section
stringclasses 51
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values | Courses of Treatment
stringlengths 6
98.9k
⌀ | Important Radiologic
stringlengths 40
1.05k
⌀ | Patient History
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479
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|---|---|---|---|---|
Case 20
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HR(−) HER2(+) Breast Cancer
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20.1. . Courses of Treatment. Neoadjuvant chemotherapy (#6 cycles of. docetaxel and carboplatin and trastuzumab and. pertuzumab) + Operation + Post-operative radia. tion therapy + Trastuzumab.. Operation. 147. Pathology Report. Invasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of tumor: 1.1 cm (ypT1c).. 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 3/HPF).. 4. Intraductal component: present, intratu. moral/extratumoral (10%) (nuclear grade:. high, necrosis: absent, architectural pattern:. solid, extensive intraductal component:. absent).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) superior margin: 10 mm,. . (b) inferior margin: 10 mm,. . (c) medial margin: 15 mm,. . (d) lateral margin: 10 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: 2 mm.. 7. Lymph nodes:. . (a) metastasis in one out of two axillary. lymph nodes (ypN1a(sn)) (sentinel LN:. 1/2),. . (b) perinodal extension: absent,. . (c) size of metastatic carcinoma: 2.5 mm.. a. b. . Y. Kwon et al.. 511. 8. Arteriovenous invasion: absent.. 9. Lymphovascular. invasion:. present,. intratumoral.. . 10. Tumor border: infiltrative.. . 11. Microcalcification:. present,. tumoral/. non-tumoral.. . 12. Pathological TN category (AJCC 2017):. ypT1cN1a(sn).. Result. Intensity. Positive %. Estrogen. receptor. Negative. (0/8). 0. 0. Progesterone. receptor. Negative. (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in. 45% of. tumor cells. 21.
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Important Radiologic. Findings. 141 142. 143. HR(−) HER2(+) Breast Cancer. 508. . . . Y. Kwon et al.. 509. 20.3. . After Neoadjuvant. Chemotherapy. 144 145. 146. . . . HR(−) HER2(+) Breast Cancer. 510. 20.4.
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Patient History and Progress. Female/54 years old, post-menopause.. Screen detected mass lesion on left breast 11. o’clock direction.. Family history of breast cancer, aunt. (paternal).. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 20.2.
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Case 20
|
HR(−) HER2(−) Breast Cancer
|
20.1. . Courses of Treatment. Neoadjuvant chemotherapy (#4 cycles of. doxorubicin and cyclophosphamide + #4. cycles of docetaxel) + Operation + Post-. operative radiation therapy.. Operation. 143. Pathology Report. No residual tumor with stromal fibrosis. E. S. Lee et al.. 645. . . . HR(−) HER2(−) Breast Cancer. 646. . 1. Post-chemotherapy status.. . 2. Lymph nodes: no metastasis in seven axillary. lymph nodes (ypN0) (sentinel LN: 0/1, non-. sentinel LN: 0/6).. . 3. Microcalcification:. present,. tumoral/. non-tumoral.. Result. Intensity. Positive. %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Negative (1+). Ki-67. Positive in 46%. of tumor cells. . . E. S. Lee et al.. 647. 21.
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Important Radiologic. Findings. 135 136 137. 138. E. S. Lee et al.. 643. . . . . HR(−) HER2(−) Breast Cancer. 644. . After Neoadjuvant. Chemotherapy. 139 140 141. 142. 20.3.
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Patient History and Progress. Female/59 years old, post-menopause.. Screen detected mass lesion on left breast 9:30. o’clock direction.. Family history of breast cancer, aunt. (maternal).. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 20.2.
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Case 20
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Local Recurrence
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20.1. . Courses of Treatment. Right breast DCIS → Operation → Adjuvant. therapy → Right breast recurrence (microinva. sive ductal carcinoma).. Primary Treatment. 140. Operation. Jul. 2017 Right breast conserving surgery, senti. nel lymph node biopsy (outside).. Pathology Report. Ductal Carcinoma In Situ. 1. Size of tumor: 1.2 cm.. 2. Nuclear grade: high.. 3. Necrosis: present, central.. 4. Architectural pattern: comedo.. 5. Skin: no involvement of tumor.. 6. Surgical margins: uninvolved by DCIS dis. tance from closest margin: 2 mm (specify. margin: 9H).. 7. Lymph nodes: no metastasis in five lymph. nodes (pN0(sn)).. 8. Lymphovascular invasion: not identified.. 9. Perineural invasion: not identified.. . 10. Pathological TN category: pTisN0.. Result. Intensity. Positive %. Estrogen. receptor. Negative. 0. 0. Progesterone. receptor. Negative. 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in 35%. of tumor cells. . . Y. Kim et al.. 773. Adjuvant Therapy. Postoperative radiation therapy.. Treatments After Recurrence. 141 142. 143. Operation. . 144. 145. Pathology Report. . 1. Microinvasive Ductal Carcinoma. . (a) Size of invasive component: <0.1 cm. (pT1mi).. . (b) Size of in situ component: 1.5 cm.. . (c) Histologic grade: not applicable.. . (d) Intraductal component: present, intratu. moral/extratumoral (99%) (nuclear grade:. high, necrosis: present, architectural pat. tern: micropapillary/cribriform/solid/com. edo, extensive intraductal component:. present).. . (e) Surgical margins:. • Deep margin: 3 mm.. • Superficial margin: 8 mm.. . (f) Lymph nodes: no metastasis in three axil. lary lymph nodes (pN0(sn)) (sentinel LN:. 0/3).. . (g) Arteriovenous invasion: absent.. . . . Local Recurrence. 774. . a. b. . . (h) Lymphovascular invasion: absent.. . (i) Tumor border: infiltrative.. . (j) Microcalcification:. present,. tumoral/. non-tumoral.. . (k) Pathological TN category (AJCC 2017):. pT1miN0(sn).. . (l) Related slides: none.. . 2. Fibroadenoma.. Result. Intensity. Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Weak (3/8). 2. <1%. C-erbB2. Positive (3+). Ki-67. Positive in 23%. of tumor cells. 21.
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Patient History and Progress. Female/41 years old, pre-menopause.. Screen detected mass lesion on right breast 12. o’clock direction.. Outside result of biopsy: Ductal carcinoma in. situ.. No family history.. s/p Right breast conserving surgery (Breast. cancer), s/p parotidectomy, Panic disorder.. BRCA 1 VUS (variant of uncertain), APC,. and MSH2 VUS.. 20.2.
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Case 20
|
Metastatic Breast Cancer
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Courses of Treatment. Left breast cancer → Operation → Adjuvant. therapy → Ipsilateral axillary lymph node. recurrence.. Primary Treatment. Operation. Sep. 1998 Left breast conserving surgery, axil. lary lymph node dissection.. Pathology: Invasive ductal carcinoma, stage. pT1aN0.. Size of tumor: N.A, lymph node: 0/16.. Result. Intensity. Positive %. Estrogen. receptor. Positive. N.A. N.A. Progesterone. receptor. Positive. N.A. N.A. C-erbB2. N.A. Ki-67. N.A. Adjuvant Therapy. Adjuvant. chemotherapy. #3. cycles. (Cyclophosphamide. &. Methotrexate. &. Fluorouracil).. Post-operative radiation therapy +Tamoxifen. 20 mg/day for 0.5 year.. Treatments After Recurrence. 3. >2/3. Progesterone. receptor. Intermediate. (6/8). 2. 1/3–2/3. C-erbB2. Negative (0). Ki-67. Positive in 32%. of tumor cells. Neoadjuvant Chemotherapy. Neoadjuvant. chemotherapy. #6. cycles. (Adriamycin & Cyclophosphamide #4 →. Docetaxel #2).. Estrogen. receptor. Strong. (8/8). 3. >2/3. Progesterone. receptor. Weak (3/8). 1. 1–10%. C-erbB2. Negative. (0). Ki-67. Positive in. 12% of
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Family history of breast cancer, maternal. cousin.. BRCA 1 & 2 mutation: Not detected.. 20.2.
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Case 21
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Benign and Proliferative
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21.1. . Courses of Treatment. →2021-07-07 excision, both.. Pathology Report. Diagnosis. • Breast, left, excision:. –. – Intraductal papilloma.. –. – Sclerosing. adenosis. with. microcal-. cification.. Diagnosis. • Breast, right, excision:. –. – Intraductal papilloma.. –. – Sclerosing adenosis with microcalcification.. C. W. Lee et al.. 43. . . . Benign and Proliferative Case Series. 44. 22.
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Important Radiologic. Findings. 39 40. 41. 21.3.
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Patient History and Progress. Female/42 years old, pre-menopause.. Screen detected mass lesion on right breast 7. o’clock direction and left 1 o’clock direction.. Outside result of biopsy: both papillary. neoplasm.. No family history.. s/p Right breast mammotome biopsy (result:. fibroadenoma).. 21.2.
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Case 21
|
Carcinoma In Situ
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21.1. . Courses of Treatment. Operation + Postoperative radiation therapy +. Tamoxifen 20 mg/day for 5 years.. . . E. S. Lee et al.. 99. Operation. 98. 99. Pathology Report. Ductal carcinoma in situ, pathological TN cat. egory (AJCC 2017): pTisN0 (sn). . 1. Size of tumor: 3.0 cm (pTis).. . 2. Nuclear grade: low.. . 3. Necrosis: absent.. . 4. Architectural pattern: papillary/micropapil. lary/cribriform/solid.. . 5. Skin: no involvement of tumor.. . 6. Surgical margins:. . (a) superior margin: 20 mm,. . (b) inferior margin: (see Note 1),. . (c) medial margin: (see Note 2),. . (d) lateral margin: 20 mm,. . (e) deep margin: <1 mm from ductal carci. noma in situ (slides 2 and 6),. . (f) superficial margin: <1 mm from ductal. carcinoma in situ (slide 3).. . 7. Lymph nodes: no metastasis in two axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/2).. . 8. Microcalcification:. present,. . tumoral/non-. tumoral.. Note: 1. The inferior margin of the lumpec. tomy specimen (slide 9) is positive for ductal. carcinoma in situ but this margin submitted. for frozen diagnosis (Fro 2) is free of tumor.. 2. The medial margin of the lumpectomy speci. men (slide 4) is close to ductal carcinoma in. situ (2 mm) and atypical ductal hyperplasia is. present only in the permanent section of Fro 3.. Result. Intensity Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative (1+). Ki-67. Positive in 5%. of tumor cells. . . Carcinoma In Situ. 100. . . 22.
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Important Radiologic. Findings. 95 96. 97. 21.3.
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Patient History and Progress. Female/37 years old, pre-menopause.. Screen detected mass lesion on right breast. 9 o’clock direction.. Outside result of biopsy: Right 9 o’clock, duc. tal carcinoma in situ.. No family history.. Thyroid papillary carcinoma: follow-up at. outside hospital.. BRCA 1 and 2: not detected, POLE VUS. (variant of uncertain).. 21.2.
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Case 21
|
HR(+) HER2(+) Breast Cancer
|
21.1. . Courses of Treatment. Neoadjuvant chemotherapy (#6 cycles of. docetaxel and carboplatin and trastuzumab. and pertuzumab) + Operation + Post-. operative radiation therapy + Letrozole. 2.5 mg/day.. 117. Pathology Report. Invasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of tumor: 1.1 cm (ypT1c).. 3. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 1/10 HPF).. S. Park et al.. 365. . . 4. Intraductal component: present, intratu. moral/extratumoral (20%) (nuclear grade:. low, necrosis: absent, architectural pattern:. micropapillary/cribriform, extensive intra. ductal component: absent).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) superior margin: 25 mm,. . (b) inferior margin: 50 mm,. . (c) medial margin: 10 mm,. . (d) lateral margin: 20 mm,. . (e) deep margin: 15 mm,. . (f) superficial margin: 10 mm.. 7. Lymph nodes: no metastasis in one axillary. lymph node (ypN0(sn)) (sentinel LN: 0/1).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular invasion: present, intratu. moral/peritumoral.. . 10. Tumor border: infiltrative.. . 11. Microcalcification:. present,. tumoral/. non-tumoral.. . 12. Pathological TN category (AJCC 2017):. ypT1cN0(sn).. Result. Intensity. Positive. %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Weak (4/8). 2. 1–10%. C-erbB2. Equivocal (2+). Ki-67. Positive in 1% of. tumor cells. SISH. Positive. HR(+) HER2(+) Breast Cancer. 366. . S. Park et al.. 367. . F. ig. 115. HR(+) HER2(+) Breast Cancer. 368. a. b. . 22.
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Important Radiologic. Findings. 111 112 113 114 115. 116. 21.3.
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Patient History and Progress. Female/69 years old, post-menopause.. Screen detected mass lesion on right breast 6. o’clock direction.. Family history of breast cancer, paternal aunt,. cousin (paternal).. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 21.2.
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Case 21
|
HR(+) HER2(-) Breast Cancer
|
21.1. . Courses of Treatment. Operation + Post-operative radiation ther. apy + Letrozole 2.5 mg/day.. Operation (1st, Dec. 2020). nent: absent).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) superior margin: 5 mm.. . (b) inferior margin: 20 mm.. . (c) medial margin: 10 mm.. . (d) lateral margin: 20 mm.. . (e) deep margin: 2 mm.. . (f) superficial margin: 2 mm.. 6. Arteriovenous invasion: absent.. 7. Lymphovascular. invasion:. present,. intratumoral.. Positive. %. Estrogen. receptor. Intermediate. (6/8). 3. 10%–. 1/3. Progesterone. receptor. Strong (7/8). 3. 1/3–2/3. C-erbB2. Negative (0). Ki-67. Positive in 2% of. tumor cells. HR(+) HER2(−) Breast Cancer
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Important Radiologic. Findings. See Figs. 114, 115, 116 and 117.. 21.3.
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Patient History and Progress. Female/78 years old, post-menopause.. Screen detected mass lesion on left breast 12. o’clock direction.. No family history.. Hypertension, s/p hysterectomy.. 21.2.
|
Case 21
|
HR(−) HER2(+) Breast Cancer
|
21.1. . Operation. 156. Pathology Report. Invasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of tumor: 1.0 cm (ypT1b).. 3. Histologic grade: 3/3 (tubule formation: 2/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 49/10HPF).. 4. Intraductal component: absent.. Y. Kwon et al.. 515. a. b. . 5. Surgical margins:. . (a) superior margin: 15 mm,. . (b) inferior margin: 35 mm,. . (c) medial margin: 5 mm,. . (d) lateral margin: 15 mm,. . (e) deep margin: 10 mm,. . (f) superficial margin: 3 mm.. 6. Lymph nodes: no metastasis in three axillary. lymph nodes (ypN0(sn)) (sentinel LN: 0/2,. axillary LN: 0/1).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular invasion: absent.. 9. Tumor border: infiltrative.. . 10. Microcalcification: present, non-tumoral.. . 11. Pathological TN category (AJCC 2017):. ypT1bN0(sn).. Result. Intensity. Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in. 39% of tumor. cells. HR(−) HER2(+) Breast Cancer. 516. 22.
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Important Radiologic. Findings. 148 149 150. 151. . HR(−) HER2(+) Breast Cancer. 512. . . . . Y. Kwon et al.. 513. 21.3. . After Neoadjuvant. Chemotherapy. 152 153 154. 155. . HR(−) HER2(+) Breast Cancer
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Patient History and Progress. Female/55 years old, pre-menopause.. Self-detected palpable mass lesion on right. breast.. No family history.. S/P Tuberculosis.. 21.2.
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Case 21
|
HR(−) HER2(−) Breast Cancer
|
21.1. . Courses of Treatment. Neoadjuvant chemotherapy (#4 cycles of. doxorubicin and cyclophosphamide + #4. cycles of docetaxel) + Operation + Post-. operative radiation therapy + Letrozole. 2.5 mg + Adjuvant capecitabine.. Operation. 152. Pathology Report. Microinvasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of invasive component: <0.1 cm. (ypT1mi).. 3. Size of intraductal component: 2.0 cm.. 4. Histologic grade: not applicable.. 5. Intraductal component: present, intratu. moral/extratumoral (>95%) (nuclear grade:. high, necrosis: present, architectural pattern:. cribriform/solid/comedo, extensive intra. ductal component: present).. 6. Skin: no involvement of tumor.. 7. Surgical margins:. HR(−) HER2(−) Breast Cancer. 650. . . . . . (a) Superior margin: positive for ductal car. cinoma in situ (Fro 1) (see note).. . (b) Inferior margin: 5 mm.. . (c) Medial margin: 5 mm.. . (d) Lateral margin: 5 mm.. . (e) Deep margin: 2 mm.. . (f) Superficial margin: <1 mm from inva. sive ductal carcinoma (slide 5).. 8. Lymph nodes:. . (a) Metastasis in two out of six axillary. lymph nodes (ypN1a(sn)) (sentinel LN:. 2/2, axillary LN: 0/4).. . (b) Perinodal extension: absent.. . (c) Size of metastatic carcinoma: 3 mm.. 9. Arteriovenous invasion: absent.. . 10. Lymphovascular. invasion:. present,. peritumoral.. . 11. Tumor border: infiltrative.. . 12. Microcalcification: absent.. . 13. Pathological TN category (AJCC 2017):. ypT1miN1a(sn).. Note: 1. Ductal carcinoma in situ is present. only in the permanent section of Fro 1.. Result. Intensity. Positive %. Estrogen. receptor. Weak (3/8). 1. 1–10%. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Negative (0). Ki-67. Positive in 52%. of tumor cells. E. S. Lee et al.. 651. . . 22.
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Important Radiologic Findings. 144 145 146. 147. . HR(−) HER2(−) Breast Cancer. 648. . . . . . E. S. Lee et al.. 649. . After Neoadjuvant. Chemotherapy. 148 149 150. 151. 21.3.
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Patient History and Progress. Female/50 years old, pre-menopause.. Screen detected mass lesion on left breast 1. o’clock direction.. No family history.. No comorbidities.. BRCA 1 and 2 mutation: Not detected, STK11. VUS (variant of uncertain).. 21.2.
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Case 21
|
Local Recurrence
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21.1. . Courses of Treatment. Right breast DCIS→ → Operation → Right. breast recurrence (DCIS).. Y. Kim et al.. 775. Primary Treatment. 146. Operation. . 147. 148. Pathology Report. Ductal Carcinoma In Situ. . 1. Size of tumor: 5.5 cm (pTis).. . 2. Nuclear grade: low.. . 3. Necrosis: present.. . 4. Architectural pattern: micropapillary/solid/. comedo.. . 5. Skin: no involvement of tumor.. . 6. Surgical margins:. . (a) Deep margin: (see note).. . (b) Superficial margin: <1 mm from ductal. carcinoma in situ (slide MG5).. . 7. Lymph nodes: no metastasis in two axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/2).. . . . Local Recurrence. 776. . 8. Microcalcification:. present,. tumoral/. non-tumoral.. . 9. Pathologic stage (AJCC 2010): pTisN0(sn).. Note: 1. The deep margin of the mastectomy. specimen (slide 7) is close to ductal carcinoma in. situ (<1 mm), but this margin submitted for fro. zen diagnosis (Fro 4) is free of tumor.. Result. Intensity Positive %. Estrogen. receptor. Intermediate (5/8) 2. 10%-1/3. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in 22%. of tumor cells. Treatments After Recurrence. 149. 150. Operation. 151. Pathology Report. Ductal Carcinoma In Situ. . 1. Post-nipple-sparing mastectomy status.. . 2. Size of tumor: 1.1 cm (rpTis).. . 3. Nuclear grade: low.. . 4. Necrosis: absent.. . 5. Architectural pattern: solid.. . 6. Skin and nipple: no involvement of tumor.. . 7. Surgical margins:. . (a) Superior margin: 5 mm.. . (b) Inferior margin: 11 mm.. . (c) Medial margin: 5 mm.. . (d) Lateral margin: 10 mm.. . (e) Deep margin: (see note).. . (f) Superficial margin: 2 mm.. . 8. Microcalcification: present, tumoral.. . 9. Pathological TN category (AJCC 2017):. rpTis.. Note: 1. The deep margin of the lumpectomy. specimen (slide 1) is close to ductal carcinoma in. situ (<1 mm), but this margin submitted for fro. zen diagnosis (Fro 5) is free of tumor.. Result. Intensity. Positive %. Estrogen. receptor. Weak (4/8). 1. 10%-1/3. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in 8%. of tumor cells. Adjuvant Therapy. Postoperative radiation therapy.. . . . Y. Kim et al.. 777. a. b. . . 22.
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Patient History and Progress. Female/55 years old, peri-menopause.. Screen detected calcification on upper portion. of right breast.. Outside result of biopsy: suggestive ductal. carcinoma in situ.. No family history.. S/p hysterectomy.. 21.2.
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Case 21
|
Metastatic Breast Cancer
|
Left breast cancer → Operation → Adjuvant. therapy → Neck node recurrence → Lymph. nodes, bone metastasis → Skull, brain. metastasis.. Primary Treatment. Operation. Apr. 2002 Left breast conserving surgery, senti. nel lymph node biopsy.. Y. Kwon et al.. 895. Pathology: Microinvasive infiltrating duct car. cinoma, stage T1miN0(sn).. Size of tumor: N.A, lymph node: 0/2.. Result. Intensity. Positive %. Estrogen. receptor. Positive. Intermediate. 60%. Progesterone. receptor. Positive. Weak. 20%. C-erbB2. Negative. (1+). Ki-67. N.A. Adjuvant Therapy. Post-operative radiation therapy +Tamoxifen. 20 mg/day for 5 years.. Treatments After Recurrence
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Case 22
|
Benign and Proliferative
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22.1. . Courses of Treatment. →2021-07-07 excision, Rt.. Diagnosis. • Breast, right, excision:. –. – Atypical. ductal. hyperplasia. with. microcalcification.. . C. W. Lee et al.. 45. . . . 23.
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Important Radiologic. Findings. 42. 22.3.
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Patient History and Progress. Female/50 years old, peri-menopause.. Screen detected microcalcification on upper. outer portion of right breast.. No family history.. Hypertension (taking medication), carotid. atherosclerosis.. 22.2.
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Case 22
|
Carcinoma In Situ
|
22.1. . Courses of Treatment:. Operation. Operation. 103. 104. Pathology Report. Ductal carcinoma in situ, pathological TN cat. egory (AJCC 2017): pTis(Paget)N0(sn). . 1. Size of tumor: 0.5 cm (pTis(Paget)).. . 2. Nuclear grade: high.. . 3. Necrosis: absent.. . 4. Architectural pattern: micropapillary.. . 5. Nipple: Paget disease with involvement of. lactiferous duct.. . 6. Surgical margins: deep margin: 20 mm.. . 7. Lymph nodes: no metastasis in two axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/2).. . 8. Microcalcification: present, non-tumoral.. Result. Intensity Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in. 14% of tumor. cells. E. S. Lee et al.. 101. E. S. Lee et al.. 103. 23.
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Important Radiologic. Findings. 100 101. 102. 22.3.
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Patient History and Progress. Female/57 years old, post-menopause.. Visible detected redness on Left nipple.. Outside result of biopsy: Paget’s disease.. Family history of breast cancer, sister at her. 45 years old.. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 22.2.
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Case 22
|
HR(+) HER2(+) Breast Cancer
|
22.1. . Courses of Treatment. Neoadjuvant chemotherapy (#6 cycles of. docetaxel and carboplatin and trastuzumab. and pertuzumab) + Operation + Trastuzumab. + Letrozole 2.5 mg/day.. 125. Pathology Report. Invasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of tumor: 0.5 cm (ypT1a).. S. Park et al.. 369. . . . 3. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, <1/10HPF).. 4. Intraductal component: absent.. 5. Surgical margins:. . (a) superior margin: 10 mm,. . (b) inferior margin: (see Note 1),. . (c) medial margin: 5 mm,. . (d) lateral margin: 5 mm,. . (e) deep margin: <1 mm from invasive duc. tal carcinoma (slide 1),. . (f) superficial margin: 1 mm from invasive. ductal carcinoma (slide 3).. 6. Lymph nodes:. . (a) metastasis in two out of three axillary. lymph nodes (ypN1mi(sn)) (see note). (sentinel LN: 1/1, axillary LN: 1/2),. . (b) perinodal extension: absent,. . (c) size of metastatic carcinoma: 0.3 mm.. 7. Arteriovenous invasion: absent.. 8. Lymphovascular invasion: absent.. 9. Tumor border: infiltrative.. . 10. Microcalcification: present, non-tumoral.. . 11. Pathological TN category (AJCC 2017):. ypT1aN1mi(sn).. HR(+) HER2(+) Breast Cancer. 370. . . S. Park et al.. 371. . . Note: 1. The inferior margin of the lumpec. tomy specimen (slide 3) is close to invasive duc. tal carcinoma (<1 mm) but this margin submitted. for frozen diagnosis (Fro 5) is free of tumor.. 2. Micrometastasis is present only in the per. manent section of Fro 1.. Result. Intensity. Positive. %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Equivocal (2+). Ki-67. Positive in <1%. of tumor cells. SISH. Positive. HR(+) HER2(+) Breast Cancer. 372. . . S. Park et al.. 373. a. b. . 23.
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Important Radiologic. Findings. 118 119 120 121 122 123. 124. 22.3.
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Patient History and Progress. Female/54 years old, post-menopause.. Self-detected nipple retraction on left breast.. No family history.. Hepatitis B carrier.. 22.2.
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Case 22
|
HR(+) HER2(-) Breast Cancer
|
. Courses of Treatment. Neoadjuvant chemotherapy (#4 cycles of. doxorubicin & cyclophosphamide followed by. #4 cycles of docetaxel) + Operation + Post-. operative radiation therapy + Letrozole. 2.5 mg/day.. Operation. tumor.. 6. Surgical margins:. . (a) deep margin: positive for invasive carci. noma (slide 1).. . (b) superficial margin: positive for invasive. carcinoma (slide 4).. 7. Lymph nodes:. . (a) metastasis in nine out of nine axillary. lymph nodes (ypN2a).. . (b) perinodal extension: present.. . (c) size of metastatic carcinoma: 6 mm.. 8. Arteriovenous. invasion:. present,. peritumoral.. 9. Lymphovascular. invasion:. present,. peritumoral.. . 10. Tumor border: infiltrative.. HR(+) HER2(−) Breast Cancer. Result. Intensity. Positive. %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Negative (2/8). 1. <1%. C-erbB2. Equivocal (2+). (SISH negative). Ki-67. Positive in 14%
|
Important Radiologic. Findings. See Figs. 119, 120, 121, 122, 123 and 124.. 22.3.
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Patient History and Progress. Female/61 years old, post-menopause.. Screen detected mass lesion on entire left. breast.. No family history.. Diabetes mellitus, Spinal stenosis.. 22.2.
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Case 22
|
HR(−) HER2(+) Breast Cancer
|
22.1. . Courses of Treatment. Operation + Adjuvant chemotherapy (#4 cycles. of doxorubicin and cyclophosphamide) + Post-. operative radiation therapy + Trastuzumab.. Operation. 161. . a. b. . HR(−) HER2(+) Breast Cancer. 518. Pathology Report. Invasive Ductal Carcinoma with apocrine dif. ferentiation and medullary pattern. 1. Size of invasive component: 1.3 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:. 2/3, 15/10HPF).. 4. Intraductal component: present, extratumoral. (70%) (nuclear grade: high, necrosis: pres. ent, architectural pattern: solid/comedo,. extensive intraductal component: present).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) superior margin: 6 mm,. . (b) inferior margin: 6 mm,. . (c) medial margin: positive for ductal carci. noma in situ (Fro 4) (see note),. . (d) lateral margin: 6 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: 5 mm.. 7. Lymph nodes: no metastasis in two axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/2).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular invasion: absent.. . 10. Tumor border: infiltrative.. . 11. Microcalcification:. present,. tumoral/. non-tumoral.. . 12. Pathological TN category (AJCC 2017):. pT1cN0(sn).. Note: 1. Ductal carcinoma in situ is present. only in the permanent section of Fro 4.. Result. Intensity. Positive %. Estrogen. receptor. Negative (2/8). 1. <1%. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in 49%. of tumor cells. 23.
|
Important Radiologic Findings. 157 158 159. 160. . . . Y. Kwon et al.. 517. 22.3.
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Patient History and Progress. Female/53 years old, peri-menopause.. Self-detected palpable mass lesion on right. breast 4 o’clock direction.. No family history.. S/P hemorrhoids operation.. 22.2.
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Case 22
|
HR(−) HER2(−) Breast Cancer
|
22.1. . Courses of Treatment. Neoadjuvant chemotherapy (#4 cycles of. doxorubicin and cyclophosphamide + #4. cycles of docetaxel) + Operation + Post-. operative radiation therapy + Adjuvant. capecitabine.. Operation. 161. Pathology Report. Invasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of tumor: 0.9 cm (ypT1b).. 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 11/10HPF).. 4. Intraductal component: absent.. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) Superior margin: 25 mm.. . (b) Inferior margin: 20 mm.. . (c) Medial margin: 5 mm.. . (d) Lateral margin: 10 mm.. . (e) Deep margin: 5 mm.. . (f) Superficial margin: 10 mm.. 7. Lymph nodes:. . (a) Metastasis in two out of three axillary. lymph nodes (ypN1a(sn)) (sentinel LN:. 2/3).. . (b) Perinodal extension: absent.. . (c) Size of metastatic carcinoma: 5 mm.. 8. Arteriovenous invasion: absent.. 9. Lymphovascular invasion: absent.. . 10. Tumor border: infiltrative.. . 11. Microcalcification: absent.. . 12. Pathological TN category (AJCC 2017):. ypT1bN1a(sn).. Result. Intensity. Positive. %. Estrogen. receptor. Negative (2/8). 1. <1%. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Negative (1+). Ki-67. Positive in 12%. of tumor cells. HR(−) HER2(−) Breast Cancer. 654. . . . . E. S. Lee et al.. 655. . . . HR(−) HER2(−) Breast Cancer. 656. . 23.
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Important Radiologic. Findings. 153 154 155. 156. HR(−) HER2(−) Breast Cancer. 652. . . . . . E. S. Lee et al.. 653. . After Neoadjuvant. Chemotherapy. 157 158 159. 160. 22.3.
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Patient History and Progress. Female/57 years old, post-menopause.. Self-detected palpable mass lesion on right. breast.. Family history of breast cancer, uncle. (paternal).. s/p retinal detachments operation.. BRCA 1 and 2 mutation: Not detected, PALB2. PV, STK11 VUS (variant of uncertain).. 22.2.
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Case 22
|
Local Recurrence
|
22.1. . Courses of Treatment. Left breast mucinous carcinoma→ Adjuvant. therapy → Right breast recurrence (mucinous. carcinoma).. Primary Treatment. 152. Operation. Apr. 2007 Left breast mass excision (outside).. Pathology Report. Mucinous Carcinoma. . 1. Size of tumor: 2.0 cm.. . 2. Margin involved.. Result. Intensity Positive %. Estrogen receptor. Strong. (7/8). 3. >2/3. Progesterone. receptor. Weak. (3/8). 1. 10%-1/3. C-erbB2. Negative. (0). Operation (2nd). . 153. Pathology Report. No residual carcinoma with foreign body. reaction.. . 1. Post-excisional biopsy status.. Local Recurrence. 778. a. b. . . Adjuvant Therapy. Adjuvant chemotherapy #4 cycles of doxorubicin. and cyclophosphamide.. Postoperative radiation therapy.. Letrozole 2.5 mg/day 1.7 years, tamoxifen. 20 mg/day for 2.2 years.. Treatments After Recurrence. 154. Letrozole 2.5 mg/day (rejection of surgical. treatment).. 23.
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Patient History and Progress. Female/80 years old, post-menopause.. Screen detected mass lesion on upper outer. portion of Left breast.. Outside. result. of. biopsy:. Mucinous. carcinoma.. No family history.. Dementia.. BRCA 1 and 2 mutation: No examination.. 22.2.
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Case 22
|
Metastatic Breast Cancer
|
Courses of Treatment. Left breast cancer → Operation → Adjuvant. therapy → Right axillary lymph node recur. rence → Right breast recurrence → Chest wall. → Bone → Pleural effusion metastasis.. Primary Treatment. mide #3 → Doxorubicin + Docetaxel #3).. Operation. Mar. 2008 Left total mastectomy, axillary lymph. node dissection.. Pathology: Invasive apocrine carcinoma, stage. ypT1bN2a.. Size of tumor: 1.0 cm, lymph node: 6/6, size. of metastatic carcinoma: 10 mm.. Result. Intensity Positive %. Estrogen. receptor. Negative (0/7). 0. 0. Progesterone. receptor. Negative (0/7). 0. 0. C-erbB2. Negative (1+). Ki-67. Positive in 5%. of tumor cells. Adjuvant Therapy. Post-operative radiation therapy.. Treatments After Recurrence. Right Axillary Lymph Node Recurrence. 0. Progesterone. receptor. Negative. (0/7). 0. 0. C-erbB2. Negative. (1+). Ki-67. N.A. Neoadjuvant Chemotherapy. Chemotherapy #15 cycles (Capecitabine).. Operation. Apr. 2014 Right axillary lymph node dissection.. Pathology: Metastatic ductal carcinoma in. eight out of eight axillary lymph nodes, size of. metastatic carcinoma: 18 mm.. Metastatic Breast Cancer. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Negative (1+). Ki-67. Positive in 6%. of tumor cells. Adjuvant Therapy. Post-operative radiation therapy (axilla).. Right Breast Recurrence. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Negative (1+). Ki-67. Positive in. 42% of tumor. cells. Neoadjuvant Chemotherapy. Chemotherapy #8 cycles (paclitaxel + Cisplatin).. Radiation therapy (breast).. Chemotherapy #12 cycles (Cyclophosphamide. + Methotrexate).. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Negative (1+). Ki-67. Positive in 1%. of tumor cells. Chest Wall → Bone → Pleural Effusion. Metastasis. Jan. 2018 Right chest wall skin biopsy.. Pathology: Metastatic ductal carcinoma.. 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 3%. of tumor cells. Palliative Therapy. Chemotherapy #10 cycles (Harven): Progressive. disease.. Chemotherapy #31 cycles (Capecitabine):. Progressive disease on bone.. Chemotherapy #11 cycles (Gemcitabine):. Progressive disease on bone.. Chemotherapy. (Vinorelbine. tartrate. +Cisplatin)~. See Figs. 77 and 78.. Y. Kwon et al.
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Case 23
|
Benign and Proliferative
|
23.1. . Courses of Treatment. →2021-07-13 Excision, Lt.. Benign and Proliferative Case Series. 46. Pathology Report. Diagnosis. • Breast, left, excision:. –. – Atypical ductal hyperplasia involving intra. ductal papilloma with microcalcification.. 24.
|
Important Radiologic. Findings. 43 44. 45. 23.3.
|
Patient History and Progress. Female/47 years old, pre-menopause.. Screen detected mass lesion on left breast 1. o’clock direction.. Outside result of biopsy: atypical papilloma.. No family history.. No comorbidities.. 23.2.
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Case 23
|
Carcinoma In Situ
|
23.1. . Courses of Treatment:. Operation. Operation. 107. 108. Pathology Report. Lobular carcinoma in situ, pathological TN. category (AJCC 2017): pTis. . 1. Size of tumor: 0.5 cm (pTis).. . 2. Nuclear grade: low.. . 3. Necrosis: absent.. . 4. Architectural pattern: solid.. . 5. Skin: no involvement of tumor.. . 6. Surgical margins:. . (a) superior margin: <1 mm (slide 3),. . (b) inferior margin: 20 mm,. . (c) medial margin: 5 mm,. . (d) lateral margin: 5 mm,. . (e) deep margin: 10 mm,. . (f) superficial margin: 1 mm (slide 1).. . 7. Microcalcification: present, tumoral.. Result. Intensity. Positive %. Estrogen. receptor. Strong (7/8). 3. 1/3–2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative (1+). Ki-67. Positive in 7%. of tumor cells. . . . Carcinoma In Situ. 104. . . 24.
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Important Radiologic. Findings. 105. 106. 23.3.
|
Patient History and Progress. Female/44 years old, pre-menopause.. Screen detected microcalcification on upper. outer portion of right breast.. No family history.. No comorbidities.. 23.2.
|
Case 23
|
HR(+) HER2(+) Breast Cancer
|
23.1. . Courses of Treatment. Neoadjuvant chemotherapy (#6 cycles of. docetaxel and carboplatin and trastuzumab. and pertuzumab) + Operation + Post-. HR(+) HER2(+) Breast Cancer. 374. . . . operative radiation therapy + Trastuzumab +. Tamoxifen 20 mg/day.. . . 132. 133. Pathology Report. . 1. No residual tumor with stromal degeneration.. . (a) Post-chemotherapy status.. . (b) Lymph nodes: no metastasis in six axillary. lymph nodes (ypN0) (axillary LN: 0/6).. . 2. Atypical ductal hyperplasia, focal.. . 3. Intraductal papilloma.. . 4. Fibroadenoma.. Result. Intensity. Positive. %. Estrogen. receptor. Weak (4/8). 2. 1–10%. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Positive (3+). Ki-67. Positive in 30%. of tumor cells. S. Park et al.. 375. . . HR(+) HER2(+) Breast Cancer. 376. F. i. g. 130. . S. Park et al.. 377. a. b. . a. b. . HR(+) HER2(+) Breast Cancer. 378. 24.
|
Important Radiologic. Findings. 126 127 128 129 130. 131. 23.3.
|
Patient History and Progress. Female/46 years old, pre-menopause.. Self-detected palpable mass lesion on both. breast.. Family history of breast cancer, sister.. Hypertension, S/P varicose veins operation.. BRCA 1 and 2 mutation: Not detected. (BRCAPRO mutation probability 0.118).. 23.2.
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Case 23
|
HR(+) HER2(-) Breast Cancer
|
2.5 mg/day.. Operation. Right breast conserving surgery, sentinel lymph. . (d) Histologic grade: 3/3 (tubule formation:. 3/3, nuclear pleomorphism: 3/3, mitotic. count: 2/3, 10/10 HPF). . (e) Intraductal component: present, intratu. moral/extratumoral. (99%). (nuclear. grade: high, necrosis: present, architec. tural pattern: solid/comedo, extensive. intraductal component: present).. . (f) Skin: no involvement of tumor.. . (g) Surgical margins:. • superior margin: 10 mm.. • inferior margin: (see note).. • medial margin: 5 mm.. • lateral margin: 10 mm.. HR(+) HER2(−) Breast Cancer. . (j) Lymphovascular invasion: absent.. . (k) Tumor border: infiltrative.. . (l) Microcalcification:. present,. tumoral/. non-tumoral.. . (m) Pathological TN category (AJCC 2017):. ypT1miN0(sn).. . 2. Intraductal papilloma with usual ductal. hyperplasia.. . 3. Fibroadenoma.. . 4. Complex sclerosing lesion.. Note: 1. The inferior margin of the lumpec. tomy specimen (slide 7) is close to ductal car. cinoma in situ (2 mm) but this margin. submitted for frozen diagnosis (Fro 4) is free. of tumor.. Result. Intensity. Positive %. Estrogen receptor. Strong (7/8). 3. 1/3–2/3. Progesterone receptor. Weak (3/8). 1. 1–10%. C-erbB2. Negative (1+). Ki-67. Positive in 15% of tumor cells. HR(+) HER2(−) Breast Cancer. 248. 24.
|
Important Radiologic. Findings. See Figs. 126, 127, 128, 129 and 130.. Y. Kim et al.
|
sister.. Diabetes mellitus, s/p right thyroidectomy. (thyroid cancer), s/p cholecystectomy, s/p. hysterectomy.. BRCA 1 and 2 mutation: Not detected.. 23.2.
|
Case 23
|
HR(−) HER2(+) Breast Cancer
|
23.1. . Courses of Treatment. Operation + Operation + Adjuvant paclitaxel and. trastuzumab.. Operation. . 166. Pathology Report. Breast, right, nipple-sparing mastectomy:. Microinvasive Ductal Carcinoma. 1. Size of invasive component: <0.1 cm. (pT1mi).. 2. Size of intraductal component: 6.0 cm.. 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 3/10HPF).. 4. Intraductal component: present, intratu. moral/extratumoral (99%) (nuclear grade:. high, necrosis: present, architectural pattern:. micropapillary/cribriform/solid/comedo,. extensive intraductal component: present).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) deep margin: 2 mm,. . (b) superficial margin: 2 mm.. 7. Lymph nodes: no metastasis in one axillary. lymph node (pN0(sn)) (sentinel LN: 0/1).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular invasion: absent.. . 10. Tumor border: infiltrative.. HR(−) HER2(+) Breast Cancer. 520. . . 11. Microcalcification:. present,. tumoral/. non-tumoral.. . 12. Pathological TN category (AJCC 2017):. pT1miN0(sn).. Result. Intensity. Positive %. Estrogen. receptor. Negative. (0/8). 0. 0. Progesterone. receptor. Negative. (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in. 32% of tumor. cells. Operation. . 167. Pathology Report. Invasive Ductal Carcinoma. 1. Post nipple-sparing mastectomy status.. 2. Size of tumor: 0.7 cm (rpT1b).. 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 21/10HPF).. Y. Kwon et al.. 521. . 4. Intraductal component: absent.. 5. Skin and nipple: no involvement of tumor.. 6. Surgical margins:. . (a) superior margin: 3 mm,. . (b) inferior margin: 21 mm,. . (c) medial margin: 25 mm,. . (d) lateral margin: 10 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: 18 mm.. 7. Lymph nodes: not submitted (rpNx).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular invasion: absent.. . 10. Tumor border: infiltrative.. . 11. Microcalcification: absent.. . 12. Pathological TN category (AJCC 2017):. rpT1bNx.. 24.
|
Important Radiologic. Findings. 162 163 164. 165. . Y. Kwon et al.. 519. . . . . 23.3.
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Patient History and Progress. Female/49 years old, pre-menopause.. Self-detected bloody discharge on nipple of. right breast.. No family history.. No comorbidities.. 23.2.
|
Case 23
|
HR(−) HER2(−) Breast Cancer
|
23.1. . Courses of Treatment. Neoadjuvant chemotherapy (#4 cycles of. doxorubicin and cyclophosphamide + #4. cycles of docetaxel) + Operation + Post-. operative radiation therapy.. Operation. 169. E. S. Lee et al.. 657. . . . . HR(−) HER2(−) Breast Cancer. 658. . . . Pathology Report. No residual tumor with foamy histiocytic. collection. . 1. Post-chemotherapy status.. . 2. Lymph nodes: no metastasis in one axillary. lymph node (ypN0(sn)) (sentinel LN: 0/1).. Note: Histologic mapping has been done.. Result. Intensity Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Negative (1+). Ki-67. Positive in 74%. of tumor cells. E. S. Lee et al.. 659. . 24.
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Important Radiologic Findings. 162 163. 164. After Neoadjuvant. Chemotherapy. 165 166 167. 168. 23.3.
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Patient History and Progress. Female/56 years old, post-menopause.. Self-detected mass lesion on right breast.. Family history of breast cancer, aunt. (maternal).. s/p Right knee fracture operation.. BRCA 1 and 2 mutation: Not detected,. POLD1 VUS (variant of uncertain).. 23.2.
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Case 23
|
Local Recurrence
|
23.1. . Courses of Treatment. Left breast medullary carcinoma → Operation. → Adjuvant therapy → Left breast recurrence. (IDC)/Right breast intraductal papilloma.. Primary Treatment. Operation. 2003 Left breast conserving surgery, axillary. lymph node dissection (outside).. Pathology Report. Medullary Carcinoma.. Y. Kim et al.. 779. Adjuvant Therapy. Adjuvant chemotherapy #6 cycles of doxorubicin. and cyclophosphamide.. Postoperative radiation therapy.. Treatments After Recurrence. 155 156. 157. Operation. 158. 159. Pathology Report. <Right>. . 1. Intraductal papilloma with:. . (a) sclerosing adenosis.. . (b) microcalcification.. . 2. Sclerosing adenosis.. . 3. Columnar cell hyperplasia.. . 4. Fibroadenomatous change.. <Left>. . 1. Invasive Ductal Carcinoma with focal papil. lary pattern.. . . . Local Recurrence. 780. . . . (a) Size of tumor: 1.9 cm (pT1c(2)).. . (b) Histologic grade: 3/3 (tubule formation:. 3/3, nuclear pleomorphism: 3/3, mitotic. count: 3/3, 11/HPF).. . (c) Intraductal component: present, extratu. moral (5%) (nuclear grade: high, necrosis:. absent, architectural pattern: papillary/solid,. extensive intraductal component: absent).. . (d) Skin: no involvement of tumor.. . (e) Surgical margins:. • Deep margin: (see note).. • Superficial margin: 15 mm.. . (f) Lymph nodes: no lymph node identified.. . (g) Arteriovenous invasion: absent.. . (h) Lymphovascular invasion: absent.. . (i) Tumor border: infiltrative.. . (j) Microcalcification: absent.. . (k) Pathological TN category (AJCC 2017):. pT1c.. . 2. Invasive Ductal Carcinoma.. . (a) Size of tumor: 0.6 cm.. . (b) Histologic grade: 2/3 (tubule formation:. 3/3, nuclear pleomorphism: 2/3, mitotic. count: 1/3, 1/10HPF).. . (c) Intraductal component: present, intratu. moral/extratumoral (30%) (nuclear grade:. low, necrosis: absent, architectural pat. tern: cribriform, extensive intraductal. component: present).. . (d) Arteriovenous invasion: absent.. . (e) Lymphovascular invasion: absent.. . (f) Tumor border: infiltrative.. Note: 1. The deep margin of the lumpectomy. specimen (slide 2) is close to invasive ductal car. cinoma (<1 mm), but this margin separately sub. mitted for permanent diagnosis (slide B) is free. of tumor.. Y. Kim et al.. 781. . . Result. Intensity. Positive %. Estrogen. receptor. Negative (2/8). 1. <1%. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Negative (1+). Ki-67. Positive in 48%. of tumor cells. Adjuvant Therapy. Adjuvant chemotherapy #4 cycles of cyclophos. phamide and docetaxel.. 24.
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Patient History and Progress. Female/49 years old, pre-menopause.. Palpable mass lesion on left breast 2 o’clock. direction.. Family history of breast cancer, maternal. grandmother.. s/p Left breast conserving surgery (breast can. cer), s/p Bilateral salpingo-oophorectomy.. BRCA 1 mutation carrier.. 23.2.
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Case 23
|
Metastatic Breast Cancer
|
Courses of Treatment. Left breast cancer → Neoadjuvant chemother. apy → Operation → Adjuvant therapy →. Pericardial effusion, Metastatic lymph nodes. → Bone, brain metastasis.. Primary Treatment. Docetaxel #4).. Result. Intensity. Positive. %. Estrogen. receptor. Negative (0/7). 0. 0. Progesterone. receptor. Negative (0/7). 0. 0. C-erbB2. Negative (0). Ki-67. Positive in. 40% of tumor. cells. Metastatic Breast Cancer. 900. Clinical stage: cT3N1M0.. Estrogen. receptor. Weak (3/8). 1. 1–10%. Progesterone. receptor. Negative. (0/8). 0. 0. C-erbB2. Negative (0). Ki-67. Positive in. 21% of. tumor cells. Adjuvant Therapy. Post-operative radiation therapy + Tamoxifen. 20 mg/day for 5 years.. Treatments After Recurrence. Chemotherapy #12 cycles (Gemcitabine &. Cisplatin): Progressive disease on leptomenin. geal, brain.. Intrathecal chemotherapy (Methotrexate).. Chemotherapy. (Vinorelbine. tartrate. &. Cisplatin)~
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Case 24
|
Benign and Proliferative
|
24.1. . Courses of Treatment. →2021-07-14 excision, both.. . . C. W. Lee et al.. 47. . . Pathology Report. Diagnosis. • Breast, right, excision:. –. – Intraductal papilloma.. Post-excision status.. Usual ductal hyperplasia.. Apocrine metaplasia.. –. – Sclerosing adenosis with microcalcification.. Diagnosis. • Breast, left, excision:. –. – Atypical ductal hyperplasia, focal.. –. – Intraductal papilloma.. 25.
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Important Radiologic. Findings. 46 47. 48. 24.3.
|
Patient History and Progress. Female/44 years old, pre-menopause.. Screen detected mass lesion in both breasts.. No family history.. s/p total thyroidectomy (thyroid cancer), s/p. right breast excision (intraductal papilloma).. 24.2.
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Case 24
|
Carcinoma In Situ
|
24.1. . Courses of Treatment:. Operation. Operation. 112. 113. E. S. Lee et al.. . 2. Nuclear grade: low.. . 3. Necrosis: absent.. . 4. Architectural pattern: solid.. . 5. Surgical margins:. . (a) superior margin: 11 mm,. . (b) inferior margin: 3 mm,. . (c) medial margin: 15 mm,. . (d) lateral margin: 15 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: 4 mm.. . 6. Microcalcification: absent.. Carcinoma In Situ. 106. a. b. . . a. b. . E. S. Lee et al.. 107. . . 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 6%. of tumor cells. 25.
|
Important Radiologic. Findings. 109 110 111. 24.3.
|
Patient History and Progress. Female/42 years old, pre-menopause.. Screen detected mass lesion on left breast. 2 o’clock direction.. Outside result of biopsy: Left breast 2 o’clock,. fibroadenoma, favor lobular carcinoma in situ.. No family history.. S/P Retinal detachment operation 15 years. ago.. 24.2.
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Case 24
|
HR(+) HER2(+) Breast Cancer
|
24.1. . Courses of Treatment. Neoadjuvant chemotherapy (#6 cycles of. docetaxel and carboplatin and trastuzumab. and pertuzumab) + Operation + Post-. operative. radiation. ther. apy + Trastuzumab + Tamoxifen 20 mg/day.. 140. Pathology Report. Ductal Carcinoma In Situ. . 1. Post-chemotherapy status.. . 2. Size of tumor: 0.2 cm (ypTis).. . 3. Nuclear grade: low.. . 4. Necrosis: absent.. . 5. Architectural pattern: solid.. . 6. Surgical margins:. . (a) superior margin: 5 mm,. . (b) inferior margin: 5 mm,. . (c) medial margin: 15 mm,. . (d) lateral margin: 10 mm,. . (e) deep margin: 5 mm,. . (f) superficial margin: 5 mm.. . 7. Lymph nodes: no metastasis in two axillary. lymph nodes (ypN0(sn)) (sentinel LN: 0/2).. . 8. Microcalcification:. present,. tumoral/. non-tumoral.. . 9. Pathological TN category (AJCC 2017):. ypTisN0(sn).. . . S. Park et al.. 379. . Result. Intensity. Positive %. Estrogen receptor. Negative (0/8). 0. 0. Strong (8/8) in core needle biopsy. 3. >2/3. Progesterone receptor. Negative (0/8). 0. 0. Intermediate (6/8) in core needle. biopsy. 3. 10%-1/3. C-erbB2. Positive (3+). Ki-67. Not informative due to low cellularity. HR(+) HER2(+) Breast Cancer. 380. F. ig. 137. 381. . a. b. . HR(+) HER2(+) Breast Cancer. 382. 25.
|
Important Radiologic. Findings. 134 135 136 137 138. 139. 24.3.
|
Patient History and Progress. Female/41 years old, pre-menopause.. Self-detected palpable mass lesion and nipple. discharge on right breast.. No family history.. S/P appendectomy, s/p hepatitis A.. 24.2.
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Case 24
|
HR(+) HER2(-) Breast Cancer
|
24.1. . Courses of Treatment. Neoadjuvant chemotherapy (#4 cycles of. doxorubicin & cyclophosphamide followed by. #4 cycles of docetaxel) & letrozole 2.5 mg/day. with leuprolide acetate + Operation + Post-. operative radiation therapy.. Operation (1st, Jan. 2021). Right breast conserving surgery, axillary lymph. sive intraductal component: absent).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) superior margin: positive for ductal car. cinoma in situ (Fro 1) (see note).. . (b) inferior margin: 10 mm.. . (a) metastasis in five out of twelve axillary. lymph nodes (ypN2a) (sentinel LN: 3/3,. axillary LN: 2/9). . (b) perinodal extension: present.. . (c) size of metastatic carcinoma: 6 mm.. 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):. ypT1cN2a.. 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. Weak (3/8). 1. 1–10%. C-erbB2. Equivocal (2+). (SISH equivocal). Ki-67. Positive in 1% of. tumor cells. Operation (2nd, Feb. 2021)
|
Important Radiologic. Findings. See Figs. 132, 133, 134, 135 and 136.. 24.3.
|
Patient History and Progress. Female/45 years old, pre-menopause.. Screen detected mass lesion on right breast 9. o’clock direction and right axillary LN.. No family history.. No comorbidities.. 24.2.
|
Case 24
|
HR(−) HER2(+) Breast Cancer
|
24.1. . Courses of Treatment. Neoadjuvant chemotherapy (#3 cycles of. docetaxel and carboplatin and trastuzumab and. pertuzumab) + Operation + Post-operative radia. tion therapy + Trastuzumab and pertuzumab.. Operation. 176. . . HR(−) HER2(+) Breast Cancer. 526. Pathology Report. . 1. No residual tumor with stromal fibrosis.. . (a) Post-chemotherapy status.. . (b) Lymph nodes: no metastasis in two axil. lary lymph nodes (ypN0(sn)) (sentinel. LN: 0/2).. . 2. Sclerosing adenosis with microcalcification.. 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. 36% of tumor. cells. 25.
|
Important Radiologic. Findings. 168 169 170. 171. HR(−) HER2(+) Breast Cancer. 522. . . . Y. Kwon et al.. . After Neoadjuvant. Chemotherapy. 172 173 174
|
Patient History and Progress. Female/55 years old, pre-menopause.. Self-detected palpable mass lesion on left. breast 10–12 o’clock direction.. No family history.. Hypertension.. 24.2.
|
Case 24
|
HR(−) HER2(−) Breast Cancer
|
24.1. . Courses of Treatment. Neoadjuvant chemotherapy (#4 cycles of. doxorubicin and cyclophosphamide + #4. cycles of paclitaxel) + Operation + Post-. operative radiation therapy + Adjuvant. capecitabine.. Operation. 177. HR(−) HER2(−) Breast Cancer. 660. . . . . . E. S. Lee et al.. 661. . . . . . HR(−) HER2(−) Breast Cancer. 662. Pathology Report. Invasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of tumor: 2.7 cm (ypT2).. 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 54/10HPF).. 4. Intraductal component: present, intratu. moral/extratumoral (5%) (nuclear grade:. high, necrosis: absent, architectural pattern:. micropapillary, extensive intraductal compo. nent: absent).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) Superior margin: (see note).. . (b) Inferior margin: 15 mm.. . (c) Medial margin: 10 mm.. . (d) Lateral margin: 20 mm.. . (e) Deep margin: 10 mm.. . (f) Superficial margin: 2.5 mm.. 7. Lymph nodes: no metastasis in three axil. lary lymph nodes (ypN0(sn)) (sentinel. LN: 0/3).. . . E. S. Lee et al.. 663. 8. Arteriovenous invasion: absent.. 9. Lymphovascular invasion: absent.. . 10. Tumor border: infiltrative.. . 11. Microcalcification: present, non-tumoral.. . 12. Pathological TN category (AJCC 2017):. ypT2N0(sn).. Note: 1. The superior margin of the lumpec. tomy specimen (slide 3) is positive for invasive. ductal carcinoma, but this margin submitted for. frozen diagnosis (Fro 1) is free of tumor.. 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. 54% of tumor. cells. 25.
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Important Radiologic. Findings. 170 171. 172. After Neoadjuvant. Chemotherapy. 173 174 175. 176. 24.3.
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Patient History and Progress. Female/44 years old, pre-menopause.. Self-detected mass lesion on right breast.. Family history of breast cancer, aunt. (paternal).. Family history of ovarian cancer, sister.. No comorbidities.. BRCA 1 and 2 mutation: Not detected,. EPCAM and MLH1 VUS (variant of uncertain).. 24.2.
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Case 24
|
Local Recurrence
|
24.1. . Courses of Treatment. Left breast IDC → Neoadjuvant chemotherapy. → Operation → Adjuvant therapy → Left chest. wall recurrence (IDC).. Primary Treatment. 160 161 162. 163. Neoadjuvant Chemotherapy. #4 cycles of doxorubicin and cyclophosphamide. followed by #4 cycles of docetaxel.. Operation. 164. Pathology Report. Invasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of tumor: 5.0 cm (ypT2).. 3. Histologic grade: 3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 2/3, 16/10HPF).. 4. Intraductal component: present, intratu. moral/extratumoral (20%) (nuclear grade:. Local Recurrence. 782. . . . high, necrosis: present, architectural pattern:. solid/comedo, extensive intraductal compo. nent: absent).. 5. Skin and nipple: no involvement of tumor.. 6. Surgical margins:. . (a) Deep margin: <1 mm from invasive duc. tal carcinoma (slides 2 and 8).. . (b) Superficial margin: 20 mm.. 7. Lymph nodes: no metastasis in 17 axillary. lymph nodes (ypN0) (sentinel LN: 0/6, non-. sentinel LN: 0/11).. 8. Arteriovenous invasion: present, intratumoral.. 9. Lymphovascular. invasion:. present,. intratumoral.. . 10. Tumor border: infiltrative.. . 11. Microcalcification:. present,. tumoral/. non-tumoral.. . 12. Pathological TN category (AJCC 2017):. ypT2N0.. Y. Kim et al.. 783. . . . . Result. Intensity. Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Equivocal (2+). (SISH negative). Ki-67. Positive in 46%. of tumor cells. Adjuvant Therapy. Postoperative radiation therapy.. Adjuvant. chemotherapy. #8. cycles. of. capecitabine.. Treatments After Recurrence. 165. 166. Operation. 167. Pathology Report. Invasive Ductal Carcinoma. 1. Post-modified radical mastectomy status.. 2. Size of tumor: 1.0 cm (rpT1b).. 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 10/HPF).. 4. Intraductal component: absent.. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) Superior margin: 8 mm.. . (b) Inferior margin: 10 mm.. . (c) Medial margin: 20 mm.. . (d) Lateral margin: 5 mm.. . (e) Deep margin: 9 mm.. . (f) Superficial margin: 3 mm.. Local Recurrence. 784. 7. Arteriovenous invasion: absent.. 8. Lymphovascular invasion: absent.. 9. Tumor border: infiltrative.. . 10. Microcalcification: absent.. . 11. Pathological TN category (AJCC 2017):. rpT1b.. 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 72%. of tumor cells. Adjuvant Therapy. Adjuvant chemotherapy #8 cycles of paclitaxel.. 25.
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Patient History and Progress. Female/45 years old, pre-menopause.. Screen detected mass lesion on upper outer. portion of left breast.. Outside result of biopsy: Invasive ductal. carcinoma.. Family history of breast cancer, maternal aunt,. another aunt.. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 24.2.
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Case 24
|
Metastatic Breast Cancer
|
Courses of Treatment. Right breast cancer → Operation → Adjuvant. therapy → Lung metastasis.. Primary Treatment. Estrogen. receptor. Strong (7/7). 3. >2/3. Result. Intensity. Positive %. Progesterone. receptor. Strong (7/7). 3. >2/3. C-erbB2. Negative (1+). Ki-67. Positive in. 30% of tumor. cells. Adjuvant Therapy. Adjuvant chemotherapy #8 cycles (Adriamycin +. Cyclophosphamide #4 → Docetaxel #4).. Post-operative radiation therapy + Tamoxifen. 20 mg/day → Letrozole 2.5 mg/day.. Treatments After Recurrence. >2/3. Progesterone. receptor. Intermediate. (6/8). 2. 1/3–2/3. C-erbB2. Negative (1+). Ki-67. Positive in 7%. of tumor cells. Palliative Therapy
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24.2.
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Case 25
|
Benign and Proliferative
|
25.1. . Courses of Treatment. →2021-07-27 excision, Lt.. Diagnosis. • Breast, left, excision:. –. – Atypical ductal hyperplasia involving. intraductal papilloma.. –. – Tubular adenoma.. 26.
|
Important Radiologic. Findings. 49. 50. Benign and Proliferative Case Series. 48. . . 25.3.
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Patient History and Progress. Female/46 years old, pre-menopause.. Screen detected mass lesion on left breast 3. o’clock direction.. Outside result of biopsy: Intraductal papilloma.. No family history.. No comorbidities.. 25.2.
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Case 25
|
Carcinoma In Situ
|
25.1. . Courses of Treatment. Operation + Postoperative radiation therapy. (Left) + Tamoxifen 20 mg/day for 5 years.. Operation. 116. 117. Pathology Report. Right.. Lobular carcinoma in situ. . 1. Size of tumor: 0.3 cm.. . 2. Nuclear grade: low.. . 3. Necrosis: absent.. . 4. Architectural pattern: solid.. . 5. Skin: no involvement of tumor.. . 6. Surgical margins:. . (a) superior margin: 2 mm,. . (b) inferior margin: 5 mm,. . (c) medial margin: 2 mm,. . (d) lateral margin: 2 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: 2 mm.. . 7. Microcalcification:. present,. tumoral/non-. tumoral.. Left.. Invasive ductal carcinoma, pathological TN. category (AJCC 2017): pT1cN0(sn). 1. Size of invasive component: 1.5 cm (pT1c).. 2. Size of intraductal component: 5.0 cm.. Carcinoma In Situ. 108. . a. b. c. d. . . E. S. Lee et al.. 109. 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 4/HPF).. 4. Intraductal component: present, intratu. moral/extratumoral (70%) (nuclear grade:. high, necrosis: present, architectural pattern:. cribriform/solid/comedo, extensive intra. ductal component: present).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) superior margin: 5 mm,. . (b) inferior margin: 10 mm,. . (c) medial margin: 10 mm,. . (d) lateral margin: 10 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: <1 mm from ductal. carcinoma in situ (slide 2).. 7. Lymph nodes: no metastasis in one axillary. lymph node (pN0(sn)) (sentinel LN: 0/1).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular. invasion:. present,. intratumoral.. . 10. Tumor border: infiltrative.. . 11. Microcalcification: present, tumoral/non-. tumoral.. Result. Intensity. Positive %. Estrogen. receptor. Strong (7/8). 3. 1/3–2/3. Progesterone. receptor. Strong (7/8). 3. 1/3–2/3. C-erbB2. Equivocal (2+). Ki-67. Positive in. 25% of tumor. cells. 26.
|
Important Radiologic. Findings. 114. 115. 25.3.
|
Patient History and Progress. Female/52 years old, pre-menopause.. Screen detected mass lesion on left breast. 1 o’clock direction.. Outside result of biopsy: Left breast 1 o’clock,. ductal carcinoma in situ, r/o invasion.. No family history.. S/P Robotic cholecystectomy (GB stone).. BRCA 1 and 2: Not examination.. 25.2.
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Case 25
|
HR(+) HER2(+) Breast Cancer
|
25.1. . Courses of Treatment. Operation + Adjuvant chemotherapy (#4. cycles of doxorubicin and cyclophosphamide. followed by #4 cycles of docetaxel and. . trastuzumab) + Post-operative radiation ther. apy + Trastuzumab + Letrozole 2.5 mg/day.. . 145. 146. Pathology Report. [Right].. . 1. Invasive Ductal Carcinoma. . (a) Size of tumor: 1.2 cm (pT1c).. . (b) Histologic grade: 2/3 (tubule formation:. 2/3, nuclear pleomorphism: 2/3, mitotic. count: 3/3, 15/10 HPF).. . (c) Intraductal component: present, extratu. moral (30%) (nuclear grade: low, necro. sis:. present,. architectural. pattern:. cribriform/solid/comedo, extensive intra. ductal component: absent).. . (d) Skin: no involvement of tumor.. . (e) Surgical margins:. • superior margin: 8 mm,. • inferior margin: 15 mm,. • medial margin: 15 mm,. • lateral margin: 15 mm,. • deep margin: 2 mm,. • superficial margin: 10 mm.. . (f) Lymph nodes: no metastasis in one axil. lary lymph node (pN0(sn)) (sentinel LN:. 0/1).. . (g) Arteriovenous invasion: absent.. . (h) Lymphovascular. invasion:. present,. peritumoral.. . . . S. Park et al.. hyperplasia, (2) microcalcification.. 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 26%. of tumor cells. [Left].. Invasive ductal carcinoma with micropapil. lary pattern.. 1. Size of tumor: 1.1 cm (pT1c).. 2. Histologic grade: 2/3 (tubule formation: 2/3,. nuclear pleomorphism: 2/3, mitotic count:. 2/3, 6/10 HPF).. 3. Intraductal component: present, extratumoral. (26%) (nuclear grade: low, necrosis: absent,. HR(+) HER2(+) Breast Cancer. 384. . . architectural pattern: micropapillary/cribri. form, extensive intraductal component:. absent).. 4. Surgical margins:. . (a) superior margin: 16 mm,. . (b) inferior margin: (see note),. . (c) medial margin: 20 mm,. . (d) lateral margin: (see note),. . (e) deep margin: 2 mm,. . (f) superficial margin: <1 mm from invasive. ductal carcinoma (slides 2 and 3).. 5. Lymph nodes:. . (a) metastasis in one out of seven axillary. lymph nodes (pN1a) (sentinel LN: 1/3,. non-sentinel LN: 0/4),. S. Park et al.. 385. a. b. . a. b. . . (b) perinodal extension: absent,. . (c) size of metastatic carcinoma: 6 mm.. 6. Arteriovenous invasion: absent.. 7. Lymphovascular invasion: absent.. 8. Tumor border: infiltrative.. 9. Microcalcification: present, tumoral.. . 10. Pathological TN category (AJCC 2017):. pT1cN1a.. HR(+) HER2(+) Breast Cancer. 386. Note: 1. The inferior margin of the lumpec. tomy specimen (slides 2 and 3) is close to inva. sive ductal carcinoma (<1 mm) but this margin. submitted for frozen diagnosis (Fro 3) is free of. tumor.. 2. The lateral margin of the lumpectomy spec. imen (slide 8) is close to ductal carcinoma in situ. (<1 mm) but this margin submitted for frozen. diagnosis (Fro 5) 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. Equivocal (2+). Ki-67. Positive in 19%. of tumor cells. SISH. Negative. 26.
|
Important Radiologic. Findings. 141 142 143. 144. 25.3.
|
Patient History and Progress. Female/62 years old, post-menopause.. Screen detected mass lesion on right breast 5. o’clock direction and left breast subareolar area.. No family history.. Hypertension, dyslipidemia.. 25.2.
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Case 25
|
HR(+) HER2(-) Breast Cancer
|
Courses of Treatment. Neoadjuvant therapy (giredestrant 30 mg/day. with palbociclib 100 mg/day) + Operation +. Adjuvant chemotherapy (#4 cycles of doxorubi. cin & cyclophosphamide followed by #4 cycles of. docetaxel) + Post-. operative radiation ther. apy + Letrozole 2.5 mg/day.. Operation. Left breast conserving surgery, axillary lymph. solid/comedo, extensive intraductal compo. nent: absent).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (f) superficial margin: 2 mm.. 7. Lymph nodes:. . (a) metastasis in eight out of twelve axillary. lymph nodes (ypN2a) (sentinel LN: 2/2,. axillary LN: 6/10). . (b) perinodal extension: present.. . (c) size of metastatic carcinoma: 5 mm.. 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):. ypT1cN2a.. Y. Kim et al.. 1/3–2/3. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Negative (0). Ki-67. Positive in 43%. of tumor cells. 26.
|
Important Radiologic. Findings. See Figs. 139, 140, 141, 142 and 143.. 25.3.
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o’clock direction and left axillary LN.. No family history.. No comorbidities.. 25.2.
|
Case 25
|
HR(−) HER2(+) Breast Cancer
|
25.1. . Courses of Treatment. Operation + Post-operative radiation therapy. (adjuvant chemotherapy refuse).. Operation. 180. Pathology Report. Invasive Ductal Carcinoma. 1. Size of invasive component: 2.5 cm (pT2).. 2. Size of intraductal component: 4.0 cm.. 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 2/3, 11/10HPF).. 4. Intraductal component: present, intratu. moral/extratumoral (50%) (nuclear grade:. high, necrosis: present, architectural pattern:. cribriform/solid/comedo, extensive intra. ductal component: present).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) superior margin: 15 mm,. . (b) inferior margin: positive for ductal carci. noma in situ (Fro 2) (see note),. . (c) medial margin: 10 mm,. . (d) lateral margin: 20 mm,. . (e) deep margin: <2 mm from ductal carci. noma in situ (slide 11),. . (f) superficial margin: 13 mm.. 7. Lymph nodes:. . (a) metastasis in two out of four axillary. lymph nodes (pN1a(sn)) (sentinel LN:. 2/4),. . (b) perinodal extension: present,. . (c) size of metastatic carcinoma: 8 mm.. 8. Arteriovenous invasion: absent.. 9. Lymphovascular. invasion:. present,. peritumoral.. HR(−) HER2(+) Breast Cancer. 528. a. b. . . 10. Tumor border: infiltrative.. . 11. Microcalcification:. present,. . tumoral/. non-tumoral.. . 12. Pathological TN category (AJCC 2017):. pT2N1a(sn).. Note: 1. Ductal carcinoma in situ is focally. present only in the permanent section of Fro 2.. 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. 52% of. tumor cells. 26.
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Important Radiologic Findings. 177 178. 179. . Y. Kwon et al.. 527. . . . 25.3.
|
Patient History and Progress. Female/82 years old, post-menopause.. Screen detected mass lesion on left breast 2:30. o’clock direction.. No family history.. S/P Left hemiplegia (due to brain hemor. rhage), hypertension, S/P spinal stenosis opera. tion, s/p Tuberculosis.. 25.2.
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Case 25
|
HR(−) HER2(−) Breast Cancer
|
25.1. . Courses of Treatment. Neoadjuvant chemotherapy (#4 cycles of doxo. rubicin and cyclophosphamide + #4 cycles of. docetaxel) + Operation + Post-operative radia. tion therapy + Adjuvant capecitabine.. Operation. 185. Pathology Report. Invasive Ductal Carcinoma with (a) focal squa. mous differentiation, (b) focal papillary pattern.. 1. Post-chemotherapy status.. 2. Size of tumor: 1.2 cm (ypT1c).. 3. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 1/3, <1/10HPF).. 4. Intraductal component: present, intratumoral/. extratumoral (15%) (nuclear grade: high,. necrosis: absent, architectural pattern: papil. lary, extensive intraductal component: absent).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) Superior margin: 10 mm.. . (b) Inferior margin: 15 mm.. . (c) Medial margin: 10 mm.. . (d) Lateral margin: 35 mm.. . (e) Deep margin: 6 mm.. . (f) Superficial margin: 15 mm.. 7. Lymph nodes: no metastasis in two axillary. lymph nodes (ypN0(sn)) (sentinel LN: 0/1,. non-sentinel LN: 0/1).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular invasion: absent.. . 10. Tumor border: infiltrative.. . 11. Microcalcification: absent.. . 12. Pathological TN category (AJCC 2017):. ypT1cN0(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 28%. of tumor cells. HR(−) HER2(−) Breast Cancer. 664. . . . . E. S. Lee et al.. 665. . . . . HR(−) HER2(−) Breast Cancer. 666. . . E. S. Lee et al.. 667. 26.
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Important Radiologic. Findings. 178 179. 180. 25.3. . After Neoadjuvant. Chemotherapy. 181 182 183. 184. 25.4.
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Patient History and Progress. Female/70 years old, post-menopause.. Screen detected mass lesion on left breast 2. o’clock direction.. Family history of breast cancer, cousin. (paternal).. Macular degeneration.. BRCA 1 and 2 mutation: Not tested.. 25.2.
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Case 25
|
Local Recurrence
|
25.1. . Courses of Treatment. Left breast IDC → Operation → Adjuvant ther. apy → Left breast recurrence (DCIS).. Primary Treatment. Operation. Nov. 2007 Left breast conserving surgery, axil. lary lymph node dissection (outside).. Pathology Report. Invasive Ductal Carcinoma. . 1. Size of tumor: 1.1 cm (pT1c).. . 2. Histologic grade: 3/3.. . 3. Lymph nodes: three metastases in fourteen. axillary lymph nodes (pN1).. Result. Intensity. Positive %. Estrogen. receptor. Negative (0/7). 0. 0. Progesterone. receptor. Strong (6/7). 3. 1/3–2/3. C-erbB2. Equivocal (2+). (SISH negative). Adjuvant Therapy. Adjuvant chemotherapy #4 cycles of doxorubicin. and cyclophosphamide followed by #4 cycles of. docetaxel.. Postoperative radiation therapy.. Letrozole 2.5 mg/day for 5 years.. Treatments After Recurrence. 168. Operation. 169. Pathology Report. Ductal Carcinoma In Situ with apocrine dif. ferentiation involving fibroadenoma. . 1. Post-lumpectomy status.. . 2. Size of tumor: 0.6 cm (rpTis).. . 3. Nuclear grade: low.. . 4. Necrosis: present.. . 5. Architectural. pattern:. cribriform/solid/. comedo.. . Y. Kim et al.. 785. Intensity. Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Equivocal (2+). Ki-67. Positive in 9%. of tumor cells. 26.
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Patient History and Progress. Female/69 years old, post-menopause.. For chemotherapy after left breast cancer. surgery.. No family history.. s/p Left breast conserving surgery, s/p total. Thyroidectomy (thyroid cancer).. s/p. Hysterectomy. and. bilateral. salpingo-oophorectomy.. 25.2.
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Case 25
|
Metastatic Breast Cancer
|
Courses of Treatment. Left breast cancer → Operation → Adjuvant. therapy → Ipsilateral breast skin metastasis.. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative (0). Ki-67. Positive in. 7% of tumor. cells. Adjuvant Therapy. Tamoxifen 20 mg/day for 0.75 year.. Treatments After Recurrence. See Figs. 89 and 90.. Jun. 2021 Left breast skin biopsy.. Pathology: Invasive ductal carcinoma, clini. cally recurrent.. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Intermediate. (5/8). 2. 10%–1/3. C-erbB2. Negative (1+). Ki-67. Positive in. 40% of tumor. cells. Strong (8/8). 3. >2/3. C-erbB2. Equivocal (2+). Ki-67. Positive in. 42% of tumor. cells. SISH. Negative. Oncotype Dx RS scores: 39.. Adjuvant Therapy. → Adjuvant chemotherapy #4 (Docetaxel &. Cyclophosphamide). → Letrozole 2.5 mg/day ~. 26.
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Hyperthyroidism,. s/p. bilateral. salpingo-oophorectomy.. 25.2.
|
Case 26
|
Benign and Proliferative
|
26.1. . Courses of Treatment. →2021-06-16 excision, Rt.. Pathology Report. Diagnosis. • Breast, right, excision:. –. – Intraductal papilloma with usual ductal. hyperplasia.. . . Benign and Proliferative Case Series. 50. 27.
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Important Radiologic. Findings. 51. 52. 26.3.
|
Patient History and Progress. Female/72 years old, post-menopause.. Screen detected nodular asymmetry on outer. central portion of right breast.. No family history.. s/p Total thyroidectomy (thyroid cancer).. C. W. Lee et al.. 49. 26.2.
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Case 26
|
Carcinoma In Situ
|
26.1. . Courses of Treatment. Operation + Tamoxifen 20 mg/day for 5 years.. Operation. 121. 122. Pathology Report. Lobular carcinoma in situ, pathological TN. category (AJCC 2017): pTis. . 1. Size of tumor: up to 0.6 cm (pTis).. . 2. Nuclear grade: low.. . . . Carcinoma In Situ. 110. . 3. Necrosis: absent.. . 4. Architectural pattern: solid.. . 5. Surgical margins:. . (a) superior margin: 5 mm,. . (b) inferior margin: 5 mm,. . (c) medial margin: 10 mm,. . (d) lateral margin: 20 mm,. . (e) deep margin: 5 mm,. . (f) superficial margin: <1 mm from lobular. carcinoma in situ (slide 2).. . 6. Microcalcification: absent.. Result. Intensity. Positive %. Estrogen. receptor. Intermediate. (6/8). 2. 1/3–2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Equivocal (2+). Ki-67. Positive in 4%. of tumor cells. . a. b. . E. S. Lee et al.. 111. a. b. . . . 27.
|
Important Radiologic. Findings. 118 119. 120. 26.3.
|
Patient History and Progress. Female/48 years old, pre-menopause.. Screen detected mass and microcalcification. on upper portion of right breast.. No family history.. No comorbidities.. 26.2.
|
Case 26
|
HR(+) HER2(+) Breast Cancer
|
26.1. . Courses of Treatment. Neoadjuvant chemotherapy (#6 cycles of. docetaxel and carboplatin and trastuzumab. and pertuzumab) + Operation + Post-. operative radiation therapy + Trastuzumab +. Letrozole 2.5 mg/day.. 153. 154. Pathology Report. Invasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of tumor: 2.3 cm (ypT2).. . . HR(+) HER2(+) Breast Cancer. moral/extratumoral (50%) (nuclear grade:. high, necrosis: present, architectural pattern:. solid/comedo, extensive intraductal compo. nent: present).. 5. Surgical margins:. . (a) deep margin: <1 mm from ductal carci. noma in situ (slides 1 and 2),. . (b) superficial margin: <1 mm from ductal. carcinoma in situ (slide 3).. S. Park et al.. 389. a. b. . . 6. Lymph nodes: no metastasis in three axillary. lymph nodes (ypN0(sn)) (sentinel LN: 0/3).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular invasion: absent.. 9. Tumor border: infiltrative.. . 10. Microcalcification: present, tumoral.. . 11. Pathological TN category (AJCC 2017):. ypT2N0(sn).. Result. Intensity. Positive. %. Estrogen. receptor. Weak (4/8). 2. 1–10%. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in 46%. of tumor cells. HR(+) HER2(+) Breast Cancer. 390. 27.
|
Important Radiologic. Findings. 147 148 149 150 151. 152. . S. Park et al.. 387. 26.3.
|
Patient History and Progress. Female/61 years old, post-menopause.. Self-detected palpable mass lesion on right. breast 11 o’clock direction.. No family history.. S/P. Tuberculosis,. diabetes. mellitus,. dyslipidemia.. 26.2.
|
Case 26
|
HR(+) HER2(-) Breast Cancer
|
26.1. . Courses of Treatment. Operation + Adjuvant chemotherapy (#4 cycles. of doxorubicin & cyclophosphamide) + Post-. operative radiation therapy + Tamoxifen. 20 mg/day.. Operation. Left breast conserving surgery, sentinel lymph. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) superior margin: 25 mm.. Y. Kim et al.. (f) superficial margin: 15 mm.. 6. Lymph nodes: no metastasis in two axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/2). 7. Arteriovenous invasion: absent.. 8. Lymphovascular invasion: absent.. 9. Tumor border: infiltrative.. . 10. Microcalcification:. present,. . tumoral/. non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT1cN0(sn).. Result. Intensity Positive %. Estrogen. receptor. Strong (7/8). 2. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative (0). Result. Intensity Positive %. Ki-67. Positive in 62%. of tumor cells. 27.
|
Important Radiologic. Findings. See Figs. 145, 146, 147 and 148.. 26.3.
|
Patient History and Progress. Female/48 years old, pre-menopause.. Screen detected mass lesion on left breast 1. o’clock direction.. Family history of breast cancer, maternal aunt.. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 26.2.
|
Case 26
|
HR(−) HER2(+) Breast Cancer
|
26.1. . Courses of Treatment. Operation + Adjuvant chemotherapy (#4 cycles. of doxorubicin + cyclophosphamide) + Post-. operative radiation therapy + Trastuzumab.. Operation. 184. Pathology Report. Invasive Ductal Carcinoma with medullary. pattern. 1. Size of tumor: 1.5 cm (pT1c).. 2. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 2/3, 12/10HPF).. 3. Intraductal component: present, intratu. moral/extratumoral (5%) (nuclear grade:. high, necrosis: absent, architectural pattern:. solid, extensive intraductal component:. absent).. HR(−) HER2(+) Breast Cancer. 530. . 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) superior margin: 20 mm,. . (b) inferior margin: 5 mm,. . (c) medial margin: 5 mm,. . (d) lateral margin: 5 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: 2 mm.. 6. Lymph nodes: no metastasis in one axillary. lymph node (pN0(sn)) (sentinel LN: 0/1).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular. invasion:. present,. intratumoral.. 9. Tumor border: infiltrative.. . 10. Microcalcification:. present,. tumoral/. non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT1cN0(sn).. Result. Intensity. Positive %. Estrogen. receptor. Negative. (0/8). 0. 0. Progesterone. receptor. Negative. (2/8). 1. <1%. C-erbB2. Positive (3+). Ki-67. Positive in. 23% of. tumor cells. Y. Kwon et al.. 531. 27.
|
Important Radiologic. Findings. 181 182. 183. Y. Kwon et al.. 529. . . . 26.3.
|
Patient History and Progress. Female/49 years old, pre-menopause.. Self-detected palpable mass lesion on right. breast 1 o’clock direction.. No family history.. No comorbidities.. 26.2.
|
Case 26
|
HR(−) HER2(−) Breast Cancer
|
26.1. . Courses of Treatment. Neoadjuvant chemotherapy (#4 cycles of. doxorubicin and cyclophosphamide + #3. cycles of docetaxel + Trastuzumab) + Operati. on + Adjuvant capecitabine + Trastuzumab.. Operation. 193 194. 195. Pathology Report. <Right>. No residual tumor with stromal fibrosis. . 1. Post-chemotherapy status.. . 2. Lymph nodes: no metastasis in two axillary. lymph nodes (ypN0(sn)) (sentinel LN: 0/2).. <Left>. Invasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of tumor: 1.8 cm (ypT1c).. 3. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, <1/10HPF).. 4. Intraductal component: present, intratumoral. (60%) (nuclear grade: high, necrosis: absent,. architectural pattern: solid, extensive intra. ductal component: present).. 5. Surgical margins:. . (a) Deep margin: 1 mm from ductal carci. noma in situ (slide 3).. . (b) Superficial margin: 13 mm.. 6. Lymph nodes:. . (a) Metastasis in one out of eight axillary. lymph nodes (ypN1mi) (see note). (sentinel LN: 1/2, non-sentinel LN:. 0/6).. . (b) Perinodal extension: absent.. . (c) Size of metastatic carcinoma: 0.5 mm.. 7. Arteriovenous invasion: absent.. 8. Lymphovascular. invasion:. present,. intratumoral.. 9. Tumor border: infiltrative.. HR(−) HER2(−) Breast Cancer. 668. . . . . E. S. Lee et al.. 669. . . . . HR(−) HER2(−) Breast Cancer. 670. . 10. Microcalcification: present, non-tumoral.. . 11. Pathological TN category (AJCC 2017):. ypT1cN1mi.. Note: 1. Micrometastasis is present only in the. permanent section of Fro 3.. Result. Intensity Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Negative (0). Ki-67. Positive in 1%. of tumor cells. . . . E. S. Lee et al.. 671. 27.
|
Important Radiologic Findings. 186 187. 188. Breast, right, needle biopsy: Invasive ductal car. cinoma, histologic grade 3 with medullary pattern.. Result. Intensity Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Negative (1+). Ki-67. Positive in 51%. of tumor cells. Breast, left, needle biopsy: Invasive ductal. carcinoma, histologic grade 3.. Result. Intensity Positive %. Estrogen. receptor. Negative (2/8). 1. <1%. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Equivocal (2+). Ki-67. Positive in 39%. of tumor cells. SISH. Tumor. heterogeneity. After Neoadjuvant. Chemotherapy. 189 190 191. 192. 26.3.
|
Patient History and Progress. Female/53 years old, post-menopause.. Self-detected mass lesion on right breast.. Family history of breast cancer, grandmother.. Family history of ovarian cancer, sister.. S/P appendectomy, s/p bilateral salpingo-. oophorectomy, s/p left shoulder operation.. BRCA 1 mutation carrier.. 26.2.
|
Case 26
|
Local Recurrence
|
26.1. . Courses of Treatment. Right breast DCIS→ Operation → Adjuvant. therapy → Right breast recurrence (IDC).. Primary Treatment. 170. 171. Local Recurrence. 786. a. b. . . Operation. 172. Pathology Report. Ductal Carcinoma In Situ. . 1. Post-excisional biopsy status.. . 2. Size of tumor: 2.0 cm, residual.. . 3. Nuclear grade: low.. . 4. Necrosis: absent.. . 5. Architectural. pattern:. cribriform. and. papillary.. . 6. Skin: no involvement of tumor.. . 7. Surgical margins:. . (a) Superior margin: 25 mm.. . (b) Inferior margin: 7 mm.. . (c) Medial margin: 30 mm.. . (d) Lateral margin: 20 mm.. . (e) Deep margin: 3 mm.. . (f) Superficial margin: 13 mm.. . 8. Microcalcification: absent.. Result. Intensity. Positive %. Estrogen. receptor. Strong (7/8). 2. >2/3. Progesterone. receptor. Strong (8/8). 2. >2/3. C-erbB2. Negative (0). Ki-67. Positive in 5%. of tumor cells. Adjuvant Therapy. Postoperative radiation therapy.. Treatments After Recurrence. 173. 174. Operation. . 175. Pathology Report. Invasive Ductal Carcinoma. 1. Post-lumpectomy status.. 2. Size of tumor: 1.2 cm (rpT1c).. 3. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 2/3, 11/10HPF).. Y. Kim et al.. 787. 4. Intraductal component: present, intratu. moral/extratumoral (10%) (nuclear grade:. low, necrosis: absent, architectural pattern:. cribriform, extensive intraductal component:. absent).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) Deep margin: 2 mm.. . (b) Superficial margin: 2 mm.. 7. Lymph nodes: not submitted.. 8. Arteriovenous invasion: absent.. 9. Lymphovascular. invasion:. present,. intratumoral.. . 10. Tumor border: infiltrative.. . 11. Microcalcification:. present,. tumoral/. non-tumoral.. . 12. Pathological TN category (AJCC 2017):. rpT1c.. . . Local Recurrence. 788. . . Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 2. >2/3. Progesterone. receptor. Strong (8/8). 2. >2/3. C-erbB2. Negative (1+). Ki-67. Positive in 11%. of tumor cells. Adjuvant Therapy. Anastrozole 1 mg/day.. 27.
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Patient History and Progress. Female/40 years old, post-menopause.. Bloody nipple discharge from right breast.. Outside result of biopsy: Ductal carcinoma in. situ.. No family history.. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 26.2.
|
Case 26
|
Metastatic Breast Cancer
|
26.1. . Courses of Treatment. Right breast cancer → Operation → Adjuvant. therapy → Stomach and bone metastasis.. Primary Treatment. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative (1+). Ki-67. Positive in. 29% of tumor. cells. Left> Invasive lobular carcinoma, stage. pT1c(m)N1mi.. Size of tumor: up to 1.5 cm, multiple, lymph. node: 2/7, size of metastatic carcinoma: 1.5 mm.. Result. Intensity Positive %. Estrogen. receptor. Strong (7/8). 2. >2/3. Progesterone. receptor. Strong (7/8). 3. 1/3–2/3. C-erbB2. Negative (0). Ki-67. Positive in. 17% of tumor. cells. Adjuvant Therapy. Adjuvant chemotherapy #8 cycles (Adriamycin. & Cyclophosphamide #4 → Docetaxel #4).. Post-operative radiation therapy +Tamoxifen. 20 mg/day for 5 years.. Treatments After Recurrence. See Figs. 93 and 94.. May 2018 Metastasis on stomach, bone.. Stomach biopsy Pathology: Metastatic ductal. carcinoma.. Result. Intensity. Positive %. Estrogen. receptor. Intermediate. (6/8). 2. 1/3–2/3. Progesterone. receptor. Strong (7/8). 3. 1/3–2/3. C-erbB2. Negative (0). Ki-67. Positive in. 8% of tumor. cells. Palliative Therapy. Bilateral salpingo-oophorectomy.. Letrozole 2.5 mg/day + Palbociclib~. Total gastrectomy.. Y. Kwon et al.
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Patient History and Progress. Female/54 years old, post-menopause.. No family history.. S/p cholecystectomy, s/p total gastrectomy (gas. tric cancer), s/p bilateral salpingo-oophorectomy.. 26.2.
|
Case 27
|
Benign and Proliferative
|
27.1. . Courses of Treatment. →2021-06-07 excision, Rt.. Pathology Report. Diagnosis. • Breast, right, excision:. –. – Intraductal papilloma with usual ductal. hyperplasia.. . C. W. Lee et al.. 51. © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023. E. S. Lee (ed.), A Practical Guide to Breast Cancer Treatment,. https://doi.org/10.1007/978-981-19-9044-1_3
|
Important Radiologic. Findings. 53. 27.3.
|
Patient History and Progress. Female/41 years old, pre-menopause.. Screen detected mass lesion on right breast 4. o’clock direction.. Outside result of biopsy: Papillary neoplasm.. No family history.. No comorbidities.. 27.2.
|
Case 27
|
Carcinoma In Situ
|
27.1. . Courses of Treatment. Operation + Tamoxifen 20 mg/day for 5 years.. Operation. 126. 127. Pathology Report. Lobular carcinoma in situ, pathological TN. category (AJCC 2017): pTis. . 1. Size of tumor: 1.5 cm(pTis).. . 2. Nuclear grade: low.. Carcinoma In Situ. 113. . 3. Necrosis: absent.. . 4. Architectural pattern: solid.. . 5. Skin: no involvement of tumor.. . 6. Surgical margins:. . (a) superior margin: 50 mm,. . (b) inferior margin: (see Note 1),. . (c) medial margin: 5 mm,. . (d) lateral margin: 10 mm,. . (e) deep margin: positive for lobular carci. noma in situ (slide 1),. . (f) superficial margin: 5 mm.. . 7. Microcalcification: absent.. Note: 1. The inferior margin of the lumpec. tomy specimen (slide 4) is close to lobular. carcinoma in situ (<1 mm) but this margin. submitted for frozen diagnosis (Fro 2) is free. of tumor.. Result. Intensity. Positive %. Estrogen. receptor. Strong (7/8). 2. >2/3. Progesterone. receptor. Strong (7/8). 2. >2/3. C-erbB2. Negative (0). Ki-67. Positive in 2%. of tumor cells. 28.
|
Important Radiologic. Findings. 123 124. 125. 27.3.
|
Patient History and Progress. Female/50 years old, pre-menopause.. Screen detected mass lesion on left breast. 2 o’clock direction.. Outside result of mammotome biopsy:. Lobular carcinoma in situ.. No family history.. 27.2.
|
Case 27
|
HR(+) HER2(+) Breast Cancer
|
27.1. . Courses of Treatment. Neoadjuvant chemotherapy (#6 cycles of. docetaxel and carboplatin and trastuzumab. and pertuzumab) + Operation + Post-. operative. radiation. ther. apy + Trastuzumab + Tamoxifen 20 mg/day.. . 160. 161. Pathology Report. [Right].. . 1. Ductal carcinoma in situ involving sclerosing. adenosis.. . (a) Post-chemotherapy status.. . (b) Size of tumor: 0.3 cm (ypTis).. . (c) Nuclear grade: low.. . (d) Necrosis: absent.. . (e) Architectural pattern: cribriform/solid.. . (f) Skin: no involvement of tumor.. . (g) Surgical margins:. • superior margin: 10 mm,. • inferior margin: 20 mm,. • medial margin: 5 mm,. • lateral margin: 15 mm,. • deep margin: 5 mm,. • superficial margin: 5 mm.. . (h) Microcalcification: present, non-tumoral.. . (i) Pathological TN category (AJCC 2017):. ypTis.. . 2. Fibroadenoma.. Result. Intensity. Positive. %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Intermediate. (5/8). 2. 10%-. 1/3. C-erbB2. Negative (0). Ki-67. Positive in <1%. of tumor cells. [Left].. Invasive ductal carcinoma, histologic grade 2. with extensive intraductal component. . 1. No residual tumor with (1) necrotic detritus,. (2) foamy histiocytic collection.. . (a) Post-chemotherapy status. . (b) Lymph nodes: no metastasis in one axil. lary lymph node (ypN0(sn)) (sentinel LN:. 0/1). . (c) Microcalcification: present, non-tumoral. . 2. Sclerosing adenosis with microcalcification.. Result. Intensity. Positive. %. Estrogen. receptor. Strong (7/8). 3. 1/3–2/3. Progesterone. receptor. Weak (3/8). 1. 1–10%. C-erbB2. Positive (3+). Ki-67. Positive in 32%. of tumor cells. HR(+) HER2(+) Breast Cancer. 392. . . S. Park et al.. 393. . a. b. . HR(+) HER2(+) Breast Cancer. 394. a. b. . . 28.
|
Important Radiologic. Findings. 155 156 157 158. 159. . S. Park et al.. 391. . . 27.3.
|
Patient History and Progress. Female/52 years old, peri-menopause.. Self-detected palpable mass lesion on left. breast 11 o’clock direction.. Family history of breast cancer, cousin. (maternal).. s/p Ovarian cyst excision.. BRCA 1 and 2 mutation: Not detected, NBN. VUS (variant of uncertain).. 27.2.
|
Case 27
|
HR(+) HER2(-) Breast Cancer
|
27.1. . ductal component: present).. 4. Surgical margins:. . (a) superior margin: positive for ductal car. cinoma in situ (Fro 1) (see note 1).. . (b) inferior margin: 25 mm.. . (c) medial margin: (see note 2).. . (d) lateral margin: 15 mm.. . (e) deep margin: <1 mm from invasive duc. tal carcinoma (slide 7).. . (f) superficial margin: <1 mm from invasive. ductal carcinoma (slide 6).. 5. Lymph nodes: no metastasis in one axillary. lymph node (pN0(sn)) (sentinel LN: 0/1). 6. Arteriovenous invasion: absent.. 7. Lymphovascular invasion: absent.. 8. Tumor border: infiltrative.. 9. Microcalcification: present, tumoral.. . 10. Pathological TN category (AJCC 2017):. pT2N0(sn).. HR(+) HER2(−) Breast Cancer. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Intermediate. (6/8). 2. 1/3–2/3. C-erbB2. Negative (1+). Ki-67. Positive in 44%. of tumor cells. Y. Kim et al.
|
Important Radiologic. Findings. See Figs. 150, 151, 152 and 153.. Y. Kim et al.
|
Patient History and Progress. Female/60 years old, post-menopause.. Screen detected mass lesion on left breast 10. o’clock direction.. No family history.. No comorbidities.. 27.2.
|
Case 27
|
HR(−) HER2(+) Breast Cancer
|
27.1. . Courses of Treatment. Operation + Post-operative radiation ther. apy + Adjuvant paclitaxel and trastuzumab.. Operation. 188. Pathology Report. . 1. Invasive ductal carcinoma with medullary. pattern.. . (a) Size of tumor: 0.8 cm (pT1b).. . (b) Histologic grade: 3/3 (tubule formation:. 3/3, nuclear pleomorphism: 3/3, mitotic. count: 3/3, 4/HPF).. . (c) Intraductal component: present, intratu. moral/extratumoral (50%) (nuclear grade:. high, necrosis: absent, architectural pat. tern: solid, extensive intraductal compo. nent: present).. . (d) Skin: no involvement of tumor.. . (e) Surgical margins:. • superior margin: 5 mm,. • inferior margin: 20 mm,. • medial margin: 5 mm,. • lateral margin: 5 mm,. • deep margin: 1.5 mm from ductal car. cinoma in situ (slide 1),. • superficial margin: 2 mm.. . (f) Lymph nodes: no metastasis in one axil. lary lymph node (pN0(sn)) (sentinel LN:. 0/1).. . (g) Arteriovenous invasion: absent.. . (h) Lymphovascular. invasion:. present,. intratumoral.. a. b. . Y. Kwon et al.. 533. . (i) Tumor border: infiltrative.. . (j) Microcalcification:. present,. tumoral/. non-tumoral.. . (k) Pathological TN category (AJCC 2017):. pT1bN0(sn).. . 2. Intraductal papilloma with usual ductal. hyperplasia.. Result. Intensity. Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Equivocal(2+),. SISH(+). Ki-67. Positive in. 26% of tumor. cells. 28.
|
Important Radiologic. Findings. 185 186. 187. . . . HR(−) HER2(+) Breast Cancer. 532. 27.3.
|
Patient History and Progress. Female/69 years old, post-menopause.. Screen detected mass lesion on right breast 9. o’clock direction.. Family history of breast cancer, sister.. Hypertension, dyslipidemia.. BRCA 1 and 2 mutation: Not examination.. 27.2.
|
Case 27
|
HR(−) HER2(−) Breast Cancer
|
27.1. . Courses of Treatment. Neoadjuvant chemotherapy (#4 cycles of. doxorubicin and cyclophosphamide + #4. cycles of docetaxel) + Operation + Post-. operative radiation therapy + Adjuvant. capecitabine.. Operation. 203. Pathology Report. Invasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of tumor: 2.8 cm (ypT2).. 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 14/10HPF).. 4. Intraductal component: absent.. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) Superior margin: 5 mm.. . (b) Inferior margin: 5 mm.. . (c) Medial margin: 5 mm.. . (d) Lateral margin: 5 mm.. . (e) Deep margin: 2 mm.. . (f) Superficial margin: 2 mm.. 7. Lymph nodes: no metastasis in three axillary. lymph nodes (ypN0(i+)(sn)) (sentinel LN:. 0/2, axillary LN: 0/1).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular. invasion:. present,. intratumoral.. . 10. Tumor border: infiltrative.. . 11. Microcalcification:. present,. tumoral/. non-tumoral.. . 12. Pathological TN category (AJCC 2017):. ypT2N0(i+)(sn).. Note: 1. A few isolated tumor cells are present. only in the permanent section of Fro 6 for. . immunohistochemical staining.. HR(−) HER2(−) Breast Cancer. 674. . . . E. S. Lee et al.. 675. . . . Result. Intensity Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Negative (1+). Ki-67. Positive in 89%. of tumor cells. 28.
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Important Radiologic. Findings. 196 197 198. 199. . HR(−) HER2(−) Breast Cancer. 672. . . . . E. S. Lee et al.. 673. . After Neoadjuvant. Chemotherapy. 200 201. 202. 27.3.
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Patient History and Progress. Female/36 years old, pre-menopause.. Self-detected palpable mass lesion on left. breast.. Family history of breast cancer, aunt. (maternal).. No comorbidities.. BRCA 1 and 2 mutation: Not detected,. RAD50 VUS (variant of uncertain).. 27.2.
|
Case 27
|
Local Recurrence
|
27.1. . Courses of Treatment. Right breast tubular carcinoma → Operation. → Adjuvant therapy → Left breast recurrence. (IDC).. Primary Treatment. 176 177 178. 179. Operation. . 180. Pathology Report. Tubular Carcinoma. 1. Size of tumor: 1.5 cm (pT1c).. 2. Histologic grade: 1/3 (tubule formation: 1/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 2/10HPF).. Y. Kim et al.. 789. 3. Intraductal component: present, intratu. moral/extratumoral (5%) (nuclear grade:. low, necrosis: absent, architectural pattern:. cribriform, extensive intraductal component:. absent).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) Superior margin: 18 mm.. . (b) Inferior margin: 13 mm.. . (c) Medial margin: 10 mm.. . (d) Lateral margin: 10 mm.. . (e) Deep margin: 3 mm.. . (f) Superficial margin: 3 mm.. 6. Lymph nodes: no metastasis in one axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/1).. 7. Vascular invasion: absent.. 8. Lymphatic invasion: absent.. 9. Tumor border: infiltrative.. . 10. Microcalcification: present, tumoral.. . 11. Pathologic stage (AJCC 2010): pT1cN0(sn).. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative (1+). Ki-67. Positive in 11%. of tumor cells. . . a. b. . Local Recurrence. 790. Adjuvant Therapy. Postoperative radiation therapy.. Tamoxifen 20 mg/day for 5 years.. Treatments After Recurrence. 181 182. 183. Operation. . 184. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 0.3 cm (pT1a).. 2. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 6/10HPF).. 3. Intraductal component: present, intratu. moral/extratumoral (50%) (nuclear grade:. low, necrosis: absent, architectural pattern:. micropapillary/cribriform, extensive intra. ductal component: present).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) Superior margin: 10 mm.. . (b) Inferior margin: positive for invasive. ductal carcinoma (Fro 7) (see note).. . (c) Medial margin: 10 mm.. . (d) Lateral margin: 10 mm.. . (e) Deep margin: <1 mm from ductal carci. noma in situ (slide 1).. . (f) Superficial margin: 2 mm.. 6. Lymph nodes: no metastasis in two axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/2).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular invasion: absent.. 9. Tumor border: infiltrative.. . 10. Microcalcification:. present,. tumoral/. non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT1aN0(sn).. Note: 1. Invasive ductal carcinoma is focally. present only in the permanent section of Fro 7.. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Intermediate. (6/8). 3. 10%-1/3. C-erbB2. Negative (1+). Ki-67. Positive in 2%. of tumor cells. . . . . Y. Kim et al.. 791. a. b. . . . Operation. Second Operation (Dec. 2021) Left breast wide. excision.. Pathology Report. Atypical ductal hyperplasia. . 1. Post-lumpectomy status.. Adjuvant Therapy. Postoperative radiation therapy.. 28.
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Patient History and Progress. Female/57 years old, post-menopause.. Screen detected mass lesion on right breast 1. o’clock direction.. Outside result of biopsy: Invasive ductal. carcinoma.. Family history of breast cancer, younger. sister.. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 27.2.
|
Case 27
|
Metastatic Breast Cancer
|
Courses of Treatment. Left breast cancer → Operation → Adjuvant. therapy. →. Right. shoulder. soft. tissue. metastasis.. Primary Treatment. Estrogen. receptor. Strong (6/7). 3. 1/3–2/3. Progesterone. receptor. Weak (2/7). 1. <10%. C-erbB2. Equivocal. (2+). Ki-67. Positive in. 15% of tumor. cells. FISH. Negative. Adjuvant Therapy. Adjuvant chemotherapy #8 cycles (Adriamycin. & Cyclophosphamide #4 → Docetaxel #4).. Post-operative radiation therapy + Letrozole. 2.5 mg/day for 1 year → Tamoxifen 20 mg/day. for 1 year.. Jun. 2021 Right shoulder soft tissue biopsy.. Pathology: Metastatic ductal carcinoma.. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Weak (3/8). 1. 1–10%. C-erbB2. Negative (1+). Ki-67. Positive in. 6% of tumor. cells. Palliative Therapy. Clinical trial enrolled (SAR439859/placebo +. Letrozole/placebo+ Palbociclib)~. 28.
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27.2.
|
Case 28
|
Carcinoma In Situ
|
28.1. . Courses of Treatment. Operation + Tamoxifen 20 mg/day for 5 years.. Operation. 131. 132. Pathology Report. Lobular carcinoma in situ, pathological TN. category (AJCC 2017): pTis. . 1. Size of tumor: 0.7 cm (pTis).. . 2. Nuclear grade: low.. . 3. Necrosis: absent.. . 4. Architectural pattern: solid.. . 5. Skin: No involvement of tumor.. . 6. Surgical margins:. . (a) superior margin: (see Note),. . (b) inferior margin: 25 mm,. . (c) medial margin: 10 mm,. . (d) lateral margin: 20 mm,. . (e) deep margin: 5 mm,. . (f) superficial margin: 2 mm.. . 7. Microcalcification: absent.. Note: 1. The superior margin of the. lumpectomy specimen (slide 1) is close to. lobular carcinoma in situ (1 mm) but this mar. gin submitted for frozen diagnosis (Fro 1) is. free of tumor.. Result. Intensity. Positive %. Estrogen. receptor. Intermediate. (6/8). 1. >2/3. Progesterone. receptor. Strong (7/8). 2. >2/3. C-erbB2. Negative (1+). Ki-67. Positive in 6%. of tumor cells. . Carcinoma In Situ. . 29.
|
Important Radiologic. Findings. 128 129. 130. 28.3.
|
Patient History and Progress. Female/50 years old, pre-menopause.. Screen detected microcalcification on upper. outer portion of right breast.. Outside result of stereotactic excisional. biopsy: Lobular carcinoma in situ.. No family history.. No comorbidities.. 28.2.
|
Case 28
|
HR(+) HER2(+) Breast Cancer
|
28.1. . Courses of Treatment. Operation + Adjuvant chemotherapy (#3. cycles of doxorubicin and cyclophospha. mide). +. Post-operative. radiation. ther. apy + Trastuzumab + Tamoxifen 20 mg/day.. 166. Pathology Report. . 1. Invasive Ductal Carcinoma.. . (a) Size of invasive component: 1.6 cm. (pT1c).. . (b) Size of intraductal component: 3.0 cm.. S. Park et al.. 395. . . . HR(+) HER2(+) Breast Cancer. 396. a. b. . . (c) Histologic grade: 3/3 (tubule formation:. 3/3, nuclear pleomorphism: 3/3, mitotic. count: 3/3, 3/HPF).. . (d) Intraductal component: present, intratu. moral/extratumoral (50%) (nuclear grade:. high, necrosis: present, architectural pat. tern: solid/comedo, extensive intraductal. component: present).. . (e) Skin: no involvement of tumor.. . (f) Surgical margins:. • superior margin: 10 mm,. • inferior margin: 10 mm,. • medial margin: 5 mm,. • lateral margin: 5 mm,. • deep margin: 2 mm,. • superficial margin: 2 mm.. . (g) Lymph nodes: no metastasis in two axil. lary lymph nodes (pN0(sn)) (sentinel LN:. 0/2).. . (h) Arteriovenous invasion: absent.. . (i) Lymphovascular. invasion:. present,. intratumoral.. . (j) Tumor border: infiltrative.. . (k) Microcalcification:. present,. tumoral/. non-tumoral.. . (l) Pathological TN category (AJCC 2017):. pT1cN0(sn).. . 2. Intraductal papilloma with usual ductal. hyperplasia.. Result. Intensity. Positive. %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Equivocal (2+). Ki-67. Positive in 44%. of tumor cells. SISH. Positive. S. Park et al.. 397. 29.
|
Important Radiologic. Findings. 162 163 164. 165. 28.3.
|
Patient History and Progress. Female/47 years old, pre-menopause.. Self-detected palpable mass lesion on right. breast 6 o’clock direction.. No family history.. Hepatitis B carrier.. 28.2.
|
Case 28
|
HR(+) HER2(-) Breast Cancer
|
. Courses of Treatment. Operation + Post-operative radiation ther. apy + Letrozole 2.5 mg/day with palbociclib. 100 mg/day.. Operation. Right breast conserving surgery, sentinel lymph. ponent: absent).. 4. Skin: no involvement of tumor.. HR(+) HER2(−) Breast Cancer. . (e) deep margin: 5 mm.. . (f) superficial margin: 2 mm.. 6. Lymph nodes:. . (a) metastasis in two out of two axillary. lymph nodes (pN1a(sn)) (see note) (sen. tinel LN: 1/1, axillary LN: 1/1). . (b) perinodal extension: present.. . (c) size of metastatic carcinoma: 6 mm.. 7. Arteriovenous invasion: absent.. 8. Lymphovascular. invasion:. present,. intratumoral.. 9. Tumor border: infiltrative.. . 10. Microcalcification: present, tumoral.. . 11. Pathological TN category (AJCC 2017):. pT2N1a(sn).. Note: 1. Micrometastasis is present only. in the permanent section of Fro 1.. Result. Intensity. Positive %. Estrogen receptor. Strong (8/8). 3. >2/3. Progesterone receptor. Intermediate (6/8). 2. 1/3–2/3. C-erbB2. Negative (1+). Ki-67. Positive in 9% of tumor cells. Y. Kim et al.
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Important Radiologic. Findings. See Figs. 155, 156, 157 and 158.. 28.3.
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Patient History and Progress. Female/72 years old, post-menopause.. Screen detected mass lesion on right breast 8. o’clock direction.. No family history.. S/p cholecystectomy, hypertension.. 28.2.
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Case 28
|
HR(−) HER2(+) Breast Cancer
|
28.1. . docetaxel and carboplatin and trastuzumab and. pertuzumab) + Operation + Post-operative radia. tion therapy + Trastuzumab and pertuzumab.. Operation. 196. Pathology Report. Ductal Carcinoma In Situ. 1. Post-chemotherapy status.. 2. Size of tumor: 0.2 cm (ypTis).. 3. Nuclear grade: high.. 4. Necrosis: absent.. 5. Architectural pattern: solid.. 6. Skin: no involvement of tumor.. 7. Surgical margins:. . (a) superior margin: 20 mm,. . (b) inferior margin: 10 mm,. . (c) medial margin: 30 mm,. . (d) lateral margin: 5 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: 2 mm.. 8. Lymph nodes: no metastasis in three axillary. lymph nodes (ypN0(sn)) (sentinel LN: 0/3).. 9. Microcalcification:. present,. tumoral/. non-tumoral.. . 10. Pathological TN category (AJCC 2017):. ypTisN0(sn).. Result. Intensity. Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in 38%. of tumor cells. . Y. Kwon et al.. 537. 29.
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Important Radiologic. Findings. 189 190 191. 192. . HR(−) HER2(+) Breast Cancer. 534. . . . F. ig. 192. Chemotherapy. 193 194. 195. . .
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Patient History and Progress. Female/61 years old, post-menopause.. Screen detected mass lesion on right breast 9. o’clock direction.. No family history.. Hypertension.. 28.2.
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Case 28
|
HR(−) HER2(−) Breast Cancer
|
28.1. . Courses of Treatment. Operation + Post-operative radiation therapy. (Adjuvant chemotherapy refuse).. Operation. 207. Pathology Report. Malignant Adenomyoepithelioma (Epithelial-. Myoepithelial Carcinoma). 1. Size of tumor: 2.0 cm (pT1c).. HR(−) HER2(−) Breast Cancer. 676. . . . . E. S. Lee et al.. 677. . 2. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 3/3, 23/10HPF).. 3. Intraductal component: absent.. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) Superior margin: 10 mm.. . (b) Inferior margin: 10 mm.. . (c) Medial margin: 15 mm.. . (d) Lateral margin: 25 mm.. . (e) Deep margin: 9 mm.. . (f) Superficial margin: <1 mm from. epithelial-. myoepithelial. carcinoma. (slides 2 and 7).. 6. Arteriovenous invasion: absent.. 7. Lymphovascular invasion: absent.. 8. Tumor border: pushing.. 9. Microcalcification: present, non-tumoral.. . 10. Pathological TN category (AJCC 2017):. pT1c.. Result. Intensity Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Negative (0). Ki-67. Positive in 18%. of tumor cells. 29.
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Important Radiologic Findings. 204 205. 206. 28.3.
|
Patient History and Progress. Female/57 years old, post-menopause.. Self-detected palpable mass lesion on right.. No family history.. S/P. right. neck. excision. (due. to. lymphadenitis).. 28.2.
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Case 28
|
Local Recurrence
|
28.1. . Courses of Treatment. Left breast DCIS → Operation → Adjuvant. therapy → Left breast recurrence (microinva. sive ductal carcinoma).. Primary Treatment. 185 186 187. 188. Local Recurrence. 792. . . . . Operation. . 189. Pathology Report. Ductal carcinoma in situ. 1. Post mammotome biopsy status.. 2. Size of tumor: 2.0 cm, residual (pTis).. 3. Nuclear grade: high.. 4. Necrosis: present.. 5. Architectural pattern: solid and comedo.. 6. Skin: no involvement of tumor.. 7. Surgical margins:. . (a) Superior margin: 10 mm.. . (b) Inferior margin: 10 mm.. . (c) Medial margin: 10 mm.. . (d) Lateral margin: 10 mm.. . (e) Deep margin: 2 mm.. 8. Lymph nodes: no metastasis in 3 axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/3,. axillary LN: 0/0).. Y. Kim et al.. 793. . . 9. Microcalcification:. present,. tumoral/. non-tumoral.. . 10. Pathologic staging: pTisN0(sn).. Result. Intensity. Positive %. Estrogen. receptor. Negative (0/7). 0. 0. Progesterone. receptor. Negative (0/7). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in 10%. of tumor cells. Adjuvant Therapy. Postoperative radiation therapy.. Treatments After Recurrence. 190 191. 192. Operation. . 193. Local Recurrence. 794. Pathology Report. Microinvasive Ductal Carcinoma. 1. Size of tumor: 0.1 cm (pTis).. 2. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, not identified).. 3. Intraductal component: present, intratu. moral/extratumoral (90%) (nuclear grade:. high, necrosis: present, architectural pattern:. comedo, cribriform, and solid, extensive. intraductal component: absent/present).. 4. Skin: no involvement of tumor.. 5. Surgical margins: (deep margin: 1 mm from. ductal carcinoma in situ).. 6. Vascular invasion: absent.. 7. Lymphatic invasion: absent.. 8. Tumor border: infiltrative.. 9. Microcalcification:. present,. tumoral/. non-tumoral.. . 10. Pathologic stage (AJCC 2010): pTisNx.. Result. Intensity. Positive %. Estrogen. receptor. Strong (7/7). 3. >2/3. Progesterone. receptor. Strong (7/7). 3. >2/3. C-erbB2. Positive (2+). Ki-67. Positive in 25%. of tumor cells. . . . a. b. . Y. Kim et al.. 795. Adjuvant Therapy. Tamoxifen 20 mg/day for 6.5 years with. goserelin.. 29.
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Patient History and Progress. Female/50 years old, pre-menopause.. Screen detected mass lesion on left breast 2. o’clock direction.. Outside result of mammotome excision:. Ductal carcinoma in situ.. No family history.. No comorbidities.. 28.2.
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Case 28
|
Metastatic Breast Cancer
|
28.1. . Courses of Treatment. Right breast cancer → Operation → Adjuvant. therapy. →. Right. shoulder. soft. tissue. metastasis.. Primary Treatment. receptor. Strong (7/8). 2. >2/3. Progesterone. receptor. Strong (7/8). 2. >2/3. C-erbB2. Negative (1+). Ki-67. Positive in 7%. of tumor cells. Adjuvant Therapy. Post-operative radiation therapy + Tamoxifen. 20 mg/day.. Treatments After Recurrence. >2/3. Progesterone. receptor. Weak (3/8). 2. <1%. C-erbB2. Negative (1+). Ki-67. Positive in. 6% of tumor. Apr. 2020 Left axillary lymph node sampling and. bilateral salpingo-oophorectomy.. Pathology: Metastatic ductal carcinoma in one. out of three axillary lymph nodes.. Size of metastatic carcinoma: 6 mm.. Result. Intensity. Positive %. Estrogen. receptor. Intermediate. (5/8). 2. 10–1/3. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Negative (1+). Ki-67. Positive in 1%. of tumor cells. Adjuvant Therapy. Post-operative radiation therapy (axilla).. Liver Metastasis. May 2020 Liver MRI: r/o liver metastasis.
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Patient History and Progress. Female/51 years old, post-menopause.. No family history.. BRCA 1 & 2 mutation: Not detected, ATM. VUS (variant of uncertain).. Metastatic Breast Cancer. 908. 28.2.
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Case 29
|
Carcinoma In Situ
|
29.1. . Courses of Treatment. Operation + Adjuvant chemotherapy #4 cycles. (Doxorubicin and Cyclophosphamide) + Postope. rative radiation therapy (both) + Letrozole. 2.5 mg/day for 5 years.. Operation. 136. 137. Pathology Report. Right.. Lobular carcinoma in situ, pathological TN. category (AJCC 2017): pTis. . 1. Size of tumor: 2.5 cm (pTis).. . 2. Nuclear grade: low.. . 3. Necrosis: absent.. . 4. Architectural pattern: solid.. . 5. Surgical margins:. . (a) superior margin: (see Note 1),. . (b) inferior margin: (see Note 2),. . (c) medial margin: 5 mm,. . (d) lateral margin: positive for lobular carci. noma in situ (Fro 4) (see Note 3),. . (e) deep margin: <1 mm from lobular carci. noma in situ (slides 4 and 5),. . (f) superficial margin: 3 mm.. . 6. Microcalcification:. present,. tumoral/. non-tumoral.. Note: 1. The superior margin of the. lumpectomy specimen (slide 2) is close to. lobular carcinoma in situ (3 mm) but this mar. gin submitted for frozen diagnosis (Fro 1) is. free of tumor.. 2. The inferior margin of the lumpectomy. specimen (slide 4) is close to lobular car. cinoma in situ (<1 mm) but this margin. submitted for frozen diagnosis (Fro 2) is. free of tumor.. 3. Lobular carcinoma in situ is present only in. the permanent section of Fro 4.. Carcinoma In Situ. 116. . . E. S. Lee et al.. 117. a. b. c. d. . . Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Intermediate. (5/8). 3. 1%–10%. C-erbB2. Negative. (1+). Ki-67. Positive in. 1% of tumor. cells. Left.. Invasive ductal carcinoma, pathological TN. category (AJCC 2017): pT1cN0(sn). . 1. Size of tumor: 1.5 cm (pT1c).. . 2. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 2/3, 11/10HPF).. . 3. Intraductal component: present, intratumoral. (20%) (nuclear grade: low, necrosis: present,. architectural pattern: micropapillary/cribri. form/solid/comedo,. extensive. intraductal. component: absent).. . 4. Surgical margins:. . (a) superior margin: 20 mm,. . (b) inferior margin: 15 mm,. . (c) medial margin: 10 mm,. . (d) lateral margin: 10 mm,. . (e) deep margin: 8 mm,. . (f) superficial margin: 10 mm.. . 5. Lymph nodes: no metastasis in two axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/2).. . 6. Arteriovenous invasion: absent.. . 7. Lymphovascular. invasion:. present,. intratumoral.. . 8. Tumor border: infiltrative.. . 9. Microcalcification: present, non-tumoral.. Result. Intensity Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Negative (2/8). 1. <1%. C-erbB2. Negative (1+). Ki-67. Positive in 17%. of tumor cells. Carcinoma In Situ. 118. 30.
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Important Radiologic. Findings. 133 134. 135. 29.3.
|
Patient History and Progress. Female/50 years old, post-menopause.. Screen detected mass lesion on left breast. 2 o’clock direction.. Outside result of biopsy: Left breast 2 o’clock,. invasive ductal carcinoma.. No family history.. No comorbidities.. BRCA 1 and 2 mutation: Not detected, MSH6. VUS (variant of uncertain).. 29.2.
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Case 29
|
HR(+) HER2(+) Breast Cancer
|
29.1. . Courses of Treatment. Operation + Adjuvant chemotherapy (#4. cycles of docetaxel and cyclophosphamide and. trastuzumab) + Post-operative radiation ther. apy + Trastuzumab + Letrozole 2.5 mg/day.. 171. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 2.1 cm (pT2).. 2. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 2/3, 11/10 HPF).. 3. Intraductal component: present, intratu. moral/extratumoral (5%) (nuclear grade:. low, necrosis: absent, architectural pattern:. papillary/cribriform/solid, extensive intra. ductal component: absent).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) superior margin: 10 mm,. . (b) inferior margin: 10 mm,. . (c) medial margin: 10 mm,. . (d) lateral margin: 4 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: <1 mm from invasive. ductal carcinoma (slide 4).. 6. Lymph nodes: no metastasis in three axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/3).. a. b. . HR(+) HER2(+) Breast Cancer. 400. 7. Arteriovenous invasion: absent.. 8. Lymphovascular. invasion:. present,. intratumoral.. 9. Tumor border: infiltrative.. . 10. Microcalcification:. present,. . tumoral/. non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT2N0(sn).. Result. Intensity. Positive. %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (7/8). 3. 1/3–2/3. C-erbB2. Positive (3+). Ki-67. Positive in 28%. of tumor cells. 30.
|
Important Radiologic. Findings. 167 168 169. 29.3.
|
Patient History and Progress. Female/80 years old, post-menopause.. Self-detected mass lesion on right breast 8. o’clock direction.. No family history.. Hypertension, dyslipidemia, s/p tympano. plasty.. 29.2.
|
Case 29
|
HR(+) HER2(-) Breast Cancer
|
Courses of Treatment. Operation + Post-operative radiation ther. apy + Letrozole 2.5 mg/day.. Y. Kim et al.. 265. Operation. Left breast conserving surgery, sentinel lymph. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) superior margin: 20 mm.. . (b) inferior margin: 10 mm.. . (c) medial margin: 15 mm.. . (d) lateral margin: 15 mm.. . (e) deep margin: 10 mm.. . (f) superficial margin: 5 mm.. 6. Lymph nodes: no metastasis in two axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/2,. non-sentinel LN: 0/0). 7. Arteriovenous invasion: absent.. 8. Lymphovascular invasion: absent.. 9. Tumor border: infiltrative.. . 10. Microcalcification: present, non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT1bN0(sn).. Result. Intensity. Positive. %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative (0). Ki-67. Positive in 4% of
|
Important Radiologic. Findings. See Figs. 160, 161, 162 and 163.. 29.3.
|
S/P hysterectomy, hypertension, s/p left cere. bral infarction, s/p transient ischemic attack.. 29.2.
|
Case 29
|
HR(−) HER2(+) Breast Cancer
|
29.1. . Courses of Treatment. Operation (adjuvant chemotherapy refuse).. Operation. 200. 201. Pathology Report. Microinvasive Ductal Carcinoma. 1. Size of invasive component: <0.1 cm (pT1mi).. 2. Size of intraductal component: 5.0 cm.. 3. Histologic grade: not applicable.. 4. Intraductal component: present, intratu. moral/extratumoral (99%) (nuclear grade:. high, necrosis: present, architectural pattern:. micropapillary/cribriform/comedo,. exten. sive intraductal component: present).. 5. Skin: no involvement of tumor.. 6. Surgical margins: (see Note 1).. . (a) deep margin: 2 mm,. . (b) superficial margin: 2 mm.. 7. Lymph nodes: no metastasis in two axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/2,. axillary LN: 0/0).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular invasion: absent.. . 10. Tumor border: infiltrative.. . 11. Microcalcification:. present,. tumoral/. non-tumoral.. . 12. Pathological TN category (AJCC 2017):. pT1miN0(sn).. Breast, left nipple, excision: Ductal carcinoma. in situ (see Note 2).. Breast, left nipple margin, excision: Ductal. carcinoma in situ (see Note 2).. Note: 1. The lateral border of the mastectomy. specimen (slide MG8) is close to ductal carci. noma in situ (<1 mm).. 2. The nipple margin separately submitted for. permanent diagnosis (slides B&C) is positive for. ductal carcinoma in situ but this margin submit. ted for frozen diagnosis (Fro 9) is free of tumor.. Result. Intensity. Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in. 29% of tumor. cells. . Y. Kwon et al.. 539. a. b. . . . 30.
|
Important Radiologic. Findings. 197 198. 199. . . . . HR(−) HER2(+) Breast Cancer. 538. 29.3.
|
Patient History and Progress. Female/39 years old, pre-menopause.. Self-detected palpable mass lesion on upper. outer portion of left breast.. No family history.. S/P Left salpingo-oophorectomy.. BRCA 1 and 2 mutation: Not detected.. 29.2.
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Case 29
|
HR(−) HER2(−) Breast Cancer
|
29.1. . Courses of Treatment. Neoadjuvant chemotherapy (#4 cycles of doxo. rubicin and cyclophosphamide + #4 cycles of. docetaxel) + Operation + Post-operative radia. tion therapy + Adjuvant capecitabine.. Operation. 215. Pathology Report. Microinvasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of tumor: <0.1 cm (ypT1mi).. 3. Histologic grade: not applicable.. 4. Intraductal component: absent.. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) Superior margin: 10 mm.. . (b) Inferior margin: 10 mm.. . (c) Medial margin: 10 mm.. . (d) Lateral margin: 10 mm.. . (e) Deep margin: 2 mm.. . (f) Superficial margin: 2 mm.. 7. Lymph nodes: no metastasis in six axillary. lymph nodes (ypN0) (sentinel LN: 0/3, non-. sentinel LN: 0/3).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular invasion: absent.. . 10. Tumor border: infiltrative.. . 11. Microcalcification: present, tumoral/non-. tumoral.. . 12. Pathological TN category (AJCC 2017):. ypT1miN0.. Result. Intensity. Positive. %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Negative (1+). Ki-67. Positive in 43%. of tumor cells. E. S. Lee et al.. 681. . . . . . HR(−) HER2(−) Breast Cancer. 682. 30.
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Important Radiologic Findings. 208 209 210. 211. . E. S. Lee et al.. 679. . . . . HR(−) HER2(−) Breast Cancer. 680. . After Neoadjuvant. Chemotherapy. 212 213. 214. 29.3.
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Patient History and Progress. Female/27 years old, pre-menopause.. Self-detected mass lesion on left breast.. No family history.. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. HR(−) HER2(−) Breast Cancer. 678. 29.2.
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Case 29
|
Local Recurrence
|
29.1. . Courses of Treatment. Left breast IDC→ Operation → Adjuvant ther. apy → Left breast recurrence (IDC).. Primary Treatment. 194 195 196. 197. Operation. . 198. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 3.0 cm (pT2).. . . . . Local Recurrence. 796. 2. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 2/3, 12/10HPF).. 3. Intraductal component: present, intratu. moral/extratumoral (20%) (nuclear grade:. low, necrosis: present, architectural pattern:. cribriform/solid/comedo, extensive intra. ductal component: present).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) Deep margin: <1 mm from invasive duc. tal carcinoma (slide 2).. . (b) Superficial margin: <1 mm from ductal. carcinoma in situ (slide 9).. . . Y. Kim et al.. 797. 6. Lymph nodes: no metastasis in one axillary. lymph node (pN0(sn)) (sentinel LN: 0/1).. 7. Arteriovenous invasion: absent.. 8. Extensive lymphovascular invasion: present,. intratumoral/peritumoral.. 9. Tumor border: infiltrative.. . 10. Microcalcification:. present,. tumoral/. non-tumoral.. . 11. Pathologic stage (AJCC 2010): pT2N0(sn).. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Negative (2/8). 1. <1%. C-erbB2. Equivocal (2+). (SISH negative). Ki-67. Positive in 11%. of tumor cells. Adjuvant Therapy. Adjuvant chemotherapy #4 cycles of cyclophos. phamide and docetaxel.. Tamoxifen 20 mg/day for 3.6 years.. Treatments After Recurrence. 199. 200. Operation. . 201. 202. Pathology Report. <Right>. Fibrocystic change.. <Left>. Invasive Ductal Carcinoma. 1. Post-nipple-sparing mastectomy status.. 2. Size of tumor: 2.0 cm and 1.8 cm (rpT1c(2)).. 3. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 2/3, 11/10HPF).. 4. Intraductal component: absent.. 5. Skin: dermal involvement of tumor.. 6. Surgical margins:. . (a) Deep margin: positive for invasive. . ductal carcinoma (slide 1).. . (b) Superficial margin: 2 mm.. 7. Lymph nodes: no metastasis in one axillary. lymph node (rpN0(sn)) (sentinel LN: 0/1).. . . Local Recurrence. 798. a. b. c. d. . a. b. . 8. Arteriovenous invasion: absent.. 9. Lymphovascular. invasion:. present,. intratumoral.. . 10. Tumor border: infiltrative.. . 11. Microcalcification:. present,. tumoral/. non-tumoral.. . 12. Pathological TN category (AJCC 2017):. rpT1cN0(sn).. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Negative (2/8). 1. <1%. C-erbB2. Equivocal (2+). (SISH negative). Ki-67. Positive in 2%. of tumor cells. Y. Kim et al.. 799. Adjuvant Therapy. Postoperative radiation therapy.. Letrozole 2.5 mg/day.. 30.
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Patient History and Progress. Female/46 years old, pre-menopause.. Screen detected mass lesion on left breast 7:30. o’clock direction.. Outside result of biopsy: (1) Invasive ductal. carcinoma, (2) Atypical ductal hyperplasia.. Family history of breast cancer, mother.. Asthma.. BRCA 1 VUS (variant of uncertain).. 29.2.
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Case 29
|
Metastatic Breast Cancer
|
Courses of Treatment. Right breast cancer → Neoadjuvant chemother. apy → Operation → Adjuvant therapy → Lung. metastasis.. Primary Treatment. receptor. Strong. (6/7). 3. 1/3–2/3. Progesterone. receptor. Strong. (6/7). 3. 1/3–2/3. C-erbB2. Negative. (1+). Ki-67. N.A. Clinical stage: cT3N1M0.. Operation. Oct. 2007 Right total mastectomy, axillary lymph. node dissection.. Pathology: Invasive ductal carcinoma, stage. ypT2N0.. Size of tumor: 2.5 cm, lymph node: 0/6.. Result. Intensity. Positive %. Estrogen. receptor. Strong (6/7). 3. 1/3–2/3. Progesterone. receptor. Weak (2/7). 1. <10%. C-erbB2. Negative. (1+). Ki-67. Positive in. 5% of tumor. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative (0). Ki-67. Positive in. 15% of. tumor cells. Aug. 2021 Chest CT:. LN enlargement, right interlobar and right. lower paratracheal, metastasis.. Bronchovascular bundle thickening in RUL. and centrilobular nodules in RLL, lymphangitic. metastasis.. Palliative Therapy. Letrozole 2.5 mg/day + (ribociclib #1→ palboci. clib~) + zoladex~. Y. Kwon et al.. 911. 30.
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Case 3
|
Benign and Proliferative
|
3.1. . Courses of Treatment. → 2021-12-10 Excision, Rt.. C. W. Lee et al.. 21. . . . . 3.3.1. . Pathology Report. Diagnosis. • Breast, right, excision:. –. – Intraductal papilloma.. 4.
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Important Radiologic. Findings. 4. 5. 3.3.
|
Patient History and Progress. Female/72 years old, post-menopause.. Screen detected nodular lesion on right breast. 9 o’clock direction.. No family history.. Hypertension.. 3.2.
|
Case 3
|
Carcinoma In Situ
|
Courses of Treatment. Operation + Tamoxifen 20 mg/day for 5 years.. 3.3.1. . Operation. 13. 14. 3.3.2. . Pathology Report. <First operation>. Lobular carcinoma in situ. . 1. Size of tumor: 0.3 cm.. . 2. Nuclear grade: low.. . 3. Necrosis: absent.. . 4. Architectural pattern: solid.. . 5. Surgical margins:. . (a) superior margin: <1 mm (slide 3),. . (b) inferior margin: 5 mm,. . (c) medial margin: positive (slide 4),. . (d) lateral margin: 5 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: 2 mm.. . 6. Microcalcification:. present,. tumoral/non-. tumoral.. Result. Intensity. Positive %. Estrogen. receptor. Strong (7/8). 3. 1/3–2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative (1+). Ki-67. Positive in 5%. of tumor cells. <Second operation>. E. S. Lee et al.. 57. . . Carcinoma In Situ. 58. Lobular carcinoma in situ. . 1. Post-excision status.. . 2. Size of tumor: 0.3 cm, residual.. . 3. Nuclear grade: low.. . 4. Necrosis: absent.. . 5. Architectural pattern: solid.. . 6. Surgical margins:. . (a) Superior margin: 5 mm.. . (b) Inferior margin: 5 mm.. . (c) Medial margin: 5 mm.. . (d) Lateral margin: 5 mm.. . (e) Deep margin: 2 mm.. . (f) Superficial margin: 2 mm.. . 7. Microcalcification: present, non-tumoral.. 4.
|
3.1. . Important Radiologic. Findings. 11. 12. 3.3.
|
Patient History and Progress. Female/41 years old, pre-menopause.. Screen detected microcalcifications on right. breast upper outer.. Outside result of biopsy: Right 10 o’clock. 1.. Usual ductal hyperplasia, 2. duct ectasia.. No family history.. S/P Hallux valgus operation.. 3.2.
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Case 3
|
HR(+) HER2(+) Breast Cancer
|
3.1. . Courses of Treatment. Operation + Adjuvant chemotherapy (#4. cycles of doxorubicin and cyclophospha. mide). +. Post-operative. radiation. ther. apy + Trastuzumab + Letrozole 2.5 mg/day.. . . S. Park et al.. 307. . 18. 3.3.1. . Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 1.8 cm (pT1c).. 2. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 2/3, 10/10 HPF).. 3. Intraductal component: present, intratu. moral/extratumoral (10%) (nuclear grade:. high, necrosis: present, architectural pattern:. solid/comedo, extensive intraductal compo. nent: absent).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) superior margin: 10 mm,. . (b) inferior margin: (see note),. . (c) medial margin: 5 mm,. . (d) lateral margin: 10 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: 4 mm.. HR(+) HER2(+) Breast Cancer. 308. 6. Lymph nodes: no metastasis in one axillary. lymph node (pN0(sn)) (sentinel LN: 0/1).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular invasion: absent.. 9. Tumor border: infiltrative.. . 10. Microcalcification:. present,. tumoral/. non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT1cN0(sn).. Note: 1. The inferior margin of the lumpec. tomy specimen (slides 3 and 4) is close to ductal. carcinoma in situ (2 mm) but this margin submit. ted for frozen diagnosis (Fro 2) is free of tumor.. Result. Intensity. Positive. %. Estrogen. receptor. Strong (7/8). 2. >2/3. Progesterone. receptor. Intermediate. (6/8). 2. 1/3–2/3. C-erbB2. Equivocal (2+). Ki-67. Positive in 43%. of tumor cells. SISH. Positive. . . S. Park et al.. 309. a. b. . 4.
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Important Radiologic. Findings. 13 14 15 16. 17. 3.3.
|
Patient History and Progress. Female/58 years old, post-menopause.. Screen detected mass lesion on right breast 7. o’clock direction.. No family history.. Dyslipidemia.. 3.2.
|
Case 3
|
HR(+) HER2(-) Breast Cancer
|
Courses of Treatment. Operation + Post-operative radiation ther. apy + Letrozole 2.5 mg/day.. Y. Kim et al.. moral/extratumoral (5%) (nuclear grade:. low, necrosis: absent, architectural pattern:. cribriform, extensive intraductal component:. absent).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) superior margin: 10 mm,. . (b) inferior margin: 20 mm,. . (c) medial margin: 10 mm,. . (d) lateral margin: 10 mm (see note 1),. . (e) deep margin: 2 mm,. . (f) superficial margin: 2 mm.. 6. Lymph nodes: no metastasis in three axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/1,. non-sentinel LN: 0/2).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular. invasion:. present,. intratumoral.. 9. Tumor border: infiltrative.. . 10. Microcalcification:. present,. tumoral/. non-tumoral.. Breast, right subareolar:. Invasive Ductal Carcinoma. 1. Size of tumor: 1.1 cm (pT1c).. 2. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 2/3, 11/10 HPF).. 3. Intraductal component: present, intratu. moral/extratumoral (10%) (nuclear grade:. low, necrosis: absent, architectural pattern:. cribriform, extensive intraductal component:. absent).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) superior margin: 10 mm,. . (b) inferior margin: (see note 2),. . (c) medial margin: 10 mm,. . (d) lateral margin: 10 mm,. . (e) deep margin: 1 mm from invasive ductal. carcinoma (slide 9),. . (f) superficial margin: 2 mm.. 6. Arteriovenous invasion: absent.. 7. Lymphovascular. invasion:. present,. intratumoral.. 8. Tumor border: infiltrative.. 9. Microcalcification:. present,. tumoral/. non-tumoral.. . 10. Pathological TN category (AJCC 2017):. pT1cN0(sn).. Result. Intensity. Positive %. Estrogen receptor. Strong (7/8). 2. >2/3. Progesterone receptor. Weak (3/8). 1. 1–10%. C-erbB2. Negative (1+). Ki-67. Positive in 4% of tumor cells. Y. Kim et al.
|
Important Radiologic. Findings. See Figs. 10, 11, 12 and 13.. 3.3.
|
No family history.. L-spine disc herniation.. 3.2.
|
Case 3
|
HR(−) HER2(+) Breast Cancer
|
3.1. . Courses of Treatment. Palliative chemotherapy (#7 cycles of docetaxel. and. trastuzumab. and. pertuzumab). +. Operation. +. Post-operative. radiation. ther. apy + Palliative trastuzumab and pertuzumab.. 3.4.1. . Operation. 26. 3.4.2. . Pathology Report. Ductal Carcinoma In Situ. 1. Post-chemotherapy status.. 2. Size of tumor: 0.2 cm (ypTis).. 3. Nuclear grade: high.. 4. Necrosis: absent.. 5. Architectural pattern: solid.. 6. Skin: no involvement of tumor.. 7. Surgical margins:. . (a) superior margin: 12 mm,. . (b) inferior margin: (see note),. . (c) medial margin: 10 mm,. . (d) lateral margin: 20 mm,. . (e) deep margin: 10 mm,. . (f) superficial margin: 12 mm.. 8. Lymph nodes: no metastasis in four axillary. lymph nodes (ypN0(sn)) (sentinel LN: 0/4).. 9. Arteriovenous invasion: absent.. . 10. Lymphovascular invasion: absent.. . 11. Tumor border: pushing.. . 12. Microcalcification:. present,. tumoral/. non-tumoral.. . 13. Pathological TN category (AJCC 2017):. ypTisN0(sn).. Result. Intensity. Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in. 14% of tumor. cells. . . . HR(−) HER2(+) Breast Cancer. 442. 4.
|
Important Radiologic. Findings. 18 19 20. 21. . HR(−) HER2(+) Breast Cancer. 438. . . . Y. Kwon et al.. 439. F. i. g. . 21. . . . . . . . 3.3. . After Neoadjuvant. Chemotherapy. 22 23 24. 25. Y. Kwon et al.. 441. 3.4.
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Patient History and Progress. Female/61 years old, post-menopause.. Self-detected nipple retraction on right breast.. Family history of breast cancer, cousin. (maternal).. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 3.2.
|
Case 3
|
HR(−) HER2(−) Breast Cancer
|
3.1. . Courses of Treatment. Operation + operation, Transfer.. 3.3.1. . Operation. 20. 3.3.2. . Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 2.3 cm (pT2).. 2. Histologic grade: 3/3 (tubule formation: 2/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 82/10HPF).. 3. Intraductal component: present, extratumoral. (30%) (nuclear grade: high, necrosis: pres. ent, architectural pattern: solid/comedo,. extensive intraductal component: present).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) superior margin: (see note),. . (b) inferior margin: positive for ductal carci. noma in situ (Fro 5),. E. S. Lee et al.. 583. . . . . . . HR(−) HER2(−) Breast Cancer. 584. . . . . . (c) medial margin: positive for ductal carci. noma in situ (Fro 6),. . (d) lateral margin: 5 mm,. . (e) deep margin: <1 mm from ductal carci. noma in situ (slide 11),. . (f) superficial margin: 5 mm.. 6. Lymph nodes: no metastasis in three axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/3,. non-sentinel LN: 0/0).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular. invasion:. present,. intratumoral.. E. S. Lee et al.. 585. . 9. Tumor border: infiltrative.. . 10. Microcalcification: present, tumoral.. . 11. Pathological TN category (AJCC 2017):. pT2N0(sn).. Breast, left 2 o’clock, lumpectomy:. Invasive Ductal Carcinoma. 1. Size of invasive component: 0.2 cm.. 2. Size of intraductal component: 2.0 cm.. 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 2/3, 13/10HPF).. 4. Intraductal component: present, intratu. moral/extratumoral (90%) (nuclear grade:. high, necrosis: present, architectural pattern:. solid/comedo, extensive intraductal compo. nent: present).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) Superior margin: 5 mm.. . (b) Inferior margin: positive for ductal car. cinoma in situ (slide 21).. . (c) Medial margin: 5 mm.. . (d) Lateral margin: <1 mm from ductal car. cinoma in situ (slide 22).. . (e) Deep margin: <1 mm from ductal carci. noma in situ (slide 21).. . (f) Superficial margin: 1 mm from ductal. carcinoma in situ (slide 18).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular invasion: absent.. 9. Tumor border: infiltrative.. . 10. Microcalcification: present, non-tumoral.. Note: 1. The superior margin of the. lumpectomy specimen (slide 1) is positive for. ductal carcinoma in situ, but this margin sub. mitted for frozen diagnosis (Fro 4) is free of. tumor.. 21. Result. Intensity. Positive. %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Negative (0). Ki-67. Positive in 53%. of tumor cells. 4.
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Important Radiologic. Findings. 16 17 18. 19. 3.3.
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Patient History and Progress. Female/41 years old, pre-menopause.. Screen detected mass lesion on left breast 3. o’clock direction.. No family history.. No comorbidities.. 3.2.
|
Case 3
|
Local Recurrence
|
3.1. . Courses of Treatment. Left breast IDC + DCIS → Operation → Left. breast recurrence (DCIS).. 14. 15. 3.2.1. . Operation. 16. 3.2.2. . Pathology Report. Ductal Carcinoma In Situ. . 1. Size of tumor: 1.5 cm.. . 2. Nuclear grade: high.. . 3. Necrosis: present.. . 4. Architectural pattern: solid/comedo.. . 5. Surgical margins:. . (a) Superior margin: 2 mm (slide 6).. . (b) Inferior margin: 1.5 mm (slide 6).. . (c) Medial margin: 10 mm.. . (d) Lateral margin: <1 mm (slide 7).. . (e) Deep margin: 2 mm.. . 6. Microcalcification:. present,. tumoral/. non-tumoral.. Result. Intensity. Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (2/8). 1. <1%. C-erbB2. Positive (3+). Ki-67. Positive in 35%. of tumor cells. Y. Kim et al.. 723. a. b. . a. b. c. d. . 3.2.3. . Operation. 17. 3.2.4. . Pathology Report. Invasive Ductal Carcinoma. 1. Post-excision status.. 2. Size of invasive component: 0.2 cm (pT1a).. 3. Size of intraductal component: 3.5 cm.. 4. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 1/3, <1/10HPF).. 5. Intraductal component: present, extratumoral. (99%) (nuclear grade: high, necrosis: pres. ent, architectural pattern: micropapillary/. cribriform/solid/comedo, extensive intra. ductal component: present).. Local Recurrence. 724. 6. Skin: no involvement of tumor.. 7. Surgical margins:. . (a) Superior margin: (see note 1).. . (b) Inferior margin: (see note 2).. . (c) Medial margin: 15 mm.. . (d) Lateral margin: (see note 3).. . (e) Deep margin: <1 mm from ductal carci. noma in situ (slide 14).. . (f) Superficial margin: 2 mm.. 8. Arteriovenous invasion: absent.. 9. Lymphovascular invasion: absent.. . 10. Tumor border: infiltrative.. . 11. Microcalcification: present, tumoral.. . 12. Pathological TN category (AJCC 2017): pT1a.. Result. Intensity. Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in 65%. of tumor cells. 3.3. . Treatments After Recurrence. 18 19. 20. 3.3.1. . Operation. . 21. 3.3.2. . Pathology Report. Ductal Carcinoma In Situ. 1. Post-excision status.. 2. Size of tumor: 1.5 cm (rpTis).. 3. Nuclear grade: high.. 4. Necrosis: present.. 5. Architectural pattern: micropapillary.. 6. Skin: no involvement of tumor.. 7. Surgical margins:. . (a) Deep margin: 2 mm.. . (b) Superficial margin: 2 mm.. 8. Lymph nodes: no metastasis in one axillary. lymph node (pN0(sn)) (sentinel LN:0/1).. . . . Y. Kim et al.. 725. . 9. Microcalcification:. present,. tumoral/. non-tumoral.. . 10. Pathological TN category (AJCC 2017):. rpTisN0(sn).. Result. Intensity Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in 19%. of tumor cells. 4.
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Patient History and Progress. Female/47 years old, pre-menopause.. Screen detected microcalcification on upper. portion of left breast.. Family history of colon cancer, father.. No comorbidities.. 3.2.
|
Case 3
|
Metastatic Breast Cancer
|
Courses of Treatment. Left. breast. cancer. →. Neoadjuvant. Chemotherapy → Operation → Adjuvant therapy. → Bone, lung, and brain metastasis.. 3.2.1. . Primary Treatment. Docetaxel #4).. Operation. Mar. 2018 Left modified radical mastectomy.. Pathology: Invasive ductal carcinoma, stage. ypT2N1.. Size of tumor: 2.7 * 2.4 cm, lymph node: 2/5,. size of metastatic carcinoma: 4 mm.. Metastatic Breast Cancer. Estrogen. receptor. Negative. (0/8). 0. 0. Progesterone. receptor. Negative. (0/8). 0. 0. C-erbB2. Negative. (1+). Ki-67. Positive. in 26% of. tumor. cells. Adjuvant Therapy. Post-operative radiation therapy +adjuvant che. motherapy (Xeloda).. 3.2.2. . Treatments After Recurrence. Bone metastasis → Lung metastasis → Brain. metastasis → Progression.. Palliative Therapy. Apr. 2020 Bone scan: multiple bone metastasis in. right T2-5, T7 and left 4th–5th ribs.. → Nab-paclitaxel/atezolizumab #7 cycles:. Progressive disease on pleural nodule.. → Xeloda #7 cycles: Progressive disease on. brain → Whole brain radiation therapy.. → Gemcitabine #2 cycles: Progressive disease. on pleural effusion.. → Eribulin #2 cycles: Progressive disease on. pleural effusion.. → Vinorelbine/carboplatin #3 cycles: clini. cally progressive disease.. See Figs. 9, 10, 11, and 12.. Y. Kwon et al.
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Case 30
|
Carcinoma In Situ
|
30.1. . Courses of Treatment. Operation + Postoperative Radiation therapy.. Operation. 142. 143. Pathology Report. Ductal carcinoma in situ, pathological TN cat. egory (AJCC 2017): pTisN0(sn). . 1. Size of tumor: 2.0 cm (pTis).. . 2. Nuclear grade: high.. . 3. Necrosis: present.. . 4. Architectural pattern: micropapillary/cribri. form/solid/comedo.. . 5. Skin: no involvement of tumor.. . 6. Surgical margins:. . (a) nipple margin: positive for ductal carci. noma in situ (Fro 4),. . (b) subareolar margin: positive for ductal car. cinoma in situ (Fro 1),. . (c) deep margin: 2 mm,. . (d) superficial margin: 2 mm.. . 7. Lymph nodes: no metastasis in one axillary. lymph node (pN0(sn)) (sentinel LN: 0/1).. . 8. Microcalcification:. present,. tumoral/non-. tumoral.. . Carcinoma In Situ. 120. . . Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Intermediate. (5/8). 2. 10%−1/3. C-erbB2. Positive (3+). Ki-67. Positive in. 11% of tumor. cells. 31.
|
Important Radiologic. Findings. 138 139 140. 141. 30.3.
|
Patient History and Progress. Female/60 years old, post-menopause.. Screen detected mass and microcalcification. on left breast 10 o’clock direction.. Outside result of biopsy: Ductal carcinoma in. situ.. No family history.. Claustrophobia, hypertension.. 30.2.
|
Case 30
|
HR(+) HER2(+) Breast Cancer
|
30.1. . Courses of Treatment. Neoadjuvant chemotherapy (#6 cycles of. docetaxel and carboplatin and trastuzumab. and pertuzumab) + Operation + Post-. operative radiation therapy.. 179. Pathology Report. Ductal Carcinoma In Situ. . 1. Post-chemotherapy status.. . 2. Size of tumor: 2.0 cm (ypTis).. . 3. Nuclear grade: high.. . 4. Necrosis: present.. . 5. Architectural pattern: papillary/micropapil. lary/cribriform/solid/comedo.. . 6. Surgical margins:. . (a) superior margin: 8 mm,. . (b) inferior margin: 7 mm,. . (c) medial margin: 15 mm,. . (d) lateral margin: (see note),. . (e) deep margin: 3 mm,. . (f) superficial margin: 7 mm.. . 7. Lymph nodes: no metastasis in three axillary. lymph nodes (ypN0(sn)) (sentinel LN: 0/3).. . 8. Microcalcification: present, tumoral.. . 9. Pathological TN category (AJCC 2017):. ypTisN0(sn).. Note: 1. The lateral margin of the lumpectomy. specimen (slide 4) is close to ductal carcinoma in. situ (3 mm) but this margin submitted for frozen. diagnosis (Fro 4) is free of tumor.. Result. Intensity Positive %. Estrogen. receptor. Strong (7/8). 3. 1/3–2/3. Progesterone. receptor. Intermediate. (5/8). 2. 10%-1/3. C-erbB2. Positive (3+). Ki-67. Positive in 9%. of tumor cells. S. Park et al.. 403. . . . HR(+) HER2(+) Breast Cancer. 404. a. b. . 31.
|
Important Radiologic. Findings. 172 173 174 175 176 177. 178
|
Patient History and Progress. Female/31 years old, pre-menopause.. Self-detected palpable mass lesion on outer. inner portion of right breast.. No family history.. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 30.2.
|
Case 30
|
HR(+) HER2(-) Breast Cancer
|
Courses of Treatment. Operation + Post-operative radiation ther. apy + Letrozole 2.5 mg/day.. Operation. Left breast conserving surgery, sentinel lymph. ponent: absent).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) superior margin: 15 mm.. . (b) inferior margin: 15 mm.. . (c) medial margin: 10 mm.. . (d) lateral margin: 15 mm.. . (e) deep margin: 3 mm.. . (f) superficial margin: 15 mm.. 6. Lymph nodes: no metastasis in one axillary. lymph node (pN0(i+)(sn)) (see note) (senti. nel LN: 0/1, non-sentinel LN: 0/0). 7. Arteriovenous invasion: absent.. 8. Lymphovascular. invasion:. present,. intratumoral.. 9. Tumor border: infiltrative.. . 10. Microcalcification: present, non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT1cN0(i+)(sn).. Note: 1. A few isolated tumor cells are. present only in the permanent section of Fro. 1 for immunohistochemical staining.. Result. Intensity. Positive %. Estrogen receptor. Strong (8/8). 3. >2/3. Progesterone receptor. Strong (7/8). 2. >2/3. C-erbB2. Negative (1+). Ki-67. Positive in 11% of tumor cells. Y. Kim et al.
|
Important Radiologic. Findings. See Figs. 165, 166, 167 and 168.. 30.3.
|
s/p Left optic nerve palsy, hypertension, s/p. right rotator cuff tear operation.. 30.2.
|
Case 30
|
HR(−) HER2(+) Breast Cancer
|
30.1. . Courses of Treatment. Neoadjuvant chemotherapy (#6 cycles of. docetaxel and carboplatin and trastuzumab and. pertuzumab) + Operation + Post-operative radia. tion therapy + Trastuzumab and pertuzumab.. 3. Histologic grade: not applicable.. 4. Intraductal component: absent.. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) superior margin: 10 mm,. . (b) inferior margin: (see note),. . (c) medial margin: 10 mm,. . (d) lateral margin: 10 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: 2 mm.. 7. Lymph nodes: no metastasis in three axillary. lymph nodes (ypN0(sn)) (sentinel LN: 0/3).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular invasion: absent.. . 10. Tumor border: infiltrative.. . 11. Microcalcification: present, tumoral.. . 12. Pathological TN category (AJCC 2017):. ypT1miN0(sn).. Note: 1. The inferior margin of the lumpec. tomy specimen (slide 5) is close to microinvasive. ductal carcinoma (2 mm) but this margin submit. ted for frozen diagnosis (Fro 2) is free of tumor.. Result. Intensity. Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in. 19% of tumor. cells. a. b. . Y. Kwon et al.. 543. 31.
|
Important Radiologic. Findings. 202 203. 204. HR(−) HER2(+) Breast Cancer. 540. . . Y. Kwon et al.. 541. 30.3. . After Neoadjuvant. Chemotherapy. 205 206. 207. 30.4.
|
Patient History and Progress. Female/41 years old, pre-menopause.. Self-detected palpable mass and nipple dis. charge on left breast.. No family history.. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 30.2.
|
Case 30
|
HR(−) HER2(−) Breast Cancer
|
30.1. . Courses of Treatment. Neoadjuvant chemotherapy (#2 cycles of. doxorubicin and cyclophosphamide + #3. cycles of paclitaxel) + Operation + Adjuvant. capecitabine.. Operation. 224. Pathology Report. Invasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of tumor: 3.5 cm (ypT2).. 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 4/1HPF).. 4. Intraductal component: present, extratumoral. (5%) (nuclear grade: high, necrosis: absent,. architectural pattern: solid, extensive intra. ductal component: absent).. 5. Skin and nipple: no involvement of tumor.. 6. Surgical margins:. . (a) Deep margin: 1 mm from invasive ductal. carcinoma (slide 6).. . (b) Superficial margin: 2 mm.. . . . . HR(−) HER2(−) Breast Cancer. 684. . E. S. Lee et al.. 685. . . . 7. Lymph nodes: no metastasis in two axillary. lymph nodes (ypN0(sn)) (sentinel LN: 0/2).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular. invasion:. present,. intratumoral.. . 10. Tumor border: infiltrative.. . 11. Microcalcification:. present,. tumoral/. non-tumoral.. . 12. Pathological TN category (AJCC 2017):. ypT2N0(sn).. Result. Intensity. Positive. %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Equivocal (2+),. SISH (−). Ki-67. Positive in 86%. of tumor cells. HR(−) HER2(−) Breast Cancer. 686. . 31.
|
Important Radiologic. Findings. 216 217. 218. . E. S. Lee et al.. 683. After Neoadjuvant. Chemotherapy. 219 220 221 222. 223. 30.3.
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Patient History and Progress. Female/69 years old, post-menopause.. Self-detected palpable mass lesion on left. breast.. No family history.. h/o Tuberculosis, s/p thoracic vertebra com. pression fracture.. 30.2.
|
Case 30
|
Local Recurrence
|
30.1. . Courses of Treatment. Right breast IDC → Operation → Adjuvant. therapy → Left breast recurrence (IDC).. Primary Treatment. 203 204 205. 206. . . . . Local Recurrence. 800. a. b. c. d. . Operation. 207. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 2.2 cm (pT2).. 2. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 5/10HPF).. 3. Intraductal component: present, intratu. moral/extratumoral (5%) (nuclear grade:. low, necrosis: present, architectural pattern:. cribriform/solid, extensive intraductal com. ponent: absent).. 4. Skin and nipple: no involvement of tumor.. 5. No involvement of skeletal muscle.. 6. Surgical margins:. . (a) Deep margin: 8 mm.. . (b) Superficial margin: 15 mm.. 7. Lymph nodes:. . (a) metastasis in 1 out of 5 axillary lymph. nodes (pN1a) (sentinel LN: 1/3, axillary. LN: 0/2).. . (b) perinodal extension: present.. . (c) size of metastatic carcinoma: 11 mm.. 8. Arteriovenous invasion: absent.. 9. Lymphovascular. invasion:. present,. peritumoral.. . 10. Tumor border: infiltrative.. . 11. Microcalcification: present, tumoral.. . 12. Pathologic stage (AJCC 2010): pT2N1a.. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Weak (3/8). 1. 1–10%. C-erbB2. Negative (1+). Ki-67. Positive in 11%. of tumor cells. Adjuvant Therapy. Anastrozole 1 mg/day for 4 years.. Y. Kim et al.. 801. Treatments After Recurrence. 208 209. 210. Operation. 211. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 0.9 cm (pT1b).. 2. Histologic grade: 2 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 1/3, 3/10HPF).. 3. Intraductal component: present, intratu. moral/extratumoral (50%) (nuclear grade:. high, necrosis: present, architectural pattern:. comedo, extensive intraductal component:. present).. 4. Skin and nipple: no involvement of tumor.. 5. Surgical margins:. . (a) Deep margin: 2 mm.. . (b) Superficial margin: 20 mm.. 6. Lymph nodes: no metastasis in one axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/1).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular invasion: absent.. . . . Local Recurrence. 802. a. b. c. d. . 9. Tumor border: infiltrative.. . 10. Microcalcification: absent.. . 11. Pathological TN category (AJCC 2017):. pT1bN0(sn).. Result. Intensity. Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Equivocal (2+). (SISH negative). Ki-67. Positive in 6%. of tumor cells. 31.
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Patient History and Progress. Female/89 years old, post-menopause.. Screen detected mass lesion on right breast 1. o’clock direction.. Outside result of biopsy: Invasive ductal. carcinoma.. No family history.. Hypertension, Hypothyroidism, s/p Cardiac. stent insertion (angina).. s/p Shoulder ligament rupture operation.. 30.2.
|
Case 30
|
Metastatic Breast Cancer
|
30.1. . Courses of Treatment. Right breast cancer → Operation → Adjuvant. therapy → Bone metastasis.. Positive %. Estrogen. receptor. Strong (7/8). 3. 1/3–2/3. Progesterone. receptor. Strong (7/8). 3. 1/3–2/3. C-erbB2. Negative (0). Ki-67. Positive in. 5% of tumor. cells. Adjuvant Therapy. Tamoxifen 20 mg/day.. Treatments After Recurrence
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Patient History and Progress. Female/50 years old, pre-menopause.. No family history.. Hepatitis B virus carrier, s/p myomectomy.. 30.2.
|
Case 31
|
Carcinoma In Situ
|
31.1. . Courses of Treatment:. Operation. Operation. 146. 147. Pathology Report. Ductal carcinoma in situ, pathological TN cat. egory (AJCC 2017): pTis. . 1. Size of tumor: 2.0 cm (pTis).. . 2. Nuclear grade: low.. . 3. Necrosis: absent.. . 4. Architectural pattern: papillary/micropapil. lary/cribriform.. E. S. Lee et al.. 121. . . . 5. Skin: no involvement of tumor.. . 6. Surgical margins:. . (a) deep margin: 2 mm,. . (b) superficial margin: 2 mm.. . 7. Microcalcification:. present,. tumoral/non-. tumoral.. Result. Intensity Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Equivocal (2+). Ki-67. Positive in 3%. of tumor cells. Carcinoma In Situ. 122. a. b. d. e. . . . E. S. Lee et al.. 123. 32.
|
Important Radiologic. Findings. 144. 145. 31.3.
|
Patient History and Progress. Female/31 years old, pre-menopause.. Screen detected calcification on left breast. 11 o’clock direction.. Outside result of mammotome biopsy: Ductal. carcinoma in situ.. No family history.. No comorbidities.. BRCA 1 and 2: Not detected.. 31.2.
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Case 31
|
HR(+) HER2(+) Breast Cancer
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31.1. . Courses of Treatment. Operation + Adjuvant chemotherapy (#4. cycles of doxorubicin and cyclophosphamide. followed by #4 cycles of docetaxel and trastu. zumab) + Post-operative radiation ther. apy + Trastuzumab + Letrozole 2.5 mg/day.. 184. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 1.7 cm (pT1c).. S. Park et al.. micropapillary/comedo,. extensive. intra. ductal component: absent).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) superior margin: 10 mm,. . (b) inferior margin: 15 mm,. . (c) medial margin: 15 mm,. . (d) lateral margin: 10 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: 2 mm.. HR(+) HER2(+) Breast Cancer. 406. . . S. Park et al.. 407. 6. Lymph nodes:. . (a) metastasis in one out of two axillary. lymph nodes (pN1a(sn)) (sentinel LN:. 1/1, axillary LN: 0/1),. . (b) perinodal extension: present,. . (c) size of metastatic carcinoma: 8 mm.. 7. Arteriovenous invasion: absent.. 8. Lymphovascular. invasion:. present,. intratumoral.. 9. Tumor border: infiltrative.. . 10. Microcalcification:. present,. tumoral/. non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT1cN1a(sn).. . a. b. . HR(+) HER2(+) Breast Cancer. 408. Result. Intensity. Positive. %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (7/8). 3. 1/3–2/3. C-erbB2. Positive (3+). Ki-67. Positive in 19%. of tumor cells. 32.
|
Important Radiologic. Findings. 180 181 182. 183. 31.3.
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Patient History and Progress. Female/69 years old, post-menopause.. Self-detected nipple retraction on left breast.. No family history.. Hypertension.. 31.2.
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Case 31
|
HR(+) HER2(-) Breast Cancer
|
Courses of Treatment. Operation. +. Adjuvant. chemotherapy. (#4 cycles of docetaxel & . cyclophosphamide) +. Post-operative radiation therapy + Letrozole. 2.5 mg/day.. Operation. Right breast conserving surgery, sentinel lymph. . (c) medial margin: 10 mm.. . (d) lateral margin: 10 mm.. . (e) deep margin: <1 mm from invasive duc. tal carcinoma (slide 2).. . (f) superficial margin: 5 mm.. 6. Lymph nodes:. . (a) metastasis in one out of four axillary. lymph nodes (pN1a(sn)) (sentinel LN:. 1/1, axillary LN: 0/3). . (b) perinodal extension: present.. . (c) size of metastatic carcinoma: 10 mm.. 7. Arteriovenous invasion: absent.. 8. Lymphovascular. invasion:. present,. intratumoral.. 9. Tumor border: infiltrative.. . 10. Microcalcification: absent.. . 11. Pathological TN category (AJCC 2017):. pT2N1a(sn).. Result. Intensity. Positive %. Estrogen receptor. Strong (8/8). 3. >2/3. Progesterone receptor. Negative (1/8) IDC. Strong (8/8) DCIS. 1. 3. <1%. >2/3. C-erbB2. Equivocal (2+) (SISH negative). Ki-67. Positive in 43% of tumor cells. HR(+) HER2(−) Breast Cancer
|
Important Radiologic. Findings. See Figs. 170, 171, 172 and 173.. 31.3.
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niece.. S/P. Hysterectomy. and. salpingo-oophorectomy.. BRCA 1 exon 9-13 deletion, exon 2-6. deletion.. 31.2.
|
Case 31
|
HR(−) HER2(+) Breast Cancer
|
31.1. . Operation. 213. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 2.1 cm (pT2).. 2. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 5/HPF).. 3. Intraductal component: present, intratu. moral/extratumoral (50%) (nuclear grade:. high, necrosis: present, architectural pattern:. solid/comedo, extensive intraductal compo. nent: present).. Y. Kwon et al.. 545. a. b. . 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) superior margin: 10 mm,. . (b) inferior margin: 10 mm,. . (c) medial margin: 20 mm,. . (d) lateral margin: 15 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: 2 mm.. 6. Lymph nodes: no metastasis in one axillary. lymph node (pN0(sn)) (sentinel LN: 0/1).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular invasion: present, intratumoral.. 9. Tumor border: infiltrative.. . 10. Microcalcification:. present,. tumoral/. non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT2N0(sn).. HR(−) HER2(+) Breast Cancer. 546. . . Result. Intensity. Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in. 79% of tumor. cells. 32.
|
Important Radiologic. Findings. 209 210 211. 212. . HR(−) HER2(+) Breast Cancer
|
Patient History and Progress. Female/74 years old, post-menopause.. Screen detected mass lesion on left breast 1. o’clock direction.. No family history.. Hypertension.. 31.2.
|
Case 31
|
HR(−) HER2(−) Breast Cancer
|
31.1. . Courses of Treatment. Neoadjuvant chemotherapy (#4 cycles of. doxorubicin and cyclophosphamide + #4. cycles of docetaxel) + Operation + Post-. operative radiation therapy + Adjuvant. capecitabine.. Operation. 233. Pathology Report. Invasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of tumor: 0.9 cm (ypT1b).. 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 18/10HPF).. 4. Intraductal component: absent.. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) Superior margin: 38 mm.. . (b) Inferior margin: 21 mm.. . (c) Medial margin: 20 mm.. . (d) Lateral margin: 15 mm.. . (e) Deep margin: 6 mm.. . (f) Superficial margin: 22 mm.. 7. Lymph nodes: no metastasis in five axillary. lymph nodes (ypN0(sn)) (sentinel LN: 0/3,. non-sentinel LN: 0/2).. E. S. Lee et al.. 689. . . . . HR(−) HER2(−) Breast Cancer. 690. 8. Arteriovenous invasion: absent.. 9. Lymphovascular invasion: absent.. . 10. Tumor border: infiltrative.. . 11. Microcalcification: absent.. . 12. Pathological TN category (AJCC 2017):. ypT1bN0(sn).. Result. Intensity Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Negative (0). Ki-67. Positive in 75%. of tumor cells. . . E. S. Lee et al.. 691. 32.
|
Important Radiologic. Findings. 225 226 227. 228. E. S. Lee et al.. 687. . . . . HR(−) HER2(−) Breast Cancer. 688. . After Neoadjuvant. Chemotherapy. 229 230 231. 232. 31.3.
|
Patient History and Progress. Female/41 years old, pre-menopause.. Self-detected mass lesion on right breast.. No family history.. No comorbidities.. BRCA 1 and 2 mutation: Not detected, STK11. VUS (variant of uncertain).. 31.2.
|
Case 31
|
Local Recurrence
|
31.1. . Courses of Treatment. Right breast Papillary carcinoma in situ→. Operation → Right breast recurrence (DCIS).. Primary Treatment. 212 213 214. 215. Operation. . . 216 217. 218. Pathology Report. <Right>. Y. Kim et al.. 803. . . . . . Papillary carcinoma in situ. . 1. Size of tumor: 5.0 cm (pTis).. . 2. Nuclear grade: low.. . 3. Necrosis: present.. . 4. Architectural pattern: papillary/cribriform.. . 5. Surgical margins:. . (a) Deep margin: <1 mm (slide 6).. . (b) Superficial margin: 0.08 mm (slide 2).. . 6. Lymph nodes: no metastasis in four axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/4).. . 7. Microcalcification: absent.. . 8. Pathologic stage (AJCC 2010): pTisN0(sn).. Result. Intensity. Positive %. Estrogen. receptor. Strong (7/8). 3. 1/3–2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Equivocal (2+). Ki-67. Positive in 26%. of tumor cells. <Left>. Local Recurrence. 804. . . Y. Kim et al.. 805. . . . 1. Intraductal papillomas, multiple, up to 0.8 cm. . 2. Sclerosing adenosis with microcalcification.. Treatments After Recurrence. 219. 220. Biopsy. Right 1 o’clock.. Ductal carcinoma in situ:. . 1. Nuclear grade: low.. . 2. Necrosis: absent.. . 3. Architectural pattern: papillary/cribriform.. . 4. Microcalcification: absent.. Local Recurrence. 806. . Closed follow-up due to rejection of surgical. treatment.. 32.
| null |
Patient History and Progress. Female/49 years old, pre-menopause.. Screen detected mass lesion on right breast 1. o’clock direction.. No family history.. No comorbidities.. 31.2.
|
Case 31
|
Metastatic Breast Cancer
|
Courses of Treatment. Right breast cancer → Operation → Adjuvant. therapy → Lung metastasis.. Primary Treatment. receptor. Negative (0/8). 0. 0. C-erbB2. Negative (0). Ki-67. Positive in. 85% of tumor. cells. Adjuvant Therapy. Adjuvant chemotherapy #6 cycles (Fluorouracil. & Doxorubicin & Cyclophosphamide).. Post-operative radiation therapy to right breast.. Olaparib & placebo (clinical trial 0040, for. 1 year).. Operation. Nov. 2014 Bilateral salpingo-oophorectomy (due. to BRCA 1, positive for deleterious mutation).. Treatments After Recurrence
| null |
BRCA 1: positive for deleterious mutation.. S/p bilateral salpingo-oophorectomy.. 31.2.
|
Case 32
|
Carcinoma In Situ
|
32.1. . Courses of Treatment. Operation + Postoperative radiation therapy.. Operation. 151. 152. Pathology Report. Ductal carcinoma in situ, pathological TN cat. egory (AJCC 2017): pTis. . 1. Size of tumor: 4.0 cm (pTis).. . 2. Nuclear grade: high.. . 3. Necrosis: present.. . 4. Architectural pattern: . micropapillary/cribri. form/comedo.. . 5. Skin: no involvement of tumor.. . 6. Surgical margins:. . (a) superior margin: 10 mm,. . (b) inferior margin: 10 mm,. . (c) medial margin: 40 mm,. . (d) lateral margin: 5 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: 2 mm.. . 7. Microcalcification:. present,. tumoral/non-. tumoral.. Result. Intensity. Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Equivocal. (2+). Ki-67. Positive in. 27% of tumor. cells. .
|
Important Radiologic. Findings. 148 149. 150. 32.3.
|
Patient History and Progress. Female/72 years old, post-menopause.. Screen detected mass lesion on right breast. 8 o’clock direction.. Outside result of biopsy: Ductal carcinoma in. situ.. No family history.. No comorbidities.. 32.2.
|
Case 32
|
HR(+) HER2(+) Breast Cancer
|
32.1. . Courses of Treatment. Neoadjuvant chemotherapy (#3 cycles of. docetaxel. and. trastuzumab. and. pertu. zumab) + Operation + Post-operative radia. tion therapy + Trastuzumab emtansine +. Letrozole 2.5 mg/day.. Operation:. Left. axillary. lymph. node. . dissection.. Pathology Report. Metastatic Ductal Carcinoma. . 1. Post-chemotherapy status.. . 2. metastasis in 7 out of 20 axillary lymph nodes. (axillary LN: 7/20).. . 3. perinodal extension: present.. . 4. size of metastatic carcinoma: 40 mm.. Result. Intensity. Positive. %. Estrogen. receptor. Intermediate. (5/8). 2. 10%-. 1/3. Progesterone. receptor. Negative (2/8). 1. <1%. C-erbB2. Positive (3+). Ki-67. Positive in 48%. of tumor cells. S. Park et al.. 409. . . HR(+) HER2(+) Breast Cancer
|
Important Radiologic. Findings. 185 186 187 188. 189. 32.3.
|
Patient History and Progress. Female/74 years old, post-menopause.. Self-detected mass lesion on left axillary.. No family history.. S/P Tuberculosis, asthma.. 32.2.
|
Case 32
|
HR(+) HER2(-) Breast Cancer
|
Courses of Treatment. Operation + Post-operative radiation ther. apy + Letrozole 2.5 mg/day.. Operation. Right breast conserving surgery, sentinel lymph. ponent: absent).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) superior margin: 20 mm.. . (b) inferior margin: 40 mm.. . (c) medial margin: 15 mm.. . (d) lateral margin: 20 mm.. . (e) deep margin: 5 mm.. . (f) superficial margin: 10 mm.. 6. Lymph nodes: no metastasis in one axillary. lymph node (pN0(sn)) (sentinel LN: 0/1,. 11. Pathological TN category (AJCC 2017):. pT1cN0(sn).. Result. Intensity. Positive. %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative (0). Ki-67. Positive in 9% of. tumor cells. HR(+) HER2(−) Breast Cancer
|
Important Radiologic. Findings. See Figs. 175, 176, 177 and 178.. 32.3.
|
o’clock direction.. No family history.. Hypertension, s/p bronchiectasis, s/p left hip. arthroplasty.. 32.2.
|
Case 32
|
HR(−) HER2(+) Breast Cancer
|
32.1. . Courses of Treatment. Neoadjuvant chemotherapy (#5 cycles of. docetaxel and carboplatin and trastuzumab and. pertuzumab after followed #1 cycle of trastu. zumab and pertuzumab) + Operation + Post-. operative radiation therapy + Trastuzumab.. Operation. 220. Pathology Report. No residual tumor with stromal degeneration.. . 1. Post-chemotherapy status.. . 2. Lymph nodes: no metastasis in three axillary. lymph nodes (ypN0(sn)) (sentinel LN: 0/3).. Result. Intensity. Positive %. Estrogen. receptor. Negative. (2/8). 1. <1%. Progesterone. receptor. Negative. (2/8). 1. <1%. C-erbB2. Positive (3+). Ki-67. Positive in. 45% of tumor. cells. Y. Kwon et al.. 549. a. b. . 33.
|
Important Radiologic. Findings. 214 215. 216. 32.3. . After Neoadjuvant. Chemotherapy. 217 218. 219. Y. Kwon et al.. 547. . . . . HR(−) HER2(+) Breast Cancer. 548. . . 32.4.
|
Patient History and Progress. Female/55 years old, post-menopause.. Screen detected mass lesion on right breast 8. o’clock direction.. No family history.. Hypertension, thyroid nodules.. 32.2.
|
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