WHITE MEMORIAL MEDICAL CENTER
DEPARTMENT OF PATHOLOGY Location: 4511
1720 Cesar E. Chavez Avenue Patient Name: BAILEY, JENNIFER
Los Angeles, CA 90033 Date of Birth:
Telephone: (323) 268-5000 Sex: F
Attending Phys: Shirazi, Sherin K MD
Attending Phys: Shirazi, Sherin K MD
PATHOLOGISTS/DIRECTORS Collection Date: 24AUG07
M. Cosgrove, MD K.U. LEe, MD Received Date: 27AUG07
G.E. Dalgleish, MD D. Sahmedini, MD
G.E. Dalgleish, MD D. Sahmedini, MD
J.B. Harris, MD C. Seneviratne, MD
D.V. Kon, MD
SURGICAL PATHOLOGY FINAL
SOURCE OF TISSUE:
1. RIGHT BREAST SENTINEL NODE
2. RIGHT SENTINEL NODE
3. RIGHT BREAST MASS
4. RIGHT BREAST ADDITIONAL TISSUE
CLINICAL INFORMATION:
Rt. breast mass
INTRAOPERATIVE CONSULTATION:
1RFS: NEGATIVE FOR METASTASIS.
2RFS: NEGATIVE FOR METASTASIS
3RFS: INFLTRATING CARCINOMA
4RFS: NEGATIVE FOR METASTASIS
GROSS EXAMINATION:
1. The specimen is received fresh for frozen section labeled "rt. breast sentinel node" and consists of a 2 x 1.5 cm. portion of fibroadipose tissue containing a single node. A representative section of this node is submitted in 1RFS; the rest of the node is sectioned and submitted entirely in 1A and 1B.
2. The specimen is received frest for frozed section labeled "rt. breast sentinel node" and consists of a 1 x 0.6 x 0.4 cm. tan/yellow node. Submitted entirely in 2RFS for frozen section.
3. The speciment is received fresh labeled "rt. breast mass" and consists of a 5.5 x 4 x 3 cm. portion of fibroadipose tissue with dense stroma. A short suture is tied to the "superior" margin, and double long suture is seen at the "lateral" margin. Dense white stroma extends to all of the margins. A distinct mass is not grossly identified; however, indistinct induration involving an approximate 0.8 cm. area is seen approximately 1 cm. from the deep margin and 0.8 cm from the inferior margin. This area of induration is 1.5 cm from the cuperior and lateral margins and 1 cm from the medial margin. Representative sections of the frozen sepcimen are labeled 3RFSA and 3RFSB; additional representative sections submitted in 3A-3H.
CASSETTE SUMMARY
3A, 3B - inferior margin
3C - area of induration, deep and inferior margin
3D - deep margin
3D - superior margin
GROSS EXAMINATION:
3F - superficial margin
3G - medial margin
3H - lateral margin
4. The specimen is received frest for frozen section labeled "rt. breast mass" and consists of a 3.8 x 1.5 x 1 cm. portion of fibroadipose tissue with a suture attached. The area of this suture is dyed black. The rest of the specimen is not linked. A representative section is in cassette 4FS for frozen section. Dense white stroma is seen through approximately half of the specimen. Representative sections are submitted in cassettes 4RFSA-4RFSC.
MICROSCOPIC DESCRIPTION:
1. Multiple sections show a benign lymph node with focal sinus histiocytosis and focal fatty infiltration. No evidence of malignancy is seen.
2. Multiple sections of the entire specimen show fibroadipose tissue with no evidence of lymph node.
3. The frozen section shows a somewhat ill-defined infiltrating malignant neoplasm measuring 0.9 x 0.6 cm. This area is infiltrated by small and partially spindling malignant neoplastic cells in the dense fibrous tissue. At the peripheral portion of the invasive duct carcinoma are multiple dilated ducts showing intraductal carcinoma, small cell type, with occasional centrol necrosis. Tumor cells are basically small in size with occasional focal areas of spindling transformation. No evidence of tubule formation is seen. Tumor cells show very few mitotic activities. Multiple sections from different areas of the specimen show no evidence of residual infiltrating duct carcinoma. All the sections show fibrocystic changes with occasional sclerosing adenosis.
4. Multiple representative sections and frozen section show benign breast tissue with focal areas of old hemorrhage, fibrosis and lymphocytic infiltrates. No evidence of malignancy is seen.
DIAGNOSIS:
1. BENIGN LYMPH NODE (1) - RIGHT BREAST SENTINEL NODE
2. FIBROADIPOSE TISSUE WITH NO EVIDENCE OF LYMPH NODE - SPECIMEN LABELED AS "RIGHT SENTINEL NODE".
3. INFILTRATIN DUCT CARCINOMA, MODERATELY DIFFERENTIATED;
NOTTINGHAM HISTOLOGIC SCORE (6) WITH TUBULE FORMATION (3), NUCLEAR
PLEOMORPHISM (2) AND MITOTIC COUNT (1).
SIZE: 0.9 X 0.6 CM.
FREE RESECTIONS MARGINS.
ABSENT VENOUS/LYMPHATIC INVASION.
MICROCALCIFICATIONS NOT IDENTIFIED.
DUCT CARCINOMA IN-SITU, INTERMEDIATE NUCLEAR GRADE (NG2)
4. BENIGN BREAST TISSUE - RT BREAST ADDITIONAL TISSUE
Cancer Shecklist Summary: Breast
SPECIMEN TYPE:
_x__ Excision
___ Mastectomy
___ Other (specify): _____
___ Not specified
LYMPH NODE SAMPLING:
___ No lymph node sampling
_x_ Sentinel lymph node(s) only
___ Sentinel lymph node with auxillary dissection
___ Axillary dissection
SPECIMEN SIZE (for excisions less than total mastectomy)
Greast dimension: 5.5 cm
*Additional dimensions: 4.0 x 3.0 cm
___ Cannot be determined (see comment)
LATERALITY
_x__ Right
___ Left
___ Not specified
TUMOR SITE (check all that apply)
___ upper outer quadrant
___ lower outer quadrant
___ upper inner quadrant
___ lower inner quadrant
DIAGNOSIS:
___ Central
_x_ Not specified
MICROSCOPIC
SIZE OF INVASIVE COMPONENT
Greatest dimension: 0.9 cm
*Additional dimensions: 0.6 x __ cm
___ Cannot be determined (see comment)
HISTOLOGIC TYPE(S) (check all that apply)
___ Noninvasive carcinoma (NOS)
_x_ Ductal carcinoma in situ
___ Loular carcinoma in situ
___ Paget disease without invasive carcinoma
___ Invasive carcinoma (NOS)
_x_ Invasive ductal carcinoma
___ Invasive ductal carcinoma with an extensive intraductal component
___ Invasive ductal carcinoma with Paget disease
___ Invasive lobular
___ Nucinous
___ Meduliary
___ Other (s) (specify): __
___ Carcinoma, type cannot be determined
HISTOLOGIC GRADE (One grading system required)
Nottingham Histologic Score
* Tubule formation:
* ___ Majority of tumor greater than 75% (score = 1)
* ___ Moderate 10% to 75% (score = 2)
* _x_ Minimal less than 10% (score = 3)
* Nuclear pleomorphism:
* ___ Small regular nuclei (score = 1)
* _x_ Moderate increase in size, etc (score = 2)
* ___ Marked variation in size, nucleoli, chromatin clumping, etc (score = 3)
Mitotic count:
For a 25X objective with a field area of 0.264 mm 2
___ Less than 10 mitoses per 10 HPF (score = 1)
___ 10 to 20 mitoses per 10 HPF (score = 2)
___ Greater than 20 mitoses per HPF (score = 3)
or
For a 40x objective with a field area of 0.152 mm 2
_x_ 0 to 5 mitoses per 10 HPF (score = 1)
___ 6 to 10 mitoses per 10 HPF (score = 2)
___ Greater than 10 mitoses per 10 HPF (score = 3)
Total Nottingham Score:
___Grade I: 3-5 points
_x_ Grade II: 6-7 points
___ Grade III: 8-9 points
___ Score cannot be determined
EXTENT OF INVASION
PRIMARY TUMOR (pT)
___ pTX: Cannot be assessed
___ pTO: No evidence of primary tumor
___ pTis: Ductal carcinoma in situ
___ pTis: Lobular carcinoma in situ
___ pTis: Paget disease without invasive carcinoma
_x_ pT1: Tumor 2.0 cm or less in greast dimension
___ pT1mic: Microinvasion 0.1 cm or less in greastest dimension
___ pT1a: Tumor more than 0.1 cm but not more than 0.5 cm in greatest dimension
___ pT1b: Tumor more than 0.5 cm but not more than 1.0 cm in greatest dimension
___ pT1c: Tumor more than 1.0 cm but not more than 2.0 cm in greatest dimension
___ pT2: Tumor more than 2.0 cm but not more than 5.0 cm in greatest dimension
___ pT3: Tumor more than 5.0 cm in greatest dimension
___ pT4: Tumor of any size with direct extension to chest wall or skin, but only as described below #.
___ pT4a: Extension to chest wall, not including pectoralis muscle
___ pT4b: Edema (including peau d'orange) or ulceration of the skin of the breast or satellite skin nodules confined to the same breast
___ pT4c: Both T4a and T4b
___ pT4d: Inflammatory carcinoma
# Clinical information may be required to designate a tumor as pT4. Dermal invasion alone (without ulceration, satellie nodules, or inflammatory breast cancer) does not alter T category. Such cases are classified as T1, T2, or T3, depending on tumor size.
DIAGNOSIS:
REGIONAL LYMPH NODES (pN)
(Choose a category based on data supplied with specimen. Immunocytochemistry and molecular studies are not required.)
___ pNX: Cannot be assessed (previously removed or not removed for pathologic study)
___ X pNO(i-): No regional lymph node metastasis histolotically (ie, none greater than 0.2 mm), no additional examination for isolated tumor cells
___ pNO(i+): No regional lymph node metastasis histologically, positive IHC, no IHC cluster greater than 0.2 mm
___ pNO(mol-): No lymph node metastasis histologically, negative moelcular findings
___ pN1mi: Micrometastasis (greater than 0.2 mm, none greater than 0.2 mm)
___ pN1mi(+): Micrometastasis detected only by IHC
___ pN1a: Metastasis in 1 to 3 axillary lymph nodes (at least 1 tumor deposit greater than 2.;0 mm)
___ pN1b: Metastasis in internal mammary lymph nodes with microscopic disease detected by sentinel lymph node dissection but not clinically apparent
___ pN1c: Metastasis in 1 to 3 axillary lymph nodes and in internal mammary nodes with microscopic disease detected by sentinel lymph node dissection but not clinically apparent
___ pN2a: Metastasis in 4 to 9 axillary lymph nodes (at least 1 tumor deposit greater than 2.0 mm)
___ pN2b: Metastasis in clinically apparent internal mammary lymph nodes in the absence of axillary lymph node metastases
___ pN3a: Metastasis in 10 or more axillary lymph nodes (atleast 1 tumor deposit greater than 2.0 mm), or metastasis to the infraclavicluar lymph nodes
___ pN3b: Metastasis in clinically apparent ipsilateral internal mammary lymph nodes in the presence of 1 or more positive axillary lymph nodes; or in more than 3 axillary lymphs and in internal mammary lymph nodes with microscopic disease detected by sentinel lymph node dissection but not clinically apparent
___ pN3c: Metastasis in ipsilateral supraclavicular lymph nodes
Specify: Number examined: __
Number involved: __
DISTANT METASTASIS (M)
___ pMX: Cannot be assessed
___ pM1: Distant metastasis
* Specify site(s), if known: __
MARGINS (check all that apply)
___ Margins cannot be assessed
_x_ Margins uninvolved by invasive carcinoma
Distance from closest margin: 10 mm
* Specity which margin: posterior
_x_ Margins uninvolved by DCIS (if present)
Distance from closest margin: 10 mm
* Specify which margin: posterior
___ Margin(s) involved by invasive carcinoma
Specify which margin: __
___ Margin(s) involved by DCIS
Specify which margin: __
* Extent of margin involvement for DCIS
* ___ Cannot be assessed
* ___ Uniforcal
* ___ Multifocal
* ___ Extensive
* ___ Other (specify): __
* VENOUS/LYMPHATIC (LARGE/SMALL VESSEL) INVASION (V/L)
* _x_ Absent
* ___ Present
* ___ Indeterminate
* MICROCALCIFICATIONS (check all that apply)
* _x__ Not identifiey
* ___ Present in DCIS
* ___ Present in invasive carcinoma
* ___ Present in nonneoplastic tissue
* ___ Present in both tumor and nonneoplastic tissue
* COMMENT(S)
FIXATION: 10% neutral buffered formalin X
Other (specify)__
DIAGOSIS:
Fixation time: 6-48 hours X other (specify)
___ unknown __
Breast Prognostic Panel:
ER/PR Ordered Yes _ No _
Complete panel ordered (ER,PR, Her2) Yes x No _
In not ordered, state reason: __
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