A Tale of Two Path Reports

The following are two actual pathology reports. As you can see, they all do not look the same. But the basic information is there and easy to recognize now that you know what to look for.

The first pathology report is for an invasive ductal carcinoma that was removed by lumpectomy. It has negative estrogen and progesterone receptors and is also Her2 negative. There was a complete axillary dissection and none of the lymph nodes were involved.

The second pathology report is for a woman who had a mastectomy. It shows that she had invasive lobular carcinoma and it is responsive to estrogen and progesterone. She is Her2 negative. The report shows that a sentinel node biopsy was attempted, but the sentinel node came back positive for cancer, so her entire axillary sac was removed. After testing, it revealed that she had four positive lymph nodes and the cancer did spread outside the lymph nodes but remained in the axillary bundle.
Surgical Pathology Report #1

Specimen: Lt Breast Mass

Clinical diagnosis and History: Left Breast Mass

Microscopic Description:

A. Type and Size of Carcinoma:

1. Infiltrating Ductal, Solitary, Size 1.3x1.0 cm

2. Intraductal Present, Solitary

B. Histologic Grade, SBR Score: 7/9
1. Nuclear grade High

C. Margins
1. For invasive ca: Positive, Superior, inferior, deep

2. For non-invasive ca: Positive

D. Vascular Invasion: Absent

E. Axillary Lymph nodes: 27/negative

F. Antigens
1. Estrogen Receptor Negative
2. Neoplastic Cells 0%
3. Progesterone Receptor Negative
4. Neoplastic Cells 0%

G. HER-2/nue

1.Cytoplasmic membrane staining Negative
2.Score: 0 (X), 1+ ( ), 2+ ( ) , 3+ ( )

H. DNA Analysis
1. Anaploid 9 (High)
2. S-phase 8% (> 8% High)
3. Ki-67 Staining 50% (> 10% High)

Remarks: Slides labeled 01-4593, representing the left breast excision, show an invasive ductal carcinoma, poorly differentiated, associated with Ductal Carcinoma In Situ (DCIS) with high nuclear grade, apocrine features, and necrosis. The DCIS is noted at the periphery of and away from the invasive component. The INVASIVE carcinoma measures 0.9 cm microscopically on slide labeled 01-A4593. Both invasive and DCIS are very close to the inked margins. I see no convincing evidence of lymphovascular invasion.

What it said:

This woman had a small tumor that began as DCIS and became invasive. It is estrogen/progesterone receptor negative, it is very aggressive because the tumor had a high S-phase, Ki-67 phase and a B/R score of 7/9. The good news is she has no positive nodes, is HER2 negative, and has no vascular invasion.

What will happen to her? If she had an ER/PR positive tumor, and a less aggressive cancer, she probably could get only a lumpectomy and radiation. The gray area of chemo or no chemo is an under one centimeter tumor, with an ER/PR positive tumor and a very un-aggressive cancer.

However, because she had a small tumor, a lumpectomy with radiation is still the only surgery she will require and a course of prophylactic chemotherapy would be the safest route.

Surgical Pathology Report #2

Histologic Type:
Invasive Lobular Carcinoma

Size of Carcinoma: 2.5 cm

Bloom/Richardson Score:
Tubule formations: 3
Nuclear pleomorphism: 3
Mitosis: 1
Total Score: 7/9

Margins: Uninvolved by carcinoma (distance from closest, deep margin is 1.1 cm)

Lymph node status

Total number of lymph nodes: 29
Number of nodes with tumor: 4
Extranodal extension: present

Skin: Not involved in Tumor

Microcalcifications: present in non-neoplastic tissue

Pathological Staging: pT2. pN2A, pMX

Hormone Receptor Status:

Estrogen Receptor: Positive
Progesterone Receptor: Positive

0 ( ) 1 (x) 2 ( ) 3 ( )

Final Diagnosis:

1. Axilla (right, sentinel lymph node), excision -one (1) lymph node positive for metastatic carcinoma with perinodal extension

2. Breast and lower axillary contents (right), mastectomy
- infiltrating lobular carcinoma

3. Axilla (right, sentinel lymph node), excision -three (3) lymph nodes

What it said:

This woman had a mastectomy and started with a sentinel node biopsy. During the biopsy it was discovered that she had cancer in the sentinel node. The entire axillary sac was removed and later tested. Four lymph nodes out of the 29 removed tested positive for cancer. There also was extra-nodal extension which means that the cancer went outside the nodes, but remained confined to the axillary sac.

Her tumor was infiltrating lobular cancer, and estrogen and progesterone positive. She tested negative for the her-2/nue oncogene. When a pathology report labels a Her2 test result with a "0" or a "1" that means the cancer is not Her2 positive.

The good news is that this woman had a complete mastectomy and all the breast tissue has been removed. She is also responsive to hormones, so after a course of chemotherapy and radiation, she will be able to benefit from the hormone blocking drugs available to women who have cancer that is fueled by estrogen.

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