Dataset Viewer
Case
string | Courses of Treatment
string | Label
string | Patient History and Progress
string | Primary Treatment
string | Cluster
string |
|---|---|---|---|---|---|
Case 39
|
Left breast IDC→ Operation → Adjuvant therapy → Left breast recurrence (IDC).
|
Local Recurrence
|
Female/42 years old, post-menopause.
Bloody discharge from left nipple.
No family history.
|
Report 1:Lt CC MG: subtle asymmetry in the outer portion of left breast. Report 2:US: irregular hypoechoic mass with angular
margin at the 2 o’clock direction of left breast. Report 3:MRI: segmental heterogeneous non-mass
enhancement in the outer portion of left breast. Report 4:Lymphoscintigraphy shows visualized sentinel lymph nodes in the left axilla. Operation
Aug. 2013 Left skin sparing mastectomy with
latissimus dorsi muscle fap reconstruction (a) Gross pathology of mastectomy specimen. (b, c) The margins get marked and sliced with different colors
on each direction. Pathology Report
Invasive Ductal Carcinoma
1. Size of invasive tumor: 3 cm (pT2).
2. Size of intraductal component: 4.5 cm.
3. Histologic grade: 1/3 (tubule formation: 3/3,
nuclear pleomorphism: 1/3, mitotic count:
1/3, 7/10HPF).
4. Intraductal component: present, intratumoral/extratumoral (30%) (nuclear grade:
low, necrosis: absent, architectural pattern:
cribriform, extensive intraductal component:
present).
5. Skin: no involvement of tumor.
6. Surgical margins: (a) Deep margin: 13 mm.
(b) Superfcial margin: 16 mm.
7. Lymph nodes:
(a) Metastasis in 1 out of 10 axillary lymph
nodes (pN1mi) (sentinel LN: 1/3, axillary LN: 0/7).
(b) Perinodal extension: absent.
(c) Size of metastatic carcinoma: 2 mm.
8. Vascular invasion: absent.
9. Lymphatic invasion: absent.
10. Tumor border: infltrative.
11. Microcalcifcation: absent.
12. Pathologic stage (AJCC 2010): pT2N1mi. Adjuvant Therapy
Tamoxifen 20 mg/day for 2.6 years with
goserelin.
|
Cluster 3: Advanced Stage Disease
|
Case 40
|
Right breast DCIS→ Operation → Right breast
recurrence (microinvasive ductal carcinoma).Rt magnifcation view (ML): segmental fne
pleomorphic microcalcifcations in right upper outer
quadrant.
|
Local Recurrence
|
Female/60 years old, post-menopause.
Screen detected mass lesion on right breast 12
o’clock and 9 o’clock direction.
Outside result of biopsy: right breast 12
o’clock, Atypical ductal hyperplasia.
Right breast 9:30 o’clock, Fibrocystic change.
Family history of breast cancer, older sister
and younger sister.
Hepatitis C virus carrier, Facet Joint Syndrome
lumbosacral region, Dyspnea disorder.
BRCA 1 VUS (variant of uncertain).
|
Rt magnifcation view (ML): segmental fne
pleomorphic microcalcifcations in right upper outer
quadrant. Operation
Jul. 2016 Right breast mass excision (a) Gross pathology of breast excision specimen. (b) The margins get marked and sliced with different colors
on each direction. Pathology Report
Ductal Carcinoma In Situ
1. Size of tumor: 0.3 cm (pTis).
2. Nuclear grade: low.
3. Necrosis: absent.
4. Architectural pattern: solid/cribriform.
5. Surgical margins:
(a) Superior margin: 7 mm.
(b) Inferior margin: 6 mm.
(c) Medial margin: 1 mm from ductal carcinoma in situ (slide 1).
(d) Lateral margin: 45 mm.
(e) Deep margin: <1 mm from ductal carcinoma in situ (slide 1).
6. Microcalcifcation: present, tumor/
non-tumor.
7. Pathologic stage (AJCC 2010): pTisNx.
|
Cluster 3: Advanced Stage Disease
|
Case 41
|
Left breast IDC → Operation → Adjuvant therapy → Right breast recurrence (DCIS).
|
Local Recurrence
|
Female/62 years old, post-menopause.
Screen detected mass lesion on left breast subareolar and retraction of left nipple.
No family history.
No comorbidities.
|
Report 1: Lt. magnifcation view (ML): indistinct irregular hyperdense mass with associated fne pleomorphic
microcalcifcations in left subareolar area. Report 2: US: irregular hypoechoic mass (white arrow)
with associated ductal dilatations (black arrow) in left
subareolar area. Report 3:Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left axilla. Operation
Jul. 2012 Left total mastectomy, sentinel lymph
node biopsy Pathology Report
Invasive Ductal Carcinoma
1. Size of invasive tumor: 1.2 cm (pT1c).
2. Size of ductal carcinoma in situ: 3.5 cm.
3. Histologic grade: 2 (tubule formation: 2/3,
nuclear pleomorphism: 3/3, mitotic count:
1/3, 3/10HPF). (a) Gross pathology of mastectomy specimen. (b) The margins get marked and sliced with different colors on
each direction. Adjuvant Therapy
Adjuvant chemotherapy #6 cycles of fuorouracil
and doxorubicin and cyclophosphamide.
Tamoxifen 20 mg/day for 2.3 years.
|
Cluster 3: Advanced Stage Disease
|
Case 42
|
Left breast ILC → Operation → Adjuvant therapy → Right breast recurrence (IDC).
|
Local Recurrence
|
Female/52 years old, pre-menopause.
Screen detected mass lesion on right breast 10
o’clock direction.
Outside result of biopsy: Invasive ductal
carcinoma.
Family history of breast cancer, younger sister
at her 44 years old.
s/p Left breast Nipple sparing mastectomy
(invasive lobular carcinoma).
BRCA 1 and 2 mutation: Not detected.
|
Lt magnifcation view (ML): multifocal
grouped fne pleomorphic microcalcifcations in left
upper breast. Operation
Aug. 2017 Left nipple-areolar complex sparing
mastectomy with transverse rectus abdominis
muscles fap reconstruction (outside).
Pathology Report
Invasive Lobular Carcinoma
1. Size of invasive tumor: 0.2 cm (pT1a).
2. Pathologic stage: pT1aNx. Adjuvant therapy. Adjuvant therapy.
Tamoxifen 20 mg/day for 0.7 year.
|
Cluster 3: Advanced Stage Disease
|
Case 43
|
Right breast ILC→ Operation → Adjuvant therapy → Left breast recurrence (microinvasive
ductal carcinoma).
|
Local Recurrence
|
Female/64 years old, post-menopause.
Screen detected mass lesion on right breast 12
o’clock direction.
Outside result of biopsy: Invasive ductal
carcinoma.
Family history of breast cancer, older sister.
Diabetes mellitus, fatty liver, dyslipidemia.
BRCA 1 and 2 mutation: Not detected, ATM
VUS (variant of uncertain).
|
Report 1: MRI: irregular heterogeneous enhancing mass
in right breast. Report 2: Lymphoscintigraphy shows visualized sentinel
lymph nodes in the right axilla. Operation
May 2014 Right breast conserving surgery, sentinel lymph node biopsy (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors
on each direction. Pathology Report
Invasive Lobular Carcinoma
1. Size of tumor: 1.5 cm (pT1c).
2. Histologic grade: 2/3 (tubule formation: 3/3,
nuclear pleomorphism: 2/3, mitotic count:
1/3, 2/10HPF).
3. In situ component: present, extratumoral
(40%).
4. Skin: no involvement of tumor.
5. Surgical margins:
(a) Superior margin: 8 mm.
(b) Inferior margin: 27 mm.
(c) Medial margin: positive for lobular carcinoma in situ (Fro 6) (see note).
(d) Lateral margin: 15 mm.
(e) Deep margin: 2 mm.
(f) Superfcial margin: 9 mm.
6. Lymph nodes: no metastasis in three axillary
lymph nodes (pN0(sn)) (sentinel LN: 0/3).
7. Arteriovenous invasion: absent.
8. Lymphovascular invasion: absent.
9. Tumor border: infltrative.
10. Microcalcifcation: absent.
11. Pathologic stage (AJCC 2010): pT1cN0(sn).
Note: 1. Lobular carcinoma in situ is present
only in the permanent section of Fro 6. Adjuvant Therapy
Postoperative radiation therapy.
Anastrozole 1 mg/day for 5 years.
|
Cluster 3: Advanced Stage Disease
|
Case 44
|
Left breast microinvasive ductal carcinoma →
Operation → Adjuvant therapy → Right breast
recurrence (IDC).
|
Local Recurrence
|
Female/54 years old, post-menopause.
Screen detected mass lesion on left breast 2
o’clock direction.
Outside result of biopsy: Ductal carcinoma.
No family history.
No comorbidities.
|
Report 1:Lt magnifcation view (ML): linear fne pleomorphic microcalcifcations in left upper breast. Report 2:US: microcalcifcations at the corresponding
area of the microcalcifcations on mammography. Report 3:US: microlobulated hypoechoic mass at
6 o’clock direction of left breast. Report 4:Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left axilla. Operation
First Operation (Feb. 2014) Left breast conserving surgery, sentinel lymph node biopsy: (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors
on each direction. Pathology Report
Microinvasive Ductal Carcinoma
1. Size of invasive component: <0.1 cm
(pT1mic).
2. Size of intraductal component: 1.2 cm.
3. Histologic grade: 2/3 (tubule formation: 3/3,
nuclear pleomorphism: 2/3, mitotic count:
1/3, 3/10HPF).
4. Intraductal component: present, extratumoral
(99%) (nuclear grade: low, necrosis: absent,
architectural pattern: solid, extensive intraductal component: present).
5. Surgical margins:
(a) Superior margin: 7 mm.
(b) Inferior margin: 17 mm.
(c) Medial margin: positive for ductal carcinoma in situ (Fro 4) (see note).
(d) Lateral margin: <2 mm from ductal carcinoma in situ (slide 6).
(e) Deep margin: 4 mm.
(f) Superfcial margin: <1 mm from ductal
carcinoma in situ (slide 1).
6. Lymph nodes: no metastasis in one axillary
lymph nodes (pN0(sn)) (sentinel LN: 0/1).
7. Venous invasion: absent.
8. Lymphovascular invasion: absent.
9. Tumor border: infltrative.
10. Microcalcifcation: present, non-tumoral. 11. Pathologic stage (AJCC 2010):
pT1micN0(sn).
Note: 1. Ductal carcinoma in situ is present
only in the permanent section of Fro 4. Operation
Second Operation (Mar. 2014) Left breast wide
excision.
Pathology Report
1. No residual tumor with foreign body
reaction.
(a) Post-lumpectomy status.
2. Atypical ductal hyperplasia, focal (see note).
Note: Atypical ductal hyperplasia is present
only in the permanent section of Fro 1.
Adjuvant Therapy
Postoperative radiation therapy.
Tamoxifen 20 mg/day for 5 years.
|
Cluster 3: Advanced Stage Disease
|
Case 45
|
Right breast LCIS→ Operation → Right breast
recurrence (DCIS).
|
Local Recurrence
|
Female/57 years old, post-menopause.
Screen detected mass lesion on right breast 12
o’clock direction.
Outside result of biopsy: Lobular carcinoma
in situ.
Family history of breast cancer, older sister.
Panic disorder.
BRCA 1 and 2 mutation: Not detected.
|
Report 1:US: irregular not parallel hypoechoic mass at
the 1 o’clock direction of right breast. Operation
Jul. 2017 Right breast conserving surgery, left
breast mass excision: (a) Gross pathology of right lumpectomy specimen. (b) The margins get marked and sliced with different colors on each direction. and (a) Gross pathology of left breast excision specimen. (b) The margins get marked and sliced with different
colors on each direction. Pathology Report
<Right Breast> 1. Lobular Carcinoma In Situ
(a) Size of tumor: up to 0.4 cm, multifocal
(pTis).
(b) Surgical margins:
• Superior margin: 5 mm.
• Inferior margin: 5 mm.
• Medial margin: 5 mm.
• Lateral margin: (see note).
• Deep margin: 5 mm.
• Superfcial margin: 5 mm.
(c) Microcalcifcation: present, non-tumoral.
(d) Pathologic stage (AJCC 2010): pTisNx.
2. Atypical ductal hyperplasia. Note: 1. The lateral margin of the lumpectomy
specimen (slide 5) is close to lobular carcinoma
in situ (<1 mm), but this margin submitted for
frozen diagnosis (Fro 5) is free of tumor. <Left Breast>
1. Atypical ductal hyperplasia involving intraductal papilloma
2. Fibroadenoma.
|
Cluster 3: Advanced Stage Disease
|
Case 46
|
Right breast papillary carcinoma in situ →
Operation → Adjuvant therapy → Right breast
recurrence (IDC).
|
Local Recurrence
|
Female/69 years old, post-menopause.
Screen detected mass lesion on upper outer
portion of right breast.
No family history.
No comorbidities.
|
Report 1:Operation
May 2007 Right breast conserving surgery. (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors
on each direction. Pathology Report
Papillary Carcinoma In Situ in background of
multiple papilloma (see note)
1. Size of intraductal carcinoma: 0.5 cm
(pTis).
2. Nuclear grade: low.
3. Necrosis: absent.
4. Architectural pattern: papillary.
5. Skin: no involvement of tumor. 6. Surgical margins:
(a) Superior margin: 18 mm.
(b) Inferior margin: positive for intraductal
papilloma.
(c) Medial margin: 15 mm.
(d) Lateral margin: 20 mm.
(e) Deep margin: 2 mm.
7. Microcalcifcation: present, tumoral/
non-tumoral.
8. Pathologic staging: pTis.
Note: The in situ component is mainly present
in the needle biopsy specimen.
Adjuvant Therapy
Tamoxifen 20 mg/day for 3.6 years.
|
Cluster 3: Advanced Stage Disease
|
Case 47
|
Right breast Infltrating ductal carcinoma→
Operation → Adjuvant therapy → Left breast
recurrence (IDC).
|
Local Recurrence
|
Female/72 years old, post-menopause.
Screen detected mass lesion on right breast 1
o’clock direction.
No family history.
Diabetes mellitus.
BRCA 1 and 2 mutation: Not detected, ATM
VUS (variant of uncertain).
POLE VUS (variant of uncertain).
|
Report 1: US: irregular hypoechoic mass with microlobulated margin at the 1 o’clock direction of right breast. Report 2: Lymphoscintigraphy shows visualized sentinel
lymph nodes in both axilla. Operation
Aug. 2003 Right breast conserving surgery, axillary lymph node dissection.
Pathology Report
Infltrating ductal carcinoma.
1. Size of tumor: 2 cm (pT1c).
2. Histologic grade: 2/3 (tubule formation: 2/3,
nuclear pleomorphism: 2/3, mitotic count: 2/3).
3. Ductal carcinoma in situ: present, intratumoral (5%) (nuclear grade: low, necrosis:
absent, architectural pattern: solid, extensive
intraductal component: absent).
4. Skin: no involvement of tumor.
5. Surgical margins: clear:
(a) Superior margin: 30 mm.
(b) Inferior margin: 35 mm.
(c) Medial margin: 35 mm.
(d) Lateral margin: 25 mm.
(e) Deep margin: 10 mm.
6. Lymph nodes:
(a) Metastasis in 2 out of 22 axillary lymph
nodes (pN1a) (sentinel LN: 1/2, axillary
LN: 1/20).
(b) Perinodal extension: absent.
(c) Size of metastatic carcinoma: 6 mm. 7. Vascular invasion: absent.
8. Lymphatic invasion: absent.
9. Tumor border: infltrative.
10. Microcalcifcation: absent.
11. Pathologic staging: pT1cN1a. Adjuvant Therapy
Adjuvant chemotherapy #6 cycles of fuorouracil
and doxorubicin and cyclophosphamide.
Postoperative radiation therapy.
Tamoxifen 20 mg/day 1.6 years, anastrozole
1 mg/day for 1 year, tamoxifen 20 mg/day for
2.3 years.
|
Cluster 3: Advanced Stage Disease
|
Case 48
|
Left breast Mucinous carcinoma → Operation
→ Adjuvant therapy → Left breast recurrence
(mucinous carcinoma).
|
Local Recurrence
|
Female/42 years old, pre-menopause.
Screen detected mass lesion on left breast 9
o’clock direction.
Outside result of biopsy: Mucinous
carcinoma.
No family history.
No comorbdities.
|
Report 1: o/s US: oval hypoechoic mass with microlobulated margin in left breast. Report 2: Lymphoscintigraphy shows visualized sentinel lymph nodes in the left axilla. Operation
Jan. 2007 Left breast conserving surgery, sentinel
lymph node biopsy Gross pathology of lumpectomy specimen.Pathology Report
Mucinous Carcinoma
1. Size of invasive carcinoma: 0.6 cm (pT1b).
2. Size of intraductal carcinoma: 1.5 cm.
3. Histologic grade: 2/3 (tubule formation: 2/3,
nuclear pleomorphism: 2/3, mitotic count:
2/3).
4. Ductal carcinoma in situ: present, intratumoral/extratumoral (50%) (nuclear grade:
low, necrosis: absent, architectural pattern:
cribriform, extensive intraductal component:
present).
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) Superior margin: 8 mm.
(b) Inferior margin: 15 mm.
(c) Medial margin: 1 mm from mucinous
carcinoma (slide 9) and.
(d) Positive for atypical ductal hyperplasia
(Fro 5) (see note).
(e) Lateral margin: 10 mm.
(f) Deep margin: 1 mm.
7. Lymph nodes: no metastasis in 1 axillary
lymph nodes (pN0(sn)) (sentinel LN: 0/1).
8. Vascular invasion: absent.
9. Lymphatic invasion: present, intratumoral.
10. Tumor border: pushing.
11. Microcalcifcation: present, tumoral/
non-tumoral.
12. Pathologic staging: pT1bN0(sn). Note: Atypical ductal hyperplasia is focally
present only in the permanent section of Fro 5. Adjuvant Therapy
Postoperative radiation therapy.
|
Cluster 3: Advanced Stage Disease
|
Case 49
|
Right breast IDC→ Operation → Adjuvant therapy → Left breast recurrence (IDC).
|
Local Recurrence
|
Female/63 years old, post-menopause.
Self-detected mass lesion on right breast
2 o’clock direction.
No family history.
No comorbidities.
BRCA 1 and 2 mutation: No examination.
|
Report 1: US: irregular hypoechoic mass with indistinct
margin at the 2 o’clock direction of right breast. Report 2:Lymphoscintigraphy shows visualized sentinel lymph nodes in the right axilla. Pathology Report
Invasive Ductal Carcinoma
1. Size of tumor: 1.5 cm (pT1c).
2. Histologic grade: 2/3 (tubule formation: 2/3,
nuclear pleomorphism: 2/3, mitotic count:
2/3).
3. Ductal carcinoma in situ: present, intratumoral/extratumoral (30%) (nuclear grade:
low, necrosis: present, architectural pattern:
cribriform and comedo, extensive intraductal
component: present).
4. Skin: no involvement of tumor.
5. Surgical margins:
(a) Superior margin: 15 mm.
(b) Inferior margin: 25 mm.
(c) Medial margin: 20 mm.
(d) Lateral margin: 20 mm.
(e) Deep margin: 5 mm.
6. Lymph nodes: no metastasis in 1 axillary
lymph nodes (pN0(sn)) (sentinel LN: 0/1).
7. Vascular invasion: absent.
8. Lymphatic invasion: absent.
9. Tumor border: infltrative.
10. Microcalcifcation: present, tumoral/
non-tumoral.
11. Pathologic staging: pT1cN0(sn). Adjuvant Therapy
Postoperative radiation therapy.
|
Cluster 3: Advanced Stage Disease
|
Case 50
|
Right breast IDC → Operation → Adjuvant
therapy → Right breast recurrence (IDC).
|
Local Recurrence
|
Female/72 years old, post-menopause.
Screen detected mass lesion on right breast 12
o’clock and 8 o’clock direction, left breast 12
o’clock direction.
No family history.
Hypertension, hepatitis B virus carrier,
claustrophobia.
|
(a) Gross pathology of right mastectomy specimen. (b) The margins get marked and sliced with different colors on each direction. 8 (a) Gross pathology of left mastectomy specimen. (b, c, d) The margins get marked and sliced with different
colors on each direction. Pathology Report
<Right Breast>
1. Invasive Ductal Carcinoma
(a) Size of tumor: 1.8 cm (pT1c).
(b) Histologic grade: 2/3 (tubule formation:
2/3, nuclear pleomorphism: 2/3, mitotic
count: 2/3, 10/10HPF).
(c) Intraductal component: present, intratumoral/extratumoral (30%) (nuclear grade:
low, necrosis: absent, architectural
pattern: solid, extensive intraductal component: present).
(d) Surgical margins:
• Deep margin: 3 mm.
• Superfcial margin: 10 mm.
(e) Lymph nodes: no metastasis in one axillary
lymph node (pN0(sn)) (sentinel LN: 0/1).
(f) Arteriovenous invasion: absent.
(g) Lymphovascular invasion: absent.
(h) Tumor border: infltrative.
(i) Microcalcifcation: present, non-tumoral.
(j) Pathologic stage (AJCC 2010):
pT1cN0(sn).
2. Intraductal Papilloma with usual ductal
hyperplasia. <Left Breast>
Intraductal papilloma with usual ductal
hyperplasia.
Adjuvant Therapy
Letrozole 2.5 mg/day for 2.8 years.
|
Cluster 3: Advanced Stage Disease
|
Case 1
|
Left breast cancer → Operation + Adjuvant
therapy → Chest wall recurrence → Palliative
therapy → Pleural fssure recurrence → Palliative therapy.
|
Metastatic Breast Cancer
|
Female/49 years old, post-menopause.
No family history.
|
Operation
Mar. 2007 Left modifed radical mastectomy.
Pathology: Invasive ductal carcinoma, stage
pT1N0, Size of tumor: 1.5 * 1.0 cm, Lymph
node: 0/21. Adjuvant Therapy
Adjuvant Chemotherapy #5 cycles (Fluorouracil
& Epirubicin & Cyclophosphamide).
Concurrent Trastuzumab therapy #9 cycles.
Zoladex for 2 years + Tamoxifen 20 mg/day
for 5 years.
|
Cluster 3: Advanced Stage Disease
|
Case 2
|
Right breast cancer → Operation + Adjuvant
therapy → Lung metastasis → Palliative therapy
→ Progression on rib and lung → Palliative
therapy → Progression on liver → Palliative
therapy.
|
Metastatic Breast Cancer
|
Female/55 years old, post-menopause.
Family history of breast cancer, mother.
BRCA 1 & 2 mutation: No examination.
|
Radiologic Finding: Breast MRI (Jul.
2012): An irregular
enhancing mass in the
right breast. Operation
Aug. 2012 Right breast conserving surgery, axillary lymph node dissection.
Pathology: Invasive ductal carcinoma, stage
pT2(m)N1a.
Size of tumor: 3.5 cm, 1.5 cm, and 0.5 cm,
Lymph node: 3/16, size of metastatic carcinoma:
8 mm. Adjuvant Therapy
Post-operative radiation therapy + Tamoxifen
20 mg/day for 2.5 years.
Letrozole 2.5 mg/day for 1 year: stop due to
skin rash → Change to Tamoxifen 20 mg/day for
1.5 years.
|
Cluster 3: Advanced Stage Disease
|
Case 3
|
Left breast cancer → Neoadjuvant
Chemotherapy → Operation → Adjuvant therapy
→ Bone, lung, and brain metastasis.
|
Metastatic Breast Cancer
|
Female/62 years old, post-menopause.
No family history.
Diabetes mellitus, rheumatoid arthritis.
|
Breast MRI
(Sep. 2017): Irregular
enhancing mass in the
left breast (white arrow).
Enlarged LN at the left
internal mammary chain
(black arrow). Left total
mastectomy = IDC. Neoadjuvant Chemotherapy
Neoadjuvant Chemotherapy #8 cycles
(Adriamycin + Cyclophosphamide #4 →
Docetaxel #4).
Operation
Mar. 2018 Left modifed 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. Adjuvant Therapy
Post-operative radiation therapy +adjuvant chemotherapy (Xeloda).
|
Cluster 3: Advanced Stage Disease
|
Case 4
|
Right breast cancer → Operation → Adjuvant
therapy → Left breast and pleural effusion
recurrence.
|
Metastatic Breast Cancer
|
Female/48 years old, pre-menopause.
No family history.
BRCA 1 mutation: detected.
s/p Appendectomy, s/p myomectomy.
|
Operation
Oct. 2008 Right breast conserving surgery, axillary lymph node dissection.
Pathology: Invasive ductal carcinoma, stage
T1(m)N1 (2/25).
Size of tumor: 1.7 * 1.5 * 1 cm and
0.5 * 0.4 cm, lymph node: 2/25, size of metastatic
carcinoma: 19 mm. Adjuvant Therapy
Adjuvant chemotherapy #6 cycles → Postoperative radiation therapy + Tamoxifen 20 mg/
day for 5 years.
|
Cluster 3: Advanced Stage Disease
|
Case 5
|
Left breast cancer → Neoadjuvant chemotherapy → Operation → Adjuvant therapy → Lung
and liver metastasis.
|
Metastatic Breast Cancer
|
Female/70 years old, post-menopause.
No family history.
Hypertension.
|
Jun. 2015 breast, left, needle biopsy:
Invasive ductal carcinoma, histologic grade 2
with apocrine differentiation. Breast MRI (Jun. 2015): Multiple malignant
enhancing masses in the left breast. US-CNB = IDC and Post-NAC breast MRI (Dec. 2015): Decreased
number and size of the previous masses in the left breast.
Left BCS = IDC. Operation
Dec. 2015 Left breast conserving surgery, sentinel lymph node biopsy.
Pathology: Invasive ductal carcinoma, stage
ypT1cN1mi (sn).
Size of tumor: 1.5 cm, lymph node: 1/3, size
of metastatic carcinoma: 1.8 mm. Adjuvant Therapy
Post-operative radiation therapy + Letrozole
2.5 mg/day for 4.9 years.
|
Cluster 3: Advanced Stage Disease
|
Case 6
|
Right breast cancer → Neoadjuvant chemotherapy → Operation → Adjuvant therapy →
Ipsilateral breast and chest wall recurrence →
Palliative therapy → Progression on the skin
and contralateral axillary lymph nodes
|
Metastatic Breast Cancer
|
Female/47 years old, pre-menopause.
No family history.
|
Aug. 2017 breast, left, needle biopsy:
Invasive ductal carcinoma, histologic grade 2. Clinical stage: cT3N1M0. Breast MRI (Sep. 2017): Conglomerated enhancing masses (black arrow) and non-mass enhancement
(white arrows) in the right breast. US-CNB = IDC. Post-NAC breast MRI (Jan. 2018): Decreased
size of the enhancing masses (black arrow) and non-mass
enhancement (white arrows) in the right breast. Right
BCS = IDC. Neoadjuvant Chemotherapy
Neoadjuvant chemotherapy #6 cycles (Docetaxel
& Carboplatin & Trastuzumab & Pertuzumab).
Operation
Jan. 2018 Right breast conserving surgery, sentinel lymph node biopsy.
Pathology: Invasive ductal carcinoma, stage
ypT1aN1mi (sn).
Size of tumor: 0.2 cm, lymph node: 1/1, size
of metastatic carcinoma: 2 mm. Adjuvant Therapy
Post-operative radiation therapy + Trastuzumab
for 1 year.
|
Cluster 3: Advanced Stage Disease
|
Case 7
|
Left breast cancer → Operation → Adjuvant
therapy → Ipsilateral breast and chest wall
recurrence → Chemotherapy → Progression on
the skin and contralateral axillary lymph
nodes.
|
Metastatic Breast Cancer
|
Female/48 years old, pre-menopause.
No family history.
|
Breast MRI (Jan. 2019): A round enhancing
mass in the left breast. Left BCS = Microinvasive ductal
carcinoma. Operation
Jan. 2019 Left breast conserving surgery, sentinel
lymph node biopsy. Pathology: Invasive ductal carcinoma, stage
pT1bN0(sn).
Size of tumor: 0.7 * 0.5 * 0.5 cm, lymph node:
0/2. Adjuvant Therapy
Adjuvant chemotherapy #6 cycles (Cyclophosphamide & Methotrexate & Fluorouracil).
Post-operative radiation therapy.
|
Cluster 3: Advanced Stage Disease
|
Case 8
|
Left breast cancer → Operation → Adjuvant
therapy → Ipsilateral axillary lymph nodes
recurrence.
|
Metastatic Breast Cancer
|
Female/55 years old, post-menopause.
No family history
|
Breast MRI (Mar. 2016): An irregular enhancing
mass in the left breast. Left BCS = IDC. Operation
Mar. 2016 Left breast conserving surgery, sentinel lymph node biopsy.
Pathology: Invasive ductal carcinoma, stage
pT2N0(sn).
Size of tumor: 2.5 cm, lymph node: 0/1. Oncotype Dx RS Score: 18. Adjuvant Therapy
Post-operative radiation therapy + Tamoxifen
20 mg/day for 4.8 years.
|
Cluster 3: Advanced Stage Disease
|
Case 9
|
Right breast cancer → Operation → Adjuvant
therapy → Ipsilateral axillary lymph nodes
recurrence.
|
Metastatic Breast Cancer
|
Female/57 years old, post-menopause.
No family history.
S/p Myomectomy & bilateral
salpingo-oophorectomy
|
Breast MRI (Jul. 2019): Mixed enhancing
masses and non-mass enhancement in the right breast.
Right BCS = IDC. Operation
Jul. 2019 Right breast conserving surgery, sentinel lymph node biopsy.
Pathology: Invasive ductal carcinoma, stage
pT1c(2)N0(sn).
Size of tumor: 1.1 cm and 0.5 cm, lymph
node: 0/1. Adjuvant Therapy
Post-operative radiation therapy + Letrozole
2.5 mg/day for 1 year.
|
Cluster 3: Advanced Stage Disease
|
Case 10
|
Left breast cancer → Operation → Adjuvant
therapy → Ipsilateral breast and lung recurrence → Palliative therapy → Progression on
lung, left breast.
|
Metastatic Breast Cancer
|
Female/53 years old, post-menopause.
No family history.
S/p cholecystectomy, s/p knee giant cell tumor
excision, s/p interstitial mammoplasty.
S/p otitis media operation
|
Mammography (Oct. 2020): Interstitial injection
mammoplasty of both breasts. Palpable lump in left breast. Breast US (Oct. 2020): A hypoechoic mass at the
palpable area of the left breast. US-VAB = IDC. Breast MRI (Oct. 2020): An oval enhancing
mass in the left breast. Left BCS = IDC. Operation
Dec. 2020 Left breast conserving surgery, sentinel lymph node biopsy.
Pathology: Invasive ductal carcinoma, stage
pT2N0(sn).
Size of tumor: 2.1 cm, lymph node: 0/1. Adjuvant Therapy
Adjuvant chemotherapy #4 cycles (Docetaxel &
cyclophosphamide).
|
Cluster 3: Advanced Stage Disease
|
Case 11
|
Both breasts cancer → Operation → Adjuvant
therapy → Right axillary lymph node
metastasis.
|
Metastatic Breast Cancer
|
Female/65 years old, post-menopause.
Family history of colon cancer, mother.
BRCA 1 & 2 mutation: Not detected.
|
Breast MRI (May 2018): Malignant masses in
the right breast (white arrows) and left breast (black
arrow). Both NSM = Both IDC. Operation
Jun. 2018 Both nipple-areolar complex sparing
mastectomy with immediate implant reconstruction, sentinel lymph node biopsy.
Pathology:
Right> Invasive ductal carcinoma, stage
pT1c(2)N0(sn).
Size of tumor: 1.8 cm and 1.7 cm, lymph
node: 0/3. HER2/CEP17 gene ratio: 1.93.
Left> Invasive ductal carcinoma, stage
pT2N0(sn).
Size of tumor: 2.1 cm, lymph node: 0/2. HER2/CEP17 gene ratio: 2.03. Adjuvant Therapy
Adjuvant chemotherapy #2 cycles (Docetaxel &
cyclophosphamide) → Trastuzumab for 1 year +
Letrozole 2.5 mg/day for 2.1 years.
|
Cluster 3: Advanced Stage Disease
|
Case 12
|
Left breast cancer → Operation → Adjuvant
therapy → Ipsilateral axillary lymph node
recurrence → Contralateral breast cancer.
|
Metastatic Breast Cancer
|
Female/78 years old, post-menopause.
No family history.
Hypertension, diabetes mellitus.
|
Breast MRI (Apr. 2014): An irregular enhancing
mass in the left breast. Left simple mastectomy = IDC. Operation
Apr. 2014 Left total mastectomy, sentinel lymph
node biopsy.
Pathology: Invasive ductal carcinoma, stage
pT2N0(sn).
Size of tumor: 2.0 cm, lymph node: 0/4.Adjuvant Therapy
Anastrozole 1 mg/day for 4.3 years.
|
Cluster 3: Advanced Stage Disease
|
Case 13
|
Right breast cancer → Operation → Adjuvant
therapy → Ipsilateral axillary lymph node
recurrence.
|
Metastatic Breast Cancer
|
Female/39 years old, post-menopause.
Family history of ovarian cancer, paternal
aunt.
BRCA 1 mutation: VUS (variant of
uncertain).
S/p bilateral salpingo-oophorectomy.
|
Breast MRI (Sep. 2017): Multiple irregular enhancing masses and non-mass enhancement in the right breast. Right NSM = IDC. Operation
Sep. 2017 Right nipple-areolar complex sparing
mastectomy with immediate implant reconstruction, sentinel lymph node biopsy.
Pathology: Invasive ductal carcinoma, stage
pT1bN0(sn).
Size of tumor: 0.7 cm, lymph node: 0/2. Adjuvant Therapy
Tamoxifen 20 mg/day for 3.3 years.
|
Cluster 3: Advanced Stage Disease
|
Case 14
|
Right breast cancer → Operation → Adjuvant
therapy → Ipsilateral axillary lymph node
recurrence.
|
Metastatic Breast Cancer
|
Female/55 years old, post-menopause.
No family history.
Hepatitis B carrier.
|
Breast MRI (Jun. 2014): Segmental non-mass
enhancement in the right breast. Right NSM = DCIS. Operation
Jun. 2014 Right nipple-areolar complex sparing
mastectomy with immediate implant reconstruction, sentinel lymph node biopsy.
Pathology: DUCTAL CARCINOMA IN
SITU, stage pTisN0(sn).
Size of tumor: 6.5 cm, lymph node: 0/1. Adjuvant Therapy
Tamoxifen 20 mg/day for 0.75 year.
|
Cluster 3: Advanced Stage Disease
|
Case 15
|
Right breast cancer → Operation → Adjuvant
therapy → Ipsilateral axillary lymph node
recurrence.
|
Metastatic Breast Cancer
|
Female/74 years old, post-menopause.
No family history.
Hypertension.
|
Breast MRI (Sep. 2015): An irregular enhancing
mass in the right breast. Right simple mastectomy = IDC. Operation
Oct. 2015 Right total mastectomy, sentinel lymph
node biopsy.
Pathology: Invasive ductal carcinoma, stage
pT2N0(sn).
Size of tumor: 2.5 cm, lymph node: 0/3. Adjuvant Therapy
Tamoxifen 20 mg/day for 5.2 years.
|
Cluster 3: Advanced Stage Disease
|
Case 16
|
Left breast cancer → Operation → Adjuvant
therapy → Ipsilateral axillary lymph node
recurrence.
|
Metastatic Breast Cancer
|
Female/46 years old, post-menopause.
No family history.
S/p myomectomy & bilateral salpingooophorectomy.
|
Breast MRI (Jul. 2013): Two irregular enhancing
masses in the left breast. Left SSM = IDC. Operation
Jul. 2013 Left skin sparing mastectomy with
immediate implant reconstruction, sentinel
lymph node biopsy. Pathology: Invasive ductal carcinoma, stage
pT2N1a(sn).
Size of tumor: 2.5 cm and 1.0 cm, lymph
node: 1/2, size of metastatic carcinoma: 2.1 mm. Adjuvant Chemotherapy
Adjuvant chemotherapy (Adriamycin +
Cyclophosphamide #2 → weekly Paclitaxel #12).
|
Cluster 3: Advanced Stage Disease
|
Case 17
|
Right breast cancer → Operation → Adjuvant
therapy → Ipsilateral axillary lymph node
recurrence. Breast MRI (Oct. 2017): An irregular enhancing
mass in the right breast. Right BCS = IDC.
|
Metastatic Breast Cancer
|
Female/69 years old, post-menopause.
Family history of breast cancer, daughter.
BRCA 1 mutation: VUS (variant of
uncertain).
|
Operation
Oct. 2017 Right breast conserving surgery, axillary lymph node dissection (Level I).
Pathology: Invasive ductal carcinoma, stage
pT1c(2)N2.
Size of tumor: 1.8 cm and 1.0 cm, lymph
node: 4/8, size of metastasis: 25 mm. Adjuvant Therapy
Adjuvant chemotherapy #8 cycles (Adriamycin +
Cyclophosphamide #4 → Docetaxel #4).
Post-operative radiation therapy + Letrozole
2.5 mg/day for 3 years.
|
Cluster 3: Advanced Stage Disease
|
Case 18
|
Left breast cancer → Operation → Ipsilateral
chest wall recurrence → Neoadjuvant chemotherapy → operation → targeted therapy →
Ipsilateral lymph node recurrence. Breast MRI (Nov. 2015): Mixed masses and nonmass enhancement in the left breast. Left BCS = IDC.
|
Metastatic Breast Cancer
|
Female/64 years old, post-menopause.
No family history.
Hypertension, diabetes mellitus.
|
Operation
Dec. 2015 Left breast conserving surgery, sentinel lymph node biopsy.
Pathology: Invasive ductal carcinoma, stage
pT1a(Pagets′)N0(sn). Size of tumor: 0.5 cm, lymph node: 0/1.
|
Cluster 3: Advanced Stage Disease
|
Case 19
|
Right breast cancer → Operation → Adjuvant
therapy → Ipsilateral axillary lymph node
recurrence → Operation → Endocrine therapy
→ Progressive disease.
|
Metastatic Breast Cancer
|
Female/45 years old, post-menopause.
No family history.
S/p bilateral salpingo-oophorectomy.
|
Breast MRI (Mar. 2017): A heterogeneously
enhancing mass in the right breast. Operation
Mar. 2017 Right nipple-areolar complex sparing
mastectomy with immediate implant reconstruction, sentinel lymph node biopsy. Pathology: Invasive ductal carcinoma, stage
pT2N1a(sn).
Size of tumor: 2.3 cm, lymph node: 3/5, size
of metastatic carcinoma: 7 mm. Adjuvant Therapy
Adjuvant chemotherapy #8 cycles (Adriamycin
& Cyclophosphamide #4 → Docetaxel #4).
Post-operative radiation therapy + Tamoxifen
20 mg/day for 3.8 years.
|
Cluster 3: Advanced Stage Disease
|
Case 20
|
Left breast cancer → Operation → Adjuvant
therapy → Ipsilateral axillary lymph node
recurrence.
|
Metastatic Breast Cancer
|
Female/61 years old, post-menopause.
Family history of breast cancer, maternal
cousin.
BRCA 1 & 2 mutation: Not detected.
|
Operation
Sep. 1998 Left breast conserving surgery, axillary lymph node dissection.
Pathology: Invasive ductal carcinoma, stage
pT1aN0.
Size of tumor: N.A, lymph node: 0/16. Adjuvant Therapy
Adjuvant chemotherapy #3 cycles
(Cyclophosphamide & Methotrexate &
Fluorouracil).
Post-operative radiation therapy +Tamoxifen
20 mg/day for 0.5 year.
|
Cluster 3: Advanced Stage Disease
|
Case 21
|
Left breast cancer → Operation → Adjuvant
therapy → Neck node recurrence → Lymph
nodes, bone metastasis → Skull, brain
metastasis.
|
Metastatic Breast Cancer
|
Female/61 years old, post-menopause.
No family history
|
Operation
Apr. 2002 Left breast conserving surgery, sentinel lymph node biopsy. Pathology: Microinvasive infltrating duct carcinoma, stage T1miN0(sn). Size of tumor: N.A, lymph node: 0/2. Adjuvant Therapy
Post-operative radiation therapy +Tamoxifen
20 mg/day for 5 years.
|
Cluster 3: Advanced Stage Disease
|
Case 22
|
Left breast cancer → Operation → Adjuvant
therapy → Right axillary lymph node recurrence → Right breast recurrence → Chest wall
→ Bone → Pleural effusion metastasis.
|
Metastatic Breast Cancer
|
Female/69 years old, post-menopause.
No family history.
Hepatitis B carrier.
|
Chest CT (Oct. 2007): Irregular
enhancing lesion (black arrow) and skin
thickening (white arrow) of the left breast. Neoadjuvant Chemotherapy
Neoadjuvant chemotherapy #6 cycles
(Fluorouracil + Doxorubicin + cyclophosphamide #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.
|
Cluster 3: Advanced Stage Disease
|
Case 23
|
Left breast cancer → Neoadjuvant chemotherapy → Operation → Adjuvant therapy →
Pericardial effusion, Metastatic lymph nodes
→ Bone, brain metastasis.
|
Metastatic Breast Cancer
|
Female/39 years old, pre-menopause.
No family history.
BRCA 1 & 2 VUS (variant of uncertain).
|
Breast MRI (Jul. 2012): Conglomerated enhancing masses involving the entire left breast. Neoadjuvant Chemotherapy
Neoadjuvant chemotherapy #8 cycles
(Adriamycin + Cyclophosphamide #4 →
Docetaxel #4). Clinical stage: cT3N1M0. Post-NAC breast MRI (Jan. 2013): Decreased
tumor burden in the left breast. Operation
Jan. 2013 Left total mastectomy, sentinel lymph
node biopsy.
Pathology: Invasive ductal carcinoma, stage
ypT1c(m)N0(sn).
Size of tumor: up to 1.5 cm, multifocal, lymph
node: 0/4. Adjuvant Therapy
Post-operative radiation therapy + Tamoxifen
20 mg/day for 5 years.
|
Cluster 3: Advanced Stage Disease
|
Case 24
|
Left breast cancer → Operation → Adjuvant
therapy → Ipsilateral breast skin metastasis. Breast MRI after multiple vacuum-assisted excisional biopsy in the left breast (Mar. 2017): Mild BPE
without defnite abnormality of both breasts
|
Metastatic Breast Cancer
|
Female/64 years old, post-menopause.
No family history.
|
Operation
Apr. 2017 Left nipple-areolar complex sparing
mastectomy with immediate implant reconstruction, sentinel lymph node biopsy.
Pathology: Invasive ductal carcinoma, stage
T1cN0(sn).
Size of tumor: 1.1 cm, lymph node: 0/1. Adjuvant Therapy
Tamoxifen 20 mg/day for 0.75 year.
|
Cluster 3: Advanced Stage Disease
|
Case 25
|
Right breast cancer → Operation → Adjuvant
therapy → Stomach and bone metastasis.
|
Metastatic Breast Cancer
|
Female/54 years old, post-menopause.
No family history.
S/p cholecystectomy, s/p total gastrectomy (gastric cancer), s/p bilateral salpingo-oophorectomy.
|
Breast MRI (Jan. 2020): Segmental heterogeneous non-mass enhancement in the right whole breast and oval heterogeneous enhancing lesion at the 8 o’clock direction of left breast. Operation
Jan. 2014 Both total mastectomy, axillary lymph
node dissection.
Pathology:
Right> Invasive lobular carcinoma, stage
pT3N3a.
Size of tumor: 7 cm, lymph node: 15/17, size
of metastatic carcinoma: 13 mm. Adjuvant Therapy
Adjuvant chemotherapy #8 cycles (Adriamycin
& Cyclophosphamide #4 → Docetaxel #4).
Post-operative radiation therapy +Tamoxifen
20 mg/day for 5 years.
|
Cluster 3: Advanced Stage Disease
|
Case 26
|
Left breast cancer → Operation → Adjuvant
therapy → Right shoulder soft tissue
metastasis.
|
Metastatic Breast Cancer
|
Female/74 years old, post-menopause.
No family history.
Hypertension, diabetes mellitus, s/p cholecystectomy (GB stone).
|
Breast MRI (Jan. 2020): Segmental heterogeneous non-mass enhancement in the right whole breast and oval heterogeneous enhancing lesion at the 8 o’clock direction of left breast. Operation
Jan. 2014 Both total mastectomy, axillary lymph
node dissection.
Pathology:
Right> Invasive lobular carcinoma, stage
pT3N3a.
Size of tumor: 7 cm, lymph node: 15/17, size
of metastatic carcinoma: 13 mm. 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. Adjuvant Therapy
Adjuvant chemotherapy #8 cycles (Adriamycin
& Cyclophosphamide #4 → Docetaxel #4).
Post-operative radiation therapy +Tamoxifen
20 mg/day for 5 years.
|
Cluster 3: Advanced Stage Disease
|
Case 27
|
Left breast cancer → Operation → Adjuvant
therapy → Right shoulder soft tissue
metastasis.
|
Metastatic Breast Cancer
|
Female/74 years old, post-menopause.
No family history.
Hypertension, diabetes mellitus, s/p cholecystectomy (GB stone).
|
Breast US (Feb. 2008): Irregular hypoechoic
mass at the 9 o’clock direction of left breast. Operation
Mar. 2008 Left breast conserving surgery, axillary lymph node dissection.
Pathology: Invasive duct carcinoma, stage
T2N1a.
Size of tumor: 3 cm, lymph node: 3/7, size of
metastatic carcinoma: 15 mm. 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. Palliative Therapy
Clinical trial enrolled (SAR439859/placebo +
Letrozole/placebo+ Palbociclib)~
|
Cluster 3: Advanced Stage Disease
|
Case 28
|
Right breast cancer → Operation → Adjuvant
therapy → Right shoulder soft tissue
metastasis
|
Metastatic Breast Cancer
|
Female/51 years old, post-menopause.
No family history.
BRCA 1 & 2 mutation: Not detected, ATM
VUS (variant of uncertain).
|
Breast US (Feb. 2015): Irregular hypoechoic
mass with spiculated margin at the 4 o’clock direction of
right breast. Operation
Feb. 2015 Right breast conserving surgery, sentinel lymph node biopsy. Pathology: Invasive duct carcinoma, stage
T1cN0(sn).
Size of tumor: 1.8 cm, lymph node: 0/1. Adjuvant Therapy
Post-operative radiation therapy + Tamoxifen
20 mg/day.
|
Cluster 3: Advanced Stage Disease
|
Case 29
|
Right breast cancer → Neoadjuvant chemotherapy → Operation → Adjuvant therapy → Lung
metastasis.
|
Metastatic Breast Cancer
|
Female/41 years old, pre-menopause.
No family history.
|
Mammography (Jul. 2007): obscured irregular isodense mass (marked by BB marker) with punctate microcalcifcations in the right upper outer quadrant. Neoadjuvant Chemotherapy
Neoadjuvant chemotherapy #4 cycles
(Adriamycin + Cyclophosphamide) + zoladex. 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. Adjuvant Therapy
Chemotherapy #4 cycles (Paclitaxel).
Post-operative radiation therapy +Tamoxifen
20 mg/day for 5 years +zoladex.
|
Cluster 3: Advanced Stage Disease
|
Case 30
|
Right breast cancer → Operation → Adjuvant
therapy → Bone metastasis. Breast US (Mar. 2017): 1 cm indistinct irregular hypoechoic mass at the 9 o’clock direction of right breast.
|
Metastatic Breast Cancer
|
Female/50 years old, pre-menopause.
No family history.
Hepatitis B virus carrier, s/p myomectomy
|
Apr. 2017 Right nipple-areolar complex sparing
mastectomy with immediate implant reconstruction, sentinel lymph node biopsy.
Pathology: Invasive duct carcinoma, stage
T1c(2)N0(sn).
Size of tumor: 1.3 cm and 0.6 cm, lymph
node: 0/2. Adjuvant Therapy
Tamoxifen 20 mg/day
|
Cluster 3: Advanced Stage Disease
|
Case 31
|
Right breast cancer → Operation → Adjuvant
therapy → Lung metastasis.
|
Metastatic Breast Cancer
|
Female/54 years old, post-menopause.
No family history.
BRCA 1: positive for deleterious mutation.
S/p bilateral salpingo-oophorectomy
|
Breast MRI (Mar. 2014): An irregular enhancing mass with associated non-mass enhancement at the
5–6 o’clock direction of right breast. Operation
Mar. 2014 Right breast conserving surgery, sentinel lymph node biopsy.
Pathology: Invasive ductal carcinoma, stage
pT2N0 (sn).
Size of tumor: 2.3 cm, lymph node: 0/1. 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).
|
Cluster 3: Advanced Stage Disease
|
Case 32
|
Left breast cancer → Operation → Adjuvant
therapy → Lung metastasis.
|
Metastatic Breast Cancer
|
Female/49 years old, peri-menopause.
No family history
|
Mammography
(Jan. 2007): Indistinct
irregular hyperdense
mass with fne
pleomorphic
microcalcifcations at the
12 o’clock direction of
left breast on left CC and
MLO views. Operation
Jan. 2007 Left breast conserving surgery, sentinel
lymph node biopsy.
Pathology: Invasive ductal carcinoma, stage
pT2N0 (sn).
Size of tumor: 3.2 cm, lymph node: 0/5.Adjuvant Therapy
Adjuvant chemotherapy # 6 cycles (Fluorouracil
& Doxorubicin & Cyclophosphamide).
Post-operative radiation therapy to left breast
+ Zoladex for 2 years + Tamoxifen 20 mg/day for
5 years.
|
Cluster 3: Advanced Stage Disease
|
Case 33
|
Right breast cancer → Operation → Adjuvant
therapy → Bone metastasis.
|
Metastatic Breast Cancer
|
Female/52 years old, peri-menopause.
No family history.
|
Breast US (Jun. 2007): Irregular hypoechoic
mass with microcalcifcations at the 9 o’clock direction of
right breast Operation
Jul. 2007 Right modifed radical mastectomy at
another hospital.
Pathology: Invasive ductal carcinoma, stage
pT2N3a.
Size of tumor: 2.7 × 1.4 cm, lymph node:
13/38. Adjuvant Therapy
Adjuvant chemotherapy #8 cycles (Doxorubicin
& cyclophosphamide #4 → Docetaxel #4).
Post-operative radiation therapy to right breast
+Tamoxifen 20 mg/day for 5 years.
|
Cluster 3: Advanced Stage Disease
|
Case 34
|
Left breast cancer → Operation → Adjuvant
therapy → Right pleural, liver, right adrenal
gland, bone metastasis → Brain metastasis.
|
Metastatic Breast Cancer
|
Female/42 years old, peri-menopause.
No family history
|
Breast MRI
(Feb. 2014): Irregular
heterogeneous
enhancing mass at the
12–3 o’clock direction
of left breast. Operation
Feb. 2014 Left breast conserving surgery, sentinel lymph node biopsy.
Pathology: Invasive ductal carcinoma, stage
pT2N1a (sn), size of tumor: 2.5 cm, lymph node:
1/4 (2.5 mm). Adjuvant Therapy
Adjuvant chemotherapy #8 cycles (Doxorubicin
& cyclophosphamide #4 → Docetaxel & trastuzumab #4).
Post-operative radiation therapy to left breast.
Concurrent Trastuzumab #13.
|
Cluster 3: Advanced Stage Disease
|
Case 35
|
Right breast cancer → Operation → Adjuvant
therapy → Bone metastasis.
|
Metastatic Breast Cancer
|
Female/51 years old, pre-menopause.
No family history.
S/p hysterectomy & Left salpingooophorectomy (benign), s/p total hip replacement
arthroplasty
|
Breast MRI
(Dec. 2013): Segmental
heterogeneous non-mass
enhancement at the 9–10
o’clock direction of
right breast. Pathology: Invasive ductal carcinoma, stage
pT1bN1a.
Size of tumor: 0.8 cm, 0.5 × 0.3 cm, lymph. Adjuvant Therapy
Post-operative radiation therapy to right breast
zoladex for 2 years +Tamoxifen 20 mg/day for
5 years.
node: 1/6 (8 mm).
|
Cluster 3: Advanced Stage Disease
|
Case 36
|
Right breast cancer → Operation → Adjuvant
therapy → Lung metastasis.
|
Metastatic Breast Cancer
|
Female/55 years old, post-menopause.
No family history.
S/p bilateral salpingo-oophorectomy, diabetes
mellitus.
|
Breast US (Sep. 2008): Indistinct heterogeneous echoic mass at the 12 o’clock direction of right
breast. Operation
Sep. 2008 Right breast conserving surgery, axillary lymph node dissection.
Pathology: Invasive ductal carcinoma, stage
pT2N1a.
Size of tumor 2.3 cm, lymph node: 1/15
(5 mm). Adjuvant Therapy
Adjuvant chemotherapy #8 cycles (Doxorubicin
& cyclophosphamide #4 → Docetaxel #4).
Post-operation radiation to right breast +
Tamoxifen 20 mg/day for 5 years.
|
Cluster 3: Advanced Stage Disease
|
Case 37
|
Right breast cancer → Operation → Adjuvant
therapy → Lung metastasis.Breast US (May 2013): Irregular hypoechoic mass
with angular margin at the 11 o’clock direction of right breast
|
Metastatic Breast Cancer
|
Female/59 years old, post-menopause.
No family history.
Hypertension, s/p right vertebral artery, transient ischemic attack.
|
Breast US (May 2013): Irregular hypoechoic mass
with angular margin at the 11 o’clock direction of right breast. Operation
May 2013 Right breast conserving surgery, axillary lymph node dissection.
Pathology: Invasive ductal carcinoma, stage
pT2N1a.
Size of tumor: 2.0 cm, lymph node: 3/30
(15 mm). Adjuvant Therapy
Adjuvant chemotherapy #8 cycles (Doxorubicin
& cyclophosphamide #4 → Docetaxel & trastuzumab #4).
Post-operative radiation therapy to right
breast.
Concurrent Trastuzumab # 4 + Tamoxifen
20 mg/day for 85 days.
|
Cluster 3: Advanced Stage Disease
|
Case 38
|
Both breasts cancer → Operation → Adjuvant
therapy → Liver metastasis.
|
Metastatic Breast Cancer
|
Female/70 years old, post-menopause.
No family history.
|
Mammography (Dec. 2008): Grouped fne
pleomorphic microcalcifcations in right inner breast and
the subareolar area of left breast. Breast MRI
(Dec. 2008): Irregular
heterogeneous
enhancing mass at the
1–3 o’clock direction of
right breast and irregular
homogeneous enhancing
mass in the subareolar
area of left breast.
|
Cluster 3: Advanced Stage Disease
|
Case 20
|
Right breast DCIS → Operation → Adjuvant
therapy → Right breast recurrence (microinvasive ductal carcinoma).
|
Local Recurrence
|
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.
|
Right US (2017): A hypoechoic mass with spiculated margins at inner central breast. Operation
Jul. 2017 Right breast conserving surgery, sentinel 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 distance from closest margin: 2 mm (specify
margin: 9H).
7. Lymph nodes: no metastasis in fve lymph
nodes (pN0(sn)).
8. Lymphovascular invasion: not identifed.
9. Perineural invasion: not identifed.
10. Pathological TN category: pTisN0. Adjuvant Therapy
Postoperative radiation therapy. Right mammography for routine surveillance
(2021): Newly developed regional fne pleomorphic
microcalcifcations at upper central breast. Stereotactic
VAB = DCIS, high grade
|
Cluster 3: Advanced Stage Disease
|
Case 21
|
Right breast DCIS→ → Operation → Right
breast recurrence (DCIS).
|
Local Recurrence
|
Female/55 years old, peri-menopause.
Screen detected calcifcation on upper portion
of right breast.
Outside result of biopsy: suggestive ductal
carcinoma in situ.
No family history.
S/p hysterectomy.
|
Right magnifcation view (2017): Fine linear
and pleomorphic microcalcifcations at upper breast.
US-CNB = DCIS, low grade. Operation
Jan. 2017 Right nipple-areolar complex sparing
mastectomy with immediate implant reconstruction, sentinel lymph node biopsy Immediate postoperative appearance. (a) Gross pathology of mastectomy specimen.
(b, c) The margins get marked and sliced with different
colors on each direction. 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) Superfcial 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). 8. Microcalcifcation: 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 frozen diagnosis (Fro 4) is free of tumor.
|
Cluster 3: Advanced Stage Disease
|
Case 22
|
Left breast mucinous carcinoma→ Adjuvant
therapy → Right breast recurrence (mucinous
carcinoma).
|
Local Recurrence
|
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.
|
Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left axilla. Operation
Apr. 2007 Left breast mass excision (outside).
Pathology Report
Mucinous Carcinoma
1. Size of tumor: 2.0 cm.
2. Margin involved. Operation (2nd)
May 2007 Left breast conserving surgery, sentinel lymph node biopsy. (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors
on each direction. Pathology Report
No residual carcinoma with foreign body
reaction.
1. Post-excisional biopsy status. 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.
|
Cluster 3: Advanced Stage Disease
|
Case 23
|
Left breast medullary carcinoma → Operation
→ Adjuvant therapy → Left breast recurrence
(IDC)/Right breast intraductal papilloma.
|
Local Recurrence
|
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 cancer), s/p Bilateral salpingo-oophorectomy.
BRCA 1 mutation carrier.
|
Operation
2003 Left breast conserving surgery, axillary
lymph node dissection (outside).
Pathology Report
Medullary Carcinoma. Adjuvant Therapy
Adjuvant chemotherapy #6 cycles of doxorubicin
and cyclophosphamide.
Postoperative radiation therapy.
|
Cluster 3: Advanced Stage Disease
|
Case 24
|
Left breast IDC → Neoadjuvant chemotherapy
→ Operation → Adjuvant therapy → Left chest
wall recurrence (IDC).
|
Local Recurrence
|
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.
|
Report 1: Left MRI (Feb. 2019): Enhancing mass at outer
breast (white arrow). Enlarged axillary LN (black arrow).
US-CNB = IDC. Report 2: Left MRI during NAC (May 2019): Decreased
and fragmented malignant tumors. Report 3: Left MRI after completion of NAC (Aug.
2019): Increased number and size of malignant masses. Report 4: Lymphoscintigraphy shows visualized sentinel lymph nodes in the left axilla. Neoadjuvant Chemotherapy
#4 cycles of doxorubicin and cyclophosphamide
followed by #4 cycles of docetaxel.
Operation
Aug. 2019 Left modifed radical mastectomy. (a) Gross pathology of mastectomy specimen.
(b, c) The margins get marked and sliced with different
colors on each direction. 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, intratumoral/extratumoral (20%) (nuclear grade: high, necrosis: present, architectural pattern:
solid/comedo, extensive intraductal component: absent).
5. Skin and nipple: no involvement of tumor.
6. Surgical margins:
(a) Deep margin: <1 mm from invasive ductal carcinoma (slides 2 and 8).
(b) Superfcial margin: 20 mm.
7. Lymph nodes: no metastasis in 17 axillary
lymph nodes (ypN0) (sentinel LN: 0/6, nonsentinel LN: 0/11).
8. Arteriovenous invasion: present, intratumoral.
9. Lymphovascular invasion: present,
intratumoral.
10. Tumor border: infltrative.
11. Microcalcifcation: present, tumoral/
non-tumoral.
12. Pathological TN category (AJCC 2017):
ypT2N0. Adjuvant Therapy
Postoperative radiation therapy.
Adjuvant chemotherapy #8 cycles of
capecitabine.
|
Cluster 3: Advanced Stage Disease
|
Case 25
|
Left breast IDC → Operation → Adjuvant therapy → Left breast recurrence (DCIS).
|
Local Recurrence
|
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.
|
Operation
Nov. 2007 Left breast conserving surgery, axillary 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.
|
Cluster 3: Advanced Stage Disease
|
Case 26
|
Right breast DCIS→ Operation → Adjuvant
therapy → Right breast recurrence (IDC).
|
Local Recurrence
|
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.
|
Mammography: oval isodense mass in right
breast. MRI: vacuum-assisted breast excision status.
Marginal enhancing lesion at the 3 o’clock location of
right breast. Operation
Jun. 2013 Right breast conserving surgery: (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors
on each direction. 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) Superfcial margin: 13 mm.
8. Microcalcifcation: absent. Adjuvant Therapy
Postoperative radiation therapy.
|
Cluster 3: Advanced Stage Disease
|
Case 27
|
Right breast tubular carcinoma → Operation
→ Adjuvant therapy → Left breast recurrence
(IDC).
|
Local Recurrence
|
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.
|
Report 1: Right MLO MG: spiculated hyperdense mass
in right upper breast. Report 2:US: spiculated oval hypoechoic mass at the 1
o’clock location of right breast. Report 3:MRI: irregular rim enhancing mass at the 1
o’clock location of right breast. Report 4: Lymphoscintigraphy shows visualized sentinel
lymph nodes in the right axilla. Operation
Sep. 2013 Right breast conserving surgery, sentinel lymph node biopsy: (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors
on each direction. 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, intratumoral/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) Superfcial 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: infltrative.
10. Microcalcifcation: present, tumoral.
11. Pathologic stage (AJCC 2010): pT1cN0(sn). Adjuvant Therapy
Postoperative radiation therapy.
Tamoxifen 20 mg/day for 5 years.
|
Cluster 3: Advanced Stage Disease
|
Case 28
|
Left breast DCIS → Operation → Adjuvant
therapy → Left breast recurrence (microinvasive ductal carcinoma).
|
Local Recurrence
|
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.
|
Report 1: MG: segmental fne linear or fne linear branching microcalcifcation with extension to left subareolar area. . Report 2: (a) Irregular hypoechoic mass with indistinct margin. (b) Echogenic dots, suggesting microcalcifcations. Report 3: MRI: regional heterogenous non-mass enhancement at the corresponding area of the microcalcifcations
on mammography. Report 4: Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left axilla. Operation
Aug. 2008 Left breast conserving surgery, axillary lymph node dissection (a) Gross pathology of mastectomy specimen. (b, c) The margins get marked with different colors on each
direction. 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). 9. Microcalcifcation: present, tumoral/
non-tumoral.
10. Pathologic staging: pTisN0(sn).Adjuvant Therapy
Postoperative radiation therapy.
|
Cluster 3: Advanced Stage Disease
|
Case 29
|
Left breast IDC→ Operation → Adjuvant therapy → Left breast recurrence (IDC).
|
Local Recurrence
|
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).
|
Outside MG Lt. CC: Regional fne linear
microcalcifcations in left inner breast. US: echogenic dots, suggesting
microcalcifcations. MRI maximum intensity projection (MIP): segmental heterogeneous non-mass enhancement. Operation
Nov. 2017 Left nipple-areolar complex sparing
mastectomy with immediate implant reconstruction, sentinel lymph node biopsy (a) Gross pathology of mastectomy specimen. (b, c) The margins get marked and sliced with different colors
on each direction. Pathology Report
Invasive Ductal Carcinoma
1. Size of tumor: 3.0 cm (pT2). 2. Histologic grade: 2/3 (tubule formation: 3/3,
nuclear pleomorphism: 2/3, mitotic count:
2/3, 12/10HPF).
3. Intraductal component: present, intratumoral/extratumoral (20%) (nuclear grade:
low, necrosis: present, architectural pattern:
cribriform/solid/comedo, extensive intraductal component: present).
4. Skin: no involvement of tumor.
5. Surgical margins:
(a) Deep margin: <1 mm from invasive ductal carcinoma (slide 2).
(b) Superfcial margin: <1 mm from ductal
carcinoma in situ (slide 9). 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: infltrative.
10. Microcalcifcation: present, tumoral/
non-tumoral.
11. Pathologic stage (AJCC 2010): pT2N0(sn). Adjuvant Therapy
Adjuvant chemotherapy #4 cycles of cyclophosphamide and docetaxel.
Tamoxifen 20 mg/day for 3.6 years.
|
Cluster 3: Advanced Stage Disease
|
Case 30
|
Right breast IDC → Operation → Adjuvant
therapy → Left breast recurrence (IDC).
|
Local Recurrence
|
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.
|
Report 1: Outside MG: spiculated hyperdense mass in the
inner portion of right breast. Report 2: Outside US: spiculated hypoechoic mass with
indistinct margin. Report 3: MRI: spiculated heterogeneous enhancing
mass at the 1 o’clock location of right breast. Report 4: Lymphoscintigraphy shows visualized sentinel
lymph nodes in the right axilla. Operation
Dec. 2015 Right total mastectomy, axillary
lymph node dissection ((a) Gross pathology of mastectomy specimen. (b, c, d) The margins get marked and sliced with different
colors on each direction). Operation
Dec. 2015 Right total mastectomy, axillary
lymph node dissection. 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, intratumoral/extratumoral (5%) (nuclear grade:
low, necrosis: present, architectural pattern:
cribriform/solid, extensive intraductal component: absent).
4. Skin and nipple: no involvement of tumor.
5. No involvement of skeletal muscle.
6. Surgical margins:
(a) Deep margin: 8 mm.
(b) Superfcial 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: infltrative.
11. Microcalcifcation: present, tumoral.
12. Pathologic stage (AJCC 2010): pT2N1a. Adjuvant Therapy
Anastrozole 1 mg/day for 4 years.
|
Cluster 3: Advanced Stage Disease
|
Case 31
|
Right breast Papillary carcinoma in situ→
Operation → Right breast recurrence (DCIS).
|
Local Recurrence
|
Female/49 years old, pre-menopause.
Screen detected mass lesion on right breast 1
o’clock direction.
No family history.
No comorbidities.
|
Report 1:Rt MLO MG: irregular hyperdense mass in
right upper inner quadrant. Report 2:US: irregular indistinct hypoechoic masses in
right upper inner quadrant. Report 3:MRI: regional heterogeneous non-mass
enhancement in right upper inner quadrant (showing moderate background parenchymal enhancement). Report 4:Lymphoscintigraphy shows visualized sentinel
lymph nodes in the right axilla. Operation
Jan. 2017 Right nipple-areolar complex sparing
mastectomy with immediate implant reconstruction, sentinel lymph node biopsy, left nippleareolar complex sparing mastectomy with
immediate implant reconstruction. 6 (a) Preoperative and (b) immediate postoperative appearance. and (a) Gross pathology of right mastectomy specimen. (b, c) The margins get marked and sliced with different colors on each direction. (a) Gross pathology of left mastectomy specimen. (b, c) The margins get marked and sliced with different colors on each direction. Pathology Report
<Right Breast> 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) Superfcial margin: 0.08 mm (slide 2).
6. Lymph nodes: no metastasis in four axillary
lymph nodes (pN0(sn)) (sentinel LN: 0/4).
7. Microcalcifcation: absent.
8. Pathologic stage (AJCC 2010): pTisN0(sn). <Left Breast> 1. Intraductal papillomas, multiple, up to 0.8 cm
2. Sclerosing adenosis with microcalcifcation.
|
Cluster 3: Advanced Stage Disease
|
Case 32
|
Right breast DCIS → Operation → Adjuvant
therapy → Right breast recurrence (tubular
carcinoma + DCIS).
|
Local Recurrence
|
Female/42 years old, pre-menopause.
Screen detected mass lesion on right breast
12 o’clock direction.
Outside result of lumpectomy: Ductal carcinoma in situ.
No family history.
No comorbidities.
BRCA 2 VUS (variant of uncertain).
|
Operation
Aug. 2014 Right breast wide excision (outside).
Pathology Report
Ductal carcinoma in situ involving intraductal
papilloma
1. Nuclear grade: low.
2. Necrosis: absent.
3. Architectural pattern: papillary/cribriform.
Result Intensity Positive %
Estrogen
receptor
Strong (8/8) 3 >2/3
Progesterone
receptor
Strong (8/8) 3 >2/3
C-erbB2 Negative (1+)
Ki-67 Positive in
10.8% of tumor
cells
Adjuvant Therapy
Postoperative radiation therapy.
Tamoxifen 20 mg/day for 2 years.
|
Cluster 3: Advanced Stage Disease
|
Case 33
|
Left breast IDC → Neoadjuvant chemotherapy
→ Operation → Adjuvant therapy → Left breast
recurrence (IDC).
|
Local Recurrence
|
Female/45 years old, pre-menopause.
Screen detected mass lesion on upper inner
portion of left breast.
Outside result of biopsy: Invasive ductal
carcinoma.
Family history of breast cancer, mother at her
50 years old.
S/P Hysterectomy, s/p bilateral breast
augmentation.
|
Report 1:Lt CC MG: Irregular hyperdense mass (white
arrow) with associated fne pleomorphic microcalcifcations (black arrow) in left upper inner quadrant. Report 2: US: irregular microlobulated hypoechoic
masses at the 10 o’clock direction of left breast. Report 3: MRI maximum intensity projection (MIP):
irregular heterogeneous enhancing masses. Report 4: Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left axilla. Neoadjuvant Chemotherapy
Neoadjuvant chemotherapy #6 cycles of trastuzumab and pertuzumab and docetaxel and
carboplatin.
Operation
Oct. 2018 Left breast conserving surgery, sentinel lymph node biopsy. (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors
on each direction. Invasive Ductal Carcinoma
1. Post-chemotherapy status.
2. Size of tumor: 3.5 cm, 1.4 cm (ypT2(2)).
3. Histologic grade: 3/3 (tubule formation: 3/3,
nuclear pleomorphism: 3/3, mitotic count:
3/3, 30/10HPF).
4. Intraductal component: present, extratumoral
(10%) (nuclear grade: high, necrosis: present, architectural pattern: micropapillary/
solid/comedo, extensive intraductal component: absent).
5. Skin: no involvement of tumor. 6. Surgical margins:
(a) Superior margin: 30 mm.
(b) Inferior margin: 6 mm.
(c) Medial margin: 15 mm.
(d) Lateral margin: (see note 1).
(e) Deep margin: 6 mm.
(f) Superfcial margin: <1 mm from invasive ductal carcinoma (slide 12).
7. Lymph nodes: no metastasis in 3 axillary
lymph nodes (ypN0(sn)) (sentinel LN: 0/3).
8. Arteriovenous invasion: absent.
9. Lymphovascular invasion: present,
intratumoral/peritumoral.
10. Tumor border: infltrative.
11. Microcalcifcation: present, tumoral.
12. Pathological TN category (AJCC 2017):
ypT2(2)N0(sn). Note: 1. The lateral margin of the lumpectomy specimen (slide 16) is close to ductal carcinoma in situ (1.5 mm), but this margin
submitted for frozen diagnosis (Fro 7) is free
of tumor. Adjuvant Therapy
Postoperative radiation therapy.
Trastuzumab for 1 year.
|
Cluster 3: Advanced Stage Disease
|
Case 34
|
Right breast IDC → Operation → Adjuvant
therapy → Right breast recurrence (IDC).
|
Local Recurrence
|
Female/47 years old, pre-menopause.
Screen detected microcalcifcation on upper
outer portion of right breast.
Family history of ovarian cancer mother.
No comorbidities.
BRCA 1 and 2 mutation: Not detected.
|
Report 1: Rt magnifcation view (ML): Grouped fne
pleomorphic microcalcifcations in right upper outer. Report 2:US: microlobulated hypoechoic mass with echogenic dots (suggesting microcalcifcations). Report 3: MRI: oval homogeneous enhancing mass at the 11 o’clock direction of right breast. Operation
Sep. 2019 Right breast conserving surgery (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors
on each direction. Pathology Report
Invasive Ductal Carcinoma
1. Size of invasive component: 0.7 cm (pT1b). 2. Size of intraductal component: 1.0 cm.
3. Histologic grade: 2/3 (tubule formation: 3/3,
nuclear pleomorphism: 2/3, mitotic count:
1/3, 3/10HPF).
4. Intraductal component: present, extratumoral
(60%) (nuclear grade: low, necrosis: present,
architectural pattern: papillary/cribriform,
extensive intraductal component: absent).
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) Superior margin: 28 mm.
(b) Inferior margin: 12 mm.
(c) Medial margin: 10 mm.
(d) Lateral margin: 30 mm.(e) Deep margin: <1 mm from ductal carcinoma in situ (slide 7).
(f) Superfcial margin: 13 mm.
7. Arteriovenous invasion: absent.
8. Lymphovascular invasion: absent.
9. Tumor border: infltrative.
10. Microcalcifcation: present, non-tumoral.
11. Pathological TN category (AJCC 2017):
pT1b. Adjuvant Therapy
Postoperative radiation therapy.
Tamoxifen 20 mg/day for 1.8 years.
|
Cluster 3: Advanced Stage Disease
|
Case 35
|
Right breast IDC → Neoadjuvant chemotherapy
→ Operation → Adjuvant therapy → Right
breast recurrence (DCIS).
|
Local Recurrence
|
Female/53 years old, peri-menopause.
Screen detected mass lesion on left breast
subareola.
No family history.
No comorbidities.
BRCA 1 and 2 mutation: Not detected.
|
Operation
First Operation (Aug. 2004) Left breast conserving surgery, sentinel lymph node biopsy.
Pathology Report
Invasive Ductal Carcinoma
1. Size of invasive carcinoma: 0.4 cm (pT1a).
2. Size of intraductal carcinoma: 4 cm.
3. Histologic grade: 2/3 (tubule formation: 2/3,
nuclear pleomorphism: 2/3, mitotic count: 2/3).
4. Ductal carcinoma in situ: present, intratumoral/extratumoral (95%) (nuclear grade:
low, necrosis: present, architectural pattern:
cribriform and comedo, extensive intraductal
component: present).
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) Superior margin: 20 mm.
(b) Inferior margin: (see note).
(c) Medial margin: 20 mm.
(d) Lateral margin: 10 mm.
(e) Deep margin: 10 mm.
7. Lymph nodes: no metastasis in 3 axillary
lymph nodes (pN0(sn)) (sentinel LN: 0/3,
axillary LN: 0/0).
8. Vascular invasion: absent.
9. Lymphatic invasion: absent.
10. Tumor border: infltrative.
11. Microcalcifcation: present, tumoral.
12. Pathologic staging: pT1aN0(sn).
Note: Ductal carcinoma in situ is noted only in
the permanent section of nipple margin (Fro 4)
and inferior margin (Fro 5). Operation
Second Operation (Sep. 2004) Left breast wide
excision.
Pathology Report
No residual carcinoma with foreign body
reaction.
1. Post-lumpectomy status.
Adjuvant Therapy
Postoperative radiation therapy.
Tamoxifen 20 mg/day for 2 years. OPD US: microlobulated hypoechoic masses. MRI: focal heterogeneous non-mass enhancement.
|
Cluster 3: Advanced Stage Disease
|
Case 36
|
Right breast DCIS → Operation → Left breast
recurrence (DCIS).
|
Local Recurrence
|
Female/48 years old, pre-menopause.
Screen detected mass lesion on right breast 10
o’clock direction.
Outside result of biopsy: Papillary carcinoma
in situ.
No family history.
s/p bilateral breast augmentation.
BRCA 1 and 2 mutation: Not detected.
|
O/S US: Oval hypoechoic mass with angular
margin at the 9 o’clock direction of right breast. Operation
Mar. 2016 Right breast conserving surgery. (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors
on each direction. Pathology Report
Ductal Carcinoma In Situ
1. Post mammotome biopsy status. 2. Size of tumor: 0.2 cm, residual.
3. Nuclear grade: low.
4. Necrosis: absent/present.
5. Architectural pattern: cribriform.
6. Surgical margins:
(a) Superior margin: (see note).
(b) Inferior margin: 7 mm.
(c) Medial margin: 4 mm from ductal carcinoma in situ.
(d) Lateral margin: 8 mm.
(e) Deep margin: 2 mm.
(f) Superfcial margin: 2 mm.
7. Microcalcifcation: absent.
Note: 1. The superior margin of the lumpectomy specimen (slide 4) is close to ductal carcinoma in situ (<1 mm), but this margin submitted
for frozen diagnosis (Fro 1) is free of tumor. US: microlobulated hypoechoic masses at the 1
o’clock direction of left breast.
|
Cluster 3: Advanced Stage Disease
|
Case 37
|
Left breast DCIS→ Operation → Adjuvant therapy → Left breast recurrence (DCIS).
|
Local Recurrence
|
Female/43 years old, pre-menopause.
Screen detected mass lesion on left breast 7
o’clock direction.
Outside result of biopsy: ductal carcinoma in
situ.
No family history.
No comorbidities.
BRCA 1 and 2 mutation: Not detected.
|
Report 1: Lt CC view: segmental fne pleomorphic or
amorphous microcalcifcations in left breast, palpable site. Report 2: US: microlobulated hypoechoic masses with microcalcifcations. Report 3: MRI: irregular
heterogeneous
enhancing mass at the 6
o’clock direction of left
breast. Operation
Feb. 2014 Left breast conserving surgery (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors
on each direction. Pathology Report
Ductal Carcinoma In Situ
1. Size of tumor: 3.0 cm (pTis).
2. Nuclear grade: low.
3. Necrosis: present.
4. Architectural pattern: micropapillary/cribriform/comedo.
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) Nipple margin: positive for atypical ductal hyperplasia (Fro 1) (see note 1).
(b) Superior margin: (see note 2).
(c) Inferior margin: 20 mm.
(d) Medial margin: 5 mm.
(e) Lateral margin: 15 mm.
(f) Deep margin: 2 mm.
(g) Superfcial margin: 2 mm.
7. Microcalcifcation: present, tumoral/
non-tumoral.
8. Pathologic stage (AJCC 2010): pTis.
Note: 1. Atypical ductal hyperplasia is present
only in the permanent section of Fro 1.
2. The superior margin of the lumpectomy
specimen (slide 1) is positive for ductal carcinoma in situ, but this margin submitted for frozen
diagnosis (Fro 2) is free of tumor. Adjuvant Therapy
Postoperative radiation therapy.
Tamoxifen 20 mg/day for 5 years.
|
Cluster 3: Advanced Stage Disease
|
Case 38
|
Right breast IDC→ Operation → Adjuvant therapy → Right breast DCIS.
|
Local Recurrence
|
Female/47 years old, pre-menopause.
Screen detected mass lesion on right breast 12
o’clock direction.
Outside result of Lumpectomy: Invasive ductal carcinoma.
No family history.
|
Operation
Jun. 2012 Right breast conserving surgery, sentinel lymph node biopsy (outside).
Pathology Report
Invasive Ductal Carcinoma
1. Size of tumor: 0.9 cm (pT1b).
2. Lymph nodes: no metastasis in four axillary
lymph nodes (pN0(sn)).
3. Pathological TN category: pT1bN0. Adjuvant Therapy
Adjuvant chemotherapy #6 cycles of cyclophosphamide and methotrexate and fuorouracil.
Postoperative radiation therapy.
Tamoxifen 20 mg/day for 5 years.
|
Cluster 3: Advanced Stage Disease
|
Case 1
|
Right breast IDC → Neoadjuvant chemotherapy
→ Operation → Adjuvant therapy → Right
breast recurrence (IDC).
|
Local Recurrence
|
Female/41 years old, pre-menopause.
Screen detected mass lesion on lower medial
and lower outer portion of right breast.
Family history of breast cancer, maternal aunt.
No comorbidities.
BRCA 1 and 2 mutation: Not detected.
|
Report 1: Right mammography (Mar. 2012): Segmental fne
pleomorphic microcalcifcations (white arrows) with an
irregular mass (black arrow) at lower breast.
US-CNB = IDC. Report 2: Right MRI (Mar. 2012): Segmental clustered ring
non-mass enhancement at lower breast. Report 3:Post-NAC right MRI (Sep. 2012): Residual
enhancing foci at lower central breast. Report 4: Lymphoscintigraphy shows visualized sentinel
lymph nodes in the right axilla. Neoadjuvant Chemotherapy
Neoadjuvant chemotherapy #4 cycles of doxorubicin and cyclophosphamide followed by #4
cycles of docetaxel and trastuzumab.
Operation
Sep. 2012 Right breast conserving surgery, sentinel lymph node biopsy (Fig. 5).
Pathology Report
Invasive Ductal Carcinoma
1. Post-chemotherapy status.
2. Size of tumor: 0.4 cm (ypT1a). 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 (10%) (nuclear grade: high,
Y. Kim et al.
719
necrosis: absent, architectural pattern: cribriform, extensive intraductal component: absent).
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) Superior margin: 40 mm.
(b) Inferior margin: 30 mm.
(c) Medial margin: 5 mm.
(d) Lateral margin: 15 mm.
(e) Deep margin: 1 mm from invasive ductal
carcinoma.
7. Lymph nodes: no metastasis in two axillary
lymph nodes (ypN0(sn)) (sentinel LN: 0/2).
8. Vascular invasion: absent.
9. Lymphatic invasion: present, intratumoral.
10. Tumor border: infltrative.
11. Microcalcifcation: present, tumoral/
non-tumoral.
12. Pathologic stage (AJCC 2010): ypT1aN0(sn). Adjuvant Therapy
Postoperative radiation therapy.
Trastuzumab for 1 year + Tamoxifen 20 mg/
day for 8.9 years.
|
Cluster 3: Advanced Stage Disease
|
Case 2
|
Left breast IDC → Operation → Adjuvant
therapy → Left breast recurrence (IDC).
|
Local Recurrence
|
Female/54 years old, peri-menopause.
Screen detected mass lesion on left breast
2 o’clock direction.
No family history.
No comorbidities.
|
Left MRI (2008): Irregular enhancing masses
with non-mass enhancement at upper outer breast. Operation
Nov. 2008 Left breast conserving surgery, sentinel lymph node biopsy (outside).
Pathology Report
Invasive Ductal Carcinoma
1. Size of tumor: 0.4 cm (pT1a).
2. Lymph nodes: no metastasis in three axillary
lymph nodes (pN0(sn)) (sentinel LN: 0/3).
3. Pathologic stage (AJCC 2010): pT1aN0(sn). Adjuvant Therapy
Postoperative radiation therapy.
|
Cluster 3: Advanced Stage Disease
|
Case 3
|
Left breast IDC + DCIS → Operation → Left
breast recurrence (DCIS). Left magnifcation view (2018): Multifocal fne
pleomorphic microcalcifcations at upper central breast.
Excisional biopsy = DCIS, high grade. Left MRI (2018): Regional heterogeneous nonmass enhancement at upper breast. Operation
First Operation (Aug. 2018) Left breast mass
excision. (a) Gross pathology of breast mass excision specimen. (b) The margins get marked and sliced with different
colors on each direction.
|
Local Recurrence
|
Female/47 years old, pre-menopause.
Screen detected microcalcifcation on upper
portion of left breast.
Family history of colon cancer, father.
No comorbidities.
|
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. Microcalcifcation: present, tumoral/
non-tumoral. Second Operation (Dec. 2018) Left breast wide
excision. (a, b) Gross pathology of wide excision specimen. (c, d) The margins get marked and sliced with different colors on each direction. (a, b) Gross pathology of wide excision specimen. (c, d) The margins get marked and sliced with different
colors on each direction. 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: present, architectural pattern: micropapillary/
cribriform/solid/comedo, extensive intraductal 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 carcinoma in situ (slide 14).
(f) Superfcial margin: 2 mm.
8. Arteriovenous invasion: absent.
9. Lymphovascular invasion: absent.
10. Tumor border: infltrative.
11. Microcalcifcation: present, tumoral.
12. Pathological TN category (AJCC 2017): pT1a.
|
Cluster 3: Advanced Stage Disease
|
Case 4
|
Left breast Invasive cribriform carcinoma →
Operation → Adjuvant therapy → Left chest
wall recurrence (IDC).
|
Local Recurrence
|
Female/41 years old, pre-menopause.
Screen detected mass lesion on left breast 1
and 2 o’clock direction.
Outside result of biopsy: Ductal carcinoma in
situ.
No family history.
No comorbidities.
BRCA 1 and 2 mutation: Not detected.
|
Report 1:Left mammography (May 2017): Amorphous
and fne pleomorphic microcalcifcations at upper breast.
US-CNB = DCIS. Report 2:Left MRI (Jun. 2017): Clumped non-mass
enhancement at upper breast. Report 3:Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left axilla. Operation
Jul. 2017 Left nipple-areolar complex sparing
mastectomy with immediate implant reconstruction, sentinel lymph node biopsy. (a) Preoperative and (b) immediate postoperative
appearance. (a) Gross pathology of mastectomy specimen. (b, c, d) The margins get marked and sliced with different colors
on each direction. Pathology Report
Invasive Cribriform Carcinoma
1. Size of invasive component: 1.5 cm and
0.5 cm (pT1c).
2. Size of intraductal component: 7.0 cm. 3. Histologic grade: 2/3 (tubule formation: 3/3,
nuclear pleomorphism: 2/3, mitotic count:
1/3, 6/10HPF).
4. Intraductal component: present, intratumoral/extratumoral (90%) (nuclear grade:
low, necrosis: present, architectural pattern:
papillary/cribriform/solid/comedo, extensive
intraductal component: present).
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) Deep margin: <1 mm from ductal carcinoma in situ (slides 4 and 15).
(b) Superfcial margin: positive for ductal
carcinoma in situ (slides 5 and 10).
7. Lymph nodes: no metastasis in two axillary
lymph nodes (pN0(sn)) (sentinel LN: 0/2)
8. Arteriovenous invasion: absent.
9. Lymphovascular invasion: absent.
10. Tumor border: infltrative.
11. Microcalcifcation: present, tumoral.
12. Pathologic stage (AJCC 2010): pT1c(m)
N0(sn). Invasive Lobular Carcinoma
1. Size of tumor: 0.4 cm.
2. Histologic grade: 2/3 (tubule formation: 3/3,
nuclear pleomorphism: 2/3, mitotic count:
1/3, 2/10HPF).
3. In situ component: present, extratumoral (30%).
4. Arteriovenous invasion: absent.
5. Lymphovascular invasion: absent.
6. Tumor border: infltrative. Adjuvant Therapy
Tamoxifen 20 mg/day for 1.2 years.
|
Cluster 3: Advanced Stage Disease
|
Case 5
|
Left breast IDC → Operation → Adjuvant therapy → Right breast recurrence (IDC).
|
Local Recurrence
|
Female/69 years old, post-menopause.
Screen detected mass lesion on left breast
2 o’clock direction.
No family history.
No other history of disease, operation, or
medication.
BRCA 1 VUS (variant of uncertain).
|
Report 1:Left mammography (2006): An irregular palpable mass at outer breast. US-CNB = IDC. Report 2: Left MRI (2006): An irregular enhancing mass at
outer breast. Report 3: Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left axilla. Operation
Jan. 2006 Left breast conserving surgery, sentinel
lymph node biopsy Gross pathology of lumpectomy specimen. The
margins get marked and sliced with different colors on
each direction. Pathology Report
Invasive Ductal Carcinoma
1. Size of tumor: 2.0 cm (pT1c).
2. Histologic grade: 3/3 (tubule formation: 3/3,
nuclear pleomorphism: 3/3, mitotic count: 2/3)
3. Ductal carcinoma in situ: present, intratumoral/
extratumoral (30%) (nuclear grade: high, necrosis: present, architectural pattern: comedo,
extensive intraductal component: present).
4. Skin: no involvement of tumor.
5. Surgical margins:
(a) Superior margin: 10 mm.
(b) Inferior margin: 30 mm.
(c) Medial margin: 30 mm.
(d) Lateral margin: 40 mm.
(e) Deep margin: 2 mm.
6. Lymph nodes: no metastasis in 4 axillary
lymph nodes (pN0(sn)) (sentinel LN: 0/4).
7. Vascular invasion: absent.
8. Lymphatic invasion: present, intratumoral.
9. Tumor border: infltrative.
10. Microcalcifcation: present, tumoral/
non-tumoral.
11. Pathologic staging: pT1cN0(sn). Adjuvant Therapy
Adjuvant chemotherapy #6 cycles of fuorouracil
and doxorubicin and cyclophosphamide.
Postoperative radiation therapy.
|
Cluster 3: Advanced Stage Disease
|
Case 6
|
Both breasts IDC→ Operation → Adjuvant
therapy → Left breast recurrence (IDC).
|
Local Recurrence
|
Female/60 years old, post-menopause.
Bloody nipple discharge on left breast.
Screen detected mass lesion on right breast 6
o’clock direction and left breast 12 o’clock
direction.
No family history.
Hypertension.
|
Report 1: Right mammography (2010): Regional amorphous microcalcifcations (white arrows) with asymmetry
(black arrow). Report 2: Right US (2010): Irregular hypoechoic mass
with echogenic microcalcifcations. CNB = IDC. Report 3: Right MRI (2010): An irregular rim enhancing
mass. Report 4: Left US for evaluation of bloody nipple discharge (2010): Irregular hypoechoic masses at upper inner
breast. Negative left mammography (not shown).
US-CNB = Intraductal papillary carcinoma. Report 5: Left MRI (2010): An irregular heterogeneously
enhancing mass at upper breast. Report 6: Lymphoscintigraphy shows visualized sentinel
lymph nodes in the right axilla. Operation
First Operation (Jul. 2010) Right breast conserving surgery, sentinel lymph node biopsy, left
breast conserving surgery. (a) Gross pathology of right lumpectomy specimen. (b) The margins get marked and sliced with different
colors on each direction. (a) Gross pathology of left lumpectomy specimen. (b) The margins get marked and sliced with different colors
on each direction. Pathology Report
<Right Breast>
Invasive Ductal Carcinoma
1. Size of tumor: 1.2 cm (pT1c).
2. Histologic grade: 1/3 (tubule formation: 2/3,
nuclear pleomorphism: 2/3, mitotic count:
1/3, 6/10HPF). 3. Intraductal component: present, intratumoral/extratumoral (40%) (nuclear grade:
low, necrosis: present, architectural pattern:
micropapillary, cribriform, and comedo,
extensive intraductal component: present).
4. Skin: no involvement of tumor.
5. Surgical margins:
(a) Superior margin: 5 mm.
(b) Inferior margin: 4 mm from ductal carcinoma in situ (slide 2).
(c) Medial margin: 10 mm.
(d) Lateral margin: 10 mm.
(e) Deep margin: 2 mm.
6. Lymph nodes: no metastasis in 2 axillary
lymph nodes (pN0) (sentinel LN: 0/2).
7. Vascular invasion: absent.
8. Lymphatic invasion: present, intratumoral.
9. Tumor border: infltrative.
10. Microcalcifcation: present, tumoral/
non-tumoral.
11. Pathologic stage (AJCC 2010): pT1cN0(sn). <Left Breast>
Invasive Ductal Carcinoma
1. Size of invasive carcinoma: 0.3 cm (pT1a). Operation
Second Operation (Aug. 2010) Left breast wide
excision, sentinel lymph node biopsy 6 Gross pathology of left breast wide excision
specimen. Pathology Report
No residual tumor with foreign body reaction.
1. Post-lumpectomy status.
2. No metastasis in 1 lymph node (pN0(sn)) (left
sentinel LN: 0/1).
Adjuvant Therapy
Postoperative radiation therapy.
Tamoxifen 20 mg/day for 5 years.
2. Size of intraductal carcinoma: 3.0 cm.
3. Histologic grade: 1/3 (tubule formation: 2/3,
nuclear pleomorphism: 1/3, mitotic count:
1/3, 5/10HPF).
4. Intraductal component: present, intratumoral/extratumoral (90%) (nuclear grade:
low, necrosis: absent, architectural pattern:
papillary and cribriform, extensive intraductal component: present).
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) Superior margin: 20 mm.
(b) Inferior margin: 15 mm.
(c) Medial margin: Positive for ductal carcinoma in situ (Fro 3).
(d) Lateral margin: 10 mm.
(e) Deep margin: 2 mm.
7. Vascular invasion: absent.
8. Lymphatic invasion: present, intratumoral.
9. Tumor border: infltrative.
10. Microcalcifcation: present, tumoral/
non-tumoral.
11. Pathologic stage (AJCC 2010): pT1a.
|
Cluster 3: Advanced Stage Disease
|
Case 7
|
Left breast microinvasive ductal carcinoma + DCIS → Operation → Adjuvant therapy
→ Right breast recurrence (DCIS).
|
Local Recurrence
|
Female/42 years old, pre-menopause.
Screen detected mass lesion on left breast
4 o’clock direction.
Family history of breast cancer, mother.
No comorbidities.
BRCA 1 and 2 mutation: Not detected.
|
Report 1: Left magnifcation view (2018): Fine pleomorphic microcalcifcations at outer breast. US-CNB = DCIS, high grade. Report 2: MRI (2019): Linear non-mass enhancement at
outer left breast (white arrow = proven DCIS). Benign
appearing enhancing foci at outer right breast (black
arrow). Report 3: Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left axilla. Pathology Report
Microinvasive Ductal Carcinoma
1. Size of invasive component: <0.1 cm
(pT1mi).
2. Size of intraductal component: 4.0 cm.
3. Histologic grade: 3/3 (tubule formation: 3/3,
nuclear pleomorphism: 3/3, mitotic count:
3/3, 3/HPF).
4. Intraductal component: present, intratumoral/extratumoral (99%) (nuclear grade:
high, necrosis: present, architectural pattern:
micropapillary/cribriform, extensive intraductal component: present).
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) Superior margin: 5 mm.
(b) Inferior margin: 15 mm.
(c) Medial margin: 10 mm.
(d) Lateral margin: positive for ductal carcinoma in situ (Fro 6) (see note).
(e) Deep margin: 2 mm.
(f) Superfcial 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. Operation
First Operation (Jan. 2019) Left breast conserving surgery, sentinel lymph node biopsy. 10. Tumor border: infltrative.
11. Microcalcifcation: present, tumoral/
non-tumoral.
12. Pathological TN category (AJCC 2017):
pT1miN0(sn).
Note: 1. Ductal carcinoma in situ is present
only in the permanent section of Fro 6. Operation
Second Operation (Feb. 2019) Left breast wide
excision. Pathology Report
1. Ductal carcinoma in situ, residual.
(a) Status post-lumpectomy status for microinvasive ductal carcinoma (S19–2090).
(b) Nuclear grade: high.
(c) Necrosis: absent.
(d) Architectural pattern: cribriform.
(e) Microcalcifcation: absent.
(f) Resection margin:
• Lateral: (see note).
2. Foreign body reaction with fat necrosis.
Note: The lateral margin of the wide excision
specimen (slide 1) is close to ductal carcinoma in itu (<1 mm), but this margin submitted for frozen diagnosis (Fro 1) is free of tumor.
Adjuvant Therapy
Postoperative radiation therapy.
Tamoxifen 20 mg/day for 3 years.
|
Cluster 3: Advanced Stage Disease
|
Case 8
|
Right breast IDC/Left breast intraductal papilloma, sclerosing → Operation → Adjuvant therapy → Left breast recurrence (DCIS).
|
Local Recurrence
|
Female/48 years old, pre-menopause.
Screen detected mass lesion on right breast
12 o’clock direction and left 6 o’clock direction.
Family history of breast cancer, maternal aunt.
No comorbidities.
BRCA 1 and 2 mutation: Not detected.
|
Right US for evaluation of bloody nipple discharge (Jan. 2021): Multiple irregular hypoechoic masses
at upper breast. US-CNB = ADH involving sclerosing
adenosis. Lymphoscintigraphy shows visualized sentinel
lymph nodes in the right axilla. Operation
First Operation (Feb. 2021) Both breast mass
excision. (a) Gross pathology of right breast mass excision specimen. (b) The margins get marked and sliced with different colors on each direction. (a) Gross pathology of left breast mass excision specimen. (b) The margins get marked and sliced with different colors on each direction. <Right Breast>
Y. Kim et al.
739
1. Invasive Ductal Carcinoma involving sclerosing adenosis.
(a) Size of tumor: 1.5 cm (pT1c).
(b) Histologic grade: 2/3 (tubule formation:
3/3, nuclear pleomorphism: 2/3, mitotic
count: 1/3, 8/10HPF).
(c) Intraductal component: present, intratumoral/extratumoral (70%) (nuclear grade:
low, necrosis: present, architectural pattern: cribriform/solid, extensive intraductal component: present).
(d) Skin: no involvement of tumor.
(e) Surgical margins:
• Superior margin: 2 mm from ductal
carcinoma in situ (slide 7).
• Inferior margin: 2 mm from ductal carcinoma in situ (slide MG4).
• Medial margin: 2 mm from invasive
ductal carcinoma (slide 6).
• Lateral margin: 2 mm from ductal carcinoma in situ (slide 9).
• Deep margin: 2 mm.
• Superfcial margin: 2 mm.
(f) Arteriovenous invasion: absent.
(g) Lymphovascular invasion: present,
intratumoral.
(h) Tumor border: infltrative (i) Microcalcifcation: present, tumoral/
non-tumoral.
(j) Pathological TN category (AJCC 2017):
pT1c.
2. Intraductal papilloma.
3. Sclerosing adenosis with microcalcifcation. <Left>
1. Intraductal papilloma with usual ductal
hyperplasia
2. Sclerosing adenosis with microcalcifcation.
Operation
Second Operation (Mar. 2021) Right axillary
lymph node sampling.
Pathology Report
No metastasis in eight axillary lymph nodes
(right sentinel LN: 0/2, right axillary LN: 0/6).
1. Post-excision status.
Adjuvant Therapy
Postoperative radiation therapy.
Tamoxifen 20 mg/day for 0.8 year.
|
Cluster 3: Advanced Stage Disease
|
Case 9
|
Right breast mucinous carcinoma → Operation
→ Adjuvant therapy → Left breast recurrence
(IDC + DCIS)/Right breast ADH.
|
Local Recurrence
|
Female/51 years old, pre-menopause.
Screen detected mass lesion on right breast 12
o’clock direction.
Outside result of biopsy: Mucinous carcinoma.
Family history of colon cancer, father.
No comorbidities.
BRCA 1 and 2 mutation: Not detected.
|
Right US for evaluation of a palpable lump
(2013): An isoechoic mass with microlobulated margins
at subareolar area. US-CNB = Mucinous carcinoma. T2-weighed right MRI (2013): An oval mass
with high T2 signal intensity at subareolar area. Lymphoscintigraphy shows visualized sentinel
lymph nodes in the right axilla. Operation
May 2013 Right breast conserving surgery, sentinel lymph node biopsy (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on each direction. Pathology Report
Mucinous Carcinoma
1. Size of tumor: 1.5 cm (pT1c).
2. Histologic grade: 1/3 (tubule formation: 2/3,
nuclear pleomorphism: 2/3, mitotic count:
1/3, 7/10HPF).
3. Intraductal component: absent.
4. Skin: no involvement of tumor.
5. Surgical margins:
(a) Superior margin: 10 mm.
(b) Inferior margin: 15 mm.
(c) Medial margin: 15 mm.
(d) Lateral margin: 20 mm.
(e) Deep margin: 12 mm.
(f) Superfcial margin: 3 mm.
6. Lymph nodes: no metastasis in one axillary
lymph node (pN0(sn)) (sentinel LN: 0/1).
7. Vascular invasion: absent.
8. Lymphatic invasion: absent.
9. Tumor border: infltrative. Adjuvant Therapy
Postoperative radiation therapy.
Tamoxifen 20 mg/day for 5 years.
|
Cluster 3: Advanced Stage Disease
|
Case 10
|
Right breast IDC→ Operation → Adjuvant therapy → Right breast recurrence (IDC).
|
Local Recurrence
|
Female/42 years old, pre-menopause.
Screen detected mass lesion on right breast 5
o’clock direction.
Outside result of biopsy: Invasive ductal
carcinoma.
No family history.
s/p myomectomy.
|
Report 1: Right mammography (2018): An irregular palpable mass at lower inner breast. US-CNB = IDC. Report 2: Right MRI (2018): An irregular enhancing mass. Report 3: Lymphoscintigraphy shows visualized sentinel
lymph nodes in the right axilla. Operation
Jul. 2018 Right nipple-areolar complex sparing
mastectomy with immediate implant reconstruction, sentinel lymph node biopsy, left breast augmentation (Figs. 79 and 80).
Pathology Report
1. Invasive ductal carcinoma.
(a) Size of tumor: 1.8 cm (pT1c).
(b) Histologic grade: 2/3 (tubule formation:
3/3, nuclear pleomorphism: 2/3, mitotic
count: 1/3, 5/10HPF).
(c) Intraductal component: present, intratumoral/extratumoral (10%) (nuclear grade:
low, necrosis: present, architectural
pattern: cribriform/solid, extensive intraductal component: absent).
(d) Skin: no involvement of tumor.
(e) Surgical margins: • Deep margin: <1 mm from invasive
ductal carcinoma (slide 3).
• Superfcial margin: (see note 1).
(f) Lymph nodes:
• Metastasis in one out of fve axillary
lymph nodes (pN1mi(sn)) (see note 2)
(sentinel LN: 1/4, non-sentinel LN: 0/1).
• Perinodal extension: absent.
• Size of metastatic carcinoma: 1.2 mm.
(g) Arteriovenous invasion: absent.
(h) Lymphovascular invasion: present, intratumoral/peritumoral.
(i) Tumor border: infltrative.
(j) Microcalcifcation: present, non-tumoral.
(k) Pathological TN category (AJCC 2017):
pT1cN1mi(sn).
2. Intraductal papilloma.
Note: 1. The superfcial margin of the lumpectomy specimen (slide 3) is close to ductal carcinoma in situ (<1 mm), but this margin submitted
for frozen diagnosis (Fro 2) is free of tumor.
2. Micrometastasis is present only in the permanent section of Fro 3. Adjuvant Therapy
Tamoxifen 20 mg/day for 3.5 years.
|
Cluster 3: Advanced Stage Disease
|
Case 11
|
Right breast IDC → Operation → Adjuvant
therapy → Right breast recurrence (IDC).
|
Local Recurrence
|
Female/45 years old, post-menopause.
Screen detected mass lesion on right breast 10
o’clock direction.
No family history.
S/P bilateral salpingo-oophorectomy (right
ovary borderline tumor).
BRCA 1 and 2 mutation: Not detected.
|
Operation
Nov. 2008 Right breast conserving surgery, sentinel lymph node biopsy (outside).
Pathology Report
Invasive Ductal Carcinoma
1. Size of tumor: 1.3 cm (pT1c).
2. Lymph nodes: no metastasis in four axillary
lymph nodes (pN0(sn)) (sentinel LN: 0/4).
3. Pathologic stage (AJCC 2010): pT1cN0(sn). Adjuvant Therapy
Adjuvant chemotherapy #4 cycles of doxorubicin
and cyclophosphamide.
Postoperative radiation therapy.
Tamoxifen 20 mg/day for 1.8 years.
|
Cluster 3: Advanced Stage Disease
|
Case 12
|
Right breast DCIS → Operation → Right breast
recurrence (microinvasive ductal carcinoma). Right US for evaluation of a palpable lump
(2007): An irregular hypoechoic mass at outer central
breast. US-CNB = DCIS, high grade. Right MRI (2007): Clumped non-mass enhancement at outer central breast.
|
Local Recurrence
|
Female/55 years old, peri-menopause.
Screen detected mass lesion on right breast 9
o’clock direction.
Family history of prostate cancer, father.
s/p hysterectomy, HPV infection.
|
Lymphoscintigraphy shows visualized sentinel
lymph nodes in the right axilla. Operation
Aug. 2007 Right breast conserving surgery, sentinel lymph node biopsy. Pathology Report
Ductal carcinoma in situ
1. Size of tumor: 2.3 cm (pTis).
2. Nuclear grade: low.
3. Necrosis: absent.
4. Architectural pattern: cribriform, solid and
papillary.
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) Superior margin: 20 mm.
(b) Inferior margin: 20 mm.
(c) Medial margin: 30 mm.
(d) Lateral margin: 50 mm.
(e) Deep margin: 2 mm.
7. Lymph nodes: no metastasis in 5 axillary
lymph nodes (pN0(sn)) (sentinel LN: 0/4,
right intramammary LN (Fro 6): 0/1). 8. Microcalcifcation: present, tumoral/
non-tumoral.
9. Pathologic staging: pTisN0(sn).
|
Cluster 3: Advanced Stage Disease
|
Case 13
|
Right breast microinvasive ductal carcinoma →
Operation → Right breast recurrence (DCIS).
|
Local Recurrence
|
Female/42 years old, pre-menopause.
Screen detected mass lesion on right breast 3
o’clock direction and bloody discharge from
right nipple.
Outside result of biopsy: Ductal carcinoma in
situ.
No family history.
No comorbidities.
BRCA 1 and 2 mutation: not detected.
|
Report 1:Right US (2016): Multiple hypoechoic lesions
with indistinct margins (partly shown). US-CNB = DCIS,
high grade. Report 2:Right MRI (2016): Multifocal clustered ring
non-mass enhancement. Report 3: Lymphoscintigraphy shows visualized sentinel
lymph nodes in the right axilla. Operation
Jul. 2016 Right nipple-areolar complex sparing
mastectomy with immediate implant reconstruction, sentinel lymph node biopsy( (a) Preoperative and (b) immediate postoperative appearance and (a) Gross pathology of mastectomy specimen. (b) The margins get marked and sliced with different colors on
each direction) Pathology Report
Microinvasive Ductal Carcinoma
1. Size of invasive component: <0.1 cm
(pT1mi).
2. Size of intraductal component: 4.5 cm.
3. Histologic grade: 3/3 (tubule formation: 3/3,
nuclear pleomorphism: 3/3, mitotic count:
2/3, 11/HPF).
4. Intraductal component: present, intratumoral/extratumoral (98%) (nuclear grade:
high, necrosis: present, architectural pattern:
micropapillary/cribriform, extensive intraductal component: present).
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) Deep margin: <1 mm from ductal carcinoma in situ (slide 3).
(b) Superfcial margin: <1 mm from ductal
carcinoma in situ (slide 10).
7. Lymph nodes: no metastasis in three axillary
lymph nodes (pN0(sn)) (sentinel LN: 0/3)
8. Arteriovenous invasion: absent.
9. Lymphovascular invasion: absent.
10. Tumor border: infltrative.
11. Microcalcifcation: present, tumoral/
non-tumoral.
12. Pathologic stage (AJCC 2010): pT1miN0(sn).
|
Cluster 3: Advanced Stage Disease
|
Case 14
|
Right breast infltrating ductal carcinoma →
Operation → Left breast recurrence (IDC).
|
Local Recurrence
|
Female/72 years old, post-menopause.
Screen detected mass lesion on right breast 1
o’clock direction and left 9 o’clock direction.
No family history.
Diabetes mellitus.
BRCA 1 and 2 mutation: Not detected, ATM
and POLE VUS (variant of uncertain).
|
Right US (2003): An irregular hypoechoic
mass. US-CNB = IDC and Lymphoscintigraphy shows visualized sentinel
lymph nodes in both axilla. Operation
Aug. 2003 Right breast conserving surgery, axillary lymph node dissection, left breast mass
excision.
Pathology Report, <Right Breast>
Infltrating Ductal Carcinoma
1. Size of tumor: 2 cm (pT1c).
2. Histologic grade: 2/3 (tubule formation: 2/3,
nuclear pleomorphism: 2/3, mitotic count:
2/3).
3. Ductal carcinoma in situ: present, intratumoral (5%) (nuclear grade: low, necrosis:
absent, architectural pattern: solid, extensive
intraductal component: absent).
4. Skin: no involvement of tumor.
5. Surgical margins: clear
(a) Superior margin: 30 mm.
(b) Inferior margin: 35 mm.
(c) Medial margin: 35 mm.
(d) Lateral margin: 25 mm.
(e) Deep margin: 10 mm.
6. Lymph nodes:
(a) Metastasis in 2 out of 22 axillary lymph
nodes (pN1a) (sentinel LN: 1/2, axillary
LN: 1/20).
(b) Perinodal extension: absent.
(c) Size of metastatic carcinoma: 6 mm.
7. Vascular invasion: absent.
8. Lymphatic invasion: absent.
9. Tumor border: infltrative.
10. Microcalcifcation: absent.
11. Pathologic staging: pT1cN1a. <Left Breast>
Ductal hyperplasia with organizing hematoma.
Adjuvant Therapy
Adjuvant chemotherapy #6 cycles of fuorouracil
and doxorubicin and cyclophosphamide.
Postoperative radiation therapy.
Tamoxifen 20 mg/day for 1.7 years followed
by anastrozole 1 mg/day for 1 year followed by
tamoxifen 20 mg/day for 2.3 years.
|
Cluster 3: Advanced Stage Disease
|
Case 15
|
Right breast IDC → Operation → Adjuvant
therapy →Left breast and axillary lymph node
recurrence (IDC) → Left axillary lymph node
recurrence.
|
Local Recurrence
|
Female/63 years old, post-menopause.
Self-detected mass lesion on right breast 9
o’clock direction.
Family history of breast cancer, mother.
Hypertension, s/p Left leg fracture operation.
BRCA 1 and 2 mutation: Not detected.
|
Report 1: Right mammography (Apr. 2012): An irregular
palpable mass with microcalcifcations. US-CNB = IDC. Report 2: Lymphoscintigraphy shows visualized sentinel lymph nodes in the left axilla. Operation
May 2012 Right totQAal mastectomy, axillary
lymph node dissection (a) Gross pathology of mastectomy specimen. (b) The margins get marked and sliced with different colors on each direction. Pathology Report
Invasive Ductal Carcinomas (×2).
1. Size of tumor: 2.1 cm, 0.7 cm (pT2(m)).
2. Histologic grade: 2 (tubule formation: 2/3,
nuclear pleomorphism: 3/3, mitotic count:
1/3, 8/10HPF). 3. Intraductal component: present, intratumoral/extratumoral (3%) (nuclear grade:
high, necrosis: present, architectural pattern:
comedo and cribriform, extensive intraductal
component: absent).
4. Skin and nipple: no involvement of tumor.
5. Surgical margins: free from tumor.
(a) Deep margin: 5 mm.
(b) Superfcial margin: 15 mm.
6. Lymph nodes:
(a) Metastasis in one out of nine axillary
lymph nodes (pN1a) (sentinel LN: 1/1,
axillary LN: 0/8).
(b) Perinodal extension: absent.
(c) Size of metastatic carcinoma: 5 mm.
7. Vascular invasion: absent.
8. Lymphatic invasion: absent.
9. Neural invasion: present.
10. Tumor border: infltrative.
11. Microcalcifcation: present, tumoral.
12. Pathologic stage (AJCC 2010): pT2(m)N1a. Adjuvant Therapy
Adjuvant chemotherapy #4 cycles of doxorubicin
and cyclophosphamide followed by #4 cycles of
docetaxel and trastuzumab for 1 year.
Anastrozole 1 mg/day for 1.3 years.
|
Cluster 3: Advanced Stage Disease
|
Case 16
|
Left breast DCIS → Operation → Adjuvant
therapy → Left breast recurrence (DCIS).
|
Local Recurrence
|
Female/43 years old, pre-menopause.
Screen detected mass lesion on left breast 7
o’clock direction.
Outside result of biopsy: Ductal carcinoma in
situ. No family history.
No comorbidities.
|
Left mammography (2014): An irregular palpable mass with microcalcifcations at lower central
breast. US-CNB = DCIS, low grade. Left MRI (2014): An irregular enhancing mass
at lower central breast. Operation
Feb. 2014 Left breast conserving surgery (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors
on each direction. Pathology Report
Ductal Carcinoma In Situ
1. Size of tumor: 3.0 cm (pTis).
2. Nuclear grade: low.
3. Necrosis: present.
4. Architectural pattern: micropapillary/cribriform/comedo.
Local Recurrence
762
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) Nipple margin: positive for atypical ductal hyperplasia (Fro 1) (see note 1).
(b) Superior margin: (see note 2).
(c) Inferior margin: 20 mm.
(d) Medial margin: 5 mm.
(e) Lateral margin: 15 mm.
(f) Deep margin: 2 mm.
(g) Superfcial margin: 2 mm.
7. Microcalcifcation: present, tumoral/
non-tumoral.
8. Pathologic stage (AJCC 2010): pTis.
Note: 1. Atypical ductal hyperplasia is present
only in the permanent section of Fro 1.
2. The superior margin of the lumpectomy
specimen (slide 1) is positive for ductal carcinoma in situ, but this margin submitted for frozen
diagnosis (Fro 2) is free of tumor. Adjuvant Therapy
Postoperative radiation therapy.
Tamoxifen 20 mg/day for 5 years.
|
Cluster 3: Advanced Stage Disease
|
Case 17
|
Right breast DCIS → Operation → Adjuvant
therapy → Right breast recurrence (mucinous
carcinoma).
|
Local Recurrence
|
Female/43 years old, pre-menopause.
Screen detected mass lesion on right breast 7
o’clock direction.
Outside result of mammotome biopsy: ductal
carcinoma in situ.
No family history.
s/p Total thyroidectomy (thyroid cancer).
BRCA 2 VUS (variant of uncertain).
|
Right US (2015): An isoechoic mass with indistinct margins at lower outer breast. US-VABE = DCIS,
high grade. Operation Nov. 2015 Right breast conserving surgery (a) Gross pathology of lumpectomy specimen. (b) The margins get marked and sliced with different colors on each direction.Pathology Report
Ductal Carcinoma In Situ
1. Post-excisional biopsy status.
2. Size of tumor: 1.5 cm, residual.
3. Nuclear grade: high.
4. Necrosis: present.
5. Architectural pattern: cribriform/solid/
comedo.
6. Skin: no involvement of tumor.
7. Surgical margins:
(a) Superior margin: 5 mm.
(b) Inferior margin: 7 mm.
(c) Medial margin: 15 mm.
(d) Lateral margin: (see note).
(e) Deep margin: 2 mm.
(f) Superfcial margin: 8 mm.
8. Microcalcifcation: present, tumoral/
non-tumoral.
Y. Kim et al.
765
Note: 1. The lateral margin of the lumpectomy
specimen (slide 7) is close to ductal carcinoma in
situ (<1 mm), but this margin submitted for frozen diagnosis (Fro 5) is free of tumor. Adjuvant Therapy
Postoperative radiation therapy
|
Cluster 3: Advanced Stage Disease
|
Case 18
|
Left breast IDC→ Operation → Adjuvant
therapy → Right breast recurrence (IDC).
|
Local Recurrence
|
Female/71 years old, post-menopause.
Screen detected mass lesion on right breast.
No family history.
Diabetes mellitus, Grave’s disease.
BRCA 2 mutation carrier.
|
Operation
May 2001 Left modifed radical mastectomy
(outside).
Pathology Report (a) Metastasis in one out of four axillary
lymph nodes (pN1mi(sn)) (sentinel LN:
1/3, non-sentinel LN: 0/1).
(b) Perinodal extension: absent.
(c) Size of metastatic carcinoma: 0.8 mm.
9. Arteriovenous invasion: absent.
10. Lymphovascular invasion: present,
intratumoral.
11. Tumor border: infltrative.
12. Microcalcifcation: present, tumoral/
non-tumoral.
13. Pathological TN category (AJCC 2017):
pT1cN1mi(sn).Adjuvant Therapy :Anastrozole 1 mg/day (stop d/t low compliance).
Invasive Ductal Carcinoma
1. Size of tumor: 3.0 cm (pT2).
2. Lymph nodes: two metastases in 24 axillary
lymph nodes (pN1) (sentinel LN: 0/2, axillary
LN: 0/2, intramammary LN: 0/1).3. Pathological TN category: pT2N1.
|
Cluster 3: Advanced Stage Disease
|
Case 19
|
Left breast IDC → Adjuvant therapy
|
Local Recurrence
|
Female/52 years old, pre-menopause.
Screen detected mass lesion on right breast
subareolar area and left breast subareolar area. No family history.
Hypertension.
|
Report 1: Mammography (2016): Irregular masses with architectural distortion at both subareolar areas (white arrow = left, black arrow = right). Report 2: US (2016): Irregular hypoechoic masses at both subareolar areas (white arrow = left, black arrow = right).
US-CNB = Left IDC, Right ADH. Report 3: MRI (2016):
Irregular enhancing masses at both subareolar areas (white arrow = left, black arrow = right). Report 4: Post-NAC
MRI (2017): Decreased
size of the masses at
both subareolar areas
(white arrow = left,
black arrow = right). Report 5: . Neoadjuvant Chemotherapy
Neoadjuvant chemotherapy #4 cycles of doxorubicin and cyclophosphamide followed by
#4 cycles of docetaxel and trastuzumab.
Operation
May 2017 Left breast conserving surgery, axillary lymph node dissection, right breast conserving surgery. Pathology Report
<Right Breast>
Complex sclerosing lesion with
microcalcifcation.
<Left Breast>
Invasive Ductal Carcinoma, associated with
complex sclerosing lesion
1. Post-chemotherapy status.
2. Size of invasion component: 1.3 cm
(ypT1c(m)).
3. Size of intraductal component: 1.6 cm. 4. Histologic grade: 2/3 (tubule formation: 3/3,
nuclear pleomorphism: 2/3, mitotic count:
1/3, 4/10HPF).
5. Intraductal component: present, extratumoral
(70%) (nuclear grade: low, necrosis: absent,
architectural pattern: micropapillary/cribriform, extensive intraductal component:
present).
6. Skin: no involvement of tumor.
7. Surgical margins:
(a) Superior margin: 15 mm.
(b) Inferior margin: 4 mm.
(c) Medial margin: (see NOTE 1).
(d) Lateral margin: 50 mm.
(e) Deep margin: 7 mm.
(f) Superfcial margin: 14 mm. 8. Lymph nodes:
(a) Metastasis in two out of eight axillary
lymph nodes (ypN1a(sn)) (sentinel LN:
2/2, axillary LN: 0/6).
(b) Perinodal extension: present.
(c) Size of metastatic carcinoma: 3 mm.
9. Arteriovenous invasion: absent.
10. Lymphovascular invasion: present,
peritumoral.
11. Tumor border: infltrative.
12. Microcalcifcation: present, tumoral/
non-tumoral.
13. Pathologic stage (AJCC 2010): ypT1c(m)
N1a(sn). Note 1: The medial margin of the lumpectomy
specimen (slide 4) is <1 mm from invasive ductal
carcinoma, but this margin submitted for frozen
diagnosis (Fro 6) is free of tumor. Adjuvant Therapy
Postoperative radiation therapy.
Trastuzumab for 1 year.
Tamoxifen 20 mg/day for 5 years.
|
Cluster 3: Advanced Stage Disease
|
Case 39
|
Right breast cancer → Neoadjuvant chemotherapy → Operation → Adjuvant therapy → Left
breast and lung metastasis.
|
Metastatic Breast Cancer
|
Female/51 years old, peri-menopause.
No family history.
BRCA 1 & 2 mutation: Not detected.
Hepatitis B virus carrier, hypertension.
|
Breast US (Jul. 2007): Microlobulated
hypoechoic mass with microcalcifcations at the 12
o’clock direction of right breast. Jul. 2007 Outside slide review > Right infltrating duct carcinoma.
Neoadjuvant Chemotherapy
Neoadjuvant chemotherapy #4 cycles
(Doxorubicin & cyclophosphamide #4). Operation
Oct. 2007 Right breast conserving surgery, sentinel lymph node biopsy.
Pathology: Invasive ductal carcinoma, stage
ypT1cN0 (sn).
Size of tumor: 1.5 × 1.0 cm, lymph node 0/1. Adjuvant Therapy
Post-operative radiation to right breast.
|
Cluster 3: Advanced Stage Disease
|
Case 40
|
Right breast cancer → Neoadjuvant chemotherapy → Operation → Adjuvant therapy → Lung
metastasis.
|
Metastatic Breast Cancer
|
Female/54 years old, post-menopause.
No family history.
S/p bilateral salpingo-oophorectomy.
|
Breast MRI (Oct. 2014): Irregular homogeneous enhancing mass in right upper outer quadrant.
Enlarged lymph nodes in right axillary area, suggesting
metastasis. Oct. 2014 Outside slide review> Right invasive ductal carcinoma.
Right axillary lymph node, metastatic ductal
carcinoma. Neoadjuvant Chemotherapy
Neoadjuvant chemotherapy #8 cycles (Doxorubicin
& cyclophosphamide #4 → Docetaxel #4). Operation
Apr. 2015 Right breast conserving surgery, axillary lymph node dissection.
Pathology: Invasive ductal carcinoma, stage
ypT1cN1mi.
Size of tumor: 1.4 cm, lymph node 2/9 (2 mm).
Adjuvant Therapy
Post-operative radiation to right breast +
Tamoxifen 20 mg/day for 2 years.
|
Cluster 3: Advanced Stage Disease
|
Case 41
|
Left breast cancer → Operation → Adjuvant
therapy → Lung, liver, and bone metastasis. Breast MRI (Oct. 2015): Irregular homogeneous enhancing mass at the 1 o’clock direction of left
breast.
|
Metastatic Breast Cancer
|
Female/52 years old, peri-menopause.
No family history.
S/p Tuberculosis.
|
Operation
Nov. 2015 Left breast conserving surgery.
Pathology: Invasive ductal carcinoma, stage
pT2N2a.
Size of tumor: 2.4 cm, lymph node: 5/12
(11 mm). Adjuvant Therapy
Adjuvant chemotherapy # 8 cycles (Doxorubicin
& cyclophosphamide #4 → Docetaxel &
Trastuzumab #4).
Post-operative radiation to left breast +
Tamoxifen 20 mg/day for 2.5 years.
Concurrent Trastuzumab # 14.
|
Cluster 3: Advanced Stage Disease
|
Case 42
|
Left breast cancer → Operation → Adjuvant
therapy → Lung metastasis.
|
Metastatic Breast Cancer
|
Female/57 years old, post-menopause.
No family history.
Arrhythmia (taking on medicine).
|
Mammography (May 2008): Irregular isodense mass (white arrow) and regional microcalcifcations in left upper outer quadrant. Operation
Jun. 2008 Left breast conserving surgery, sentinel
lymph node biopsy.
Pathology: Invasive ductal carcinoma, stage
pT1aN0 (sn).
Size of tumor: 0.6 cm, 0.5 × 0.3 cm, lymph
node: 0/2. Adjuvant Therapy
Adjuvant chemotherapy # 6 cycles (Fluorouracil-5
& Doxorubicin & Cyclophosphamide).
Post-operation radiation to left breast +
Tamoxifen 20 mg/day for 5 years.
|
Cluster 3: Advanced Stage Disease
|
Case 43
|
Right breast cancer → Operation → Adjuvant
therapy → Brain metastasis.
|
Metastatic Breast Cancer
|
Female/54 years old, post-menopause.
Family history of breast cancer, sister.
BRCA 1 & 2 mutation: Not detected.
S/p bilateral salpingo-oophorectomy.
|
Breast US (Jun. 2012): Hypoechoic mass at the
10 o’clock direction of right breast. Operation
Jun. 2012 Right breast conserving surgery, sentinel lymph node biopsy.
Pathology: Invasive ductal carcinoma, stage
pT1cN0 (sn).
Size of tumor: 1.5 cm, lymph node: 0/2. Adjuvant Therapy
Post-operation radiation to right breast +
Tamoxifen 20 mg/day for 3 years.
Concurrent Zoladex for 1 year.
|
Cluster 3: Advanced Stage Disease
|
Case 44
|
Right breast cancer with bone metastasis →
Palliative therapy. Breast MRI (Jan. 2018): Huge irregular heterogeneous enhancing mass in right breast. Enlarged lymph
nodes (white arrow) in the right axillary area, suggesting
metastases. Bone scan (May 2018): Multifocal increased
uptake in sternum, lumbar vertebral bodies, and right pelvic bone, suggesting bony metastases. Right invasive ductal carcinoma, stage IV
(metastasis in bone).
|
Metastatic Breast Cancer
|
Female/49 years old, post-menopause.
No family history.
S/p bilateral salpingo-oophorectomy.
|
Feb. 2018 Bilateral salpingo-oophorectomy.
Palliative therapy: Letrozole & Palbociclib #
16: Progressive disease.
Jul. 2019 Palliative operation: Right nipplesparing mastectomy, axillary lymph node
dissection.
Pathology: Invasive ductal carcinoma, stage
ypT1cN1a.
Size of tumor: 2.0 cm, lymph node: 3/7
(2 mm). Palliative therapy: Capecitabine (Sep. 2019 ~
Dec. 2019): Progressive disease. 6 Abdomen CT (Jan. 2020): Hypoattenuating nodules in the liver, suggesting hepatic metastases. Palliative therapy: DS-8201aU 303 # 8:
Progressive disease (liver).
Concurrent proton therapy: radiation to liver.
Palliative therapy: Albumin-bound Paclitaxel
# 8: Progressive disease.
Palliative therapy: Fluorouracil-5 &
Doxorubicin & cyclophosphamide # 5.
Palliative therapy: Eribulin.
Dec. 2021 Death.
|
Cluster 3: Advanced Stage Disease
|
Case 45
|
Left breast cancer with lung and bone metastasis → Palliative therapy. Breast MRI (Jun. 2013): Irregular heterogeneous enhancing mass at the 12 o’clock direction of left
breast. Chest CT (Jun. 2013): Multiple nodules in both lungs, suggesting pulmonary metastases. PET-CT (Jun. 2013): Hypermetabolic activity
in the 1st lumbar vertebral body, suggesting bony
metastasis. Left invasive ductal carcinoma, stage IV
(metastasis in lung, bone). Palliative therapy: Paclitaxel & Trastuzumab
# 24.
Dec. 2014 Left breast conserving surgery, sentinel lymph node biopsy.
Pathology: Invasive ductal carcinoma, stage
ypT2N0 (sn).
Size of tumor: 2.3 cm, lymph node: 0/2. Palliative therapy: fuorouracil & Doxorubicin
& cyclophosphamide # 6.
Post-op radiation to left breast & subclavicular lymph node + Tamoxifen 20 mg/day (Apr.
2015 ~ Jul. 2018).
Jul. 2018 Chest CT> increased nodule in lung,
hepatic metastasis.
Palliative therapy: Trastuzumab emtansine # 5
cycles: Progressive disease.
Palliative therapy: Lapatinib & Capecitabine #
39 cycles: Progressive disease.
Palliative therapy: Gemcitabine & Cisplatin
(Feb. 2021) ~
|
Metastatic Breast Cancer
|
Female/49 years old, pre-menopause.
No family history.
| null |
Cluster 3: Advanced Stage Disease
|
Case 46
|
Right breast cancer with bone metastasis →
Palliative therapy. Breast MRI (Jan. 2019): Irregular rim enhancing mass at the 7 o’clock direction of right breast. Whole spine MRI (Jan. 2019): Ill-defned infltrative bony enhancing lesion in the vertebral body and
post arc of the 10th thoracic vertebra, suggesting bony
metastasis. Right invasive ductal carcinoma, Stage IV
(R/O metastasis in bone, T-spine 10). Palliative therapy: Letrozole & Palbociclib # 29.
Dec. 2021 Right breast conserving surgery,
sentinel lymph node biopsy.
Pathology: Invasive ductal carcinoma, stage
ypT1bN0 (sn).
Size of tumor: 0.9 cm, lymph node: 0/2. Palliative chemotherapy #4 cycles
(Doxorubicin & Cyclophosphamide).
Post-op radiation to right breast & T-spine 10.
|
Metastatic Breast Cancer
|
Female/61 years old, post-menopause.
No family history.
s/p appendectomy, hypertension.
| null |
Cluster 3: Advanced Stage Disease
|
Case 47
|
Right breast cancer → Neoadjuvant chemotherapy → Operation → Adjuvant therapy →Ipsilateral
breast recurrence → Lung metastasis.
|
Metastatic Breast Cancer
|
Female/46 years old, pre-menopause.
No family history.
|
Breast MRI (Feb. 2013): Irregular heterogeneous enhancing mass in the left upper outer quadrant. Feb. 2012 Outside slide review> Left invasive
ductal carcinoma. Neoadjuvant Chemotherapy
Neoadjuvant chemotherapy #8 cycles
(Doxorubicin + cyclophosphamide #4 →
Docetaxel + Trastuzumab #4).
Operation
Aug. 2013 Left breast conserving surgery, sentinel lymph node biopsy.
Pathology: Ductal carcinoma in situ (residual), stage yp TisN0 (sn).
Size of tumor: up to 0.5 cm, lymph node: 0/3. Adjuvant Therapy
Post-operative radiation to left breast & subclavicular lymph node.
Concurrent Trastuzumab # 18.
|
Cluster 3: Advanced Stage Disease
|
Case 48
|
Right breast cancer with mediastinum and
bone metastasis → Palliative therapy. Breast MRI (May 2014): Huge irregular heterogeneous enhancing mass in right breast. Enlarged lymph nodes (white arrow) in the
right axillary area, suggesting metastases. PET-CT (May 2014): Hypermetabolic activity
in the mediastinal lymph node, suggesting metastasis. Whole spine MRI (Jun. 2014): Multiple
enhancing lesions in thoracic and lumbar vertebrae, suggesting bony metastases. Right invasive ductal carcinoma, stage IV
(R/O metastasis in bone).
|
Metastatic Breast Cancer
|
Female/45 years old, post-menopause.
No family history.
BRCA 1 & 2 mutation: Not detected.
S/p bilateral salpingo-oophorectomy
|
Neoadjuvant chemotherapy #8 cycles
(Doxorubicin + Cyclophosphamide #4 →
Docetaxel #4).
Dec. 2014 Right breast conserving surgery.
Pathology: Invasive ductal carcinoma, stage
ypT2N2a.
Size of tumor: 3.0 × 1.5 cm, lymph node: 4/4
(10 mm). Post-operative radiation to right breast &
internal mammary lymph node + Tamoxifen
20 mg/day & zoladex.
Mar. 2015 Bilateral salpingo-oophorectomy.
Tamoxifen 20 mg/day only.
Mar. 2016 PET-CT> metastasis in multiple
bone.
Palliative therapy: Letrozole (Mar. 2016 ~
Nov. 2017: Progressive disease).
Palliative therapy: Exemestane & Everolimus.
Oct. 2018 Chest CT> metastasis in liver.
Palliative therapy: Paclitaxel & Cisplatin #21:
Progressive disease.
Palliative therapy: Fulvestrant & Abemaciclib
(Feb. 2020)~
|
Cluster 3: Advanced Stage Disease
|
Case 49
|
Right breast cancer with bone metastasis →
Palliative therapy. Breast MRI (Nov. 2014): Irregular enhancing
mass at the 11 o’clock direction of right breast. PET-CT (Nov. 2014): Hypermetabolic bone lesions in both pelvic bones, suggesting bony metastases. Right invasive ductal carcinoma, stage IV
(metastasis in bone).Clinical trial: Tamoxifen 20 mg/day &
Goserelin 3.6 mg (Dec. 2014 ~ Jan. 2017):
Progressive disease.
Jan. 2017 Palliative right breast conserving
surgery & bilateral salpingo-oophorectomy.
Pathology: Invasive ductal carcinoma, stage
yp T1p. Size of tumor: 1.4 cm. Palliative therapy: Letrozole & Palbociclib
(Jan. 2017) ~ Post-operative radiation to pelvic bone.
|
Metastatic Breast Cancer
|
Female/55 years old, post-menopause.
No family history.
S/p bilateral salpingo-oophorectomy, s/p Left
pelvis cementoplasty
| null |
Cluster 3: Advanced Stage Disease
|
Case 50
|
Left breast cancer with lung metastasis →
Palliative therapy. Breast US (Nov. 2019): Irregular hypoechoic
mass with echogenic halo at the 11 o’clock direction of
left breast. Chest CT (Feb. 2020): Several nodules, both
lungs, suggesting pulmonary metastases. Left invasive ductal carcinoma, stage IV
(metastasis in ovary, s/p bilateral
salpingo-oophorectomy).. Palliative therapy: Letrozole & Palbociclib
#11.
Jan. 2021 Left breast conserving surgery.
Pathology: Invasive ductal carcinoma, stage
ypT2N1a.
Size of tumor: 2.5 cm, lymph node: 1/7
(6 mm). Palliative chemotherapy # 4 cycles (Docetaxel
& cyclophosphamide #4).
Post-operative radiation to left breast & subclavicular lymph node + Tamoxifen 20 mg/day
(May 2021)~
|
Metastatic Breast Cancer
|
Female/47 years old, post-menopause.
No family history.
S/p bilateral salpingo-oophorectomy, diabetes
mellitus.
| null |
Cluster 3: Advanced Stage Disease
|
README.md exists but content is empty.
- Downloads last month
- 3