SMX without reconstruction Pathoogy Report
I follow up with Breast Surgeon tomorrow so will get answers,but was wondering if any of you can tell me if I am reading this as it showed Her2 positive as well ad are doing FISH test to confirm. My biopsy showed ER PR strongly positive like the pathology but Her2 neg, and a little difference in Stage, but curious about Her2 positive in pathology. And the of course if it is, what that means for treatment.
Here is report:
PATHOLOGY TISSUE - Details
About this testStudy Result
Narrative
Diagnosis
A. Lymph node, left axillary sentinel #1, excision:
- Benign reactive lymph node (0/1).
B. Breast, left, simple mastectomy:
- Invasive ductal carcinoma, see synoptic.
(cmf)
Martina Pejchal M.D. Ph.D. , Pathologist
(Case signed 08 01 2022)
Case signout location
Sparrow Lab (Main)
1215 E. Michigan Ave.
Lansing, MI 48912
Comment
This case was reviewed in consultation by Dr. Flynn. The tumor cells
are positive for AE1/AE3 and GATA3. E-cadherin and P120 staining
supports a ductal diagnosis. HER2 FISH will be ordered. When testing is
complete, the results will be issued in a separate addendum.
Supplemental tumor markers of malignant breast lesions. Testing was
performed on block B3. All immunohistochemical controls show
appropriate staining.
ERA / PRA by Immunohistochemistry
Test Result Tumor Nuclei Staining Relative Intensity
Estrogen Receptor Positive 91-100% Strong
Progesterone Receptor Positive 91-100% Strong
Positive: 10-100%
*Low Positive: 1-9% (*Only to be utilized for reporting of ER in
invasive carcinomas)
Negative: < 1%
Monoclonal Rabbit Anti-Human Estrogen Receptor, clone: SP1 and
Monoclonal Rabbit Anti-Human Progesterone Receptor, clone: 1E2 staining
was performed on formalin-fixed, paraffin-embedded tissue using
ultraView Universal DAB Detection Kit.
HER2 by Immunohistochemistry
Results: Positive (Score 2+)
HER2 IHC clone, fixation, and detection disclaimer: Monoclonal Rabbit
Anti-HER2/neu, clone 4B5, staining was performed on formalin-fixed,
paraffin-embedded tissue using the ultraView Universal DAB Detection
Kit. Criteria for scoring (2020 ASCO/CAP Guidelines):
Negative (Score 0): No staining is observed or membrane staining
that is incomplete and is faint/barely perceptible and in </=10% of
tumor cells.
Negative (Score 1+): Incomplete membrane staining that is faint/barely
perceptible and in > 10% of tumor cells.
Equivocal (Score 2+): Weak to moderate complete membrane staining
observed in > 10% of tumor cells.
Positive (Score 3+): Circumferential membrane staining that is
complete, intense and in > 10% of tumor cells.
Synoptic
B. College of American Pathologists (CAP) Cancer Protocol for Invasive
Carcinoma Resections of the Breast:
Version: 4.7.0.0 Protocol Posting Date: June 2022
PROCEDURE: Total mastectomy.
SPECIMEN LATERALITY: Left.
HISTOLOGIC TYPE: Invasive ductal carcinoma with lobular features.
HISTOLOGIC GRADE (Nottingham Histologic Score):
Glandular (Acinar)/Tubular Differentiation: 3.
Nuclear Pleomorphism: 2.
Mitotic Rate: 1.
Overall Grade: Grade 2 (score of 6).
TUMOR SIZE: Mass #1:10 by 7 by 5 mm, mass #2 (grossly designated as mass
#3): 7 by 5 by 4 mm.
DUCTAL CARCINOMA IN SITU (DCIS): Not identified.
TUMOR EXTENT:
Skin: Uninvolved.
Nipple: Uninvolved.
Skeletal muscle: Not present.
TREATMENT EFFECT IN THE BREAST: No known prior therapy.
MARGINS:
Invasive Carcinoma Margins:
All margins negative for invasive carcinoma. Distance from
invasive carcinoma to closest margin: The tumor masses are greater than
10 mm from any margin.
DCIS Margins: Not applicable (no DCIS in specimen)
REGIONAL LYMPH NODES:
All regional lymph nodes negative for tumor cells.
Total Number of Lymph Nodes Examined (sentinel and non-sentinel):
1.
Number of Sentinel Nodes Examined: 1.
DISTANT SITE(S) INVOLVED: Unknown.
PATHOLOGIC STAGE CLASSIFICATION (pTNM, AJCC 8th Edition): mpT1b.
pN0(sn).
+OPTIONAL DATA ELEMENTS:
+TUMOR SITE: Mass #1 located at the junction of the upper inner and
lower inner quadrants. Mass #2 located at the junction of the upper
outer quadrant and the lower outer quadrant.
+TUMOR FOCALITY: Multifocal, at least 2 separate foci.
+LOBULAR CARCINOMA IN SITU (LCIS): Not identified.
+LYMPHOVASCULAR INVASION: Not identified.
+DERMAL LYMPHOVASCULAR INVASION: Not identified.
+MICROCALCIFICATIONS: There is a gross area of calcification within
dense scar, consistent with the patient's previous lumpectomy site.
+ADDITIONAL PATHOLOGIC FINDINGS: Healing previous biopsy site in the
area of mass #1 filled with gelatinous material. There is a large area
of scar with is trophic calcification consistent with prior lumpectomy
site. There is a fibroadenoma identified in the area of mass #1. The
malignant tumors are designated as mass #1 grossly and mass #3 grossly.
+BREAST BIOMARKER TESTING PERFORMED ON PREVIOUS BIOPSY
+Testing performed on case number: Outside case from McLaren
Greater Lansing (IS22-5183), slides not directly reviewed.
Test
Result Tumor Nuclei Staining
Relative Intensity
Estrogen Receptors Positive.
91-100%. Strong.
Progesterone Receptors Positive.
91-100%. Strong.
Positive: 10-100%
Low Positive: 1-9%
Negative: < 1%
HER2 by Immunohistochemistry: Negative (score = 0).
Gross
A. Received fresh for frozen section, labeled "left sentinel node #1"
are multiple portions of yellow, lobulated adipose tissue aggregating to
3.5 x 2.0 x 1.0 cm. Palpation reveals one lymph node candidate (1.7 x
1.0 x 0.6 cm). The lymph node candidate is bisected and submitted
entirely in cassettes A1 and A2. The frozen section was performed at
Sparrow Main by Dr. Pejchal and reported to Dr. Bumpers. Critical
readback of the frozen section diagnosis was read back to Dr. Pejchal by
Dr. Bumpers. Specimen was received on 07/27/2022 at 5:00 p.m. and
reported at 5:20 p.m. HLC/CBR/sal 07/28/2022
B. NOTE: The specimen is excised on 7/27/2022 at 1708 and placed in
formalin on the same date at 1725. The cold ischemic time is
approximately 17 minutes and the total fixation time is approximately 25
hours. The cold ischemic time and fixation times for this specimen are
in compliance with CAP/ASCO guidelines. Received in formalin labeled
"left breast, stitch on axillary tail" is a 398 gram oriented mastectomy
specimen (16.1 cm from medial to lateral, 12.5 cm from superior to
inferior, 3.5 cm from anterior to posterior) with attached skin (10.3 cm
by 7.3 cm) and everted nipple (1.0 x 0.9 x 0.3 cm). There is a single
black suture present designating the axillary tail per the clinician.
The skin is lightly pigmented, wrinkled, and previously dyed blue. The
specimen is inked blue for superior-anterior, yellow for
inferior-anterior and black for posterior. The specimen is serially
sectioned from medial to lateral to reveal three masses and two abnormal
rubbery areas. A 0.7 x 0.4 x 0.4 cm biopsy site filled with blue
gelatinous material is located at the junction of the upper inner
quadrant and lower inner quadrant. Mass one (0.7 x 0.5 x 0.5 cm) is
white, firm, has stellate borders, and is located adjacent to the
aforementioned, possibly-involved biopsy site. Mass one measures 3.3 cm
from the closest skin, 3.3 cm to the closest anterior superior margin,
3.6 cm to the closest anterior inferior margin, and 4.6 cm to the
closest posterior deep margin. In the same plane, 3.0 cm away from the
mass, is an abnormal gray, rubbery area of tissue (0.7 x 0.5 x 0.5 cm)
that is located in the upper inner quadrant. There is a focal area of
rubbery, well-circumscribed tissue (0.6 x 0.5 x 0.4 cm) within a densely
blue-dyed area at the junction between the lower inner quadrant and the
lower outer quadrant. Mass two (2.0 x 0.6 x 0.5 cm) is densely
calcified and located at the junction of the lower inner quadrant and
the lower outer quadrant. Mass two measures 1.0 cm to the closest
anterior inferior margin. Mass three (0.7 x 0.5 x 0.4 cm) is tan, firm,
has stellate borders, and is identified at the junction of the upper
outer quadrant and the lower outer quadrant. Mass three measures 2.6 cm
from the closest posterior deep margin, 5.1 cm from the closest anterior
inferior margin, 4.0 cm from the closest anterior superior margin, and
6.2 cm from the closest skin. The remaining breast tissue is comprised
of approximately 5-10% of white-gray fibrous stroma and predominately
yellow, glistening cut surfaces. Additionally in the container is a 4.0
x 2.3 x 1.0 cm unoriented, fibrofatty tissue fragment. Representative
sections are submitted as follows: B1 and B2 - nipple and underlying
breast tissue, bisected; B3 through B4 - biopsy marker site and adjacent
mass one, with the closest skin and posterior deep margins in B4; B5 -
laterally adjacent tissue to mass one; B6 - abnormal rubbery gray area
close to the mass, with the closest anterior superior margin, bisected;
B7 - rubbery, well-circumscribed area of tissue from the junction of the
lower inner quadrant and lower outer quadrant; B8 and B9 - mass two with
the anterior inferior margin, following decalcification; B10 -
intervening tissue between mass one and two; B11 and B12 - mass three,
with the closest posterior margin in B11 and the closest inferior
anterior margin in B12; B13 and B14 - representative upper inner
quadrant; B15 and B16 - representative lower inner quadrant; B17 and B18
- representative upper outer quadrant; B19 through B20 - representative
upper outer quadrant. HLC/CBR/sal 07/28/2022
Intraoperative Consultation
A. Sentinel node #1
- Negative for carcinoma.
- Performed by Martina Pejchal, M.D., Ph.D.
Clinical Information
A. Diagnosis/Pre-Op: Malignant neoplasm of breast, female
Post-Op: Same
Procedure: Left breast mastectomy
Source
A. Sentinel node, left #1 ; B. Breast-mastectomy simple, left