. Lymph nodes: no metastasis in seven axillary. node biopsy (Fig. 47).. Y. Kim et al.. 199Fig. 43 [BB:51.259;248.064;246.379;658.808]. Fig. 43 Left mammography (Dec. 2020): an irregular. mass with microcalcifications at upper inner quadrantFig. 44. Fig. 44 Left breast US (Dec. 2020): an irregular. hypoechoic mass with angular margins. US-CNB = IDC. 9.3.2. . Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 3.0 cm (pT2).. 2. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 3/3, 40/10 HPF).. 3. Intraductal component: present, intratu. 200Fig. 45 [BB:51.271;387.653;453.296;658.808]. Fig. 45 Breast MRI (Dec. 2020): an irregular enhancing mass in the left breastFig. 46. Fig. 46 Lymphoscintigraphy shows visualized sentinel. lymph nodes in the left axilla. Y. Kim et al.. 201Fig. 47 [BB:51.314;361.830;453.253;658.808]. a. b. Fig. 47 (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on. each direction. 10. . 10.1. . Patient History and Progress. Female/50 years old, pre-menopause.. Screen detected mass lesion on left breast 12. o’clock direction.. No family history.. node dissection (Fig. 52).. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 2.7 cm (pT2).. HR(+) HER2(−) Breast Cancer. 202Fig. 48 [BB:51.256;313.199;246.381;658.808]. Fig. 48 Left mammography (Nov. 2020): an irregular. hyperdense mass at upper centerFig. 49. Fig. 49 Left breast US (Nov. 2020): an irregular. hypoechoic mass with spiculated margins. US-CNB = IDC. 2. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 3/3, 24/10 HPF).. 3. Intraductal component: present, intratu. moral/extratumoral (20%) (nuclear grade:. high, necrosis: present, architectural pattern:. cribriform/solid/comedo, extensive intra. ductal component: absent).. 4. Skin: no involvement of tumor.. 203Fig. 50 [BB:51.283;306.892;453.284;658.808]. Fig. 50 Breast MRI (Dec. 2020): an irregular enhancing mass in the left breast. Enlarged lymph nodes at the left axilla. (white arrow) and internal mammary chain (black arrow)Fig. 51. Fig. 51 Lymphoscintigraphy shows visualized sentinel. lymph nodes in the left axilla. HR(+) HER2(−) Breast Cancer. 204Fig. 52 [BB:51.306;362.070;453.261;658.808]. a. b. Fig. 52 (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on. each direction. 11. . 11.1. . Patient History and Progress. Female/60 years old, post-menopause.. Screen detected mass lesion on upper outer. portion of left breast.. No family history.. node biopsy (Fig. 57).. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 2.5 cm (pT2).. Y. Kim et al.. 205Fig. 53 [BB:51.259;301.002;246.379;658.808]. Fig. 53 Left CC mammography (Nov. 2016, Nov. 2020):. negative finding in 2016. A new mass at the outer breast in. 2020Fig. 54. Fig. 54 Left breast US (Dec. 2020): an irregular. hypoechoic mass at upper outer quadrant. US-CNB = IDC. 2. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 3/3, 29/10 HPF).. 3. Intraductal component: present, intratu. moral/extratumoral (10%) (nuclear grade:. low, necrosis: absent, architectural pattern:. cribriform, extensive intraductal component:. absent).. 4. Skin: no involvement of tumor.. 206Fig. 55 [BB:51.271;279.761;453.296;658.808]. Fig. 55 Breast MRI (Dec. 2020): a rim-enhancing mass in the left breastFig. 56. Fig. 56 Lymphoscintigraphy shows visualized sentinel. lymph nodes in the left axilla. Y. Kim et al.. 207Fig. 57 [BB:51.314;360.405;453.253;658.808]. a. b. Fig. 57 (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on. each direction. 12. . 12.1. . Patient History and Progress. Female/55 years old, pre-menopause.. Screen detected mass lesion on right breast 5. o’clock direction.. No family history.. node biopsy (Fig. 62).. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 2.3 cm (pT2).. HR(+) HER2(−) Breast Cancer. 208Fig. 58 [BB:51.259;308.321;246.379;658.808]. Fig. 58 Right mammography (Nov. 2020): a spiculated. mass with architectural distortion at lower inner quadrantFig. 59. Fig. 59 Right breast US (Dec. 2020): an irregular. hypoechoic. mass. with. non-parallel. orientation.. US-CNB = IDC. 2. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 1/3, mitotic count:. 1/3, 5/10 HPF).. 3. Intraductal component: present, intratumoral/. 209Fig. 60 [BB:51.271;246.533;453.296;658.808]. Fig. 60 Breast MRI (Dec. 2020): an irregular enhancing mass in the right breastFig. 61. Fig. 61 Lymphoscintigraphy shows visualized sentinel. lymph nodes in the right axilla. HR(+) HER2(−) Breast Cancer. 210Fig. 62 [BB:51.314;361.831;453.253;658.808]. a. b. Fig. 62 (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on. each direction. 13. . 13.1. . Patient History and Progress. Female/64 years old, post-menopause.. Screen detected mass lesion on left breast 10. o’clock direction.. No family history.. Left modified radical mastectomy (Fig. 67).. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 5.2 cm (pT3).. Y. Kim et al.. 211Fig. 63 [BB:51.257;214.430;453.310;658.808]. Fig. 63 Mammography (Nov. 2020): an irregular mass. with microcalcifications at upper inner quadrant of the left. breast. Associated global asymmetry and thickening of. the nipple–areolar complex (black arrow). Enlarged. lymph nodes at the left axilla (white arrows). 2. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 2/3, 10/10 HPF).. 3. Intraductal component: present, intratumoral. (5%) (nuclear grade: high, necrosis: present,. architectural pattern: solid/comedo, exten. 212Fig. 64. Fig. 64 Left breast US (Nov. 2020): an irregular. hypoechoic. mass. with. microcalcifications.. US-CNB = IDCFig. 65 [BB:51.273;123.597;453.294;428.000]. Fig. 65 Breast MRI (Dec. 2020): an irregular enhancing mass (white arrow) with diffuse non-mass enhancement. (black arrows) in the left breastFig. 66. Fig. 66 Lymphoscintigraphy shows visualized sentinel. lymph nodes in the left axilla. Y. Kim et al.. 213Fig. 67 [BB:51.307;226.018;453.260;658.808]. a. b. c. d. Fig. 67 (a) Gross pathology of mastectomy specimen. (b, c and d) The margins get marked and sliced with different. colors on each direction. . (a) metastasis in eight out of nine axillary. lymph nodes (pN2a) (sentinel LN: 4/4,. axillary LN: 4/5).. . (b) perinodal extension: present.. . (c) size of metastatic carcinoma: 11 mm.. 7. Arteriovenous invasion: absent.. 214Fig. 68 [BB:258.168;162.552;453.328;578.000]. Fig. 68 Left mammography (Dec. 2020): a focal asym. metry with microcalcifications (black arrows) at outer. subareolar area. Result. Intensity. Positive %. Estrogen receptor. Strong (8/8). 3. >2/3. Progesterone receptor. node biopsy (Fig. 73).. Pathology Report. Mucinous Carcinoma. 1. Post-chemotherapy status.. 2. Size of tumor: 2.0 cm (ypT1c).. 3. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 6/10 HPF).. Y. Kim et al.. 215Fig. 69. Fig. 69 Left breast US (Dec. 2020): an oval isoechoic. mass with microcalcifications. US-CNB = IDC with. mucinous componentFig. 70 [BB:51.271;138.290;453.296;445.250]. Fig. 70 Breast MRI (Dec. 2020): a rim-enhancing mass in the left breastFig. 71. Fig. 71 Post-NAC breast MRI (June 2021): decreased. tumor burden after NAC. HR(+) HER2(−) Breast Cancer. 216. 4. Intraductal component: present, intratu. moral/extratumoral (30%) (nuclear grade:. low, necrosis: absent, architectural pattern:. cribriform/solid, extensive intraductal com. ponent: present).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. nous carcinoma (slide 1).Fig. 72. Fig. 72 Lymphoscintigraphy shows visualized sentinel. lymph nodes in the left axillaFig. 73 [BB:51.306;153.023;453.261;450.000]. a. b. Fig. 73 (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on. each direction. Y. Kim et al.. 217. 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.. . node biopsy (Fig. 78).Fig. 74 [BB:258.224;447.128;453.272;658.808]. Fig. 74 Left mammography (Dec. 2020): negative. findingFig. 75. Fig. 75 Left breast US (Dec. 2020): a hypoechoic mass. with non-parallel orientation at upper outer quadrant.. US-CNB = IDC. HR(+) HER2(−) Breast Cancer. 218Fig. 76 [BB:51.283;260.893;453.284;658.808]. Fig. 76 Breast MRI (Dec. 2020): an irregular enhancing mass in the left breast. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 0.9 cm (pT1b).. 2. Histologic grade: 2/3 (tubule formation: 2/3,. nuclear pleomorphism: 2/3, mitotic count:. 2/3, 10/10 HPF).. 3. Intraductal component: absent.. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . 219Fig. 77. Fig. 77 Lymphoscintigraphy shows visualized sentinel. lymph nodes in the left axillaFig. 78 [BB:51.306;171.022;453.261;468.000]. a. b. Fig. 78 (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on. each direction. Result. Intensity. Positive %. Estrogen receptor. Strong (8/8). 3. >2/3. Progesterone receptor. Intermediate (5/8). node biopsy (Fig. 83).. Pathology Report. Invasive Ductal Carcinoma. 1. Post-mammotome excision status.. 2. Size of tumor: 0.6 cm, residual.. 3. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 1/10 HPF).. 4. Intraductal component: present, intratu. moral/extratumoral (40%) (nuclear grade:. low, necrosis: absent, architectural pattern:. 11. Microcalcification: present, non-tumoral.Fig. 79 [BB:258.163;242.868;453.333;658.808]. Fig. 79 Left mammography (Oct. 2020): one-view. asymmetry at outer breast. Outside US-VABE = IDC (no. available image). Y. Kim et al.. 221. Note: 1. The inferior margin of the. lumpectomy specimen (slide 6) is close to. ductal carcinoma in situ (<1 mm) but this. margin submitted for frozen diagnosis (Fro. 7) is free of tumor.. Result. tumor cellsFig. 80. Fig. 80 Left breast US (Dec. 2020): an irregular. hypoechoic area at the VABE siteFig. 81 [BB:51.271;80.578;453.296;442.063]. Fig. 81 Breast MRI (Dec. 2020): some enhancing foci at the VABE site. HR(+) HER2(−) Breast Cancer. 222Fig. 82. Fig. 82 Lymphoscintigraphy shows visualized sentinel. lymph nodes in the left axillaFig. 83 [BB:51.307;165.925;453.261;462.662]. a. b. Fig. 83 (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on. each direction. Y. Kim et al.. 223. 17. . 17.1. . Patient History and Progress. Female/50 years old, peri-menopause.. Screen detected mass lesion on left breast 4. node biopsy (Fig. 88).. Pathology Report. Invasive Ductal Carcinoma. 1. Size of invasive component: 0.4 cm (pT1a).. 2. Size of intraductal component: 3.0 cm.. 3. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 1/10 HPF).. 4. Intraductal component: present, extratumoral. (80%) (nuclear grade: low, necrosis: absent,. architectural pattern: cribriform/solid, exten. pT1aN0(i+)(sn).Fig. 84 [BB:51.354;105.578;246.284;354.698]. Fig. 84 Left mammography, MLO view (Dec. 2020):. negative findingFig. 85. Fig. 85 Left breast US (Dec. 2020): a small hypoechoic. mass at lower outer quadrant. US-CNB = IDC. HR(+) HER2(−) Breast Cancer. 224Fig. 86. Fig. 86 Breast MRI (Dec. 2020): no suspicious finding in both breastsFig. 87. Fig. 87 Lymphoscintigraphy shows visualized sentinel. lymph nodes in the left axilla. Note: 1. The inferior margin of the lumpectomy. specimen (slide 3) is close to ductal carci. noma in situ (2 mm) but this margin submit. ted for frozen diagnosis (Fro 4) is free of. tumor.. 2. The lateral margin of the lumpectomy speci. men (slide 5) is close to invasive ductal car. cinoma (1 mm) but this margin submitted for. frozen diagnosis (Fro 4) is free of tumor.. 225Fig. 88 [BB:51.307;361.830;453.260;658.808]. a. b. Fig. 88 (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on. each direction. 18. . 18.1. . Patient History and Progress. Female/61 years old, post-menopause.. Screen detected microcalcification of upper. outer portion on left breast.. No family history.. Left breast excision (Fig. 97).. Pathology Report. Ductal Carcinoma in Situ. . 1. Size of tumor: 0.5 cm (pTis).. HR(+) HER2(−) Breast Cancer. 226Fig. 89 [BB:51.242;335.477;246.396;658.808]. Fig. 89 Left mammography (July 2010): regional amor. phous microcalcifications at upper outer quadrant. . 2. Nuclear grade: low.. . 3. Necrosis: present.. . 4. Architectural. pattern:. cribriform. and. node biopsy (Fig. 98).. Pathology Report. No residual carcinoma.. . 1. Post-excisional biopsy status.. . 2. Lymph nodes: no metastasis in five axillary. lymph nodes (pN0) (sentinel LN: 0/2, axillary. LN: 0/3).. . 3. Additional pathologic findings: Flat atypia. 227Fig. 90. Fig. 90 Breast MRI (Aug. 2010): regional non-mass enhancement at the operative site (white arrow). A benign appear. ing mass in the right breast (black arrow)Fig. 91. Fig. 91 Lymphoscintigraphy shows visualized sentinel. lymph nodes in the left axilla (Aug. 2010)Fig. 92 [BB:258.283;168.920;453.213;341.000]. Fig. 92 Left mammography (Nov. 2011): post-operative. change at upper outer quadrant. An intramammary lymph. node at upper outer quadrant (black arrow). HR(+) HER2(−) Breast Cancer. 228Fig. 93 [BB:51.259;292.408;246.379;658.808]. Fig. 93 Left mammography (Nov. 2020): newly devel. oped irregular masses at the operative site (white arrows).. No change in the benign intramammary lymph node. (black arrow)Fig. 94. Fig. 94 Left breast US (Nov. 2020): two masses with. non-parallel orientation. US-CNB = IDC. 3. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 3/10 HPF).. 4. Intraductal component: present, intratumoral. (5%) (nuclear grade: low, necrosis: absent,. architectural pattern: solid, extensive intra. ductal component: absent).. 5. Skin and nipple: no involvement of tumor.. 6. Surgical margins:. 229Fig. 95 [BB:71.383;255.576;433.183;658.808]. Fig. 95 Breast MRI (Nov. 2020): an irregular enhancing mass in the left breast (white arrow). No change of a benign. appearing mass in the right breast (black arrow)Fig. 96. Fig. 96 Lymphoscintigraphy shows visualized sentinel. lymph nodes in the left axilla (Jan. 2021)Fig. 97. Fig. 97 Gross pathology of breast excision specimen. HR(+) HER2(−) Breast Cancer. 230Fig. 98. Fig. 98 Gross pathology of lumpectomy specimenFig. 99 [BB:51.306;217.571;453.261;486.500]. a. b. c. d. Fig. 99 (a) Gross pathology of right mastectomy specimen. (b, c and d) The margins get marked and sliced with dif. ferent colors on each direction. Y. Kim et al.. 231Fig. 100 [BB:51.226;392.693;453.341;658.808]. a. b. c. d. Fig. 100 (a) Gross pathology of left mastectomy specimen. (b, c and d) The margins get marked and sliced with dif. ferent colors on each direction. 19. . 19.1. . Patient History and Progress. Female/43 years old, pre-menopause.. Screen detected mass lesion of lower inner on. left breast.. No family history.. 232Fig. 101 [BB:51.259;243.015;246.379;658.808]. Fig. 101 Left mammography (Jan. 2021): an irregular. mass at lower inner quadrantFig. 102. Fig. 102 Left breast US (Jan. 2021): a hypoechoic mass. with angular margins at lower inner quadrant.. US-CNB = IDC. 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.. 233Fig. 103 [BB:51.280;285.793;453.287;658.808]. Fig. 103 Breast MRI (Jan. 2021): an irregular enhancing mass at lower inner quadrant of the left breast (white arrow,. proven IDC). Another irregular enhancing mass at the lower outer quadrant of the left breast (black arrow)Fig. 104. Fig. 104 MRI-directed left breast US (Jan. 2021): a. hypoechoic mass with non-parallel orientation at lower. outer quadrant. US-CNB = IDCFig. 105. Fig. 105 Lymphoscintigraphy shows visualized sentinel. lymph nodes in the left axilla. HR(+) HER2(−) Breast Cancer. 234Fig. 106 [BB:51.323;370.528;453.244;658.808]. a. bFig. 106 [BB:51.323;370.528;453.244;658.808]. Fig. 106 (a) Preoperative and (b) immediate post-operative appearance. F. i. g. 107 [BB:51.307;63.094;453.260;332.000]. Fig. 107 (a) Gross pathology of mastectomy specimen. (b, c) The margins get marked and sliced with different colors. on each direction. Y. Kim et al.. 235. 20. . 20.1. . Patient History and Progress. Female/49 years old, pre-menopause.. Screen detected mass lesion on left breast 2. node biopsy (Fig. 113).. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 0.9 cm (pT1b).. 2. Histologic grade: 1/3 (tubule formation: 2/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 1/10 HPF).. 3. Intraductal component: present, intratu. moral/extratumoral (40%) (nuclear grade:. low, necrosis: absent, architectural pattern:. micropapillary/cribriform/solid/comedo,. (f) superficial margin: 3 mm.Fig. 108 [BB:258.188;292.037;453.308;658.808]. Fig. 108 Left mammography (Nov. 2020): an irregular. mass at upper outer quadrantFig. 109. Fig. 109 Left breast US (Nov. 2020): an irregular mass. with non-parallel orientation. US-CNB = IDC. HR(+) HER2(−) Breast Cancer. 236Fig. 110 [BB:51.271;275.977;453.296;658.808]. Fig. 110 Breast MRI (Nov. 2021): an irregular enhancing mass in the left breastFig. 111. Fig. 111 Lymphoscintigraphy shows visualized sentinel. lymph nodes in the left axilla. 6. Lymph nodes: no metastasis in six axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/3,. non-sentinel LN: 0/3).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular invasion: absent.. 9. Tumor border: infiltrative.. . 10. Microcalcification:. present,. 237Fig. 112. Fig. 112 Breast MRI for routine surveillance (Oct. 2021): No abnormal finding in both breastsFig. 113 [BB:51.306;157.023;453.261;454.000]. a. b. Fig. 113 (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors. on each direction. Result. Intensity. Positive %. Estrogen receptor. Intermediate (6/8). 1. >2/3. Progesterone receptor. Intermediate (6/8). Left breast conserving surgery (Fig. 118).. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 1.2 cm (pT1c).. 2. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 2/3, 11/10 HPF).. 3. Intraductal component: present, intratu. moral/extratumoral (20%) (nuclear grade:. low, necrosis: present, architectural pattern:. solid/comedo, extensive intraductal compo. 8. Tumor border: infiltrative.Fig. 114 [BB:51.238;100.578;246.400;438.999]. Fig. 114 Left CC mammography (June 2019, Nov.. 2020): negative finding in 2019. A new mass at the central. breast in 2020Fig. 115. Fig. 115 Left breast US (Nov. 2020): a hypoechoic mass. with microlobulated margins at 12 o’clock direction.. Outside US-CNB = DCIS. Y. Kim et al.. 239Fig. 116 [BB:51.271;251.490;453.296;658.808]. Fig. 116 Breast MRI (Nov. 2020): an irregular enhancing mass in the left breastFig. 117. Fig. 117 Lymphoscintigraphy shows visualized sentinel. lymph nodes in the left lateral breast. 9. Microcalcification:. present,. tumoral/. non-tumoral.. . 10. Pathological TN category (AJCC 2017):. pT1c.. Result. Intensity. 240Fig. 118 [BB:51.306;361.831;453.261;658.808]. a. b. Fig. 118 (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors. on each direction. Operation (2nd, Jan. 2021). Left sentinel lymph node biopsy.. Pathology Report. No metastasis in two axillary lymph nodes. . 1. Post-lumpectomy status.. 22. . 22.1. Left modified radical mastectomy (Fig. 125).. Y. Kim et al.. 241Fig. 119 [BB:51.287;469.207;453.280;658.808]. Fig. 119 Mammography (June 2020): global asymmetry with edema in the left breastFig. 120 [BB:51.366;285.700;453.200;428.500]. Fig. 120 Left breast US (July 2020): irregular hypoechoic lesion with posterior acoustic shadowing involving the. entire left breast (partly shown). US-CNB = IDC. Pathology Report. Invasive Micropapillary Carcinoma. 1. Post-chemotherapy status.. 2. Size of tumor: 11.0 cm (ypT3).. 3. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 2/10HPF).. 4. Intraductal component: absent.. 5. Skin and nipple: dermal involvement of. 242Fig. 121 [BB:51.283;321.652;453.284;658.808]. Fig. 121 Breast MRI (Aug. 2020): diffuse non-mass enhancement with involvement of the skin. Enlarged lymph nodes. at the left axilla (black arrow)Fig. 122. Fig. 122 Post-NAC breast MRI (Dec. 2020): slightly decreased tumor burden in the left breast. Y. Kim et al.. 243. . 11. Microcalcification:. present,. tumoral/. non-tumoral.. . 12. Pathological TN category (AJCC 2017):. ypT3N2a.. of tumor cellsFig. 123. Fig. 123 Lymphoscintigraphy shows visualized sentinel. lymph nodes in the left axillaFig. 124. Fig. 124 Breast MRI for routine surveillance (July 2021): no abnormal finding in right breast and anterior left chest. wall. HR(+) HER2(−) Breast Cancer. 244Fig. 125 [BB:51.306;225.861;453.261;658.808]. a. b. c. d. Fig. 125 (a) Gross pathology of mastectomy specimen. (b, c and d) The margins get marked and sliced with different. colors on each direction. 23. . 23.1. . Patient History and Progress. Female/53 years old, post-menopause.. Screen detected mass lesion on right breast 7. o’clock direction.. Family history of breast cancer, younger. 245Fig. 126 [BB:51.259;290.486;246.379;658.808]. Fig. 126 Right mammography (July 2020): an irregular. mass with microcalcifications at lower center. Another. oval mass at the upper outer quadrant (black arrow).. Multiple enlarged lymph nodes at the right axilla (white. arrows)Fig. 127 [BB:258.188;397.253;453.308;658.808]. Fig. 127 Right breast US (July 2020): an irregular. hypoechoic mass with microcalcifications at lower center. (white arrows, US-CNB = IDC). Another oval isoechoic. mass at the upper outer quadrant (black arrow). 23.3. . Courses of Treatment. Neoadjuvant chemotherapy (#4 cycles of. doxorubicin & cyclophosphamide followed by. #4 cycles of docetaxel) + Operation + Post-. operative radiation therapy + Letrozole. node biopsy (Fig. 131).. Pathology Report. . 1. Microinvasive ductal carcinoma. . (a) Post-chemotherapy status.. . (b) Size of invasive component: <0.1 cm. (ypT1mi).. . (c) Size of intraductal component: 1.5 cm.. 246Fig. 128 [BB:51.283;295.732;453.284;658.808]. Fig. 128 Breast MRI (July 2020): an irregular enhancing mass in the right breast (white arrow). Enlarged lymph node. at the right axilla (black arrow)Fig. 129. Fig. 129 Post-NAC breast MRI (Dec. 2020): Decreased. size of the tumor after NACFig. 130. Fig. 130 Lymphoscintigraphy shows visualized sentinel. lymph nodes in the right axilla. Y. Kim et al.. 247Fig. 131 [BB:51.306;361.830;453.261;658.808]. a. b. Fig. 131 (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors. on each direction. • deep margin: <1 mm from ductal car. cinoma in situ (slide 1).. • superficial margin: 5 mm.. . (h) Lymph nodes: no metastasis in three. axillary lymph nodes (ypN0(sn)) (senti. nel LN: 0/1, axillary LN: 0/2). . (i) Arteriovenous invasion: absent.. node dissection (Fig. 137).. Pathology Report. Invasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of tumor: 2.0 cm (ypT1c).. 3. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 1/10 HPF). 4. Intraductal component: present, intratumoral/. extratumoral (5%) (nuclear grade: low, necro. sis: absent, architectural pattern: solid, exten. (c) medial margin: 10 mm.Fig. 132 [BB:258.171;287.331;453.325;658.808]. Fig. 132 Breast MRI (July 2020): an irregular enhancing. mass in the right breast (white arrow). Enlarged lymph. node at the right axilla (black arrow). Y. Kim et al.. 249Fig. 133 [BB:51.366;472.087;453.200;658.808]. Fig. 133 Right breast US (June 2020): an irregular mass with microcalcifications at outer center (white arrow,. US-CNB = IDC). Another irregular mass at the lower outer quadrant (black arrow). . (d) lateral margin: positive for invasive duc. tal carcinoma (Fro 4).. . (e) deep margin: 5 mm.. . (f) superficial margin: 3 mm.. 7. Lymph nodes:. . Right breast wide excision (Fig. 138).. Pathology Report. No residual tumor with foreign body reaction.. . 1. Post-lumpectomy status.. HR(+) HER2(−) Breast Cancer. 250Fig. 134 [BB:51.283;174.330;453.284;658.808]. Fig. 134 Breast MRI (June 2020): two irregular enhancing masses in the right breast. Multiple enlarged lymph nodes. at the right axilla (circle, US-CNB = Metastatic ductal carcinoma). Y. Kim et al.. 251Fig. 135. Fig. 135 Post-NAC breast MRI (Jan. 2021): decreased size of the tumors and lymph nodes after NACFig. 136. Fig. 136 Lymphoscintigraphy shows visualized sentinel. lymph nodes in the right axilla. HR(+) HER2(−) Breast Cancer. 252Fig. 137 [BB:51.314;361.830;453.253;658.808]. a. b. Fig. 137 (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors. on each directionFig. 138 [BB:51.366;177.540;453.201;310.500]. a. b. Fig. 138 (a) Gross pathology of breast wide excision specimen. (b) The margins get marked and sliced with different. colors on each direction. Y. Kim et al.. 253. 25. . 25.1. . Patient History and Progress. Female/61 years old, post-menopause.. Screen detected mass lesion on left breast 12. node dissection (Fig. 144).. Pathology Report. Invasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of tumor: 1.8 cm (ypT1c).. 3. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 2/3, 11/10 HPF). 4. Intraductal component: present, intratu. moral/extratumoral (5%) (nuclear grade:. low, necrosis: present, architectural pattern:. (a) superior margin: 20 mm.Fig. 139 [BB:258.168;320.135;453.328;658.808]. Fig. 139 Left mammography (Dec. 2020): an irregular. mass with spiculated margins at upper centerFig. 140. Fig. 140 Left breast US (Dec. 2020): an irregular. hypoechoic mass with angular margins. US-CNB = IDC. HR(+) HER2(−) Breast Cancer. 254Fig. 141 [BB:51.271;237.337;453.296;658.808]. Fig. 141 Breast MRI (Dec. 2020): an irregular enhancing mass in the left breast (white arrow). Mildly enlarged lymph. node at the left axilla (black arrow, US-CNB = Metastatic ductal carcinoma). . (b) inferior margin: 10 mm.. . (c) medial margin: 10 mm.. . (d) lateral margin: 10 mm.. . (e) deep margin: 2 mm.. . 255Fig. 142. Fig. 142 Post-NAC breast MRI (June 2021): decreased. volume of the tumor after NACFig. 143. Fig. 143 Lymphoscintigraphy shows faintly visualized. sentinel lymph nodes in the left axillaFig. 144 [BB:51.315;112.022;453.252;409.000]. a. b. Fig. 144 (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors. on each direction. HR(+) HER2(−) Breast Cancer. 256Fig. 145 [BB:258.188;221.265;453.308;658.808]. Fig. 145 Left mammography (Dec. 2020): an irregular. mass with spiculated margins at upper outer quadrant. Result. Intensity. Positive. %. Estrogen. receptor. Intermediate. (6/8). 2. node biopsy (Fig. 149).. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 1.7 cm (pT1c).. 2. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 2/10 HPF). 3. Intraductal component: present, intratumoral. (5%) (nuclear grade: low, necrosis: absent,. architectural pattern: solid, extensive intra. ductal component: absent).. 257Fig. 146. Fig. 146 Left breast US (Dec. 2020): an irregular. hypoechoic. mass. with. non-parallel. orientation.. US-CNB = IDCFig. 147 [BB:51.271;93.078;453.296;425.732]. Fig. 147 Breast MRI (Dec. 2020): an irregular rim-enhancing mass in the left breastFig. 148. Fig. 148 Lymphoscintigraphy shows visualized sentinel. lymph nodes in the left axilla. HR(+) HER2(−) Breast Cancer. 258Fig. 149 [BB:51.306;361.830;453.261;658.808]. a. b. Fig. 149 (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors. on each direction. . (b) inferior margin: 6 mm.. . (c) medial margin: 10 mm.. . (d) lateral margin: 15 mm.. . (e) deep margin: 8 mm.. . 259Fig. 150 [BB:51.236;185.710;246.402;658.808]. Fig. 150 Left mammography (Dec. 2020): two irregular. masses at upper inner quadrantFig. 151. Fig. 151 Left breast US (Dec. 2020): two hypoechoic. masses with spiculated margins. US-CNB = IDC. 27.3. . Courses of Treatment. Operation + Post-operative radiation ther. apy + Anastrozole 1 mg/day.. Operation (1st, Jan. 2021). Left breast conserving surgery, sentinel lymph. node biopsy (Fig. 154).. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 2.1 cm (pT2).. 2. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 3/10 HPF). 3. Intraductal component: present, intratu. moral/extratumoral (50%) (nuclear grade:. low, necrosis: present, architectural pattern:. cribriform/solid/comedo, extensive intra. 260Fig. 152 [BB:51.279;264.180;453.288;658.808]. Fig. 152 Breast MRI (Dec. 2020): two irregular enhancing masses in the left breastFig. 153. Fig. 153 Lymphoscintigraphy shows visualized sentinel. lymph nodes in the left axilla. Intraductal Papilloma. Note: 1. Ductal carcinoma in situ is present only. in the permanent section of Fro 1.. The medial margin of the lumpectomy specimen. (slide 9) is positive for ductal carcinoma in. situ but this margin submitted for frozen diag. nosis (Fro 3) is free of tumor. Result. Intensity Positive %. 261Fig. 154 [BB:51.306;361.830;453.261;658.808]. a. b. Fig. 154 (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors. on each direction. Operation (2nd, Feb. 2021). Left breast wide excision.. Pathology Report. No residual tumor with foreign body reaction.. . 1. Post-lumpectomy status.. 28. . 28.1. node biopsy (Fig. 159).. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 2.9 cm (pT2).. 2. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 3/10 HPF). 3. Intraductal component: present, intratu. moral/extratumoral (5%) (nuclear grade:. low, necrosis: absent, architectural pattern:. cribriform/solid, extensive intraductal com. 262Fig. 155 [BB:51.259;235.492;246.379;658.808]. Fig. 155 Right mammography (Oct. 2020): an irregular. mass with microcalcifications at lower outer quadrantFig. 156. Fig. 156 Right breast US (Dec. 2020): an irregular. hypoechoic mass. US-CNB = IDC. 5. Surgical margins:. . (a) superior margin: 15 mm.. . (b) inferior margin: 6 mm.. . (c) medial margin: 10 mm.. . (d) lateral margin: 10 mm.. 263Fig. 157 [BB:51.271;285.075;453.296;658.808]. Fig. 157 Breast MRI (Dec. 2020): an irregular enhancing mass in the right breast (white arrow). Enlarged lymph nodes. at the right axilla (black arrow)Fig. 158. Fig. 158 Lymphoscintigraphy shows visualized sentinel. lymph nodes in the right axilla. HR(+) HER2(−) Breast Cancer. 264Fig. 159 [BB:51.307;362.070;453.260;658.808]. a. b. Fig. 159 (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors. on each direction. 29. . 29.1. . Patient History and Progress. Female/80 years old, post-menopause.. Screen detected mass lesion on left breast 10. o’clock direction.. No family history.. node biopsy (Fig. 164).. Pathology Report. Invasive ductal carcinoma with mucinous. component associated with mucocele-. like. lesion.. 1. Size of tumor: 0.8 cm (pT1b).. 2. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 1/10 HPF). 3. Intraductal component: absent.. tumor cellsFig. 160 [BB:51.240;285.092;246.398;658.808]. Fig. 160 Left mammography (Dec. 2020): an irregular. mass at upper inner quadrantFig. 161. Fig. 161 Left breast US (Dec. 2020): an irregular. isoechoic. mass. with. angular. margins.. US-CNB = Mucinous carcinoma. HR(+) HER2(−) Breast Cancer. 266Fig. 162 [BB:51.271;331.592;453.296;658.808]. Fig. 162 Breast MRI (Dec. 2020): an irregular enhancing mass in the left breastFig. 163. Fig. 163 Lymphoscintigraphy shows visualized sentinel. lymph nodes in the left axilla. Y. Kim et al.. 267Fig. 164 [BB:51.306;361.830;453.261;658.808]. a. b. Fig. 164 (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors. on each direction. 30. . 30.1. . Patient History and Progress. Female/63 years old, post-menopause.. Screen detected mass lesion on left breast 4. o’clock direction.. No family history.. node biopsy (Fig. 169).. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 1.1 cm (pT1c).. 2. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 6/10 HPF). HR(+) HER2(−) Breast Cancer. 268Fig. 165 [BB:51.259;311.573;246.380;658.808]. Fig. 165 Left mammography (Dec. 2020): an irregular. mass with spiculated margins at lower outer quadrantFig. 166. Fig. 166 Left breast US (Dec. 2020): an irregular. hypoechoic. mass. with. non-parallel. orientation.. US-CNB = IDC. 3. Intraductal component: present, intratu. moral/extratumoral (10%) (nuclear grade:. low, necrosis: absent, architectural pattern:. cribriform/solid, extensive intraductal com. 269Fig. 167 [BB:51.271;293.217;453.296;658.808]. Fig. 167 Breast MRI (Dec. 2020): an irregular enhancing mass in the left breastFig. 168. Fig. 168 Lymphoscintigraphy shows visualized sentinel. lymph nodes in the left axilla. HR(+) HER2(−) Breast Cancer. 270Fig. 169 [BB:51.306;361.830;453.261;658.808]. a. b. Fig. 169 (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors. on each direction. 31. . 31.1. . Patient History and Progress. Female/65 years old, post-menopause.. Screen detected mass lesion on right breast 6. o’clock direction.. Family history of breast cancer, older sister,. node biopsy (Fig. 174).. 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:. 2/3, 10/10 HPF). 3. Intraductal component: present, intratu. moral/extratumoral (5%) (nuclear grade:. Y. Kim et al.. 271Fig. 170 [BB:51.259;315.264;246.379;658.078]. Fig. 170 Right mammography (Dec. 2020): an irregular. mass at lower outer quadrant. A lymph node with cortical. thickening at the right axilla (black arrow)Fig. 171. Fig. 171 Right breast US (Dec. 2020): an irregular. hypoechoic mass. US-CNB = IDC. high, necrosis: absent, architectural pattern:. cribriform/solid, extensive intraductal com. ponent: absent).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) superior margin: 30 mm.. . (b) inferior margin: 40 mm.. 272Fig. 172 [BB:51.271;244.278;453.296;658.808]. Fig. 172 Breast MRI (Dec. 2020): an irregular enhancing mass in the right breast (white arrow). An enlarged lymph. node at the right axilla (black arrow). Y. Kim et al.. 273Fig. 173. Fig. 173 Lymphoscintigraphy shows visualized sentinel. lymph nodes in the right axillaFig. 174 [BB:51.314;166.522;453.253;463.500]. a. b. Fig. 174 (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors. on each direction. HR(+) HER2(−) Breast Cancer. 274. 32. . 32.1. . Patient History and Progress. Female/70 years old, post-menopause.. Screen detected mass lesion on right breast 10. node biopsy (Fig. 179).. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 2.0 cm (pT1c).. 2. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 1/10 HPF). 3. Intraductal component: present, intratu. moral/extratumoral (5%) (nuclear grade:. low, necrosis: absent, architectural pattern:. cribriform/solid, extensive intraductal com. non-sentinel LN: 0/0)Fig. 175 [BB:51.259;109.244;246.379;432.000]. Fig. 175 Right mammography (Dec. 2020): a spiculated. mass (white arrow) with an adjacent smaller mass (black. arrow) at upper outer quadrantFig. 176. Fig. 176 Right breast US (Dec. 2020): two irregular. hypoechoic masses. US-CNB = IDC. Y. Kim et al.. 275Fig. 177 [BB:51.271;314.539;453.296;658.808]. Fig. 177 Breast MRI (Dec. 2020): a bilobed rim-enhancing mass in the right breastFig. 178. Fig. 178 Lymphoscintigraphy shows visualized sentinel. lymph nodes in the right axilla. 7. Arteriovenous invasion: absent.. 8. Lymphovascular. invasion:. present,. intratumoral.. 9. Tumor border: infiltrative.. . 10. Microcalcification: present, non-tumoral.. . 276Fig. 179 [BB:51.307;361.830;453.260;658.808]. a. b. Fig. 179 (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors. on each directionFig. 180 [BB:258.283;95.047;453.213;312.727]. Fig. 180 Left mammography (Dec. 2020): negative. finding. 33. . 33.1. . Patient History and Progress. Female/42 years old, pre-menopause.. Screen detected mass lesion on left breast 12. o’clock direction.. No family history.. 277Fig. 181. Fig. 181 Left breast US (Dec. 2020): an irregular mass. with microlobulated margins at 12 o’clock direction.. US-CNB = IDCFig. 182. Fig. 182 Breast MRI (Dec. 2020): no discernible suspicious finding in both breastsFig. 183. Fig. 183 Lymphoscintigraphy shows visualized sentinel. lymph nodes in the left axilla. Operation. Left breast conserving surgery, sentinel lymph. node biopsy (Fig. 185).. Pathology Report. Invasive Ductal Carcinoma. 1. Size of invasive component: 0.4 cm (pT1a).. 2. Size of intraductal component: 1.3 cm.. 3. Histologic grade: 1/3 (tubule formation: 2/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 1/10 HPF). 4. Intraductal component: present, intratu. moral/extratumoral (70%) (nuclear grade:. low, necrosis: absent, architectural pattern:. 278Fig. 184. Fig. 184 Breast MRI for routine surveillance (Feb. 2022): no abnormal finding in both breastsFig. 185 [BB:51.307;159.925;453.261;456.903]. a. b. Fig. 185 (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors. on each direction. 6. Surgical margins:. . (a) superior margin: 25 mm.. . (b) inferior margin: 20 mm.. . (c) medial margin: 15 mm.. . (d) lateral margin: 10 mm.. 2/3, 11/10 HPF)Fig. 186 [BB:258.283;419.528;453.213;658.808]. Fig. 186 Right mammography (Dec. 2020): negative. findingFig. 187. Fig. 187 Right breast US (Dec. 2020): a hypoechoic. mass with microlobulated margins at upper outer quad. rant. US-CNB = IDC. HR(+) HER2(−) Breast Cancer. 280Fig. 188 [BB:51.283;345.173;453.284;658.808]. Fig. 188 Breast MRI (Jan. 2021): an irregular enhancing mass in the right breast. Negative finding in the left breastFig. 189. Fig. 189 Lymphoscintigraphy shows visualized sentinel. lymph nodes in the right axilla. 3. Intraductal component: present, intratu. moral/extratumoral (10%) (nuclear grade:. high, necrosis: absent, architectural pattern:. cribriform/solid, extensive intraductal com. ponent: absent).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) deep margin: <1 mm from ductal carci. 281Fig. 190 [BB:61.355;379.833;443.212;658.808]. a. bFig. 190 [BB:61.355;379.833;443.212;658.808]. Fig. 190 (a) Preoperative and (b) immediate post-operative appearance. F. i. g. 191 [BB:61.354;83.867;443.212;339.325]. Fig. 191 (a) Gross pathology of right mastectomy specimen. (b and c) The margins get marked and sliced with differ. ent colors on each direction. HR(+) HER2(−) Breast Cancer. 282. F. i. g. 192 [BB:51.306;389.714;453.261;658.808]. Fig. 192 (a) Gross pathology of left mastectomy specimen. (b and c) The margins get marked and sliced with different. colors on each direction. 8. Lymphovascular. invasion:. present,. intratumoral.. 9. Tumor border: infiltrative.. . 10. Microcalcification:. present,. tumoral/. 283Fig. 193 [BB:51.259;257.308;246.379;658.808]. Fig. 193 Left mammography (Jan. 2021): a focal asym. metry at lower outer quadrantFig. 194. Fig. 194 Left breast US (Feb. 2021): an irregular. hypoechoic mass with angular margins. US-CNB = IDC. 35.3. . 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. node biopsy (Fig. 198).. Pathology Report. Invasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of tumor: 1.1 cm (ypT1c).. 3. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 2/3, 11/10 HPF). 4. Intraductal component: present, intratu. moral/extratumoral (50%) (nuclear grade:. low, necrosis: present, architectural pattern:. 284Fig. 195 [BB:71.372;292.081;433.194;658.808]. Fig. 195 Breast MRI (Feb. 2021): an oval enhancing mass with irregular margins in the left breastFig. 196. Fig. 196 Post-NAC breast MRI (June 2021): minimally. decreased volume of the tumor after NACFig. 197. Fig. 197 Lymphoscintigraphy shows visualized sentinel. lymph nodes in the left axilla. Y. Kim et al.. 285. F. i. g. 198 [BB:51.331;226.036;453.236;658.808]. Fig. 198 (a) Gross pathology of lumpectomy specimen. (b and c) The margins get marked and sliced with different. colors on each direction. . (b) perinodal extension: absent.. . (c) size of metastatic carcinoma: 6 mm.. 8. Arteriovenous invasion: absent.. 9. Lymphovascular. invasion:. present,. intratumoral.. node biopsy (Fig. 204).. Pathology Report. Invasive Ductal Carcinoma. • Associated with complex sclerosing lesion.. 1. Size of tumor: 0.9 cm (pT1b).. 2. Histologic grade: 1/3 (tubule formation: 2/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 6/10 HPF). 3. Intraductal component: present, intratumoral. (40%) (nuclear grade: low, necrosis: absent,. architectural pattern: . 7. Arteriovenous invasion: absent.Fig. 199 [BB:51.354;141.925;246.284;319.525]. Fig. 199 Right mammography (Dec. 2020): negative. findingFig. 200. Fig. 200 Right breast US (Dec. 2020): an irregular. hypoechoic mass with angular margins at upper outer. quadrant. US-CNB = IDC. Y. Kim et al.. 287Fig. 201 [BB:51.283;332.451;453.284;658.808]. Fig. 201 Breast MRI (Jan. 2021): an enhancing mass with irregular margins in the right breastFig. 202. Fig. 202 Lymphoscintigraphy shows visualized sentinel. lymph nodes in the right axilla. 8. Lymphovascular invasion: absent.. 9. Tumor border: infiltrative.. . 10. Microcalcification:. present,. tumoral/. non-tumoral.. . 11. Pathological TN category (AJCC 2017):. 288Fig. 203. Fig. 203 Breast MRI for routine surveillance (Feb. 2022): no abnormal finding in both breastsFig. 204 [BB:51.307;136.022;453.261;433.000]. a. b. Fig. 204 (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors. on each direction. Y. Kim et al.. 289. 37. . 37.1. . Patient History and Progress. Female/43 years old, pre-menopause.. Screen detected mass lesion on right breast. node biopsy (Fig. 209).. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 2.5 cm (pT2).. 2. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 2/3, 13/10 HPF). 3. Intraductal component: present, intratu. moral/extratumoral (40%) (nuclear grade:. high, necrosis: present, architectural pattern:. cribriform/solid/comedo, extensive intra. carcinoma in situ (slide 8).Fig. 205 [BB:258.188;276.412;453.308;658.808]. Fig. 205 Left mammography (Dec. 2020): a focal asym. metry with fine pleomorphic microcalcifications at lower. outer quadrantFig. 206. Fig. 206 Left breast US (Jan. 2021): an irregular. hypoechoic. mass. with. microcalcifications.. US-CNB = IDC. HR(+) HER2(−) Breast Cancer. 290Fig. 207 [BB:51.271;333.472;453.296;658.808]. Fig. 207 Breast MRI (Jan. 2021): an irregular enhancing mass in the left breastFig. 208. Fig. 208 Lymphoscintigraphy shows visualized sentinel. lymph nodes in the left axilla. 6. Lymph nodes: no metastasis in four axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/4). 7. Arteriovenous invasion: absent.. 8. Lymphovascular. invasion:. present,. intratumoral.. 9. Tumor border: infiltrative.. . 291Fig. 209 [BB:51.306;362.070;453.261;658.808]. a. b. Fig. 209 (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors. on each direction. Result. Intensity. Positive %. Estrogen receptor. Strong (7/8). 2. >2/3. Progesterone receptor. Intermediate (6/8). 292Fig. 210 [BB:51.259;284.932;246.379;658.808]. Fig. 210 Left mammography (Nov. 2020): an irregular. hyperdense mass at outer centerFig. 211. Fig. 211 Left breast US (Nov. 2020): a circumscribed. hypoechoic mass. Outside US-VABE = IDCFig. 212. Fig. 212 Left breast US (Jan. 2021): post-VABE changes. (black arrow) with a residual mass (white arrow). Operation. Left breast conserving surgery, sentinel lymph. node biopsy (Fig. 215).. Pathology Report. Invasive Ductal Carcinoma. 1. Post-mammotome excision status.. 2. Size of tumor: 0.5 cm, residual.. 3. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 3/10 HPF). 4. Intraductal component: present, extratumoral. (60%) (nuclear grade: low, necrosis: present,. architectural pattern: cribriform/comedo,. 293Fig. 213 [BB:51.271;352.234;453.296;658.808]. Fig. 213 Breast MRI (Jan. 2021): a residual mass in the left breastFig. 214. Fig. 214 Lymphoscintigraphy shows visualized sentinel. lymph nodes in the left axilla. 8. Arteriovenous invasion: absent.. 9. Lymphovascular invasion: absent.. . 10. Tumor border: infiltrative.. . 11. Microcalcification: present, non-tumoral.. Result. Intensity. Positive. 294Fig. 215 [BB:51.314;361.580;453.253;658.558]. a. b. Fig. 215 (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors. on each direction. 39. . 39.1. . Patient History and Progress. Female/47 years old, pre-menopause.. Screen detected mass lesion on right breast 11. o’clock direction.. No family history.. Intraductal papilloma.Fig. 216 [BB:51.259;304.612;246.379;658.808]. Fig. 216 Right mammography (Feb. 2021): a focal. asymmetry at upper inner quadrantFig. 217. Fig. 217 Right breast US (Feb. 2021): an irregular. hypoechoic mass with angular margins. US-CNB = IDC. HR(+) HER2(−) Breast Cancer. 296Fig. 218 [BB:51.271;334.475;453.296;658.808]. Fig. 218 Breast MRI (Feb. 2021): an irregular enhancing mass in the right breastFig. 219. Fig. 219 Lymphoscintigraphy shows visualized sentinel. lymph nodes in the right axilla. Y. Kim et al.. 297. F. ig. 220 [BB:51.306;369.268;453.261;658.808]. Fig. 220 (a) Preoperative and (b) immediate post-operative appearance. F. i. g. 221 [BB:51.307;64.557;453.260;333.000]. Fig. 221 (a) Gross pathology of right mastectomy specimen. (b and c) The margins get marked and sliced with differ. ent colors on each direction. HR(+) HER2(−) Breast Cancer. 298Fig. 222 [BB:51.306;525.848;453.261;658.808]. a. b. Fig. 222 (a) Gross pathology of left breast mass excision specimen. (b) The margins get marked and sliced with dif. ferent colors on each direction. Y. Kim et al.. 299. © 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_6 |
865 | Important Radiologic Findings | Important Radiologic Findings | HR(−) HER2(+) Breast Cancer | Fig. 4 PET-CT shows. (a) hypermetabolic. nodule in right upper. breast (mSUV = 5.5). and (b) prominent right. axillary LN with. hypermetabolism. (mSUV = 3.1). HR(−) HER2(+) Breast Cancer. 430. 1.3. Fig. 6. Fig. 6 Breast MRI (Dec. 2020): MRI after treatment. shows complete resolution of enhancement in the right. breast. . Y. Kwon et al.. 431. 1.4. . Courses of Treatment. Neoadjuvant chemotherapy (#6 cycles of. docetaxel and carboplatin and trastuzumab and. 12Fig. 9. Fig. 9 Mammography (July 2020):. irregular hyperdense mass in left. subareolar area. Y. Kwon et al.. 433. . . . . . HR(−) HER2(+) Breast Cancer. Fig. 21 PET-CT shows (a). hypermetabolic mass in the left upper. outer breast (mSUV = 11.7), (b). enlarged hypermetabolic LNs in the left. axilla level I–II (mSUV = 5.9), (c). hypermetabolic nodule in the left. pectoralis muscle (mSUV = 4.9), and. (d) focal hypermetabolic osteolytic. lesion in L5 (mSUV = 5.0). HR(−) HER2(+) Breast Cancer. 440. Fig. 30 PET-CT shows (a) hypermetabolic mass in. LOQ of left breast (mSUV = 7.5), (b) small soft tissue. lesions in left chest wall, medial side of mass. (mSUV = 3.7) and superior aspect (2.2) (mSUV = 2.2). HR(−) HER2(+) Breast Cancer. 444. 4.3. . After Neoadjuvant. Chemotherapy. 31 32 33. Fig. 40 (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on. each direction. 6. . 6.1. . Patient History and Progress. Female/66 years old, post-menopause.. Self-detected nipple retraction on left breast.. Family history of breast cancer, cousin. (maternal).. 450Fig. 41. Fig. 41 Mammography. (Aug. 2020): asymmetry. (white arrow) in the. outer portion of left. breast. Segmental fine. linear or fine-linear. branching. microcalcifications. (black arrows) in left. upper inner breast. . 46Fig. 44. Fig. 44 Mammography:. mammography after. treatment demonstrates. residual mass is. decreased in the longest. diameter and no change. in extent of. microcalcifications in. left upper inner breast. . . Fig. 51. Fig. 51 Breast MRI (June 2021): MRI. after treatment demonstrates residual. non-mass enhancement (arrow) that is. decreased in the longest diameter and in. the degree of enhancement. . Y. Kwon et al.. 455. 7.4. . Courses of Treatment. 457Fig. 56. Fig. 56 PET-CT shows. hypermetabolic lesions. in Rt. breast. (mSUV = 2.5). . 8.3. . Courses of Treatment. Operation + Adjuvant chemotherapy (#4 cycles. of Doxorubicin and Cyclophosphamide) + Opera. tion + Trastuzumab.. 63Fig. 60. Fig. 60 Mammography (Sept. 2020): indistinct hyperdense mass in the upper outer quadrant of left breast (marked by. BB marker). Several enlarged lymph nodes in Lt. Axilla. HR(−) HER2(+) Breast Cancer. 460Fig. 61. Fig. 61 Breast US (Sept. 2020): irregular. hypoechoic mass at the 2 o’clock direction. of left breastFig. 62. Fig. 62 Breast MRI (Sept. 2020): irregular. heterogeneous enhancing mass at the 2. o’clock direction of left breast. Y. Kwon et al.. 461. F. ig. 63. Fig. 63 PET-CT shows. (a) hypermetabolic mass. in the left upper outer. breast (mSUV = 23.1). with satellite nodules. and (b) hypermetabolic. LNs in the left axilla. level I–II. (mSUV = ~10.5). HR(−) HER2(+) Breast Cancer. 462. 463Fig. 66. Fig. 66 Breast MRI (Jan. 2021): MRI after treatment. shows complete resolution of enhancement in the left breastFig. 67. Fig. 67 Lymphoscintigraphy shows. visualized sentinel lymph nodes in the left. axilla. . . HR(−) HER2(+) Breast Cancer. 464. 9.4. . Courses of Treatment. Neoadjuvant chemotherapy (#2 cycles of. Fig. 80. Fig. 80 Breast MRI (June 2020):. segmental heterogeneous non-mass. enhancement in the upper inner quadrant of. right breast. Y. Kwon et al.. 471. . . HR(−) HER2(+) Breast Cancer. 472. 11.3. 473Fig. 84. Fig. 84 Breast MRI (Dec. 2020): MRI after treatment. demonstrates residual non-mass enhancement (white. arrow) that is decreased in the longest diameter and in. the degree of enhancement. . 11.4. . Courses of Treatment. Neoadjuvant chemotherapy (#4 cycles of doxoru. bicin and cyclophosphamide + #4 cycles of. docetaxel and trastuzumab) + Operation + Post-. 90Fig. 87. Fig. 87 Mammography:. irregular hyperdense mass. with microcalcifications in. the upper outer quadrant of. left breast (marked by BB. marker). HR(−) HER2(+) Breast Cancer. 476. . Fig. 90. Fig. 90 Lymphoscintigraphy shows visualized sentinel. lymph nodes in the left axilla. 12.3. . Courses of Treatment. Operation + Adjuvant chemotherapy (#4 cycles. of docetaxel and cyclophosphamide) + Post-. operative radiation therapy + Trastuzumab.. Operation. 91. Pathology Report. Fig. 94. Fig. 94 Breast MRI (Oct. 2020):. multicentric irregular enhancing masses and. heterogeneous non-mass enhancement in. the upper portion of left breast. Enhancing. lesion (black arrow) in left nipple. HR(−) HER2(+) Breast Cancer. 480. 13.3. . After Neoadjuvant. Chemotherapy. tion therapy + Trastuzumab emtansine.Fig. 95. Fig. 95 Mammography. (Feb. 2021): no. significant change of. segmental fine. pleomorphic. microcalcifications in. the upper portion of left. breast. Y. Kwon et al.. 481Fig. 96. Fig. 96 Breast US (Feb. 2021): US after. treatment demonstrates residual. hypoechoic mass that is decreased in the. longest diameter. Decrease in size of. previous enlarged LNs of left axilla and. left third intercostal spaceFig. 97. Fig. 97 Breast MR (Feb. 2021): MRI after. treatment demonstrates residual non-mass. enhancement (white arrow) that is decreased. in the longest diameter and in the degree of. enhancementFig. 98. Fig. 98 Lymphoscintigraphy shows. visualized sentinel lymph node in left axilla. and left internal mammary area. HR(−) HER2(+) Breast Cancer. 482. Operation. 99. Pathology Report. Invasive Ductal Carcinoma with apocrine. differentiation. 1. Post-chemotherapy status.. 484Fig. 101. Fig. 101 Breast US (Sept. 2020): irregular. hypoechoic mass at the 12 o’clock direction. of right breastFig. 102. Fig. 102 Breast MRI (Sept. 2020): irregular. enhancing mass at the 12 o’clock direction. of right breast. Enlarged lymph nodes in. right axilla. Y. Kwon et al.. 485. . . . 14.3. . 108Fig. 106. Fig. 106 Breast MRI (Dec. 2020): MRI after. treatment demonstrates residual enhancing mass. (white arrow) that is decreased in the longest diameter. and in the degree of enhancement Decrease in size of. suspicious lymph nodes (black arrow) in right axilla. . . Y. Kwon et al.. 487. . Pathology Report. 112Fig. 109. Fig. 109 Mammo. graphy (Mar. 2021): irregular hyperdense mass in the upper mid portion of right breast. Enlarged. lymph nodes in right axilla. HR(−) HER2(+) Breast Cancer. 490. . . . Y. Kwon et al.. 491. 15.3. Fig. 115. Fig. 115 Breast US (July 2021): US after treatment. demonstrates residual hypoechoic mass that is. decreased in the longest diameter. 15.4. . Courses of Treatment. Neoadjuvant chemotherapy (#6 cycles of. docetaxel and carboplatin and trastuzumab and. pertuzumab) + Operation + Post-operative radia. tion therapy + Trastuzumab.. Operation. 120Fig. 117. Fig. 117 Mammography. (Feb. 2021): irregular. isodense mass with obscured. margin in the mid-outer. portion of left breast. Y. Kwon et al.. 495. . . . 16.3. Fig. 133. Fig. 133 Breast MRI (Aug. 2021): MRI after treatment. demonstrates residual irregular mass (white arrow) that is. decreased in the longest diameterFig. 134. Fig. 134 Lymphoscintigraphy shows. visualized sentinel lymph nodes in the left. axilla. Operation. 135. Pathology Report. Invasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of tumor: 0.7 cm (ypT1b).. 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. Fig. 137. Fig. 137 Breast US (Apr. 2021): US irregular. hypoechoic mass at the 12 o’clock direction of. left breast. HR(−) HER2(+) Breast Cancer. 506. 19.3. . Courses of Treatment. Operation + Adjuvant chemotherapy (#4 cycles. of doxorubicin and cyclophosphamide) + Post-. operative radiation therapy + Trastuzumab.. 514Fig. 155. Fig. 155 Lymphoscintigraphy shows. visualized sentinel lymph nodes in the right. axilla. Fig. 154. Fig. 154 Breast MRI (Sept. 2021): MRI after treatment. demonstrates residual enhancing mass (white arrow) that. is decreased in the longest diameter and disappearance of. enlarged lymph nodes in right axilla. 21.4. . Courses of Treatment. Neoadjuvant chemotherapy (#6 cycles of. docetaxel and carboplatin and trastuzumab and. pertuzumab) + Operation + Post-operative radia. tion therapy + Trastuzumab and Pertuzumab.. 523Fig. 171. Fig. 171 PET-CT shows. (a) hypermetabolic lesion. in left breast, upper inner. quadrant (mSUV = ~6.6). and (b) hypermetabolic. lymph nodes in left SCN. (2.4), left axilla level II. and interpectoral area. HR(−) HER2(+) Breast Cancer. 524. 24.3. 175Fig. 174. Fig. 174 Breast MRI: MRI after treatment demonstrates. residual non-mass enhancement (white arrow) that is. decreased in the longest diameter and in the degree of. enhancement. No change of suspected metastatic lymph. nodes (black arrow) in left axilla. . . Y. Kwon et al.. 525. 24.4. . Fig. 192 PET-CT shows. (a) a hypermetabolic. breast mass, right outer. (mSUV = 5.7) and (b). hypermetabolic LNs along. right axilla, level I–III. Y. Kwon et al.. 535. 28.3. . After Neoadjuvant. Fig. 195. Fig. 195 Breast MRI (Oct. 2021): MRI after treatment. demonstrates residual non-mass enhancement that is. decreased in the longest diameter and in the degree of. enhancement and decrease in size of enlarged right. axillary lymph node. HR(−) HER2(+) Breast Cancer. 536. 28.4. . Courses of Treatment. Neoadjuvant chemotherapy (#6 cycles of. Fig. 206. Fig. 206 Breast MRI (Nov. 2021): MRI after treatment. shows complete resolution of enhancement in the left. breastFig. 207. Fig. 207 Lymphoscintigraphy shows. visualized sentinel lymph nodes in the left. axilla. HR(−) HER2(+) Breast Cancer. 542. Operation. 208. Pathology Report. Microinvasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of tumor: <0.1 cm (ypT1mi).. 544Fig. 210. Fig. 210 Breast US (May 2021): irregular hypoechoic. mass with microcalcifications at the 1 o’clock direction of. left breast. . . 31.3. . Courses of Treatment. Operation + Adjuvant chemotherapy (#4 cycles. of doxorubicin and cyclophosphamide) + Post-. operative radiation therapy + Trastuzumab.. 550Fig. 221. Fig. 221 Mammography. (Feb. 2021): irregular. hyperdense mass in the. upper outer quadrant of. left breast. Enlarged. lymph nodes in left axilla. . . . Y. Kwon et al.. 551. 553Fig. 226. Fig. 226 Breast US (May 2021): US. after treatment demonstrates residual. hypoechoic mass that is decreased in the. longest diameter. . 33.4. . Courses of Treatment. Neoadjuvant chemotherapy (#6 cycles of. docetaxel and carboplatin and trastuzumab and. pertuzumab) + Operation + Post-operative radia. Fig. 240. Fig. 240 Breast MRI (Nov. 2021): MRI after. treatment demonstrates residual enhancing foci (white. arrow) that are decreased in the longest diameter and. in the degree of enhancement and a normal-appearing. axillary lymph node (black arrow)Fig. 241. Fig. 241 Lymphoscintigraphy shows. visualized sentinel lymph nodes in the right. axilla. Y. Kwon et al.. 563. a. b. . HR(−) HER2(+) Breast Cancer. 564. 5. Intraductal component: present, intratu. Fig. 243 PET-CT. shows (a) a. hypermetabolic mass in. the left breast. (mSUV = 14.8), (b). small hypermetabolic. lesions in the left upper. outer breast. (mSUV = 1.6), and (c). small lymph nodes in. the left axilla level I–II. 572Fig. 257. Fig. 257 Lymphoscintigraphy shows. visualized sentinel lymph nodes in the right. axilla. . Pathology Report. Invasive Ductal Carcinoma with medullary. pattern. 1. Size of tumor: 1.1 cm (pT1c).. 2. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 30/10HPF). |
866 | Important Radiologic Findings | Important Radiologic Findings | HR(−) HER2(−) Breast Cancer | 634Fig. 118. Fig.. 118 Mammography:. An irregular hyperdense. mass at the upper outer. quadrant of the left. breast. The other. circumscribed oval mass. at the inner portion was. identified as a cyst on. ultrasound. |
867 | Important Radiologic Findings | Important Radiologic Findings | Local Recurrence | Fig. 71. Fig. 71 MRI (2021):. An enhancing mass in. the left breast (white. arrow = proven IDC).. Another enhancing mass. in the right breast (black. arrow). . . Local Recurrence. 744. Fig. 120. Fig. 120 MRI for. evaluation of left nipple. eczema (2018): Strongly. enhanced left nipple.. Punch biopsy = Paget’s. disease. a. b. . Local Recurrence. 764. Fig. 135. Fig. 135 MRI (2016):. Irregular enhancing. masses at both. subareolar areas. (white arrow = left,. black arrow = right)Fig. 136. Fig. 136 Post-NAC. MRI (2017): Decreased. size of the masses at. both subareolar areas. (white arrow = left,. black arrow = right). 4. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 4/10HPF).. 5. Intraductal component: present, extratumoral. (70%) (nuclear grade: low, necrosis: absent,. Fig. 170. Fig. 170 Mammography: oval isodense mass in right. breast. . . 6. Surgical margins: <1 mm from the nearest. margin (slide 1).. . 7. Microcalcification: present, non-tumoral.. . 8. Pathological TN category (AJCC 2017): rpTis.. Result. diagnosis (Fro 2) is free of tumor.Fig. 251. Fig. 251 MRI: irregular. heterogeneous. enhancing mass at the 6. o’clock direction of left. breast. . . Y. Kim et al.. 821. . |
868 | Important Radiologic Findings | Important Radiologic Findings | Metastatic Breast Cancer | See Fig. 1.. Feb. 2014 Left chest well excisional biopsy.. Pathology: Invasive ductal carcinoma, clini. cally recurrent.. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. Letrozole 2.5 mg/day re-start.Fig. 1. Fig. 1 PET-CT (Feb. 2014): A hypermetabolic lesion at. the left chest wallFig. 2 [BB:51.282;105.840;453.285;300.000]. Fig. 2 Chest CT (Mar. 2022): Multiple pleural/fissural nodules in the left hemithorax. Y. Kwon et al.. 863Fig. 3 [BB:51.282;476.648;453.284;658.808]. Fig. 3 PET-CT (Mar. 2022): Multiple pleural/fissural nodules with hypermetabolism in the left hemithorax. 2. . 2.1. . Patient History and Progress. Female/55 years old, post-menopause.. Family history of breast cancer, mother.. BRCA 1 & 2 mutation: No examination.. 2.2. . See Fig. 4.. Operation. Aug. 2012 Right breast conserving surgery, axil. lary lymph node dissection.. Pathology: Invasive ductal carcinoma, stage. pT2(m)N1a.. Size of tumor: 3.5 cm, 1.5 cm, and 0.5 cm,. Lymph node: 3/16, size of metastatic carcinoma:. 8 mm.. Result. Intensity Positive %. 864Fig. 4. Fig. 4 Breast MRI (Jul.. 2012): An irregular. enhancing mass in the. right breastFig. 5 [BB:153.734;304.567;453.543;503.288]. Fig. 5 Chest CT (Jun.. 2016, Apr. 2019): A new. lung nodule (white. arrow) was getting. enlarged (black arrow). in the right lung. Wedge. resection = Metastatic. ductal carcinoma from. breast. 2.2.2. . See Fig. 7.. Y. Kwon et al.. 865Fig. 6 [BB:51.307;458.701;453.260;658.808]. Fig. 6 Bone scan (Aug. 2017, Jan. 2019, Mar. 2022): An. increased uptake in the right 8th rib (black arrow) was get. ting enlarged. Multiple developing increased uptakes in. the right ribs, thoracic vertebrae, sternum, left iliac bone,. and left femur (white arrows)Fig. 7. Fig. 7 Abdomen CT (Mar. 2022): Multiple developing. low attenuation lesions in the liver (partly shown). 3. . 3.1. . Patient History and Progress. Female/62 years old, post-menopause.. No family history.. Diabetes mellitus, rheumatoid arthritis.. 3.2. See Fig. 8.. Neoadjuvant Chemotherapy. Neoadjuvant. Chemotherapy. #8. cycles. (Adriamycin. +. Cyclophosphamide. #4. →. 866Fig. 8. Fig. 8 Breast MRI. (Sep. 2017): Irregular. enhancing mass in the. left breast (white arrow).. Enlarged LN at the left. internal mammary chain. (black arrow). Left total. mastectomy = IDCFig. 9 [BB:153.612;321.127;453.543;531.368]. Fig. 9 Bone scan (Apr.. 2020, Aug. 2020):. Multiple uptakes in the. thoracic vertebrae and. left ribs (white arrows). were getting increased. in intensity (black. arrows). Result. Intensity. Positive %. 867Fig. 10 [BB:153.613;481.928;453.543;658.808]. Fig. 10 Chest CT (Apr.. 2020): Multiple fissural. nodules (white arrows). and lung nodules (black. arrow, partly shown) in. the right lungFig. 11. Fig. 11 Chest X-ray (Sep. 2021): Large amount of pleu. ral effusion in the right hemithorax. Pleural fluid cytology. = Positive for malignant cellsFig. 12. Fig. 12 Brain MRI (Apr. 2021): Multiple necrotic. enhancing lesions in the brain (partly shown). Metastatic Breast Cancer. 868. 4. . 4.1. . Patient History and Progress. Female/48 years old, pre-menopause.. No family history.. See Fig. 13.. May 2021 breast, left, needle biopsy:. Invasive ductal carcinoma, histologic grade 2.. Result. Intensity. Positive %. Estrogen. receptor. Negative. (0/8). 0. See Fig. 14.Fig. 13. Fig. 13 Chest CT (May 2021): Huge mass in the left. breast (black arrow, CNB = IDC) and left pleural effusion. (white arrow). Y. Kwon et al.. 869Fig. 14. Fig. 14 Post-NAC chest CT (Jan. 2022): Disappearance. of the previous left breast mass and left pleural effusion.. Left MRM = No residual tumorFig. 15. Fig. 15 Breast MRI (Jun. 2015): Multiple malignant. enhancing masses in the left breast. US-CNB = IDCFig. 16. Fig. 16 Post-NAC breast MRI (Dec. 2015): Decreased. number and size of the previous masses in the left breast.. Left BCS = IDC. 5. . 5.1. . Patient History and Progress. Female/70 years old, post-menopause.. No family history.. Hypertension.. See Figs. 17, 18, and 19.Fig. 17 [BB:153.613;329.602;453.544;514.403]. Fig. 17 Chest CT (Feb.. 2020, Nov. 2020): A. new lung nodule (white. arrow) was getting. enlarged (black arrow). in the right lungFig. 18. Fig. 18 Abdomen CT (Dec. 2020): Multiple low attenu. ation lesions with peripheral rim enhancement in the liver. (partly shown). US-CNB = Metastatic ductal carcinomaFig. 19. Fig. 19 Abdomen CT (Feb. 2022): Disappearance of the. previous metastatic masses in the liver. Y. Kwon et al.. 871. 6. . 6.1. . Patient History and Progress. Female/47 years old, pre-menopause.. No family history.. See Fig. 22.Fig. 20. Fig. 20 Breast MRI (Sep. 2017): Conglomerated enhanc. ing masses (black arrow) and non-mass enhancement. (white arrows) in the right breast. US-CNB = IDCFig. 21. Fig. 21 Post-NAC breast MRI (Jan. 2018): Decreased. size of the enhancing masses (black arrow) and non-mass. enhancement (white arrows) in the right breast. Right. BCS = IDC. Metastatic Breast Cancer. 872Fig. 22. Fig. 22 Breast MRI (May 2020): Multifocal parenchy. mal non-mass enhancement (white arrow) and skin. enhancement (black arrows) in the right breast (partly. shown). US-CNB = IDC, Skin shave biopsy = IDCFig. 23. Fig. 23 Breast MRI (May 2021): Multiple enlarged. lymph nodes in the left axilla. US-CNB = Metastatic duc. tal carcinoma. May 2020 Right chest wall skin and breast. biopsy.. Pathology:. Invasive. ductal. carcinoma,. recurrent.. Result. See Fig. 23.. 7. . 7.1. . Patient History and Progress. Female/48 years old, pre-menopause.. No family history.. 7.2. . Courses of Treatment. See Fig. 24.. Operation. Jan. 2019 Left breast conserving surgery, sentinel. lymph node biopsy.. Y. Kwon et al.. 873. Pathology: Invasive ductal carcinoma, stage. pT1bN0(sn).. Size of tumor: 0.7 * 0.5 * 0.5 cm, lymph node:. 0/2.. Result. See Fig. 25.Fig. 24. Fig. 24 Breast MRI (Jan. 2019): A round enhancing. mass in the left breast. Left BCS = Microinvasive ductal. carcinomaFig. 25 [BB:51.293;214.999;453.274;341.000]. Fig. 25 Abdominopelvic CT (Mar. 2021): Multiple enlarged lymph nodes at the paraaortic and both iliac chains. Metastatic Breast Cancer. 874. 8. . 8.1. . Patient History and Progress. Female/55 years old, post-menopause.. No family history.. 8.2. See Fig. 26.. Operation. Mar. 2016 Left breast conserving surgery, senti. nel lymph node biopsy.. Pathology: Invasive ductal carcinoma, stage. pT2N0(sn).. Size of tumor: 2.5 cm, lymph node: 0/1.. Result. Intensity. Positive %. Estrogen. See Fig. 27.. Mar. 2021 Left axillary lymph node biopsy.. Pathology: Metastatic ductal carcinoma.. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. lymph nodes.Fig. 26. Fig. 26 Breast MRI (Mar. 2016): An irregular enhancing. mass in the left breast. Left BCS = IDCFig. 27. Fig. 27 Chest CT (Feb. 2021): Multiple enlarged lymph. nodes in the left axilla. US-CNB = Metastatic ductal. carcinoma. Y. Kwon et al.. 875. Radiation Therapy. Post-operative radiation therapy (axillary and. subclavian area) + Letrozole 2.5 mg/day~.. 9. . 9.1. See Fig. 28.. Operation. Jul. 2019 Right breast conserving surgery, senti. nel lymph node biopsy.. Pathology: Invasive ductal carcinoma, stage. pT1c(2)N0(sn).. Size of tumor: 1.1 cm and 0.5 cm, lymph. node: 0/1.. Result. Intensity. Positive %. cellsFig. 28. Fig. 28 Breast MRI (Jul. 2019): Mixed enhancing. masses and non-mass enhancement in the right breast.. Right BCS = IDCFig. 29. Fig. 29 Breast US. (Aug. 2021): Multiple. enlarged lymph nodes in. the right axilla. US-CNB. = Metastatic ductal. carcinoma. Metastatic Breast Cancer. 876Fig. 30. Fig. 30 PET-CT (Sep. 2021): Multiple hypermetabolic. lymph nodes in the right axillaFig. 31. Fig. 31 Mammography (Oct. 2020): Interstitial injection. mammoplasty of both breasts. Palpable lump in left breast. Neoadjuvant Chemotherapy. Neoadjuvant. chemotherapy. #8. cycles. (Adriamycin & Cyclophosphamide #4 →. Docetaxel #4).. Operation. Mar. 2022 Left axillary lymph node dissection.. 877Fig. 32. Fig. 32 Breast US (Oct. 2020): A hypoechoic mass at the. palpable area of the left breast. US-VAB = IDCFig. 33. Fig. 33 Breast MRI (Oct. 2020): An oval enhancing. mass in the left breast. Left BCS = IDCFig. 34. Fig. 34 PET-CT (Mar. 2021): Hypermetabolic nodular. lesion at the op bed of the left breast. Excision = IDC. Result. Intensity. Positive %. Estrogen. receptor. Negative. (0/8). 0. 0. See Fig. 34.. Operation. Apr. 2021 Left wide excision.. Pathology: Invasive ductal carcinoma, stage. rpT1b.. Size of tumor: 1.0 cm.. Result. Intensity. Positive %. Estrogen. receptor. See Fig. 35.. Oct. 2021 Left breast biopsy.. Pathology: Invasive ductal carcinoma.. Result. Intensity. Positive %. Estrogen. receptor. Negative. (2/8). 1. See Fig. 36.. 11. . 11.1. . Patient History and Progress. Female/65 years old, post-menopause.. Family history of colon cancer, mother.. BRCA 1 & 2 mutation: Not detected.. 11.2. . metastasis.Fig. 36 [BB:153.613;107.653;453.543;280.933]. Fig. 36 Chest CT (Mar.. 2021, Mar. 2022): A. new lung nodule (white. arrow) was getting. enlarged (black arrow). in the left lung. Multiple. other developing. nodules in both lungs. (not shown)Fig. 35. Fig. 35 Breast MRI (Oct. 2021): Enhancing. masses at the op bed of the left breast (partly. shown). US-CNB = IDC. Y. Kwon et al.. 879. Primary Treatment. See Fig. 37.. Operation. Jun. 2018 Both nipple-areolar complex sparing. mastectomy with immediate implant reconstruc. tion, sentinel lymph node biopsy.. Pathology:. Right> Invasive ductal carcinoma, stage. pT1c(2)N0(sn).. Size of tumor: 1.8 cm and 1.7 cm, lymph. node: 0/3.. Result. See Fig. 38.. Nov. 2021 Right axillary lymph node biopsy.. Pathology: Metastatic ductal carcinoma.Fig. 38 [BB:51.307;86.116;453.260;247.310]. Fig. 38 Breast US (Oct. 2021, Mar. 2022): A new irregu. lar lymph node (white arrow) at the right axillary tail.. US-CNB = Metastatic ductal carcinoma. Grossly normal. ized lymph node (black arrow) after chemotherapy. Right. ALND = No metastasis in four axillary lymph nodes.. Note the breast implant (*) for reconstructionFig. 37. Fig. 37 Breast MRI (May 2018): Malignant masses in. the right breast (white arrows) and left breast (black. arrow). Both NSM = Both IDC. Metastatic Breast Cancer. 880Fig. 39. Fig. 39 Breast MRI (Apr. 2014): An irregular enhancing. mass in the left breast. Left simple mastectomy = IDC. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. See Fig. 39.. Operation. Apr. 2014 Left total mastectomy, sentinel lymph. node biopsy.. Pathology: Invasive ductal carcinoma, stage. pT2N0(sn).. Size of tumor: 2.0 cm, lymph node: 0/4.. Result. Intensity. Positive %. Estrogen. See Fig. 40.. Aug. 2018 Left axillary lymph node biopsy.. Pathology: Metastatic ductal carcinoma.. Result. Intensity. Positive %. Estrogen. receptor. Strong (7/8). 3. 1/3–2/3. 881Fig. 40 [BB:51.366;528.008;453.200;658.808]. Fig. 40 Breast US (Aug. 2018, Apr. 2019): An enlarged. lymph node (white arrow) in the left axilla. US-CNB =. Metastatic ductal carcinoma. Normalized size of the. biopsy proven metastatic lymph node (black arrow) after. chemotherapy. Left ALND = No metastasis in five axil. lary lymph nodesFig. 41. Fig. 41 Breast MRI (Jul. 2021): A new enhancing mass. in the right breastFig. 42. Fig. 42 MRI-directed right breast US (Aug. 2021): An. irregular hypoechoic mass at the corresponding area of. the MRI abnormality. US-CNB = Ductal carcinoma,. Right MRM = DCIS. Operation. Apr. 2019 Left axillary lymph node dissection.. Pathology: No metastasis in five axillary. lymph nodes.. Adjuvant Therapy. Post-operative radiation therapy (axillary and. subclavian area) + Exemestane 25 mg/day~. See Fig. 43.. Operation. Sep. 2017 Right nipple-areolar complex sparing. mastectomy with immediate implant reconstruc. tion, sentinel lymph node biopsy.. Pathology: Invasive ductal carcinoma, stage. pT1bN0(sn).. Size of tumor: 0.7 cm, lymph node: 0/2.. Result. Intensity. Positive %. Tamoxifen 20 mg/day for 3.3 years.Fig. 43. Fig. 43 Breast MRI (Sep. 2017): Multiple irregular enhancing masses and non-mass enhancement in the right breast.. Right NSM = IDC. Y. Kwon et al.. 883. Treatments After Recurrence. See Fig. 44.. Feb. 2021 Right axillary tail biopsy.. Pathology: Metastatic ductal carcinoma.. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. 2.5 mg/day.Fig. 44. Fig. 44 Breast US (Feb. 2021): An irregular hypoechoic. mass with non-parallel orientation at the right axillary tail.. US-CNB = Metastatic ductal carcinomaFig. 45. Fig. 45 Breast MRI (Mar. 2021): An enhancing mass at. the right axillary tailFig. 46. Fig. 46 Post-NAC breast MRI (Oct. 2021): No residual. enhancing lesion after NAC. Metastatic Breast Cancer. 884. 14. . 14.1. . Patient History and Progress. Female/55 years old, post-menopause.. No family history.. See Fig. 47.. Operation. Jun. 2014 Right nipple-areolar complex sparing. mastectomy with immediate implant reconstruc. tion, sentinel lymph node biopsy.. Pathology: DUCTAL CARCINOMA IN. SITU, stage pTisN0(sn).. Size of tumor: 6.5 cm, lymph node: 0/1.. Result. Intensity. Positive %. See Fig. 48.. Oct. 2017 Right axillary lymph node biopsy.. Pathology: Metastatic ductal carcinoma.Fig. 47. Fig. 47 Breast MRI (Jun. 2014): Segmental non-mass. enhancement in the right breast. Right NSM = DCISFig. 48 [BB:51.366;136.116;453.200;290.436]. Fig. 48 Breast US (Oct. 2017, May 2018): An enlarged. lymph node (white arrow) in the right axilla. US-CNB =. Metastatic ductal carcinoma. Decreased size of the biopsy. proven metastatic lymph node (black arrow) after chemo. therapy. Right ALND = Metastatic ductal carcinoma in. one out of nine lymph nodes. Y. Kwon et al.. 885Fig. 49. Fig. 49 Breast MRI (Sep. 2015): An irregular enhancing. mass in the right breast. Right simple mastectomy = IDC. Result. Intensity. Positive %. Estrogen. receptor. Strong. (8/8). 3. >2/3. See Fig. 49.. Operation. Oct. 2015 Right total mastectomy, sentinel lymph. node biopsy.. Pathology: Invasive ductal carcinoma, stage. pT2N0(sn).. Size of tumor: 2.5 cm, lymph node: 0/3.. Result. Intensity. Positive %. Estrogen. 886Fig. 51. Fig. 51 MRI-directed US (Jul. 2020): A small irregular. lymph node at the corresponding area of the CT abnor. mality. US-CNB = Metastatic ductal carcinomaFig. 52. Fig. 52 Breast MRI (Jul. 2013): Two irregular enhancing. masses in the left breast. Left SSM = IDCFig. 50. Fig. 50 Chest CT (Jun. 2020): A small irregular lymph. node in the right axilla. Jul. 2020 Right axillary lymph node biopsy.. Pathology: Metastatic ductal carcinoma.. Result. Intensity Positive %. Estrogen receptor. Strong. (8/8). 3. >2/3. See Fig. 52.. Operation. Jul. 2013 Left skin sparing mastectomy with. immediate. implant. reconstruction,. sentinel. lymph node biopsy.. Y. Kwon et al.. 887. Pathology: Invasive ductal carcinoma, stage. See Fig. 53.. Aug. 2015 Soft tissue, left axilla biopsy.. Pathology: Metastatic carcinoma.. Result. Intensity. Positive %. Estrogen. receptor. Strong (7/8). 2. >2/3. See Fig. 54.. Operation. Aug. 2021 Left axillary lymph node dissection.. Pathology: Metastatic ductal carcinoma in 4. out of 6 lymph nodes, size of metastasis: 25 mm.Fig. 53. Fig. 53 US for evaluation of a palpable mass in the left. axilla (Aug. 2015): An oval mass with heterogeneous. echogenicity in the left axilla. US-CNB = Metastatic. carcinomaFig. 54 [BB:51.301;120.157;453.266;228.638]. Fig. 54 Chest CT (Aug. 2015, Dec. 2015, Jun. 2021):. The biopsy proven metastatic carcinoma in the left axilla. had decreased (white arrow) then increased again (black. arrow) during palliative therapy. Left ALND = Metastatic. ductal carcinoma in four out of six lymph nodes. Metastatic Breast Cancer. 888Fig. 55. Fig. 55 Breast MRI (Oct. 2017): An irregular enhancing. mass in the right breast. Right BCS = IDCFig. 56. Fig. 56 Breast US (Apr. 2021): A new round lymph node. without fatty hilum in the right axilla. US-CNB =. Metastatic ductal carcinoma. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. See Fig. 55.. Operation. Oct. 2017 Right breast conserving surgery, axil. lary lymph node dissection (Level I).. Pathology: Invasive ductal carcinoma, stage. pT1c(2)N2.. Size of tumor: 1.8 cm and 1.0 cm, lymph. node: 4/8, size of metastasis: 25 mm.. Result. Intensity. Positive %. See Fig. 56.. May 2021 Right axillary lymph node biopsy.. Pathology: Metastatic ductal carcinoma.. Y. Kwon et al.. 889Fig. 57. Fig. 57 Breast MRI (Nov. 2015): Mixed masses and non-. mass enhancement in the left breast. Left BCS = IDCFig. 58. Fig. 58 Breast US (Nov. 2018): An irregular hypoechoic. mass in the left pectoralis muscle. US-CNB = IDC. Result. Intensity Positive %. Estrogen. receptor. Intermediate. (6/8). 1. >2/3. Progesterone. See Fig. 57.. Operation. Dec. 2015 Left breast conserving surgery, senti. nel lymph node biopsy.. Pathology: Invasive ductal carcinoma, stage. pT1a(Pagets′)N0(sn).. Size of tumor: 0.5 cm, lymph node: 0/1.. Result. Intensity Positive %. Estrogen. receptor. 890Fig. 61. Fig. 61 Breast US (Oct. 2020): Multiple enlarged lymph. nodes in the left axilla (partly shown). US-CNB =. Metastatic ductal carcinomaFig. 59. Fig. 59 PET-CT (Dec. 2018): A hypermetabolic mass in. the left pectoralis muscleFig. 60. Fig. 60 Post-chemotherapy breast US (Mar. 2019):. Decreased size of the IDC in the left pectoralis muscle.. Left simple mastectomy = IDC. Result. Intensity Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. See Fig. 60.. Operation. 2019-03-29 Left total mastectomy, axillary. lymph node sampling.. Pathology: Invasive ductal carcinoma, stage. yp T1aN1.. Size of tumor: 0.3 cm, lymph node: 3/10, size. of metastatic carcinoma: 3 mm.. Result. Intensity. Positive %. See Fig. 61.. Nov. 2020 Left axillary lymph node biopsy.. Pathology: Metastatic ductal carcinoma.. Result. Intensity. Positive %. Estrogen. receptor. Strong (7/8). 3. 1/3–2/3. See Fig. 62.. Operation. Mar. 2017 Right nipple-areolar complex sparing. mastectomy with immediate implant reconstruc. tion, sentinel lymph node biopsy.. Pathology: Invasive ductal carcinoma, stage. pT2N1a(sn).. Size of tumor: 2.3 cm, lymph node: 3/5, size. of metastatic carcinoma: 7 mm.. Result. Intensity. See Fig. 63.. May 2021 Right axillary lymph node biopsy.. Pathology: Metastatic ductal carcinoma.. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. cellsFig. 62. Fig. 62 Breast MRI (Mar. 2017): A heterogeneously. enhancing mass in the right breastFig. 63. Fig. 63 Chest CT (May 2021): An irregular lymph node. in the right axilla. Metastatic Breast Cancer. 892. Operation. Jun. 2021 Right axillary lymph node dissection. and bilateral salpingo-oophorectomy.. Pathology: Metastatic ductal carcinoma in. two out of two axillary lymph nodes.. Size of metastatic carcinoma: 11 mm.. Result. Chemotherapy (Capecitabine~).Fig. 64 [BB:51.486;279.720;453.081;417.000]. Fig. 64 Chest CT and PET-CT (Mar. 2022): An enlarged lymph node with hypermetabolism at level III of the right. axillaFig. 65. Fig. 65 MRI-directed US (Mar. 2022): An. enlarged lymph node at level III of the right. axilla. Y. Kwon et al.. 893. 20. . 20.1. . Patient History and Progress. Female/61 years old, post-menopause.. See Fig. 66.. Sep. 2015 Left infraclavicular lymph node biopsy.. Pathology: Metastatic ductal carcinoma.. Left breast biopsy.. Pathology: Invasive ductal carcinoma, clini. cally recurrent.. Result. Intensity Positive %. Estrogen. receptor. Strong (8/8). See Fig. 67.. Operation. Feb. 2016 Left total mastectomy, axillary lymph. node sampling.. Pathology: Invasive ductal carcinoma, stage. ypT1c(m)N1a.. Size of tumor: up to 1.6 cm, lymph node: 1/2,. size of metastatic carcinoma: 7 mm.. Result. Intensity. Positive %. tumor cellsFig. 66. Fig. 66 Breast US (Nov. 2014): A mildly enlarged lymph. node at level II of the left axilla. Metastatic Breast Cancer. 894Fig. 67 [BB:51.366;522.008;453.200;658.808]. Fig. 67 Breast MRI (Oct. 2015): An irregular enhancing mass in the left breast (white arrow, IDC). Two mildly. enlarged lymph nodes at level II and III of the left axilla (black arrows, metastatic ductal carcinoma)Fig. 68 [BB:51.367;314.779;453.201;471.500]. Fig. 68 Chest CT (Sep. 2016, Dec. 2021): A mildly enlarged lymph node (black arrow) had become smaller (white. arrow) at level II of the left axilla. Adjuvant Therapy. Post-operative. radiation. therapy. (axilla). +Letrozole 2.5 mg/day~. See Fig. 68.. 21. . 21.1. . Patient History and Progress. Female/61 years old, post-menopause.. No family history.. 21.2. . Courses of Treatment. See Fig. 69.. Dec. 2015 Left neck lymph node aspiration. (level 4).. Pathology: Metastatic ductal carcinoma.. Palliative Therapy. Letrozole 2.5 mg/day → Progressive disease on,. lymph node, bone.. Chemotherapy #24 cycles (Paclitaxel) →. Progressive disease on brain, skull.. Whole brain radiation therapy.. Fulvestrant + abemaciclib~. See Figs. 70, 71, and 72.Fig. 69. Fig. 69 Neck US for evaluation of palpable lumps (Dec.. 2015): Multiple suspicious lymph nodes at the left lower. neckFig. 70 [BB:153.639;132.653;453.543;331.036]. Fig. 70 PET-CT (Apr.. 2019): Multifocal. hypermetabolic lesions. in the liver (white. arrow), spleen (black. arrow), and bones. Metastatic Breast Cancer. 896Fig. 71 [BB:51.366;529.448;453.200;658.808]. Fig. 71 Abdominopelvic CT (May 2019): Multiple low attenuation lesions in the liver (white arrow, partly shown) and. spleen (black arrow)Fig. 72 [BB:51.366;251.413;453.200;477.974]. Fig. 72 Brain MRI (Sep. 2020): Multiple enhancing lesions in both cerebellums, brainstem, and both cerebral hemi. spheres (partly shown). 22. . 22.1. . Patient History and Progress. Female/69 years old, post-menopause.. No family history.. Hepatitis B carrier.. 22.2. See Fig. 73.. Y. Kwon et al.. 897Fig. 73. Fig. 73 Chest CT (Oct. 2007): Irregular. enhancing lesion (black arrow) and skin. thickening (white arrow) of the left breastFig. 74 [BB:51.328;467.359;453.239;566.000]. Fig. 74 PET-CT (Apr. 2010, Oct. 2011, Apr. 2014): An. enlarged lymph node with hypermetabolism in the right. axilla. Size and metabolism of the biopsy proved meta. static lymph nodes had decreased (white arrow) and then. increased again (black arrow). Neoadjuvant Chemotherapy. Neoadjuvant. chemotherapy. #6. cycles. (Fluorouracil + Doxorubicin + cyclophospha. See Fig. 74.. Apr. 2010 Right axillary lymph node biopsy.. Pathology: Metastatic apocrine carcinoma.. Result. Intensity. Positive %. Estrogen. receptor. Negative. (0/7). 0. 898Fig. 75. Fig. 75 Breast MRI for evaluation of inflammatory. change of the right breast (Feb. 2016): Diffuse non-mass. enhancement (black arrows) and skin thickening (white. arrow) of the right breastFig. 76. Fig. 76 Post-chemotherapy breast MRI (Jan. 2017):. Decreased enhancing lesions in the parenchyma and skin. of the right breast. Result. Intensity. Positive %. Estrogen. receptor. Negative (0/8). 0. 0. See Fig. 75.. Feb. 2016 Right breast biopsy.. Pathology: Invasive ductal carcinoma.. Result. Intensity. Positive %. Estrogen. receptor. Negative (0/8). 0. 0. See Fig. 76.. Operation. Jan. 2017 Right total mastectomy.. Pathology: Invasive ductal carcinoma, stage. ypT2(m).. Size of tumor: up to 2.8 cm, multifocal.. Result. Intensity. Positive %. Estrogen. receptor. 899Fig. 77 [BB:51.307;560.748;453.260;658.808]. Fig. 77 Chest CT (Jul. 2020, Sep. 2020, Apr. 2022): The amount of pleural effusion was getting increased (white. arrow). Cytology of pleural fluid = Positive for malignant cells. Newly developed pericardial effusion (black arrow)Fig. 78 [BB:51.253;322.219;453.314;507.500]. Fig. 78 Spine MRI and bone scan (Aug. 2020): Multiple bone marrow replacing lesions (white arrows) with increased. uptake (black arrows) in the vertebrae. 23. . 23.1. . Patient History and Progress. Female/39 years old, pre-menopause.. No family history.. BRCA 1 & 2 VUS (variant of uncertain).. 23.2. See Fig. 79.. Neoadjuvant Chemotherapy. Neoadjuvant. chemotherapy. #8. cycles. (Adriamycin. +. Cyclophosphamide. #4. →. See Fig. 80.. Operation. Jan. 2013 Left total mastectomy, sentinel lymph. node biopsy.. Pathology: Invasive ductal carcinoma, stage. ypT1c(m)N0(sn).. Size of tumor: up to 1.5 cm, multifocal, lymph. node: 0/4.. Result. Intensity. Positive %. See Fig. 81.Fig. 79. Fig. 79 Breast MRI (Jul. 2012): Conglomerated enhanc. ing masses involving the entire left breastFig. 80. Fig. 80 Post-NAC breast MRI (Jan. 2013): Decreased. tumor burden in the left breastFig. 81 [BB:51.366;195.720;453.200;321.000]. Fig. 81 Chest CT and PET-CT (Apr. 2019): Pericardial effusion (white arrows) and enlarged hypermetabolic medias. tinal lymph nodes (black arrows). Y. Kwon et al.. 901. Apr. 2019 Chest CT: pericardial effusion, met. astatic lymph nodes.. Palliative Therapy. Clinical trial enrolled (Paclitaxel + ipatasertib/. placebo #18 cycles): Progressive disease on bone.. Chemotherapy #5 cycles (Capecitabine):. Progressive disease on bone.. See Figs. 82, 83, 84, and 85.Fig. 82 [BB:51.366;402.925;453.200;543.805]. Fig. 82 Neck US and PET-CT (Apr. 2019): Multiple small lymph nodes with irregular margins (white arrows) and. mild hypermetabolism (black arrows) at the lower neckFig. 83 [BB:61.355;72.540;443.212;352.752]. Fig. 83 Bone scan (Oct. 2019) and spine MRI (Dec. 2019): Increased uptake (black arrow) and bone marrow replacing. lesion with mild pathologic fracture (white arrow) in the T2 vertebra. Metastatic Breast Cancer. 902Fig. 84 [BB:51.306;392.408;453.261;658.808]. Fig. 84 Abdominopelvic CT (Mar. 2020, Nov. 2020): Multiple lymph nodes (white arrows) were getting enlarged. (black arrows) in the abdominopelvic cavity (partly shown)Fig. 85 [BB:51.307;190.021;453.260;322.500]. Fig. 85 Chest CT (Sep. 2020) and US (Oct. 2020): A palpable mass at the right parasternal area. US-CNB = Metastatic. ductal carcinoma. Y. Kwon et al.. 903. 24. . 24.1. . Patient History and Progress. Female/64 years old, post-menopause.. No family history.. See Fig. 86.. Operation. Nov. 2005 Right breast conserving surgery, axil. lary lymph node dissection.. Pathology: Invasive duct carcinoma, stage. T1cN1a.. Size of tumor: 1.9 cm, lymph node: 1/8, size. of metastatic carcinoma: 8 mm.. Result. Intensity. Positive %. See Fig. 87.. Operation. Jan. 2019 Left lower lung wedge resection.. Pathology: Metastatic carcinoma, size of. tumor: 0.9 * 0.7 * 0.3 cm.. Result. Intensity Positive %. Estrogen. receptor. Strong (8/8). 3. Palbociclib #25 cycles + Letrozole 2.5 mg/day~Fig. 86. Fig. 86 Right mammography (Oct. 2005): A palpable. mass at the lower breastFig. 87. Fig. 87 Chest CT (Dec. 2018): A nodule in the LUL lung. Metastatic Breast Cancer. 904. 25. . 25.1. . Patient History and Progress. Female/46 years old, post-menopause.. Family history of breast cancer, mother.. BRCA 1 & 2 mutation: Not detected.. See Fig. 88.. Primary Treatment. Operation. Apr. 2017 Left nipple-areolar complex sparing. mastectomy with immediate implant reconstruc. tion, sentinel lymph node biopsy.. Pathology: Invasive ductal carcinoma, stage. T1cN0(sn).. Size of tumor: 1.1 cm, lymph node: 0/1.. Result. Intensity Positive %. See Fig. 91.. Operation. Jul. 2021 Left breast wide excision, axillary. lymph. node. sampling. and. bilateral. salpingo-oophorectomy.. Pathology: Invasive ductal carcinoma, stage. rT1cN0.. Size of tumor: 1.5 cm, lymph node: 0/4.Fig. 88. Fig. 88 Breast MRI after multiple vacuum-assisted exci. sional biopsy in the left breast (Mar. 2017): Mild BPE. without definite abnormality of both breastsFig. 89. Fig. 89 Breast MRI (Jun. 2020): A tiny enhancing focus. (white arrow) in the reconstructed left breastFig. 90. Fig. 90 Breast MRI (Jun. 2020): Increased size of the. enhancing skin lesion (black arrow) in the reconstructed. left breast. Y. Kwon et al.. 905Fig. 91. Fig. 91 MRI-directed left US (Jul. 2021): Focal skin. thickening at the corresponding area of the MRI. abnormalityFig. 92 [BB:51.306;90.578;453.261;256.419]. Fig. 92 Breast MRI (Jan. 2020): Segmental heterogeneous non-mass enhancement in the right whole breast and oval. heterogeneous enhancing lesion at the 8 o’clock direction of left breast. Result. Intensity Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. See Fig. 92.. Operation. Jan. 2014 Both total mastectomy, axillary lymph. node dissection.. Pathology:. Right> Invasive lobular carcinoma, stage. pT3N3a.. Size of tumor: 7 cm, lymph node: 15/17, size. of metastatic carcinoma: 13 mm.. Metastatic Breast Cancer. 906Fig. 93. Fig. 93 Esophagogastroduodenoscopy (May 2018):. Diffuse infiltrative mass in the stomachFig. 94. Fig. 94 Bone scan (Jun. 2018): Multifocal increased. uptake in the 6th thoracic spinal body and right ribs, sug. gesting bony metastases. Result. Intensity Positive %. Estrogen. receptor. Strong (7/8). 2. >2/3. Progesterone. 907Fig. 95. Fig. 95 Breast US (Feb. 2008): Irregular hypoechoic. mass at the 9 o’clock direction of left breast. 27. . 27.1. . Patient History and Progress. Female/74 years old, post-menopause.. No family history.. Hypertension, diabetes mellitus, s/p cholecys. tectomy (GB stone).. See Fig. 95.. Operation. Mar. 2008 Left breast conserving surgery, axil. lary lymph node dissection.. Pathology: Invasive duct carcinoma, stage. T2N1a.. Size of tumor: 3 cm, lymph node: 3/7, size of. metastatic carcinoma: 15 mm.. Result. Intensity. Positive %. See Fig. 96.. Operation. Feb. 2015 Right breast conserving surgery, senti. nel lymph node biopsy.. Pathology: Invasive duct carcinoma, stage. T1cN0(sn).. Size of tumor: 1.8 cm, lymph node: 0/1.. Result. Intensity. Positive %. Estrogen. See Fig. 97.. Left Axillary Lymph Node Metastasis. Dec. 2019 Left axillary lymph node biopsy.. Pathology: Metastatic ductal carcinoma.. Result. Intensity. Positive %. Estrogen. receptor. Strong (7/8). 2. cellsFig. 96. Fig. 96 Breast US (Feb. 2015): Irregular hypoechoic. mass with spiculated margin at the 4 o’clock direction of. right breastFig. 97 [BB:51.307;90.578;453.260;254.356]. Fig. 97 Breast US (Nov. 2019): Spiculated hypoechoic mass with echogenic halo in the left axillary area. Increased. vascularity is seen on color Doppler US. Y. Kwon et al.. 909. Neoadjuvant Chemotherapy. Neoadjuvant. chemotherapy. #4. cycles. (Adriamycin & Cyclophosphamide).. Operation. See Fig. 98.. Palliative Therapy. Letrozole 2.5 mg/day + Palbociclib~. 29. . 29.1. . Patient History and Progress. Female/41 years old, pre-menopause.. No family history.. 29.2. See Fig. 99.. Neoadjuvant Chemotherapy. Neoadjuvant. chemotherapy. #4. cycles. (Adriamycin + Cyclophosphamide) + zoladex.. Result. Intensity. Positive %. Estrogen. cellsFig. 98. Fig. 98 Liver MRI (Oct. 2020): Two tiny lesions in the. segment 2 of liver, showing hyperintensity on diffusion-. weighted image. Metastatic Breast Cancer. 910Fig. 99 [BB:51.307;418.324;453.260;658.808]. Fig. 99 Mammography (Jul. 2007): obscured irregular isodense mass (marked by BB marker) with punctate microcal. cifications in the right upper outer quadrantFig. 100. Fig. 100 Chest CT (Aug. 2021): Diffuse peribronchial. infiltrates and bronchial wall thickening of right main. bronchus. Adjuvant Therapy. Chemotherapy #4 cycles (Paclitaxel).. Post-operative radiation therapy +Tamoxifen. 20 mg/day for 5 years +zoladex.. Treatments After Recurrence. See Fig. 100.. Aug. 2021 Right bronchus excision.. Pathology: Metastatic ductal carcinoma.. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. See Fig. 101.. Operation. Apr. 2017 Right nipple-areolar complex sparing. mastectomy with immediate implant reconstruc. tion, sentinel lymph node biopsy.. Pathology: Invasive duct carcinoma, stage. T1c(2)N0(sn).. Size of tumor: 1.3 cm and 0.6 cm, lymph. node: 0/2.. Result. Intensity. See Fig. 102.. Feb. 2021 PET-CT: bone metastasis at T10.. Palliative Therapy. Letrozole 2.5 mg/day + ribociclib ~. 31. . 31.1. . Patient History and Progress. Female/54 years old, post-menopause.. No family history.. See Fig. 103.. Operation. Mar. 2014 Right breast conserving surgery, senti. nel lymph node biopsy.. Pathology: Invasive ductal carcinoma, stage. pT2N0 (sn).. Size of tumor: 2.3 cm, lymph node: 0/1.Fig. 101. Fig. 101 Breast US (Mar. 2017): 1 cm indistinct irregu. lar hypoechoic mass at the 9 o’clock direction of right. breastFig. 102. Fig. 102 PET-CT (Feb. 2021): Hypermetabolic bone. lesion in 10th thoracic vertebral body, suggesting bony. metastasis. Metastatic Breast Cancer. 912Fig. 103. Fig. 103 Breast MRI (Mar. 2014): An irregular enhanc. ing mass with associated non-mass enhancement at the. 5–6 o’clock direction of right breastFig. 104. Fig. 104 PET-CT (May 2020): Focal hypermetabolic. nodule in right upper lobe. Result. Intensity. Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. See Fig. 104.. Jun. 2020 Chest CT: R/O metastasis, nodule in. right lung upper lobe.. Palliative Therapy. Paclitaxel & Atezolizumab & Ipatasertib & pla. cebo (Jun. 2020 ~ Nov. 2021).. Atezolizumab (Nov. 2021) ~. 32. . 32.1. . See Fig. 105.. Operation. Jan. 2007 Left breast conserving surgery, sentinel. lymph node biopsy.. Pathology: Invasive ductal carcinoma, stage. pT2N0 (sn).. Size of tumor: 3.2 cm, lymph node: 0/5.. Result. Intensity. Positive %. Estrogen. 913Fig. 105 [BB:153.639;259.990;453.543;658.808]. Fig. 105 Mammography. (Jan. 2007): Indistinct. irregular hyperdense. mass with fine. pleomorphic. microcalcifications at the. 12 o’clock direction of. left breast on left CC and. MLO views. Adjuvant Therapy. Adjuvant chemotherapy # 6 cycles (Fluorouracil. See Fig. 106.. Jul. 2015 Right lung, middle lobe, percutane. ous biopsy.. Pathology: Metastatic ductal carcinoma.. Result. Intensity. Positive %. Estrogen. receptor. Strong (7/8). 3. 914Fig. 106. Fig. 106 Chest CT (Jul. 2015): A round nodule in right. middle lobe, suggesting pulmonary metastasisFig. 107. Fig. 107 Breast US (Jun. 2007): Irregular hypoechoic. mass with microcalcifications at the 9 o’clock direction of. right breast. 33. . 33.1. . Patient History and Progress. Female/52 years old, peri-menopause.. No family history.. 33.2. See Fig. 107.. Operation. Jul. 2007 Right modified radical mastectomy at. another hospital.. Pathology: Invasive ductal carcinoma, stage. pT2N3a.. Size of tumor: 2.7 × 1.4 cm, lymph node:. 13/38.. Result. Intensity. Positive %. See Fig. 108.. Mar. 2018 PET-CT: R/O multiple bone metas. tasis in T8, T9, L2, L4, L5, sacrum, both pelvic. bones, right proximal femur.. Palliative Therapy. Palliative chemotherapy #15 cycles (Pertuzumab. & Trastuzumab & docetaxel).. Concurrent Bretra +zoladex (Sep. 2018 ~ Mar.. 2019): Progressive disease.. Palliative chemotherapy #38 cycles (T-DM1).. May 2021 Chest CT: T8, spinal canal. 915Fig. 108 [BB:51.367;483.607;453.200;658.808]. Fig. 108 PET-CT (Mar. 2018): Multifocal increased. uptake in thoracic and lumbar spines, sacrum, both pelvic. bones and right proximal femur, suggesting multiple bony. metastases and hypermetabolic bone lesion in 9th thoracic. vertebral body, suggesting bony metastasis. 34. . 34.1. . Patient History and Progress. Female/42 years old, peri-menopause.. See Fig. 109.. Operation. Feb. 2014 Left breast conserving surgery, senti. nel lymph node biopsy.. Pathology: Invasive ductal carcinoma, stage. pT2N1a (sn), size of tumor: 2.5 cm, lymph node:. 1/4 (2.5 mm).. Result. Intensity Positive %. Estrogen receptor. Negative. See Fig. 110.. Feb. 2021 Chest CT: Metastasis to right pleu. ral, liver, right adrenal gland, bone.. Metastatic Breast Cancer. 916Fig. 109. Fig. 109 Breast MRI. (Feb. 2014): Irregular. heterogeneous. enhancing mass at the. 12–3 o’clock direction. of left breastFig. 110. Fig. 110 Liver CT. (Mar. 2021):. Hypoattenuating masses. in the liver, suggesting. metastases. Palliative Therapy. Palliative therapy: Zanidatamab + Docetaxel. (Mar. 2021 ~ Aug. 2021) →Zanidatamab mono. (Sep. 2021 ~ Nov. 2021).. Dec. 2021 Brain MRI> r/o tiny metastasis to. brain.. See Fig. 111.. Operation. Dec. 2013 Right breast conserving surgery, axil. lary lymph node dissection.. Y. Kwon et al.. 917Fig. 111. Fig. 111 Breast MRI. (Dec. 2013): Segmental. heterogeneous non-mass. enhancement at the 9–10. o’clock direction of. right breastFig. 112. Fig. 112 Bone scan (Sep. 2017): Increased uptake in the. upper C-spine. Pathology: Invasive ductal carcinoma, stage. pT1bN1a.. Size of tumor: 0.8 cm, 0.5 × 0.3 cm, lymph. node: 1/6 (8 mm).. Result. Intensity. Positive %. Estrogen. receptor. 918Fig. 113 [BB:51.306;503.768;453.261;658.808]. Fig. 113 C-spine MRI (Sep. 2017): Infiltrative enhancing lesion in the C2 vertebra vertebral body and left lateral arc,. suggesting bony metastasisFig. 114. Fig. 114 Breast US (Sep. 2008): Indistinct heteroge. neous echoic mass at the 12 o’clock direction of right. breast. 36. . 36.1. . Patient History and Progress. Female/55 years old, post-menopause.. No family history.. S/p bilateral salpingo-oophorectomy, diabetes. See Fig. 114.. Operation. Sep. 2008 Right breast conserving surgery, axil. lary lymph node dissection.. Pathology: Invasive ductal carcinoma, stage. pT2N1a.. Size of tumor 2.3 cm, lymph node: 1/15. (5 mm).. Result. Intensity. Positive %. See Fig. 115.. Y. Kwon et al.. 919Fig. 115 [BB:51.306;467.287;453.261;658.808]. Fig. 115 CT chest (Jul. 2017): Hypodense nodule in left upper lobe, suggesting metastasis and bone metastasis, right. 4th rib. Jul. 2017 PET-CT: R/O metastasis to left lung. lobe and right 3rd rib & 4th rib.. Aug. 2017 Left lung, upper lobe, percutane. ous biopsy: Metastatic ductal carcinoma.. Result. Intensity. Positive %. Estrogen. receptor. See Fig. 116.. Operation. May 2013 Right breast conserving surgery, axil. lary lymph node dissection.. Pathology: Invasive ductal carcinoma, stage. pT2N1a.. Size of tumor: 2.0 cm, lymph node: 3/30. (15 mm).. Result. Intensity. Positive %. 2014) ~Fig. 116. Fig. 116 Breast US (May 2013): Irregular hypoechoic mass. with angular margin at the 11 o’clock direction of right breastFig. 117 [BB:51.307;108.078;453.260;361.999]. Fig. 117 Chest CT (Aug. 2013, Feb. 2014): Newly developed interlobular septal thickening in left lower lobe, suggest. ing lymphangitic metastasis. Y. Kwon et al.. 921Fig. 118 [BB:51.306;494.168;453.261;658.808]. Fig. 118 Chest CT (Feb. 2014): Enlarged mediastinal LNs, suggesting metastases and right malignant pleural. effusionFig. 119. Fig. 119 Mammography (Dec. 2008): Grouped fine. pleomorphic microcalcifications in right inner breast and. the subareolar area of left breast. 38. . 38.1. . Patient History and Progress. Female/70 years old, post-menopause.. No family history.. 38.2. 922Fig. 120. Fig. 120 Breast MRI. (Dec. 2008): Irregular. heterogeneous. enhancing mass at the. 1–3 o’clock direction of. right breast and irregular. homogeneous enhancing. mass in the subareolar. area of left breastFig. 121. Fig. 121 Liver CT (Sep. 2011): Hypoattenuating mass in. the lateral segment of liver, suggesting metastasis. Result. Intensity. Positive %. Estrogen. receptor. Negative (0/7). 0. 0. Progesterone. See Fig. 121.. Aug. 2011 PET> R/O metastasis to liver.. Palliative Therapy. Palliative therapy (clinical trial): Trastuzumab &. Paclitaxel (Sep. 2011~ Mar. 2012).. Trastuzumab mono (Mar. 2012~ Oct. 2019):. Partial response (end of treatment).. 39. . 39.1. . See Fig. 122.. Jul. 2007 Outside slide review > Right infil. trating duct carcinoma.. Neoadjuvant Chemotherapy. Neoadjuvant. chemotherapy. #4. cycles. (Doxorubicin & cyclophosphamide #4).. Y. Kwon et al.. 923Fig. 122. Fig. 122 Breast US (Jul. 2007): Microlobulated. hypoechoic mass with microcalcifications at the 12. o’clock direction of right breastFig. 123. Fig. 123 Mammography (Feb. 2021): Irregular hyper. dense mass in the upper portion of left breast. Operation. Oct. 2007 Right breast conserving surgery, senti. nel lymph node biopsy.. Pathology: Invasive ductal carcinoma, stage. ypT1cN0 (sn).. Size of tumor: 1.5 × 1.0 cm, lymph node 0/1.. Result. Intensity. Positive %. See Fig. 123.. Feb. 2021 Left 12 o’clock biopsy: Invasive. ductal carcinoma.. Left axillary lymph node biopsy: Metastatic. ductal carcinoma.. Result. Intensity. Positive %. Estrogen. receptor. Negative. See Fig. 124.. Mar. 2021 PET-CT> R/O metastasis to lung,. left supraclavicular lymph node & lower neck.. Palliative Therapy. Palliative therapy (clinical trial): Zanidatamab +. Docetaxel (Apr. 2021~ Sep. 2021).. Zanidatamab mono (Sep. 2021) ~. Metastatic Breast Cancer. 924Fig. 124 [BB:51.306;358.609;453.261;658.808]. Fig. 124 PET-CT (Mar. 2021): Hypermetabolic activity in the left supraclavicular lymph nodes, and left axillary. lymph nodes and nodule in right upper lobe, suggesting pulmonary metastasis. 40. . 40.1. . Patient History and Progress. Female/54 years old, post-menopause.. No family history.. S/p bilateral salpingo-oophorectomy.. 40.2. See Fig. 125.. Oct. 2014 Outside slide review> Right inva. sive ductal carcinoma.. Right axillary lymph node, metastatic ductal. carcinoma.. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). See Fig. 126.. Jun. 2017 PET-CT> R/O metastasis in right. lung lobe.. Palliative Therapy. Clinical trial: Capecitabine # 30 cycles:. Progressive disease.Fig. 125. Fig. 125 Breast MRI (Oct. 2014): Irregular homoge. neous enhancing mass in right upper outer quadrant.. Enlarged lymph nodes in right axillary area, suggesting. metastasisFig. 126 [BB:51.307;160.859;453.260;397.500]. Fig. 126 Chest CT (Jun. 2017, May 2019): Nodule in right lower lobe, abutting diaphragmatic pleura, showing interval. increase in size. Metastatic Breast Cancer. 926. Jun. 2019 Bilateral salpingo-oophorectomy.. Palliative therapy: Letrozole + Palbociclib. (Jul. 2019) ~. 41. . 41.1. . See Fig. 127.. Operation. Nov. 2015 Left breast conserving surgery.. Pathology: Invasive ductal carcinoma, stage. pT2N2a.. Size of tumor: 2.4 cm, lymph node: 5/12. (11 mm).. Result. Intensity Positive %. Estrogen. receptor. Feb. 2020 Brain MRI> Metastasis in brain.Fig. 127 [BB:51.259;100.578;246.379;332.179]. Fig. 127 Breast MRI (Oct. 2015): Irregular homoge. neous enhancing mass at the 1 o’clock direction of left. breastFig. 128 [BB:258.188;110.578;453.308;238.049]. Fig. 128 Chest CT (Sep. 2018): Interlobular septal line. thickening and bronchovascular bundle thickening (black. arrow), tiny nodules (white arrows) in bilateral lungs, sug. gesting hematolymphangitic metastasis. Y. Kwon et al.. 927Fig. 129 [BB:51.306;332.732;453.261;658.808]. Fig. 129 PET-CT (Oct. 2018): Hypermetabolic activity in the liver, suggesting hepatic metastasis and hypermetabolic. activity in the left ilium and 4th lumbar vertebral body, suggesting body metastases. Palliative Therapy. Radiation to whole brain.. Palliative therapy # 11 cycles (Lapatinib &. Capecitabine): Progressive disease.. Palliative therapy # 4 cycles (Trastuzumab. emtansine).. 42. . 42.1. See Fig. 130.. Operation. Jun. 2008 Left breast conserving surgery, sentinel. lymph node biopsy.. Pathology: Invasive ductal carcinoma, stage. pT1aN0 (sn).. Size of tumor: 0.6 cm, 0.5 × 0.3 cm, lymph. node: 0/2.. Metastatic Breast Cancer. 928Fig. 130 [BB:51.366;438.910;453.201;658.808]. Fig. 130 Mammography (May 2008): Irregular isodense mass (white arrow) and regional microcalcifications (black. arrow) in left upper outer quadrantFig. 131. Fig. 131 Chest CT (Jan. 2021): Hypoattenuating pleural. nodule (white arrow) in left lower lobe and enlargement of. left interlobar lymph node (black arrow), suggesting pleu. ral and lymph node metastasis. Result. Intensity Positive %. Estrogen. receptor. Strong (6/7). 3. 1/3–2/3. See Fig. 131.. Mar. 2021 Pleural fluid, cytology: Metastatic. carcinoma.. Palliative Therapy. Palliative therapy: Letrozole & Ribociclib (Jan.. 2021 ~ Mar. 2021).. Palliative therapy: Letrozole & Palbociclib. (Mar. 2021 ~ Dec. 2021).. Palliative therapy: Capecitabine # 3 (Feb.. 2022 ~ Mar. 2022): Progressive disease.. Palliative therapy: Paclitaxel & Cisplatin (Apr.. 929Fig. 132. Fig. 132 Breast US (Jun. 2012): Hypoechoic mass at the. 10 o’clock direction of right breastFig. 133. Fig. 133 Brain MRI (Jun. 2015): Small acute hemor. rhagic lesion with dense leptomeningeal enhancement in. left superior frontal gyrus, suggesting leptomeningeal. metastasis with focal cortical hemorrhage. 43. . 43.1. . Patient History and Progress. Female/54 years old, post-menopause.. Family history of breast cancer, sister.. See Fig. 132.. Operation. Jun. 2012 Right breast conserving surgery, senti. nel lymph node biopsy.. Pathology: Invasive ductal carcinoma, stage. pT1cN0 (sn).. Size of tumor: 1.5 cm, lymph node: 0/2.. Result. Intensity. Positive %. Estrogen. See Fig. 133.. Jun. 2015 Brain MRI> R/O metastasis in. leptomeningeal.. Jun. 2015 Cerebrospinal fluid cytology:. Atypical cells.. Metastatic Breast Cancer. 930. Palliative Therapy. Jul. 2015 Bilateral salpingo-oophorectomy.. Palliative therapy: Letrozole (Jul. 2015) ~. 44. See Fig. 134.. See Fig. 135.. Right invasive ductal carcinoma, stage IV. (metastasis in bone).. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. tumor cellsFig. 134. Fig. 134 Breast MRI (Jan. 2018): Huge irregular hetero. geneous enhancing mass in right breast. Enlarged lymph. nodes (white arrow) in the right axillary area, suggesting. metastasesFig. 135. Fig. 135 Bone scan (May 2018): Multifocal increased. uptake in sternum, lumbar vertebral bodies, and right pel. vic bone, suggesting bony metastases. Y. Kwon et al.. 931. Palliative Therapy. Feb. 2018 Bilateral salpingo-oophorectomy.. Palliative therapy: Letrozole & Palbociclib #. 16: Progressive disease.. Jul. 2019 Palliative operation: Right nipple-. sparing mastectomy, axillary lymph node. See Fig. 136.. Jan. 2020 Liver biopsy: Metastatic ductal. carcinoma.. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Dec. 2021 Death.Fig. 136 [BB:51.307;148.639;453.260;344.000]. Fig. 136 Abdomen CT (Jan. 2020): Hypoattenuating nodules in the liver, suggesting hepatic metastases. Metastatic Breast Cancer. 932. 45. . 45.1. . Patient History and Progress. Female/49 years old, pre-menopause.. No family history.. 45.2. PositiveFig. 137. Fig. 137 Breast MRI (Jun. 2013): Irregular heteroge. neous enhancing mass at the 12 o’clock direction of left. breastFig. 138 [BB:51.306;111.579;453.261;347.500]. Fig. 138 Chest CT (Jun. 2013): Multiple nodules in both lungs, suggesting pulmonary metastases. Y. Kwon et al.. 933Fig. 139. Fig. 139 PET-CT (Jun. 2013): Hypermetabolic activity. in the 1st lumbar vertebral body, suggesting bony. metastasisFig. 140. Fig. 140 Breast MRI (Jan. 2019): Irregular rim enhanc. ing mass at the 7 o’clock direction of right breastFig. 141. Fig. 141 Whole spine MRI (Jan. 2019): Ill-defined infil. trative bony enhancing lesion in the vertebral body and. post arc of the 10th thoracic vertebra, suggesting bony. metastasis. Palliative therapy: Paclitaxel & Trastuzumab. # 24.. Dec. 2014 Left breast conserving surgery, sen. tinel lymph node biopsy.. Pathology: Invasive ductal carcinoma, stage. ypT2N0 (sn).. Size of tumor: 2.3 cm, lymph node: 0/2.. See Fig. 142.. Feb. 2012 Outside slide review> Left invasive. ductal carcinoma.. Result. Intensity Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. of tumor cellsFig. 142. Fig. 142 Breast MRI (Feb. 2013): Irregular heteroge. neous enhancing mass in the left upper outer quadrant. Y. Kwon et al.. 935. Neoadjuvant Chemotherapy. Neoadjuvant. chemotherapy. #8. cycles. (Doxorubicin + cyclophosphamide #4 →. Docetaxel + Trastuzumab #4).. See Fig. 143.. Apr. 2016 Left breast biopsy> Invasive ductal. carcinoma.. Result. Intensity. Positive %. Estrogen. receptor. Negative (0/8). 0. 0. See Fig. 144.. Mar. 2018 Chest CT> metastasis in lung.. Palliative therapy: Trastuzumab emtansine #. 11: Progressive disease.. Palliative therapy: Lapatinib & Capecitabine #. 16: Progressive disease.Fig. 144. Fig. 144 Chest CT (Aug. 2020): Mildly enhancing. hypoattenuating mass in right upper lobe, suggesting pul. monary metastasisFig. 143. Fig. 143 Chest CT (Apr. 2016): Newly developed irregu. lar enhancing mass in left breast, suggesting recurrent. tumor. Metastatic Breast Cancer. 936. Concurrent radiation to internal mammary. lymph node.. Clinical trial: Herzuma & Vinorelbine tartrate. #4: Progressive disease.. Palliative therapy: Gemcitabine & Cisplatin. #5: Progressive disease.. See Fig. 145.. Enlarged lymph nodes (white arrow) in the. right axillary area, suggesting metastases.. See Figs. 146 and 147.. Right invasive ductal carcinoma, stage IV. (R/O metastasis in bone).Fig. 145. Fig. 145 Breast MRI (May 2014): Huge irregular hetero. geneous enhancing mass in right breastFig. 146. Fig. 146 PET-CT (May 2014): Hypermetabolic activity. in the mediastinal lymph node, suggesting metastasis. Y. Kwon et al.. 937Fig. 147. Fig. 147 Whole spine MRI (Jun. 2014): Multiple. enhancing lesions in thoracic and lumbar vertebrae, sug. gesting bony metastases. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. 938Fig. 148. Fig. 148 Breast MRI (Nov. 2014): Irregular enhancing. mass at the 11 o’clock direction of right breastFig. 149 [BB:51.306;138.080;453.261;254.000]. Fig. 149 PET-CT (Nov. 2014): Hypermetabolic bone lesions in both pelvic bones, suggesting bony metastases. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. (May 2021)~Fig. 150. Fig. 150 Breast US (Nov. 2019): Irregular hypoechoic. mass with echogenic halo at the 11 o’clock direction of. left breastFig. 151. Fig. 151 Chest CT (Feb. 2020): Several nodules, both. lungs, suggesting pulmonary metastases. Metastatic Breast Cancer. 941. © 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_11. Treatment Roadmap. and Summaries. Eun Sook Lee. 1 |
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