Case
string | Patient History
string | Important Radiologic
string | Courses of Treatment
string | Pathology Report
string | Label
string | Cluster
string |
|---|---|---|---|---|---|---|
Case 1
|
Female/37 years old, pre-menopause.Screen detected mass lesion on left breast8 o’clock and 5 o’clock direction.Outside result of biopsy: Papillary neoplasm.No family history.No comorbidities
|
Report 1: A 1 cm sized complex cystic and solid mass with increased vascularity (IDP with UDH). Report.2: A 0.6 cm oval circumscribed isoechoic mass (sclerosing adenosis)
|
2022-02-11 Excision, Lt. (8H and 5H)
|
Breast, left 8 o’clock, excision:–Intraductal papilloma with usual ductalhyperplasia.•Breast, left 5 o’clock, excision:–Sclerosing adenosis.
|
Benign and Proliferative Case Series
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 2
|
Female/47 years old, pre-menopause. Screen detected mass lesion on left breast 2 o’clock direction. Outside result of biopsy: Intraductal papilloma. No family history. No comorbidities.
|
Report 1 Ultrasonography shows a 0.6 cm lobulated hypoechoic mass in the left breast
|
2022-02-14 Excision, Lt.
|
Breast, left, excision: – Atypical ductal hyperplasia with microcalcifcation. – Intraductal papilloma with usual ductal hyperplasia.
|
Benign and Proliferative Case Series
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 3
|
Female/72 years old, post-menopause. Screen detected nodular lesion on right breast 9 o’clock direction. No family history. Hypertension.
|
Report 1: Mammogram shows a round circumscribed iso-dense mass (white arrow) in the right subareolar area. The ringshaped marker represents the skin wart. Report 2: Ultrasonogram shows a 0.8 cm round, parallel, lobulated, complex cystic and solid mass with internal vascularity in the right breast.
|
2021-12-10 Excision, Rt
|
Diagnosis • Breast, right, excision: Intraductal papilloma.
|
Benign and Proliferative Case Series
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 4
|
Female/60 years old, post-menopause. Screen detected mass lesion on left breast 12 o’clock direction. Family history of pancreatic cancer, mother. Hypertension, dyslipidemia (taking medication).
|
Report 1: Ultrasonogram shows a 0.6 cm round, parallel, microlobulated hypoechoic mass without vascularity in the left breast
|
2021-12-14 Excision, Lt.
|
Diagnosis • Breast, left, excision: – Intraductal papilloma.
|
Benign and Proliferative Case Series
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 5
|
Female/48 years old, pre-menopause. Screen detected microcalcifcation on upper outer portion of left breast. Family history of breast cancer, mother and sister. No comorbidities. BRCA 1 and 2 mutation: Not detected.
|
Report 1: Ultrasonogram shows a 0.8 cm irregular shaped, microlobulated hypoechoic mass without vascularity in the left upper inner breast. Report 2: Ultrasonogram shows a 0.7 cm oval shaped, circumscribed hypoechoic mass without vascularity in the left upper outer breast
|
2021-12-17 Excision, Lt. (11H, 1H).
|
Breast, left, excision: – Atypical ductal hyperplasia (#1. 1 o’clock & #2. 11 o’clock) involving intraductal papilloma with microcalcifcation.
|
Benign and Proliferative Case Series
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 6
|
Female/48 years old, pre-menopause. Bloody discharge from right nipple. No family history. Hypertension.
|
Report 1: Ultrasonogram shows an oval shaped, angular margin, hypoechoic mass. Report 2: Ultrasonogram shows irregular ductal dilatation (black arrow) with irregular shaped isoechoic intraductal lesion (white arrow)
|
2021-12-31 excision, both.
|
Breast, right, excision: – Intraductal papilloma with (1) usual ductal hyperplasia, (2) microcalcifcation. • Breast, left, excision: – Intraductal papilloma with (1) usual ductal hyperplasia, (2) microcalcifcation.
|
Benign and Proliferative Case Series
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 7
|
Female/58 years old, post-menopause. Screen detected microcalcifcation on upper portion of right breast. No family history. No comorbidities.
|
Report 1: Right magnifcation views show diffusely distributed amorphous and two grouped round and amorphous microcalcifcations.
|
2021-10-29 Rt upper, stereotactic biopsy.
|
Diagnosis • Breast, right upper, stereotactic biopsy:
– Atypical ductal hyperplasia (#1. Ca++)
with microcalcifcation.
– Flat epithelial atypia (#2. no Ca++) with
microcalcifcation.
→2021-11-26 excision, Rt.
Diagnosis
• Breast, right, excision:
– Atypical ductal hyperplasia with microcalcifcation.
Post-stereotactic biopsy status.
|
Benign and Proliferative Case Series
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 8
|
Female/54 years old, pre-menopause. Screen detected microcalcifcation on upper outer portion of left breast. No family history. No comorbidities.
|
Report 1: Both mammogram and left magnifcation view show regional and some linear distribution of amorphous and round microcalcifcations in left upper outer , and grouped amorphous and rounD microcalcifcations in left upper central
|
2021-11-12 excision, Lt.
|
Diagnosis Breast, left, excision:– Atypical ductal hyperplasia with
microcalcifcation.
|
Benign and Proliferative Case Series
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 9
|
Female/32 years old, pre-menopause. Screen detected mass lesion on right breast 8 o’clock direction. Family history of breast cancer, mother and maternal aunt. No comorbidities.
|
Report 1: Mammography shows no discernable abnormality. Report 2: Ultrasonography shows a 1 cm irregular shaped hypoechoic mass in right lower outer breast. Report 3: MR image shows a 1 cm focal heterogeneous non-mass enhancement in the right lower outer breast.
|
2021-11-12 Excision, Rt.
|
Diagnosis Breast, right, excision:
– Atypical ductal hyperplasia, focal.
|
Benign and Proliferative Case Series
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 10
|
Female/33 years old, pre-menopause. Bloody discharge from left nipple. No family history. No comorbidities.
|
Report 1: US shows 0.8 cm oval hyper-vascular isoechoic nodule in the nipple. Report 2: The US shows 1.3 cm hypoechoic non-mass lesions without vascularity in the left subareolar area
|
2021-10-29 excision (Lt. 3H SA, Lt. nipple mass).
|
Breast, “left subareolar 3 o’clock”, excision:
– Atypical ductal hyperplasia.
• Breast, “left nipple mass,” excision:
– Nipple adenoma (forid papillomatosis).
|
Benign and Proliferative Case Series
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 11
|
Female/39 years old, pre-menopause. Serous discharge from right nipple.
No family history.
Asthma, hyperthyroidism.
|
Report 1: US shows a 0.7 cm oval, angular margin, hypoechoic mass without vascularity
|
2021-10-29 excision, Rt.
|
Diagnosis Breast, right, excision:
– Intraductal papilloma.
|
Benign and Proliferative Case Series
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 12
|
Female/70 years old, post-menopause.
Screen detected mass lesion on left breast
2 o’clock and 5 o’clock and 9 o’clock direction.
No family history.
s/p Right breast conserving surgery (right
breast cancer), hypertension, diabetes mellitus.
|
Report 1: The US shows a round shaped, not parallel oriented hypoechoic mass in left upper outer breast. Report 2: The US shows an irregular shaped hypoechoic
mass in the left inner central breast
|
2021-10-29 excision, Lt.
|
Diagnosis Breast, left, excision:
– Intraductal papilloma (#1. 2 o’clock, #2.
5 o’clock & #3. 9 o’clock) with (1) usual
ductal hyperplasia, (2) apocrine metaplasia.
|
Benign and Proliferative Case Series
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 13
|
Female/45 years old, pre-menopause. Screen detected microcalcifcation on upper center of right breast. No family history. No comorbidities.
|
Report 1: Right mammogram with magnifcation view (lower column) shows two groups of round and amorphous microcalcifcations in the right upper central area. Report 2: Stereotactic vacuum assisted biopsy was performed at the site of microcalcifcations (a). After the successful
biopsy, the marker was inserted at the site of biopsy (b)
|
2021-10-26 excision, Rt.
|
Breast, right 12 o’clock, excision:
– Flat epithelial atypia with
microcalcifcation
• Breast, right 2 o’clock, excision:
– Atypical ductal hyperplasia with
microcalcifcation.
|
Benign and Proliferative Case Series
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 14
|
Female/60 years old, post-menopause. Screen detected mass lesion on right breast 9 o’clock direction. Family history of breast cancer, mother. s/p Total hysterectomy (leiomyoma) and Left salpingo-oophorectomy.
|
Report 1: Right MLO view of the mammogram shows asymmetry of right central portion (white arrow). Report 2: Ultrasonogram shows about 2 cm extent, aggregations of dilated ducts without vascularity
|
2021-10-15 excision, Rt.
|
Breast, right, excision:
– Atypical ductal hyperplasia involving intraductal papilloma with marked cautery artifact.
|
Benign and Proliferative Case Series
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 15
|
Female/33 years old, pre-menopause.
Screen detected mass lesion on left breast
3 o’clock direction.
Family history of pancreatic cancer, maternal
grandmother.
No comorbidities.
BRCA 1 and 2 mutation: Not detected.
|
Report 1: Ultrasonogram shows 1.2 cm irregular hypoechoic mass (white arrow) without signifcant vascularity in left outer central breast. Report 2: MR image shows an enhancing focus with washout kinetics in left outer central breast
|
2021-10-12 excision, Lt.
|
Breast, left, excision:
– Atypical ductal hyperplasia, focal
– Fibroadenomatous change.
|
Benign and Proliferative Case Series
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 16
|
Female/59 years old, post-menopause. Screen detected mass lesion on right breast 7 o’clock direction. No family history. s/p Total hysterectomy, s/p left nephrectomy (donor), s/o cholecystectomy.
|
Report 1: Mammogram shows multiple oval and round circumscribed iso-dense masses (black arrows) and focal asymmetry (white arrows) with round microcalcifcations in the right lower outer breast, extending to subareolar area. Report 2: MRI shows about 8 cm extent heterogeneous segmental non-mass enhancement at right subareolar to the right
7 o’clock direction. Report 3: Ultrasonogram shows multifocal circumscribed round and irregular indistinct hypoechoic masses in the right
breast from subareolar to right lower outer breast.
|
2021-09-13 needle biopsy
|
Diagnosis • Breast, right, needle biopsy: – Ductal carcinoma in situ. Nuclear grade: low. Necrosis: present. Diagnosis 1. Breast, right, lumpectomy: Microinvasive Ductal Carcinoma. (a) Size of tumor: <0.1 cm (pT1mi). (b) Size of in situ component: 4.0 cm. (c) Histologic grade: not applicable. (d) Intraductal component: present, intratumoral/extratumoral (>95%) (nuclear grade: high, necrosis: present, architectural pattern: micropapillary/cribriform/ solid/comedo, extensive intraductal component: present). (e) Skin: no involvement of tumor. (f) Surgical margins: • Nipple margin: positive for ductal carcinoma in situ (Fro 10). • Superior margin:. • Inferior margin: 20 mm. • Medial margin: (see Note 3). • Lateral margin: 5 mm. • Deep margin: <1 mm from ductal carcinoma in situ. • Superfcial margin: 10 mm (g) Lymph nodes: no metastasis in three axillary lymph nodes (pN0(sn)) (sentinel LN: 0/3). (h) Arteriovenous invasion: absent. (i) Lymphovascular invasion: absent. (j) Tumor border: infltrative. (k) Microcalcifcation: present, tumoral. (l) Pathological TN category (AJCC 2017): pT1miN0(sn). Note: 1. Ductal carcinoma in situ is present only in the permanent section of Fro 10. 2. The superior margin of the lumpectomy specimen (slide 3) is positive for ductal carcinoma in situ but this margin submitted for frozen diagnosis (Fro 2) is free of tumor. 3. The medial margin of the lumpectomy specimen is close to ductal carcinoma in situ (2 mm) but this margin submitted for frozen diagnosis (Fro 4) is free of tumor. 4. Histologic mapping has been done.
|
Benign and Proliferative Case Series
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 17
|
Female/39 years old, pre-menopause. Screen detected mass lesion on right breast 9 o’clock direction. No family history. s/p appendectomy (cecal cancer), s/p hysterectomy, and bilateral salpingo-oophorectomy. s/p partial hepatectomy.
|
Report 1: Mammogram shows an oval circumscribed iso-dense mass in the right upper outer breast. Report 2: Ultrasonogram shows an oval lobulated hypoechoic mass in the right 9 o’clock direction
|
2021-09-17 excision, Rt.
|
Diagnosis
• Breast, right, excision:
– Atypical ductal hyperplasia involving
mammary cyst.
– Usual ductal hyperplasia, focal with
microcalcifcation.
|
Benign and Proliferative Case Series
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 18
|
Female/57 years old, pre-menopause.
Screen detected mass lesion on right breast
9 ~ 10 o’clock direction.
No family history.
No comorbidities.
s/p Right breast excision.
|
Report 1: Mammogram shows an oval circumscribed iso-dense mass in the right outer central breast. Report 2: The US shows an oval, not parallel, circumscribed hypoechoic mass without vascularity in the right 9 o’clock direction
|
2021-08-27 excision, Rt.
|
Diagnosis
• Breast, right, excision:
– Atypical ductal hyperplasia with microcalcifcation.
Post-excision status.
– Intraductal papilloma.
|
Benign and Proliferative Case Series
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 19
|
Female/42 years old, pre-menopause.
Screen detected mass lesion on left breast 8 o’clock direction.
Outside result of biopsy: papillary neoplasm.
No family history. No comorbidities.
|
Report 1: Mammogram shows 2 cm oval circumscribed lobulated mass in left subareolar with BB marker (white arrow) and questionable iso-dense mass in left upper breast. Report 2: Ultrasonogram shows an oval shaped, angular margin, isoechoic mass without vascularity in the left 1 o’clock
direction. Report 3: Ultrasonogram shows oval shaped, circumscribed, complex cystic and solid mass with increased vascularity of solid portion in left subareolar area
|
2021-08-03 excision, Lt.
|
Diagnosis
• Breast, left 1 o’clock, excision:
– Fibroadenoma.
– Intraductal papilloma with usual ductal
hyperplasia.
• Breast, left 8 o’clock, excision:
– Intraductal papilloma with (1) usual ductal
hyperplasia, (2) microcalcifcation.
|
Benign and Proliferative Case Series
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 1
|
Female/47 years old, pre-menopause.
Screen detected a mass lesion on left breast in
10 o’clock direction. No family history of breast cancer or other
cancers. S/P Uterine myomectomy.
|
Report 1: The magnifcation view shows segmental fne
pleomorphic microcalcifcations. Report 2: MRI revealed
regional heterogeneous non-mass enhancement in the left upper inner breast. Report 3: US shows (a) a 1.5 cm irregular hypoechoic mass (white arrow) with (b) increased vascularity in color Doppler
image.
|
Operation + Postoperative radiation therapy +
Tamoxifen 20 mg/day for 5 years.
1.3.1 Operation
Nipple–areolar complex sparing mastectomy
with immediate implant reconstruction, sentinel
lymph node biopsy.
|
Ductal carcinoma in situ, pathological TN category (AJCC 2017): pTisN0(sn)
1. Size of tumor: 5.2 cm (pTis).
2. Nuclear grade: high. Necrosis: present.
4. Architectural pattern: papillary/cribriform/
solid/comedo.
5. Surgical margins:
(a) deep margin: 6 mm,
(b) superfcial margin: subareolar margin:
(see Note 1).
6. Lymph nodes: no metastasis in one axillary
lymph node (pN0(sn)) (sentinel LN: 0/1).
7. Microcalcifcation: present, tumoral.
Note: 1. The subareolar margin of the mastectomy specimen (slide 11) is close to ductal carcinoma in situ (<1 mm), but this margin submitted
for frozen diagnosis (Fro 2) is free of tumor.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 2
|
Female/47 years old, pre-menopause.
Nipple discharge on left breast.
Family history of breast cancer, mother and
sister, aunt, cousin sister.
Thrombocytopenia (Follow-up at outside
hospital).
BRCA 2 VUS (variant of uncertain).
|
Report 1: Mammogram shows regional amorphous microcalcifcations in the left breast. Report 2: US demonstrates (a) non-mass heterogeneous lesion (white arrow) with echogenic dots (black arrow)
suggesting microcalcifcations, (b, c) dilated duct with intraductal mass (white arrow). (a, b) were pathologically confirmed as intraductal papilloma with usual ductal hyperplasia and (c) was confirmed as lobular carcinoma in situ.
|
Excision
|
Lobular carcinoma in situ
1. Size of tumor: 0.2 cm2
.
2. Nuclear grade: low.
3. Necrosis: absent.
4. Architectural pattern: solid.
5. Surgical margin: 2 mm from nearest margin.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 3
|
Female/41 years old, pre-menopause. Screen detected microcalcifcations on right breast upper outer. Outside result of biopsy: Right 10 o’clock. 1. Usual ductal hyperplasia, 2. duct ectasia. No family history. S/P Hallux valgus operation
|
Report 1: Magnifcation view shows regional punctate and amorphous microcalcifcations in the right breast. Fig 2: US demonstrates ill-defned hypoechoic lesion with cystic area, which corresponds to the location of microcalcifcation
|
Operation + Tamoxifen 20 mg/day for 5 years. 3.3.1 Operation First operation: Excision, second operation: Wide excision.
|
First Operation: Lobular carcinoma in situ 1. Size of tumor: 0.3 cm. 2. Nuclear grade: low. 3. Necrosis: absent. 4. Architectural pattern: solid. 5. Surgical margins: (a) superior margin: <1 mm (slide 3), (b) inferior margin: 5 mm, (c) medial margin: positive (slide 4), (d) lateral margin: 5 mm, (e) deep margin: 2 mm, (f) superfcial margin: 2 mm. 6. Microcalcifcation: present, tumoral/nontumoral.
Second Operation: Lobular carcinoma in situ 1. Post-excision status. 2. Size of tumor: 0.3 cm, residual. 3. Nuclear grade: low. 4. Necrosis: absent. 5. Architectural pattern: solid. 6. Surgical margins: (a) Superior margin: 5 mm. (b) Inferior margin: 5 mm. (c) Medial margin: 5 mm. (d) Lateral margin: 5 mm. (e) Deep margin: 2 mm. (f) Superfcial margin: 2 mm. 7. Microcalcifcation: present, non-tumoral.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 4
|
Female/46 years old, pre-menopause. Self-detected palpable mass on right breast 8 and 9 o’clock direction. No family history. No comorbidities. BRCA 1 and 2: No detected mutation, RAD51C VUS (variant of uncertain).
|
Report 1: Mammogram shows no suspicious mass in both breasts, except 1 cm sized circumscribed iso-dense nodule in right upper outer breast, premammary fat layer
(white arrow). Report 2: US shows a round hypoechoic mass with microlobulated margin in left 12 o’clock direction (black arrow),
confrmed DCIS and fbroadenoma. Report 3:US shows an oval hypoechoic mass with angular
margin in the right 10 o’clock direction (black arrow),
confrmed LCIS and fbroadenoma. Report 4:Color Doppler US shows an oval isoechoic mass
without vascularity in the right 10 o’clock direction, premammary fat layer (white arrow), which corresponds to
MG detected lesion.
|
Operation + Postoperative radiation therapy (left
side) + Tamoxifen 20 mg/day for 5 years.
Operation
First operation: Excision, second operation: Wide
excision
|
Right.
<First operation>
Lobular carcinoma in situ
1. Size of tumor: 0.2 cm.
2. Nuclear grade: low.
3. Necrosis: absent.
4. Architectural pattern: solid.
5. Surgical margins:
(a) superior margin: 5 mm,
(b) inferior margin: 5 mm,
(c) medical margin: 10 mm, (d) lateral margin: 10 mm,
(e) deep margin: 2 mm,
(f) superfcial margin: 2 mm.
6. Microcalcifcation: present, tumoral/
non-tumoral.
<Second operation>
Lobular carcinoma in situ
1. Post-excision status.
2. Size of tumor: 0.2 cm, residual.
3. Nuclear grade: low.
4. Necrosis: absent.
5. Architectural pattern: solid.
6. Surgical margins:
(a) superior margin: 5 mm,
(b) inferior margin: 5 mm,(c) medial margin: 10 mm,
(d) lateral margin: 30 mm (see Note 1),
(e) deep margin: 10 mm,
(f) superfcial margin: 5 mm.
7. Microcalcifcation: present, non-tumoral.
Note: 1. Atypical ductal hyperplasia is present only in the permanent section of Frozen 10.
Left.
<First operation> Ductal carcinoma in situ, pathological TN category (AJCC 2017): pTis
1. Size of tumor: 0.5 cm (pTis).
2. Nuclear grade: low.
3. Necrosis: absent.
4. Architectural pattern: micropapillary/
cribriform.
5. Surgical margins:
(a) superior margin: 5 mm,
(b) inferior margin: 5 mm,
(c) medial margin: 5 mm,
(d) lateral margin: 5 mm,
(e) deep margin: 2 mm,
(f) superfcial margin: 2 mm.
6. Microcalcifcation: present, tumoral/nontumoral. <Second operation> Ductal carcinoma in situ
1. Post-excision status.
2. Size of tumor: 0.4 cm, residual.
3. Nuclear grade: low.
4. Necrosis: absent.
5. Architectural pattern: micropapillary/
cribriform.
6. Surgical margins:
(a) superior margin: 5 mm (see Note 1),
(b) inferior margin: 5 mm,
(c) medial margin: (see Note 2),
(d) lateral margin: 30 mm,
(e) deep margin: 2 mm,
(f) superfcial margin: 2 mm.
7. Microcalcifcation: present, tumoral.
Note: 1. Atypical ductal hyperplasia is
present only in the permanent section of Fro 1
2. The medial margin of the lumpectomy
specimen (slide 4) is close to ductal carcinoma in situ (2 mm) but this margin submitted for frozen diagnosis (Fro 3) is free of
tumor
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 5
|
Female/52 years old, pre-menopause. Screen detected mass lesion on left breast 11, 3 and 2 o’clock direction. Outside result of biopsy: Left breast 11 o’ clock: Intraductal proliferative lesion. Left breast 3 o’ clock: Adenosis and fbrocystic change. Left breast 2 o’clock: Fibrocystic change. No family history. No comorbidities.
|
Report 1: Magnifcation view shows three groups of amorphous microcalcifcations in left upper breast. Report 2: US shows ill-defned hypoechoic lesion with spotty vascular signal in left 11 o’clock direction, confrmed sclerosing adenosis with microcalcifcation. Report 3:US shows a few echogenic dots, suggesting microcalcifcations. Report 4: US shows ill-defned triangular shaped mass in
left 2 o’clock direction, confrmed DCIS.
|
Operation + Postoperative radiation therapy.
Operation: Excision
|
Ductal carcinoma in situ, pathological TN category (AJCC 2017): pTis
1. Size of tumor: 0.3 cm (pTis).
2. Nuclear grade: low.
3. Necrosis: absent.
4. Architectural pattern: cribriform.
5. Surgical margins:
(a) superior margin: 5 mm,
(b) inferior margin: 5 mm,
(c) medial margin: <1 mm from ductal carcinoma in situ (slide 12),
(d) lateral margin: 10 mm,
(e) deep margin: 2 mm,
(f) superfcial margin: 2 mm.
6. Microcalcifcation: present, tumoral/nontumoral.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 6
|
Female/42 years old, pre-menopause.
Screen detected microcalcifcation on left breast upper outer. No family history. s/p Lt mammotome biopsy in 2018 (result: benign).
|
Report 1: Left magnifcation view shows grouped amorphous microcalcifcations
|
Operation + Tamoxifen 20 mg/day for 5 years. Preoperative and (b) immediate postoperative appearance. (a) Gross pathology of left breast excision specimen (frst operation). (b–d) Gross pathology of breast wide excision specimen (black arrow) (second operation). Mass in 4 o’clock direction was excised and identifed as atypical ductal hyperplasia
|
Ductal carcinoma in situ, pathological TN category (AJCC 2017): pTis
1. Size of tumor: 0.3 cm (pTis).
2. Nuclear grade: low.
3. Necrosis: absent.
4. Architectural pattern: micropapillary/
cribriform.
5. Skin: no involvement of tumor.
6. Surgical margins: positive.
7. Microcalcifcation: present, tumoral/nontumoral. <Second operation>
No residual tumor with foreign body reaction.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 7
|
Female/48 years old, pre-menopause. Screen detected mass lesion on right breast 1 and 9 o’clock direction. Outside result of mammotome excision: Right breast 1 o’clock, DCIS. Right breast 9 o’clock, intraductal papilloma with atypical ductal hyperplasia. No family history. No comorbidities.
|
Report 1: Round hypoechoic mass (white arrow) with microlobulated margin and macrocalcifcations within the mass. Note associated ductal dilatation Report 2: Lymphoscintigraphy shows visualized sentinel lymph node in right axilla
|
Operation + Postoperative radiation therapy +
Tamoxifen 20 mg/day for 5 years.
Operation: Breast conserving surgery, sentinel lymph node
biopsy (a) Preoperative and (b) immediate postoperative appearance, Gross pathology of right breast (a) total (b) sliced lumpectomy specimen
|
Ductal carcinoma in situ
1. Post-mammotome excision status.
2. Size of tumor: 0.3 cm, residual. 3. Nuclear grade: low.
4. Necrosis: absent.
5. Architectural pattern: papillary/cribriform.
6. Skin: no involvement of tumor.
7. Surgical margins:
(a) superior margin: 10 mm,
(b) inferior margin: 10 mm,
(c) medial margin: 5 mm,
(d) lateral margin: 15 mm,
(e) deep margin: 2 mm,
(f) superfcial margin: 2 mm.
8. Lymph nodes: no metastasis in one axillary
lymph node (pN0(sn)) (sentinel LN: 0/1).
9. Microcalcifcation: present, tumoral/
non-tumoral.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 8
|
Female/41 years old, pre-menopause.
Detected bloody discharge in left nipple.
No family history.
No comorbidities.
ATM VUS (variant of uncertain).
|
Report 1: US shows irregular hypoechoic mass with microlobulated margin in right breast. Report 2: US shows oval hypoechoic mass with angular margin in left breast
|
First operation: Both excision, second operation: Wide excision (right side) (a) Preoperative and (b) immediate postoperative appearance. Gross pathology of right breast excision specimen (frst operation). (c, d) Gross pathology of right breast wide excision specimen (second operation). (e, f) Gross pathology of left breast excision specimen
|
Right.
<First operation>
Ductal carcinoma in situ, pathological TN category (AJCC 2017): pTis
1. Size of tumor: 0.3 cm (pTis).
2. Nuclear grade: low.
3. Necrosis: absent.
4. Architectural pattern: papillary.
5. Surgical margins: positive (slide 2).
6. Microcalcifcation: present, non-tumoral. <Second operation>
Atypical ductal hyperplasia involving intraductal papilloma.
1. Post-excision status.
Left.
Intraductal papilloma.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 9
|
Female/50 years old, pre-menopause. Screen detected microcalcifcation on inner portion of left. Outside result of biopsy: Ductal carcinoma in situ, left. Family history of breast cancer, maternal aunt. No comorbidities. BRCA 1 and 2 mutation: Not examination.
|
Report 1: Left mammography shows regional punctate or
amorphous microcalcifcations. Report 2: US shows an irregular hypoechoic mass with
angular margin. Report 3: Lymphoscintigraphy shows visualized sentinel
lymph nodes in the left axilla
|
Operation + Tamoxifen 20 mg/day for 5 years.
9.3.1 Operation
Nipple–areolar complex sparing mastectomy
with immediate implant reconstruction, sentinel
lymph node biopsy
|
Ductal carcinoma in situ, pathological TN category (AJCC 2017): pTisN0(sn)
1. Size of tumor: 1.2 cm (pTis).
2. Nuclear grade: high.
3. Necrosis: present.
4. Architectural pattern: solid/comedo.
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) deep margin: 2 mm,
(b) superfcial margin: 2 mm.
7. Lymph nodes: no metastasis in one axillary
lymph node (pN0(sn)) (sentinel LN: 0/1)).
8. Microcalcifcation: present, tumoral/nontumoral.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 10
|
Female/52 years old, pre-menopause. Screen detected microcalcifcation on mid inner portion left breast. Outside result of biopsy: Left 9:30 o’clock, ductal carcinoma in situ. Right 11 o’clock, fat epithelial atypia with microcalcifcation. No family history. BRCA 1 and 2 mutation: Not detected.
|
Report 1: Left magnifcation view shows grouped amorphous or fne pleomorphic microcalcifcations. Report 2: US shows an irregular hypoechoic mass with indistinct margin (white arrow) and microcalcifcations (black arrows) outside of the mass. Report 3: MRI shows
focal heterogeneous non-mass enhancement
|
Operation + Tamoxifen 20 mg/day for 5 years.
10.3.1 Operation
Nipple–areolar complex sparing mastectomy
with immediate implant reconstruction, sentinel
lymph node biopsy
|
Ductal carcinoma in situ, pathological TN category (AJCC 2017): pTisN0(sn)
1. Size of tumor: 2.0 cm (pTis).
2. Nuclear grade: low.
3. Necrosis: absent.
4. Architectural pattern: solid.
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) deep margin: 2 mm,
(b) superfcial margin: 2 mm. Lymph nodes: no metastasis in one axillary
lymph node (pN0(sn)) (sentinel LN: 0/1).
8. Microcalcifcation: present, tumoral/nontumoral.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 11
|
Female/44 years old, pre-menopause.
Screen detected mass lesion on right breast 8
o’clock direction.
Outside result of biopsy:
Right breast, 8 o’clock, (1) adenosis, (2) fbrocystic change, (3) fat epithelial atypia.
Family history, Father: Prostate cancer.
S/P Percutaneous closure of congenital ventricular septal detected.
|
Report 1: US shows an irregular hypoechoic mass with
microlobulated margin
|
First operation: Excision, second operation: Nipple–
areolar complex sparing mastectomy with immediate implant reconstruction. (a) Preoperative and (b) immediate postoperative appearance. ) Gross pathology of right breast excision specimen (frst operation). (c, d) Gross pathology of right breast
mastectomy specimen
|
<First operation>
1. Ductal Carcinoma In Situ, Pathological TN
Category (AJCC 2017): pTis
(a) Size of tumor: 0.3 cm (pTis).
(b) Nuclear grade: low.
(c) Necrosis: absent.
(d) Architectural pattern: micropapillary/
cribriform.
(e) Skin: no involvement of tumor.
(f) Surgical margins:
• superior margin: 10 mm,
• inferior margin: 2 mm from ductal carcinoma in situ (slide 3),
• medial margin: 10 mm,
• lateral margin: <1 mm from lobular
carcinoma in situ (slide 5),
• deep margin: 2 mm,
• superfcial margin: 2 mm.
(g) Microcalcifcation: present, tumoral/nontumoral.
2. Lobular Carcinoma In Situ
(a) Size of tumor: 0.2 cm.
(b) Nuclear grade: low.
(c) Necrosis: absent.
(d) Architectural pattern: solid.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 12
|
Female/49 years old, pre-menopause.
Screen detected mass lesion on right breast
4:30 and 9 o’clock direction.
Outside result of biopsy:
Left breast 4: 30 o’clock, ductal carcinoma in
situ.
Left breast 9 o’clock, intraductal papilloma.
Family history of breast cancer, sister at her
48 years old.
E. S. Lee et al.
77
No comorbidities.
BRCA 1 and 2 mutation: Not detected.
|
Report 1: US shows an irregular hypoechoic mass with
angular margin. Report 2: MRI shows
round homogeneous enhancing nodule at the corresponding area of the mass on US. Report 3: Lymphoscintigraphy shows visualized sentinel lymph node in left axilla
|
Operation + Tamoxifen 20 mg/day for 5 years.
12.3.1 Operation
(Robot-assisted) Nipple–areolar complex sparing mastectomy with immediate implant reconstruction, sentinel lymph node biopsy. (a, d) Preoperative, (b, e) immediate postoperative, and (c) late follow-up appearance. (a) Gross pathology of left breast mastectomy specimen. (b, c) The margins get marked and sliced with different colors on each direction
|
Ductal carcinoma in situ, pathological TN category (AJCC 2017): pTisN0(sn)
1. Size of tumor: 1.0 cm (pTis).
2. Nuclear grade: high.
3. Necrosis: present.
4. Architectural pattern: cribriform/solid/
comedo.
5. Surgical margins:
(a) deep margin: 10 mm,
(b) superfcial margin: 12 mm.
6. Lymph nodes: no metastasis in two axillary
lymph nodes (pN0(sn)) (sentinel LN: 0/1, left
intramammary LN: 0/1).
7. Microcalcifcation: present, non-tumoral.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 13
|
Female/61 years old, post-menopause. Screen detected mass lesion on left breast 10 o’clock direction. Outside result of biopsy: Left breast 10 o’clock, papillary neoplasm. Family history of breast cancer, sister. No comorbidities. BRCA 1 and 2: Not check.
|
Report 1: US shows an oval isoechoic mass with angular
margin
|
Operation + Tamoxifen 20 mg/day for 5 years.
13.3.1 Operation
First operation: Excision, second operation: Wide
excision.
|
<First operation>
Ductal carcinoma in situ, pathological TN category (AJCC 2017): pTis
1. Size of tumor: 0.5 cm (pTis).
2. Nuclear grade: low.
3. Necrosis: absent.
4. Architectural pattern: papillary/cribriform.
5. Surgical margins: positive for ductal carcinoma in situ.
6. Microcalcifcation: present, tumoral/nontumoral.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 14
|
Female/54 years old, pre-menopause.
Screen detected microcalcifcation on upper
inner portion of left.
No family history.
Taking medication for bladder dysfunction.
|
Report 1: Left magnifcation view shows grouped fne
pleomorphic microcalcifcations
|
Left magnifcation view shows grouped fne
pleomorphic microcalcifcations
|
<First operation> Ductal carcinoma in situ, pathological TN category (AJCC 2017): pTis 1. Size of tumor: 0.3 cm (pTis). 2. Nuclear grade: low. 3. Necrosis: absent. 4. Architectural pattern: papillary. 5. Surgical margins: (a) superior margin: 5 mm, (b) inferior margin: 7 mm, (c) medial margin: 20 mm, (d) lateral margin: positive for ductal carcinoma in situ (slide 5), (e) deep margin: positive for ductal carcinoma in situ (slide 5), (f) superfcial margin: 5 mm. 6. Microcalcifcation: present, tumoral. Second operation>
No residual tumor with foreign body reaction. Note: Atypical ductal hyperplasia is present only in the frozen section of Fro 1.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 15
|
Female/52 years old, pre-menopause. Screen detected mass lesion on right breast 1 o’clock direction. No family history. No comorbidities.
|
Report 1: Right magnifcation view shows grouped fne
linear microcalcifcations. Report 2: US shows indistinct irregular isoechoic mass at
the corresponding area of the microcalcifcations on
mammography Report 3: MRI shows
focal clumped non-mass
enhancement at the
corresponding area of
the microcalcifcations
on mammography. Report 4: Lymphoscintigraphy shows visualized sentinel
lymph nodes in right axilla
|
Operation + Postoperative radiation therapy +
Tamoxifen 20 mg/day for 5 years. Breast conserving surgery, sentinel lymph node
biopsy. US shows indistinct irregular isoechoic mass at
the corresponding area of the microcalcifcations on
mammography. MRI shows
focal clumped non-mass
enhancement at the
corresponding area of
the microcalcifcations
on mammography
|
Ductal carcinoma in situ, pathological TN category (AJCC 2017): pTisN0(sn)
1. Size of tumor: 4.0 cm (pTis).
2. Nuclear grade: high. (e) deep margin: 1 mm from ductal carcinoma in situ (slide 1),
(f) superfcial margin: 15 mm.
7. Lymph nodes: no metastasis in two axillary
lymph nodes (pN0(sn)) (sentinel LN: 0/2).
8. Arteriovenous invasion: absent.
9. Lymphovascular invasion: absent.
10. Tumor border: infltrative.
11. Microcalcifcation: present, tumoral/nontumoral.
3. Necrosis: present.
4. Architectural pattern: micropapillary/cribriform/solid/comedo.
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: 20 mm,
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 16
|
Female/75 years old, post-menopause.
Screen detected microcalcifcation on left
breast 12 o’clock direction.
Outside result of biopsy: Left breast 12 o’clock,
fbrosis.
Family history of breast cancer, mother.
Hypertension.
BRCA 1 and 2: Not examination.
|
Report 1: Left magnifcation view shows regional fne
pleomorphic or fne linear microcalcifcations in left
breast and some microcalcifcations in the nipple–areolar
complex. Report 2 : US shows an irregular hypoechoic mass with
associated microcalcifcations. Report 3: MRI shows segmental heterogeneous non-mass
enhancement at the corresponding area of the microcalcifcations on mammography. Report 4: Asymmetric enhancement and thickening were shown in left nipple–areolar complex
|
Skin sparing mastectomy with immediate implant
reconstruction, sentinel lymph node biopsy (a) Preoperative, (b) immediate postoperative appearance. (a) Gross pathology of left breast mastectomy specimen. (b, c) The margins get marked and sliced with different colors on each direction
|
Ductal carcinoma in situ, pathological TN category (AJCC 2017): pTis(Paget)N0 (sn)
1. Size of tumor: 1.5 cm (pTis(Paget)).
2. Nuclear grade: high.
3. Necrosis: present. 4. Architectural pattern: cribriform/solid/
comedo.
5. Nipple: Paget disease with involvement of
lactiferous duct.
6. Surgical margins:
(a) deep margin: 10 mm,
(b) superfcial margin: 10 mm.
7. Lymph nodes: no metastasis in one axillary
lymph node (pN0(sn)) (sentinel LN: 0/1).
8. Microcalcifcation: present, tumoral/nontumoral.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 17
|
Female/40 years old, pre-menopause.
Screen detected nodule and microcalcifcation
on upper outer portion of right breast.
No family history.
No comorbidities.
|
Report 1: Right magnifcation view shows multifocal
grouped fne pleomorphic microcalcifcations in right
upper outer quadrant. Report 2: US shows (a) an indistinct irregular hypoechoic mass with associated microcalcifcations at the 11 o’clock
location and (b) an indistinct irregular isoechoic mass at the 10 o’clock location of right breast. Report 3: MRI shows (a) an irregular enhancing mass with irregular margin at the 11 o’clock location and (b) focal homogeneous non-mass enhancement at the 10 o’clock location of right breast. Report 3: Lymphoscintigraphy shows visualized sentinel lymph nodes in right axilla
|
Operation + Tamoxifen 20 mg/day for 5 years. 17.3.1 Operation
Nipple–areolar complex sparing mastectomy
with immediate implant reconstruction, sentinel
lymph node biopsy. (a) Preoperative, (b) immediate postoperative appearance. b Gross pathology (a: total, b, c: sliced) of right breast mastectomy specimen
|
Ductal carcinoma in situ, pathological TN category (AJCC 2017): pTis(Paget)N0(sn)
1. Size of tumor: 1.5 cm (pTis(Paget)).
2. Nuclear grade: high.
3. Necrosis: present.
4. Architectural pattern: cribriform/solid/
comedo.
5. Nipple: Paget disease with involvement of
lactiferous duct.
6. Surgical margins:
(a) deep margin: 10 mm,
(b) superfcial margin: 10 mm.
7. Lymph nodes: no metastasis in one axillary
lymph node (pN0(sn)) (sentinel LN: 0/1).
8. Microcalcifcation: present, tumoral/nontumoral.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 18
|
Female/64 years old, post-menopause. Screen detected mass lesion on right breast 8 o’clock direction. Outside result of biopsy: Right breast 8 o’clock, atypical intraductal papillary neoplasm, favor ductal carcinoma in situ. No family history. Hypertension, diabetes mellitus.
|
Report 1: US shows a microlobulated oval hypoechoic
mass. Report 2: MRI shows an irregular enhancing mass with
irregular margin at the corresponding area of the mass on
US
|
Operation + Postoperative radiation therapy.
Operation
Breast conserving surgery. (a) Preoperative, (b) immediate postoperative appearance. (a, b) Gross pathology of right breast lumpectomy specimen. (b) The margins get marked and sliced with different colors on each direction
|
Ductal carcinoma in situ, pathological TN category (AJCC 2017): pTis
1. Size of tumor: 1.1 cm (pTis).
2. Nuclear grade: low.
3. Necrosis: present.
4. Architectural pattern: micropapillary/cribriform/solid.
5. Surgical margins:
(a) superior margin: 20 mm,
(b) inferior margin: (see Note 1),
(c) medial margin: 5 mm,
(d) lateral margin: (see Note 2),
(e) deep margin: 2 mm,
(f) superfcial margin: 5 mm.
6. Microcalcifcation: present, non-tumoral.
Note: 1. The inferior margin of the lumpectomy specimen (slide 5) is close to ductal carcinoma in situ (2 mm) but this margin submitted
for frozen diagnosis (Fro 3) is free of tumor.
2. The lateral margin of the lumpectomy specimen (slide 6) is close to ductal carcinoma in situ
(2 mm) but this margin submitted for frozen
diagnosis (Fro 7) is free of tumor.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 19
|
Female/48 years old, pre-menopause. Screen detected diffuse non-mass lesions on upper, central, and lower portion of left breast. Screen detected microcalcifcation on inner subareolar of right breast. Outside result of excisional biopsy: bilateral ductal carcinoma in situ. No family history. S/P L-spine operation. BRCA 1 and 2 mutation: Not detected.
|
Report 1: Right magnifcation view shows regional amorphous or fne pleomorphic microcalcifcations in right inner breast. Report 2: US shows (a) an indistinct oval heterogeneous echoic mass in left upper outer quadrant and (b) an oval
hypoechoic mass, suggesting stereotactic biopsy-related hematoma at the 1 o’clock direction of the right breast. Report 3: MRI shows (a) segmental clustered ring non-mass enhancement in left upper outer quadrant and (b) stereotactic biopsy-related hematoma with thin marginal enhancement at the 1 o’clock direction of the right breast. Report 4: Lymphoscintigraphy shows visualized sentinel
lymph nodes in both axilla.
|
Operation
Both nipple–areolar complex sparing mastectomy with immediate implant reconstruction,
sentinel lymph node biopsy. (a, d) Preoperative, (b, e) immediate postoperative, and (c) late follow-up appearance. (a, b) Gross pathology of right mastectomy specimen. (c–e) Gross pathology of left mastectomy specimen
|
Right Breast.
Ductal carcinoma in situ
1. Post-mammotome status.
2. Size of tumor: 0.3 cm, residual.
3. Nuclear grade: high.
4. Necrosis: absent.
5. Architectural pattern: cribriform/solid.
6. Skin and nipple: no involvement of tumor.
7. Surgical margins:
(a) deep margin: 5 mm,
(b) superfcial margin: <1 mm from ductal
carcinoma in situ (slide 11).
8. Lymph nodes: no metastasis in two axillary
lymph nodes (pN0(sn)) (sentinel LN: 0/2).
9. Microcalcifcation: present, tumoral.
Left Breast.
Ductal carcinoma in situ, pathological TN category (AJCC 2017): pTisN0(sn)
1. Size of tumor: 6.0 cm (pTis).
2. Nuclear grade: low.
3. Necrosis: absent.
4. Architectural pattern: micropapillary/cribriform/solid.
5. Skin and nipple: no involvement of tumor.
6. Surgical margins: (see note).
(a) deep margin: 1 mm from ductal carcinoma in situ (slide 4),
(b) superfcial margin: <1 mm from ductal
carcinoma in situ (slide 8).
7. Lymph nodes: no metastasis in three axillary
lymph nodes (pN0(sn)) (sentinel LN: 0/3).
8. Microcalcifcation: present, tumoral.
Note: 1. Atypical ductal hyperplasia is present only in the permanent section of Fro 3.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 21
|
Female/42 years old, pre-menopause.
Screen detected mass lesion on right breast 7
o’clock direction and left 1 o’clock direction.
Outside result of biopsy: both papillary
neoplasm.
No family history.
s/p Right breast mammotome biopsy (result:
fbroadenoma).
|
Report 1: Ultrasonogram shows a round circumscribed hypoechoic mass with internal vascularity in the left 1 o’clock direction. Report 2: Ultrasonography shows an irregular microlobulated mass without vascularity in the right 7 o’clock direction. Report 3: Ultrasonogram shows an irregular hypoechoic mass with minimal vascularity in left 2 o’clock direction.
|
2021-07-07 excision, both.
|
Diagnosis
• Breast, left, excision:
– Intraductal papilloma.
– Sclerosing adenosis with microcalcifcation.
Diagnosis
• Breast, right, excision:
– Intraductal papilloma.
– Sclerosing adenosis with microcalcifcation.
|
Benign and Proliferative Case Series
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 22
|
Female/50 years old, peri-menopause. Screen detected microcalcifcation on upper outer portion of right breast. No family history. Hypertension (taking medication), carotid atherosclerosis.
|
Report 1: Serial magnifcation views (upper column—CC views, lower column—MLO views) revealed an increased number of regional coarse heterogeneous microcalcifcations and newly developed amorphous microcalcifcations
|
2021-07-07 excision, Rt. Diagnosis
• Breast, right, excision:
– Atypical ductal hyperplasia with
microcalcifcation.
| null |
Benign and Proliferative Case Series
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 23
|
Female/47 years old, pre-menopause. Screen detected mass lesion on left breast 1 o’clock direction. Outside result of biopsy: atypical papilloma. No family history. No comorbidities.
|
Report 1: Mammogram shows a round circumscribed iso-dense mass (black arrow) in the right upper outer and questionable asymmetry in left outer breast. Report 2: Ultrasonogram shows an oval shaped, angular margin hypoechoic mass without vascularity in the left 1 o’clock
direction. Report 3 Ultrasonogram shows a round circumscribed
isoechoic mass in the right upper outer breast, which seems
to be corresponding to the lesion detected in mammogram
|
2021-07-13 Excision, Lt
|
Diagnosis
• Breast, left, excision:
– Atypical ductal hyperplasia involving intraductal papilloma with microcalcifcation.
|
Benign and Proliferative Case Series
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 24
|
Female/44 years old, pre-menopause. Screen detected mass lesion in both breasts. No family history. s/p total thyroidectomy (thyroid cancer), s/p right breast excision (intraductal papilloma).
|
Report 1: Mammogram shows no suspicious abnormal fnding with postoperative deformity at right upper outer portion. Report 2: US shows a 0.5 cm angular margin hypoechoic mass with adjacent increased vascularity in the left subareolar
area. Report 3: US shows a 0.7 cm angular margin hypoechoic mass in the right subareolar area.
|
2021-07-14 excision, both.
|
Diagnosis
• Breast, right, excision:
– Intraductal papilloma.
Post-excision status.
Usual ductal hyperplasia.
Apocrine metaplasia.
– Sclerosing adenosis with microcalcifcation.
Diagnosis
• Breast, left, excision:
– Atypical ductal hyperplasia, focal.
– Intraductal papilloma.
|
Benign and Proliferative Case Series
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 25
|
Female/46 years old, pre-menopause. Screen detected mass lesion on left breast 3 o’clock direction. Outside result of biopsy: Intraductal papilloma. No family history. No comorbidities.
|
Report 1: US shows a 0.5 cm sized oval circumscribed hypoechoic mass with ductal dilatation and minimal vascularity. US shows a 0.5 cm sized, not parallel oriented, lobulated hypoechoic mass with minimal vascularity.
|
2021-07-27 excision, Lt.
25.3.1 Diagnosis
• Breast, left, excision:
– Atypical ductal hyperplasia involving
intraductal papilloma.
– Tubular adenoma.
| null |
Benign and Proliferative Case Series
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 26
|
Female/72 years old, post-menopause. Screen detected nodular asymmetry on outer central portion of right breast. No family history. s/p Total thyroidectomy (thyroid cancer).
|
Report 1: Mammogram shows an oval circumscribed iso-dense mass in the right outer central breast. Report 2: Ultrasonography shows a round microlobulated hypoechoic mass without vascularity in the right 9 o’clock direction
|
2021-06-16 excision, Rt.
|
Diagnosis Breast, right, excision:
– Intraductal papilloma with usual ductal
hyperplasia.
|
Benign and Proliferative Case Series
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 27
|
Female/41 years old, pre-menopause. Screen detected mass lesion on right breast 4 o’clock direction. Outside result of biopsy: Papillary neoplasm. No family history. No comorbidities.
|
Report 1: The US shows a 0.7 cm irregular microlobulated hypoechoic mass with internal vascularity in the right breast
|
2021-06-07 excision, Rt.
|
Diagnosis
• Breast, right, excision:
– Intraductal papilloma with usual ductal
hyperplasia.
|
Benign and Proliferative Case Series
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 20
|
Female/37 years old, pre-menopause.
Screen detected mass lesion on right breast
9 o’clock direction.
Outside result of biopsy: Right 9 o’clock, ductal carcinoma in situ.
No family history. Thyroid papillary carcinoma: follow-up at
outside hospital.
BRCA 1 and 2: not detected, POLE VUS
(variant of uncertain).
|
Report 1: US shows irregular hypoechoic masses with
angular margin. Report 2MRI shows linear heterogeneous non-mass
enhancement. Report 3: Lymphoscintigraphy shows visualized sentinel
lymph node in right axilla.
|
First Operation + Tamoxifen 20 mg/day for
4 months. Second Operation. First operation: Breast conserving surgery, sentinel lymph node biopsy (left).
Second operation: Skin sparing mastectomy
with latissimus dorsi fap reconstruction (left).
Third operation: Excision (right).
Fourth operation: Wide excision (right). (a) Preoperative, (b) immediate postoperative appearance. (a, b) Gross pathology of left partial mastectomy
specimen (frst operation). (c, d) Gross pathology of left
mastectomy specimen after breast conserving surgery
(second operation). (e, f) Gross pathology of right breast
excision specimen (third operation)
|
Left Breast.
<First operation>
Invasive ductal Carcinoma, pathologic stage
(AJCC 2010): pT1aN0(sn)
1. Size of invasive component: 0.5 cm (pT1a).
2. Size of intraductal component: 4.0 cm.
3. Histologic grade: 2/3 (tubule formation: 3/3,
nuclear pleomorphism: 2/3, mitotic count:
1/3, 5/10HPF).
4. Intraductal component: present, intratumoral/
extratumoral (90%) (nuclear grade: low,
necrosis: absent, architectural pattern: solid
and papillary, extensive intraductal component: present).
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) superior margin: 3 mm from atypical
ductal hyperplasia (slide 1),
(b) inferior margin: (see Note 1),
(c) medial margin: (see Note 2),
(d) lateral margin: 40 mm,
(e) deep margin: positive for ductal carcinoma in situ (slide 9),
(f) superfcial margin: 3 mm.
7. Lymph nodes: no metastasis in seven axillary
lymph nodes (pN0(sn)) (sentinel LN: 0/7,
axillary LN: 0/0).
8. Vascular invasion: absent.
9. Lymphatic invasion: absent.
10. Tumor border: pushing.
11. Microcalcifcation: present, non-tumoral.
Note: 1. Atypical ductal hyperplasia is
present only in the permanent section of Fro
3. The inferior margin of the lumpectomy
specimen (slides 2, 5, 7, 9, and 11) is positive
for ductal carcinoma in site 2. The medial
margin of the lumpectomy specimen (slide
3) is close to ductal carcinoma in situ (1 mm)
but this margin submitted for frozen diagnosis (Fro 4) is free of tumor. <Second operation> Atypical ductal hyperplasia, focal.
(a) Post-lumpectomy status.
2. No residual tumor with foreign body reaction.
Right Breast.
<Third operation>
Ductal carcinoma in situ, pathological TN category (AJCC 2017): pTis
1. Size of tumor: 0.5 cm (pTis).
2. Nuclear grade: low.
3. Necrosis: absent.
4. Architectural pattern: micropapillary/
cribriform.
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) superior margin: 10 mm,
(b) inferior margin: 10 mm,
(c) medial margin: <1 mm from ductal carcinoma in situ (slide 6),
(d) lateral margin: 5 mm,
(e) deep margin: 2 mm,
(f) superfcial margin: 2 mm.
7. Microcalcifcation: present, tumoral/nontumoral. <Fourth operation>
No residual tumor with foreign body reaction.
1. Post-excision status.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 21
|
Female/37 years old, pre-menopause.
Screen detected mass lesion on right breast
9 o’clock direction.
Outside result of biopsy: Right 9 o’clock, ductal carcinoma in situ.
No family history.
|
Report 1: US shows irregular hypoechoic masses with
angular margin. Report 2: MRI shows linear heterogeneous non-mass
enhancement. Report 3: Lymphoscintigraphy shows visualized sentinel
lymph node in right axilla.
|
Operation
Breast conserving surgery, sentinel lymph node
biopsy. (a) Preoperative, (b) immediate postoperative appearance. (a, b) Gross pathology of right breast lumpectomy specimen. (b) The margins get marked and sliced with different colors on each direction
|
Ductal carcinoma in situ, pathological TN category (AJCC 2017): pTisN0 (sn) 1. Size of tumor: 3.0 cm (pTis). 2. Nuclear grade: low. 3. Necrosis: absent. 4. Architectural pattern: papillary/micropapillary/cribriform/solid. 5. Skin: no involvement of tumor. 6. Surgical margins: (a) superior margin: 20 mm, (b) inferior margin: (see Note 1), (c) medial margin: (see Note 2), (d) lateral margin: 20 mm, (e) deep margin: <1 mm from ductal carcinoma in situ (slides 2 and 6), (f) superfcial margin: <1 mm from ductal carcinoma in situ (slide 3). 7. Lymph nodes: no metastasis in two axillary lymph nodes (pN0(sn)) (sentinel LN: 0/2). 8. Microcalcifcation: present, tumoral/nontumoral. Note: 1. The inferior margin of the lumpectomy specimen (slide 9) is positive for ductal carcinoma in situ but this margin submitted for frozen diagnosis (Fro 2) is free of tumor. 2. The medial margin of the lumpectomy specimen (slide 4) is close to ductal carcinoma in situ (2 mm) and atypical ductal hyperplasia is present only in the permanent section of Fro 3.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 22
|
Female/57 years old, post-menopause.
Visible detected redness on Left nipple.
Outside result of biopsy: Paget’s disease.
Family history of breast cancer, sister at her
45 years old.
No comorbidities.
BRCA 1 and 2 mutation: Not detected.
|
Report 1: US shows mildly enlarged left nipple with increased vascularity. Report 2: MRI shows
asymmetric strong
enhancement and
thickening of left
nipple–areolar complex. Report 3: Lymphoscintigraphy shows visualized sentinel
lymph node in left axilla.
|
Skin sparing mastectomy with immediate implant
reconstruction, sentinel lymph node biopsy. (a, c) Preoperative and (b, d) immediate postoperative appearance, (a) Gross pathology of left breast mastectomy specimen. (b, c) The margins get marked and sliced with different colors on each direction
|
Ductal carcinoma in situ, pathological TN category (AJCC 2017): pTis(Paget)N0(sn) 1. Size of tumor: 0.5 cm (pTis(Paget)). 2. Nuclear grade: high. 3. Necrosis: absent. 4. Architectural pattern: micropapillary. 5. Nipple: Paget disease with involvement of lactiferous duct. 6. Surgical margins: deep margin: 20 mm. 7. Lymph nodes: no metastasis in two axillary lymph nodes (pN0(sn)) (sentinel LN: 0/2). 8. Microcalcifcation: present, non-tumoral.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 23
|
Female/44 years old, pre-menopause. Screen detected microcalcifcation on upper outer portion of right breast. No family history. No comorbidities.
|
Report 1: Right magnifcation view shows segmental
round or amorphous microcalcifcations. Report 2: US shows an irregular hypoechoic mass with
angular margin at the corresponding area of the microcalcifcations on mammography.
|
Excision: (a) Preoperative and (b) immediate postoperative appearance. (c) Gross pathology of right breast excision specimen. (d) The margins get marked and sliced with different
colors on each direction
|
Lobular carcinoma in situ, pathological TN
category (AJCC 2017): pTis
1. Size of tumor: 0.5 cm (pTis).
2. Nuclear grade: low.
3. Necrosis: absent.
4. Architectural pattern: solid.
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) superior margin: <1 mm (slide 3),
(b) inferior margin: 20 mm,
(c) medial margin: 5 mm,
(d) lateral margin: 5 mm,
(e) deep margin: 10 mm,
(f) superfcial margin: 1 mm (slide 1).
7. Microcalcifcation: present, tumoral.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 24
|
Female/42 years old, pre-menopause. Screen detected mass lesion on left breast 2 o’clock direction. Outside result of biopsy: Left breast 2 o’clock, fbroadenoma, favor lobular carcinoma in situ. No family history. S/P Retinal detachment operation 15 years ago.
|
Report 1: Asymmetry was only seen on one view, the mediolateral oblique view. Report 2: US shows a microlobulated oval hypoechoic mass in left upper outer quadrant. Report 3: MRI shows a circumscribed homogeneously enhancing mass at the 2 o’clock location of the left breast
|
Operation
Breast conserving surgery (a) Preoperative and (b) immediate postoperative appearance. (c) Gross pathology of left breast lumpectomy specimen. (d, e) The margins get marked and sliced with different colors on each direction
|
Lobular carcinoma in situ, pathological TN
category (AJCC 2017): pTis
1. Size of tumor: 1.3 cm (pTis).
2. Nuclear grade: low.
3. Necrosis: absent.
4. Architectural pattern: solid.
5. Surgical margins:
(a) superior margin: 11 mm,
(b) inferior margin: 3 mm,
(c) medial margin: 15 mm,
(d) lateral margin: 15 mm,
(e) deep margin: 2 mm,
(f) superfcial margin: 4 mm.
6. Microcalcifcation: absent.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 25
|
Female/52 years old, pre-menopause.
Screen detected mass lesion on left breast
1 o’clock direction.
Outside result of biopsy: Left breast 1 o’clock,
ductal carcinoma in situ, r/o invasion.
No family history.
S/P Robotic cholecystectomy (GB stone).
BRCA 1 and 2: Not examination.
|
Report 1: MRI of a woman with known left breast cancer.
MRI shows an irregular enhancing mass in the left breast
(arrow). No signs of malignancy are present in the right
breast. Right mammography and US were also negative
(not shown). Left BCS and right reduction mammoplasty
were performed. Pathology confrmed LCIS in the right
breast. Report 2: Lymphoscintigraphy shows visualized sentinel
lymph nodes in left axilla.
|
Operation + Postoperative radiation therapy
(Left) + Tamoxifen 20 mg/day for 5 years.
Operation
Both breast conserving surgery, sentinel lymph
node biopsy (left). (a, c) Preoperative and (b, d) immediate postoperative appearance. (e, f) Gross pathology of right breast partial mastectomy specimen. (g, h) Gross pathology of left breast partial mastectomy specimen
|
Right Breast
Lobular carcinoma in situ
1. Size of tumor: 0.3 cm.
2. Nuclear grade: low.
3. Necrosis: absent.
4. Architectural pattern: solid.
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) superior margin: 2 mm,
(b) inferior margin: 5 mm,
(c) medial margin: 2 mm,
(d) lateral margin: 2 mm,
(e) deep margin: 2 mm,
(f) superfcial margin: 2 mm.
7. Microcalcifcation: present, tumoral/nontumoral.
Left.
Invasive ductal carcinoma, pathological TN
category (AJCC 2017): pT1cN0(sn)
1. Size of invasive component: 1.5 cm (pT1c).
2. Size of intraductal component: 5.0 cm. . Histologic grade: 3/3 (tubule formation: 3/3,
nuclear pleomorphism: 3/3, mitotic count:
3/3, 4/HPF).
4. Intraductal component: present, intratumoral/extratumoral (70%) (nuclear grade:
high, necrosis: present, architectural pattern:
cribriform/solid/comedo, extensive intraductal component: present).
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) superior margin: 5 mm,
(b) inferior margin: 10 mm,
(c) medial margin: 10 mm,
(d) lateral margin: 10 mm,
(e) deep margin: 2 mm,
(f) superfcial margin: <1 mm from ductal
carcinoma in situ (slide 2).
7. Lymph nodes: no metastasis in one axillary
lymph node (pN0(sn)) (sentinel LN: 0/1).
8. Arteriovenous invasion: absent.
9. Lymphovascular invasion: present,
intratumoral.
10. Tumor border: infltrative.
11. Microcalcifcation: present, tumoral/nontumoral.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 26
|
Female/48 years old, pre-menopause. Screen detected mass and microcalcifcation on upper portion of right breast. No family history. No comorbidities.
|
Report 1: Breast US shows an oval hypoechoic mass with
partly microlobulated margins. Report 2: Magnifcation view revealed grouped amorphous microcalcifcations at the corresponding area of the
mass. Report 3: MRI demonstrates an oval enhancing mass.
|
Operation + Tamoxifen 20 mg/day for 5 years. 26.3.1 Operation Excision (a) Preoperative and (b) immediate postoperative appearance. (a) Gross pathology of right breast excision specimen. (b) The margins get marked and sliced with different colors on each direction
|
Lobular carcinoma in situ, pathological TN
category (AJCC 2017): pTis
1. Size of tumor: up to 0.6 cm (pTis).
2. Nuclear grade: low. 3. Necrosis: absent.
4. Architectural pattern: solid.
5. Surgical margins:
(a) superior margin: 5 mm,
(b) inferior margin: 5 mm,
(c) medial margin: 10 mm,
(d) lateral margin: 20 mm,
(e) deep margin: 5 mm,
(f) superfcial margin: <1 mm from lobular
carcinoma in situ (slide 2).
6. Microcalcifcation: absent.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 27
|
Female/50 years old, pre-menopause.
Screen detected mass lesion on left breast
2 o’clock direction.
Outside result of mammotome biopsy:
Lobular carcinoma in situ.
No family history.
|
Report 1: Mammography shows an obscured mass. Report 2: US reveals an irregular hypoechoic mass. US-guided VAB = LCIS. Report 3: MRI
demonstrates an
enhancing residual mass
in the left breast
|
Operation + Tamoxifen 20 mg/day for 5 years. Operation
Breast conserving surgery. (a) Preoperative and (b) immediate postoperative appearance. (c) Gross pathology of left breast partial mastectomy specimen. (d) The margins get marked and sliced with
different colors on each direction
|
Lobular carcinoma in situ, pathological TN
category (AJCC 2017): pTis
1. Size of tumor: 1.5 cm(pTis).
2. Nuclear grade: low. 3. Necrosis: absent.
4. Architectural pattern: solid.
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) superior margin: 50 mm,
(b) inferior margin: (see Note 1),
(c) medial margin: 5 mm,
(d) lateral margin: 10 mm,
(e) deep margin: positive for lobular carcinoma in situ (slide 1),
(f) superfcial margin: 5 mm.
7. Microcalcifcation: absent.
Note: 1. The inferior margin of the lumpectomy specimen (slide 4) is close to lobular
carcinoma in situ (<1 mm) but this margin
submitted for frozen diagnosis (Fro 2) is free
of tumor.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 28
|
Female/50 years old, pre-menopause.
Screen detected microcalcifcation on upper
outer portion of right breast.
Outside result of stereotactic excisional
biopsy: Lobular carcinoma in situ.
No family history.
No comorbidities.
|
Report 1: Magnifcation view shows regional amorphous
microcalcifcations. Stereotactic VAB = LCIS. Report 2: Biopsy clip
(white arrow) was inserted after stereotactic VAB. On MRI, note an
artifact related to the VAB and inserted clip. Report 3: MRI demonstrates mild BPE without defnite abnormality
|
Courses of Treatment
Operation + Tamoxifen 20 mg/day for 5 years. Operation
Breast conserving surgery. (a) Preoperative and (b) immediate postoperative appearance. (a) Gross pathology of right breast partial mastectomy specimen. (b) The margins get marked and sliced with
different colors on each direction.
|
Lobular carcinoma in situ, pathological TN
category (AJCC 2017): pTis
1. Size of tumor: 0.7 cm (pTis).
2. Nuclear grade: low.
3. Necrosis: absent.
4. Architectural pattern: solid.
5. Skin: No involvement of tumor.
6. Surgical margins:
(a) superior margin: (see Note),
(b) inferior margin: 25 mm,
(c) medial margin: 10 mm,
(d) lateral margin: 20 mm,
(e) deep margin: 5 mm,
(f) superfcial margin: 2 mm.
7. Microcalcifcation: absent.
Note: 1. The superior margin of the
lumpectomy specimen (slide 1) is close to
lobular carcinoma in situ (1 mm) but this margin submitted for frozen diagnosis (Fro 1) is
free of tumor.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 29
|
Female/50 years old, post-menopause. Screen detected mass lesion on left breast 2 o’clock direction. Outside result of biopsy: Left breast 2 o’clock, invasive ductal carcinoma. No family history. No comorbidities. BRCA 1 and 2 mutation: Not detected, MSH6 VUS (variant of uncertain).
|
Report 1: MRI of a woman with known left breast cancer. MRI shows an enhancing malignant mass in the left breast (black arrow). Report 2: An enhancing focus was
seen in the right breast. On right breast US, a small irregular mass
(white arrow) and another isoechoic lesion with indistinct
margins (black arrow) were noted at the corresponding
area of the enhancing focus on MRI. Excisional biopsy = LCIS. Report 3 Lymphoscintigraphy shows visualized sentinel lymph node in left axilla
|
Operation + Adjuvant chemotherapy #4 cycles
(Doxorubicin and Cyclophosphamide) + Postope
rative radiation therapy (both) + Letrozole
2.5 mg/day for 5 years. Operation Breast conserving surgery (left), sentinel lymph
node biopsy (left), excision (right). (a) Preoperative and (b) immediate postoperative appearance. Gross pathology of right breast excision specimen. (c, d) Gross pathology of left breast partial mastectomy specimen
|
Right Breast.
Lobular carcinoma in situ, pathological TN
category (AJCC 2017): pTis
1. Size of tumor: 2.5 cm (pTis).
2. Nuclear grade: low.
3. Necrosis: absent.
4. Architectural pattern: solid.
5. Surgical margins:
(a) superior margin: (see Note 1),
(b) inferior margin: (see Note 2),
(c) medial margin: 5 mm,
(d) lateral margin: positive for lobular carcinoma in situ (Fro 4) (see Note 3),
(e) deep margin: <1 mm from lobular carcinoma in situ (slides 4 and 5),
(f) superfcial margin: 3 mm.
6. Microcalcifcation: present, tumoral/
non-tumoral.
Note: 1. The superior margin of the
lumpectomy specimen (slide 2) is close to
lobular carcinoma in situ (3 mm) but this margin submitted for frozen diagnosis (Fro 1) is
free of tumor.
2. The inferior margin of the lumpectomy
specimen (slide 4) is close to lobular carcinoma in situ (<1 mm) but this margin
submitted for frozen diagnosis (Fro 2) is
free of tumor.
3. Lobular carcinoma in situ is present only in
the permanent section of Fro 4. Left Breast.
Invasive ductal carcinoma, pathological TN
category (AJCC 2017): pT1cN0(sn)
1. Size of tumor: 1.5 cm (pT1c).
2. Histologic grade: 2/3 (tubule formation: 3/3,
nuclear pleomorphism: 2/3, mitotic count:
2/3, 11/10HPF).
3. Intraductal component: present, intratumoral
(20%) (nuclear grade: low, necrosis: present,
architectural pattern: micropapillary/cribriform/solid/comedo, extensive intraductal
component: absent).
4. Surgical margins:
(a) superior margin: 20 mm,
(b) inferior margin: 15 mm,
(c) medial margin: 10 mm,
(d) lateral margin: 10 mm,
(e) deep margin: 8 mm,
(f) superfcial margin: 10 mm.
5. Lymph nodes: no metastasis in two axillary
lymph nodes (pN0(sn)) (sentinel LN: 0/2).
6. Arteriovenous invasion: absent.
7. Lymphovascular invasion: present,
intratumoral.
8. Tumor border: infltrative.
9. Microcalcifcation: present, non-tumoral.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 30
|
Female/60 years old, post-menopause. Screen detected mass and microcalcifcation on left breast 10 o’clock direction. Outside result of biopsy: Ductal carcinoma in situ. No family history. Claustrophobia, hypertension.
|
Report 1: Magnifcation view shows pleomorphic calcifcations with (white arrow) and without (black arrow) mass formation. Report 2: US
demonstrates
hypoechoic lesions with
echogenic calcifcations. Report 3: MRI reveals segmental clustered ring non-mass
enhancement. Report 4: Lymphoscintigraphy shows visualized sentinel
lymph node in left axilla.
|
Operation + Postoperative Radiation therapy.
30.3.1 Operation
Nipple–areolar complex sparing mastectomy
with immediate implant reconstruction, sentinel
lymph node biopsy. (a, d) immediate postoperative appearance, (c) tumor location, (b) after adjuvant radiotherapy. (a) Gross pathology of left breast mastectomy specimen. (b, c) The margins get marked and sliced with different colors on each direction
|
Ductal carcinoma in situ, pathological TN category (AJCC 2017): pTisN0(sn)
1. Size of tumor: 2.0 cm (pTis).
2. Nuclear grade: high.
3. Necrosis: present.
4. Architectural pattern: micropapillary/cribriform/solid/comedo.
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) nipple margin: positive for ductal carcinoma in situ (Fro 4),
(b) subareolar margin: positive for ductal carcinoma in situ (Fro 1),
(c) deep margin: 2 mm,
(d) superfcial margin: 2 mm.
7. Lymph nodes: no metastasis in one axillary
lymph node (pN0(sn)) (sentinel LN: 0/1).
8. Microcalcifcation: present, tumoral/nontumoral.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 31
|
Female/31 years old, pre-menopause. Screen detected calcifcation on left breast 11 o’clock direction. Outside result of mammotome biopsy: Ductal carcinoma in situ. No family history. No comorbidities. BRCA 1 and 2: Not detected.
|
Report 1: Magnifcation view shows multiple groups of
amorphous microcalcifcations. Stereotactic VAB = DCIS. Report 2: MRI demonstrates segmental clustered ring
non-mass enhancement (arrow). Note the biopsy-related
hematoma (*)
|
Nipple–areolar complex sparing mastectomy
with immediate implant reconstruction.
|
Ductal carcinoma in situ, pathological TN category (AJCC 2017): pTis
1. Size of tumor: 2.0 cm (pTis).
2. Nuclear grade: low.
3. Necrosis: absent.
4. Architectural pattern: papillary/micropapillary/cribriform. 5. Skin: no involvement of tumor.
6. Surgical margins:
(a) deep margin: 2 mm,
(b) superfcial margin: 2 mm.
7. Microcalcifcation: present, tumoral/nontumoral.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 32
|
Female/72 years old, post-menopause.
Screen detected mass lesion on right breast
8 o’clock direction.
Outside result of biopsy: Ductal carcinoma in
situ.
No family history.
No comorbidities.
|
Report 1: Mammography shows an obscured mass. Report 2: US revealed an irregular mass at the corresponding area of the mass on mammography. Report 3: MRI demonstrates an irregular enhancing mass.
|
Operation + Postoperative radiation therapy.
Operation
Breast conserving surgery. (a) Preoperative, (b) immediate postoperative appearance. (a) Gross pathology of right breast partial mastectomy specimen. (b, c) The margins get marked and sliced
with different colors on each direction
|
Ductal carcinoma in situ, pathological TN category (AJCC 2017): pTis
1. Size of tumor: 4.0 cm (pTis).
2. Nuclear grade: high.
3. Necrosis: present.
4. Architectural pattern: micropapillary/cribriform/comedo.
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) superior margin: 10 mm,
(b) inferior margin: 10 mm,
(c) medial margin: 40 mm,
(d) lateral margin: 5 mm,
(e) deep margin: 2 mm,
(f) superfcial margin: 2 mm.
7. Microcalcifcation: present, tumoral/nontumoral.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 33
|
Female/68 years old, post-menopause.
Bloody nipple discharge from right breast.
No family history.
S/P Hysterectomy
|
Report 1:This woman was presenting for evaluation of
bloody nipple discharge. US showed an isoechoic mass
with indistinct margins at the subareolar area. US biopsy
yielded ADH. Followed surgical excision confrmed
DCIS . Report 2: MRI demonstrates regional heterogeneous nonmass enhancement adjacent to the postoperative fuid collection (*). Wide excision = ADH.
|
Operation
First operation: Excision, second operation: Wide
excision (a) Preoperative, (b) immediate postoperative appearance. (a) Gross pathology of right breast excision specimen (1st operation). (b) The margins get marked and sliced
with different colors on each direction
|
<First operation>
Ductal carcinoma in situ, pathological TN category (AJCC 2017): pTis
1. Size of tumor: 0.5 cm (pTis).
2. Nuclear grade: low.
3. Necrosis: absent.
4. Architectural pattern: papillary/cribriform.
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) superior margin: 10 mm,
(b) inferior margin: 10 mm,
(c) medial margin: 5 mm,
(d) lateral margin: positive (Fro 5) (see Note),
(e) deep margin: 2 mm,
(f) superfcial margin: 2 mm.
7. Microcalcifcation: present, tumoral/nontumoral.
Note: 1. Ductal carcinoma in situ is present
only in the permanent section of Fro 5. <Second operation>
Atypical ductal hyperplasia involving intraductal papilloma.
1. with a) foreign body reaction,
2. b) fat necrosis.
(a) Post-excision status.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 34
|
Female/53 years old, pre-menopause.
Screen detected mass lesion on upper outer of
right breast.
No family history.
S/P Total gastrectomy (gastric cancer), micropapillary thyroid carcinoma (follow-up).
BRCA 1 and 2: Not examination.
|
Report 1: This woman was presenting for evaluation of a
palpable mass. A round BB marks the site of palpable
fnding on mammography. Report 2: US showed an irregular hypoechoic mass at the
symptomatic area (white arrow). Other similar-appearing
masses (black arrows) were seen near the palpable mass.
US-guided core needle biopsy = intraductal papilloma.
Surgical excision = DCIS. Report 3:MRI demonstrates marked BPE. Targeted US
was advised for another focal non-mass enhancement. Report 4:MRI-directed US and core needle
biopsy = intraductal papilloma. Surgical excision = LCIS.
|
Operation
First operation: Excision, second operation: Both
excision. (a) Preoperative, (b) immediate postoperative appearance. (a, b) Gross pathology of right breast excision specimen (frst operation). (c) Gross pathology of right breast
excision specimen (second operation). (d, e) Gross pathology of left breast excision specimen (second operation)
|
<First operation>
Ductal carcinoma in situ, pathological TN category (AJCC 2017): pTis
1. Size of tumor: 0.5 cm (pTis).
2. Nuclear grade: low.
3. Necrosis: absent.
4. Architectural pattern: papillary/cribriform.
5. Surgical margins: (a) superior margin: 15 mm,
(b) inferior margin: 30 mm,
(c) medial margin: 15 mm,
(d) lateral margin: 15 mm,
(e) deep margin: 8 mm,
(f) superfcial margin: 8 mm.
6. Microcalcifcation: absent.
<Second operation>
Right Breast.
Lobular carcinoma in situ, pathological TN
category (AJCC 2017): pTis
1. Size of tumor: 0.7 cm (pTis).
2. Nuclear grade: low.
3. Necrosis: absent.
4. Architectural pattern: solid.
5. Surgical margins: positive for lobular carcinoma in situ at the nearest resection margin
(slide 1).
6. Microcalcifcation: absent. Left Breast.
Intraductal papilloma.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 35
|
Female/59 years old, post-menopause.
Screen detected ductal dilatation on left breast
12 o’clock direction.
No family history.
S/P Hysterectomy and bilateral salpingooophorectomy, S/P total thyroidectomy (thyroid
cancer), hypertension.
|
Report 1: This woman was referred for biopsy of a mass
in the left breast. US showed an oval isoechoic mass.
US-guided CNB = LCIS within FA. Report 2: MRI demonstrates an oval enhancing mass.
|
Operation + Tamoxifen 20 mg/day for 5 years.
35.3.1 Operation
Breast conserving surgery. (a) Preoperative, (b) immediate postoperative appearance. Gross pathology of left breast lumpectomy specimen. (b)The margins get marked and sliced with different colors on each direction
|
Lobular carcinoma in situ, pathological TN
category (AJCC 2017): pTis
1. Size of tumor: 0.5 cm (pTis).
2. Nuclear grade: low.
3. Necrosis: absent.
4. Architectural pattern: solid.
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) superior margin: 5 mm,
(b) inferior margin: 5 mm,
(c) medial margin: 10 mm,
(d) lateral margin: 10 mm,
(e) deep margin: 2 mm,
(f) superfcial margin: 2 mm.
7. Microcalcifcation: present, tumoral/nontumoral.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 36
|
Female/47 years old, pre-menopause. Screen detected mass lesion on right breast 11 o’clock direction. No family history. No comorbidities.
|
Report 1: Magnifcation view shows multiple groups of
amorphous microcalcifcations. Report 2: US demonstrates an irregular hypoechoic mass
(white arrow) with echogenic microcalcifcations.
|
Operation
Excision (a) Preoperative, (b) immediate postoperative appearance. (a) Gross pathology of right breast excision specimen. (b) The margins get marked and sliced with different
colors on each direction
|
Lobular carcinoma in situ
1. Size of tumor: 0.5 cm.
2. Nuclear grade: low.
3. Necrosis: absent.
4. Architectural pattern: solid.
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) superior margin: 10 mm,
(b) inferior margin: 5 mm, (c) medial margin: 20 mm,
(d) lateral margin: 10 mm,
(e) deep margin: 2 mm,
(f) superfcial margin: 2 mm.
7. Microcalcifcation: present, tumoral/nontumoral.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 37
|
Female/46 years old, pre-menopause.
Screen detected mass lesion on left breast
12 o’clock direction.
Outside result of biopsy: Lobular carcinoma
in situ.
No family history.
No comorbidities.
|
Report 1: US shows an irregular isoechoic mass in the left
breast. US-guided CNB = LCIS. Report 2:MRI demonstrates mild BPE without defnite abnormality.
|
Breast conserving surgery: (a) Preoperative, (b) immediate postoperative appearance. Gross pathology of left breast lumpectomy specimen. (b) The margins get marked and sliced with different colors on each direction
|
Lobular carcinoma in situ
1. Size of tumor: 2.0 cm.
2. Nuclear grade: low.
3. Necrosis: absent.
4. Architectural pattern: solid.
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) superior margin: positive (Fro 1),
(b) inferior margin: 4 mm,
(c) medial margin: positive (Fro 3),
(d) lateral margin: positive (Fro 4),
(e) deep margin: <1 mm (slide 6),
(f) superfcial margin: 10 mm.
7. Microcalcifcation: absent.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 38
|
Female/51 years old, pre-menopause.
Screen detected mass and microcalcifcation
on upper outer left breast.
No family history.
No comorbidities.
BRCA 1 and 2 mutation: Not detected, POLE
VUS (variant of uncertain).
|
Report 1: Magnifcation view shows regional fne pleomorphic microcalcifcations in the left breast. Report 2: US demonstrates irregular hypoechoic lesions
with microcalcifcations in the left breast. US-guided
CNB = Microinvasive ductal carcinoma. Report 3: MRI revealed clumped enhancement in the left breast (white arrow). Similar-appearing non-mass enhancement was concerning for contralateral breast malignancy (black arrow). Report 4 : MR-directed right breast US and
biopsy = Mixed ductal carcinoma in situ and lobular carcinoma in situ. Right mammography was negative (not
shown). Report 5: Lymphoscintigraphy shows visualized sentinel
lymph nodes in both axilla.
|
Right.
Lobular carcinoma in situ
1. Post-chemotherapy status.
2. Size of tumor: 1.5 cm.
3. Nuclear grade: low.
4. Necrosis: absent.
5. Architectural pattern: solid.
6. Surgical margins:
(a) superior margin: (see note),
(b) inferior margin: 4 mm,
(c) medial margin: 20 mm,
(d) lateral margin: (see note),
(e) deep margin: <1 mm (MG2),
(f) superfcial margin: 2 mm.
7. Microcalcifcation: present, non-tumoral.
Note: 1. The superior and lateral margins of
the lumpectomy specimen (slides MG1and 5)
are close to lobular carcinoma in situ (1 mm)
but these margins submitted for frozen diagnosis (Fro 1 and Fro 4) are free of tumor.
Left.
Ductal carcinoma in situ
1. Post-chemotherapy status.
2. Size of tumor: up to 0.5 cm (ypTis).
3. Nuclear grade: high.
4. Necrosis: present.
5. Architectural pattern: papillary/cribriform/
solid/comedo.
6. Skin: no involvement of tumor.
7. Surgical margins:
(a) superior margin: 17 mm,
(b) inferior margin: 10 mm, (c) medial margin: 40 mm,
(d) lateral margin: 10 mm,
(e) deep margin: 3 mm,
(f) superfcial margin: 14 mm.
8. Lymph nodes: no metastasis in fve axillary
lymph nodes (ypN0(sn)) (sentinel LN: 0/5).
9. Microcalcifcation: present.
|
Neoadjuvant chemotherapy #6 cycles (Docetaxel
and Carboplatin and Trastuzumab and
Pertuzumab) + Operation + Postoperative radiation therapy + Tamoxifen 20 mg/day for 5 years
+ Trastuzumab for 1 year.
38.3.1 Operation
Both breast conserving surgery, sentinel lymph
node biopsy (left). (a) Preoperative, (b) immediate postoperative appearance. (a, b) Gross pathology of right breast lumpectomy specimen. (c, d) Gross pathology of left breast lumpectomy specimen.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 39
|
Female/47 years old, pre-menopause. Screen detected mass lesion on right breast 12 o’clock direction. Outside result of biopsy: lobular carcinoma in situ. No family history. Hypertension.
|
Report 1: US shows an isoechoic mass with non-parallel
orientation and microlobulated margins. US-guided
CNB = LCIS. Report 2: MRI demonstrates marked BPE without discernible abnormality.
|
Operation + Tamoxifen 20 mg/day for 6 months.
39.3.1 Operation
Breast conserving surgery. a) Preoperative, (b) immediate postoperative appearance. c) Gross pathology of right breast lumpectomy specimen. (d) The margins get marked and sliced with different colors on each direction
|
Lobular carcinoma in situ 1. Size of tumor: 2.0 cm. 2. Nuclear grade: low. 3. Necrosis: absent. E. S. Lee et al. 137 4. Architectural pattern: solid. 5. Skin: no involvement of tumor. 6. Surgical margins: (a) superior margin: <1 mm (slide 2), (b) inferior margin: <1 mm (slide 5), (c) medial margin: 1 mm (slide 4), (d) lateral margin: <1 mm (slide 6), (e) deep margin: <1 mm (slide 3), (f) superfcial margin: 2 mm. 7. Microcalcifcation: present, tumoral/nontumoral.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 40
|
Female/47 years old, post-menopause.
Screen detected mass and microcalcifcation
on right breast 10 o’clock direction.
No family history.
No comorbidities.
|
Report 1:Magnifcation view shows grouped fne pleomorphic microcalcifcations .Report 2: Stereotactic VAB = LCIS. Report 3: Specimen radiograph confrms retrieval of the
grouped microcalcifcations.
|
Breast conserving surgery. (a) Preoperative, (b) immediate postoperative appearance. (a) Gross pathology of right breast partial mastectomy specimen. (b) The margins get marked and sliced with
different colors on each direction
|
Lobular carcinoma in situ
1. Post-stereotactic excision status.
2. Size of tumor: 1.0 cm, residual.
3. Nuclear grade: low.
E. S. Lee et al.
139
4. Necrosis: absent.
5. Architectural pattern: solid.
6. Skin: no involvement of tumor.
7. Surgical margins:
(a) superior margin: 10 mm,
(b) inferior margin: 10 mm,
(c) medial margin: 10 mm,
(d) lateral margin: 20 mm,
(e) deep margin: 2 mm,
(f) superfcial margin: 2 mm.
8. Microcalcifcation: present, tumoral/nontumoral.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 41
|
Female/46 years old, pre-menopause.
Screen detected mass lesion on left breast
2 o’clock direction.
Outside result of biopsy: R/O Atypical ductal
hyperplasia or ductal carcinoma in situ.
No family history.
No comorbidities.
|
Report 1: Mammography shows an asymmetry with
architectural distortion. Report 2: On US, a heterogeneous lesion with indistinct
margins was seen at the corresponding area of the mammographic abnormality. US-guided CNB = ADH,
Excision = DCIS. Report 3: MRI demonstrates a focal non-mass enhancement adjacent to the postoperative fuid collection (*).
Wide excision = DCIS.
|
Operation + Tamoxifen 20 mg/day for 5 years. (a) Preoperative, (b) immediate postoperative appearance. Gross pathology of left breast excision specimen (frst operation). (c, d) Gross pathology of left breast wide excision specimen (second operation)
|
FIRST OPERATION: Ductal carcinoma in situ, pathological TN category (AJCC 2017): pTis 1. Size of tumor: 1.5 cm (pTis). 2. Nuclear grade: low. 3. Necrosis: absent. 4. Architectural pattern: solid. 5. Skin: no involvement of tumor. 6. Surgical margins: (a) superior margin: 5 mm, (b) inferior margin: 5 mm, (c) medial margin: <1 mm from ductal carcinoma in situ (slide 3), (d) lateral margin: 10 mm, (e) deep margin: 2 mm, (f) superfcial margin: 2 mm. 7. Microcalcifcation: present, tumoral/nontumoral.
SECOND OPERATION: Ductal carcinoma in situ 1. Post-excision status. 2. Size of tumor: 1.5 cm, residual. 3. Nuclear grade: low. 4. Necrosis: present. 5. Architectural pattern: cribriform/solid/ comedo. 6. Skin: no involvement of tumor. 7. Surgical margins: (a) inferior margin: (see Note 1), (b) medial margin: (see Note 2). 8. Microcalcifcation: present, non-tumoral. Note: 1. The inferior margin of the lumpectomy specimen (slides 2 and 3) is close to ductal carcinoma in situ (<1 mm) but this margin submitted for frozen diagnosis (Fro 1) is free of tumor.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 42
|
Female/57 years old, post-menopause.
Screen detected microcalcifcation on left
breast 6 o’clock direction.
Outside result of biopsy: Ductal carcinoma in
situ.
No family history.
Diabetes mellitus.
|
Report 1:Magnifcation view shows grouped fne pleomorphic microcalcifcations. Report 2: US demonstrates a focal heterogeneous lesion
with echogenic microcalcifcations. US-guided
CNB = DCIS. Report 3: Specimen radiograph confrms retrieval of representative microcalcifcations. Report 4: MRI reveals focal clustered ring non-mass
enhancement.
|
Breast conserving surgery. (a) Preoperative, (b) immediate postoperative appearance. (a) Gross pathology of left breast partial mastectomy specimen. (b) The margins get marked and sliced with
different colors on each direction
|
Ductal carcinoma in situ, pathological TN category (AJCC 2017): pTisNx
1. Size of tumor: 1.5 cm (pTis).
2. Nuclear grade: low.
3. Necrosis: absent.
4. Architectural pattern: papillary/cribriform.
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) superior margin: 10 mm,
(b) inferior margin: 20 mm,
(c) medial margin: 5 mm,
(d) lateral margin: 5 mm,
(e) deep margin: 2 mm,
(f) superfcial margin: 2 mm. 7. Lymph nodes: not submitted (pNx).
8. Microcalcifcation: present, tumoral/
non-tumoral.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
Case 43
|
Female/67 years old, post-menopause.
Screen detected mass lesion on left breast 4
o’clock direction.
Outside result of biopsy: Ductal carcinoma in
situ.
No family history.
Diabetes mellitus, hypertension.
|
Report 1:Left breast US shows an isoechoic mass with
microlobulated margins. US-guided CNB = DCIS. Report 2: Right breast US shows an isoechoic mass with microlobulated margins. Report 3: MRI demonstrates moderate BPE with focal
non-mass enhancements (arrows). Bilateral mammography was negative (not shown). Left BCS and right excisional biopsy were performed. Pathology confrmed LCIS
in the right breast.
|
Breast conserving surgery (left), sentinel lymph node biopsy (left), excision (right)
|
Right.
Lobular carcinoma in situ
1. Size of tumor: 0.3 cm.
2. Nuclear grade: low.
3. Necrosis: absent.
4. Architectural pattern: solid.
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) superior margin: 5 mm,
(b) inferior margin: 2 mm,
(c) medial margin: 5 mm,
(d) lateral margin: 5 mm,
(e) deep margin: 2 mm,
(f) superfcial margin: 2 mm.
7. Microcalcifcation: present, tumoral/
non-tumoral.
Left.
Ductal carcinoma in situ, pathological TN category (AJCC 2017): pTis
1. Size of tumor: 1.0 cm (pTis).
2. Nuclear grade: high.
3. Necrosis: present.
4. Architectural pattern: micropapillary/cribriform/comedo.
5. Skin: no involvement of tumor.
6. Surgical margins:
(a) superior margin: 10 mm,
(b) inferior margin: 10 mm,
(c) medial margin: 10 mm,
(d) lateral margin: 15 mm,
(e) deep margin: 2 mm,
(f) superfcial margin: 2 mm.
7. Lymph nodes: no metastasis in one axillary
lymph nodes (pN0(sn)) (sentinel LN: 0/1).
8. Microcalcifcation: present, tumoral/nontumoral.
|
Carcinoma In Situ
|
Cluster 1: Non-Invasive/Benign Conditions
|
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