prompt1 : extract information from  breast pathology report. List the histological classification, i.e. type of cancer or DCIS, subtype, description of any necrosis, any mention of tumor infiltrating lymphocytes,  histological grade, nuclear grade,  lymphovascular invasion, calcification, receptor status, IHC and any other ancillary testing results.  List out and expand the main points.
prompt2 : The report is - Subtype LumA, Hospital of Origir. QC Pathologist: FINAL PATHOLOGIC DIAGNOSIS: A. Left axillary sentinel lymph node: One lymph node containing metastatic carcinoma. Confirms frozen section diagnosis. Size of involvement within the node: 0.3 cm. B. Left breast mastectomy: Residual invasive ductal carcinoma. Size: 2.5 cm. Architectural score: 2/3. Nuclear score: 2/3. Mitotic score: 1/3. Total score: 5/9, Grade I. Carcinoma is adjacent to previous biopsy cavity. No evidence of skin or nipple involvement. Deep margin of excision is free of carcinoma. Prognostic panel was performed on the original biopsy and. will not be repeated unless requested. Multifocal areas of ductal carcinoma in situ present in. uninvolved quadrants of breast. DCIS is high grade comedo carcinoma type. Largest area of confluent DCIS is approximately 1.0 cm. TNM Classification: T2 pN1 MX. COMMENTS: CLINICAL HISTORY: Preoperative Diagnosis: Left modified radical mastectomy. with sentinel node mapping with frozen section. Invasive. ductal carcinoma, ER positive, PR positive, Ki-67 (MIB1). 33%. Postoperative Diagnosis: Symptoms/Radiologic Findings: SPECIMENS: A. Left axilla sentinel node with frozen section. B. Left breast. CODES: PROCEDURAL DEMOGRAPHICS: Accession Date/Time: GROSS DESCRIPTION: The snecimen is received in two containers labeled =. A. Auanionally labeled right sentinel node and contains a. 1.7 cm yellow tan fibrofatty soft tissue. The specimen is. bisected and entirely submitted for frozen section with the. residual entirely resubmitted for permanent section in. cassette A labeled. B. Additionally labeled left breast and contains a 641. gram, 20.0 x 13.5 x 7.0 cm simple mastectomy specimen. partially surfaced by a 17.5 x 9.3 cm ellipsé: of pink tan. wrinkled skin bearing a central 1.4 x 1.2 x 0.5 cm everted. nipple. No orientation is offered or possible. The deep. margin is inked and the specimen is serially sectioned to. reveal a 2.5 x 1.5 x 1.5 cm ill defined gray white gritty. mass that resides 3.5 cm from the skin surface and. approaches to within 3.5 cm of the inked deep margin. Located immediately adjacent to this mass is a 3.5 x 2.8 x. 2.3 cm shaggy, necrotic cavity consistent with previous. biopsy site. This cavity resides 1.5 cm below the skin. surface and approaches to within 3.5 cm of the inked deep. margin. The remainder of the cut surface is comprised of. predominantly yellow tan adipose tissue admixed with. moderate amounts of interspersed gray white fibrous tissue. No additional masses are identified. Also received in the same container is an 11.5 x 2.0 x 1.5. cm strip of pink tan wrinkled skin with adherent yellow tan. fibrofatty soft tissue. Sectioning reveals a yellow tan. fibrofatty cut surface with no discrete lesions. Representative sections are submitted in cassettes B1-B13. labeled. designated as follows: B1- nipple;. B2- inked deep margin, perpendicular; B3-B5-- mass; B6-B9--. previous biopsy cavity; B10-B12-- representative sections. from the three uninvolved quadrants; B13-- sections from. separately submitted skin and fibroadipose tissue. Additionally, a yellow and green cassette are submitted for. genomic research each labeled. INTRA-PROCEDURE CONSULTATION: A. Frozen section diagnosis: Metastatic neoplasm. approximately 0.3 mm on frozen section per Dr. margin. The specimen is inkt. is follows: Superficial -. blue, deep - black, superior - green, and inferior - orange. The specimen is serially sectioned in a medial to lateral. fashion to reveal a 0.9 x 0.8 x 0.6 cm white-tan, firm. well-defined mass/possible lymph node which extends to the. medial, superior, inferior, superficial margins, is within. 0.7 cm of the deep margin and greater then 1 cm from the. lateral margin. The mass is covered in a moderate amount of. overlying blue surgical dye. Remaining breast parenchyma is. approximately 10% tan, somewhat dense fibrous tissue. Cut. surfaces are also remarkable for a few foci of hemorrhage up. to 0.8 cm in greatest dimension The entire enecimen is. submitted in cassettes labeled. as follows: A1-A7 are in a medial to lateral fashion. A1 is a full. cross section of the mass to show the nearest superficial,. deep, superior, inferior margins; A2. Additional section of. the mass; A3-A7. Remaining full cross sections of the. specimen; A8. Medial margin and transverse sections; A9. Lateral margin and transverse sections. B. Additionally labeled "2 - Left medial margin, old. 0.8 margin cm portion up, new of margin yellow-tan, down" lobulated, and consists fibrofatty of a 1.9 breast x. 1.4 x. tissue, stitched to a Telfa pad to indicate that the new. margin tan-yellow, down; lobulated, fibrofatty inked and blue. friable cut. is face new margin is Sectioning. reveals. surfaces. No significant fibrous tissue or distinct nodular. lesions are identified. The entire specimen is submilted. sequentially in cassettes B1 and B2 labeled. INTRA-PROCEDURE CONSULTATION: MICROSCOPIC DESCRIPTION: THERAPEUTIC MARKERS. Test. Description. Breast Cancer Analvsis using Immuno-histochemistry,. 1. and Pathologist review. is a FDA approved adjunctive, computer-assisted and. interactive microscopy system which aids the pathologist in. the detection, classification, and counting of cells of. interest thereby standardizing slide scoring through. quantitative assessment of marker intensity, size and shape. Estrogen / Progesterone. Receptors ER/PR. ER = Rabbit Monocional Antibody (clone SP1). PR = Rabbit Monoclonal Antibody (Clone 1E2). Anti-Estrogen receptor (ER) primary antibody is a rabbit. monoclonal antibody (IgG) that is used for the qualitative. detection of estrogen receptor antigens in sections of. formalin-fixed, paraffin-embedded tissue on an automated. slide stainer platform used in conjunction with an indirect. biotin streptavidin detection system. The ER antibody is. directed against the epitrope present on human ER protein. located in the nucleus of norr. ind neoplastic cells. This. test is indicated as and aid in the management, prognosis,. and prediction of therapy outcome of breast cancer. Anti-Progesterone Receptor (PR) primary antibody is a rabbit. monocional antibody (IgG) that is used for the quantitative. detection of the A, B and C isoforms of human progesterone. receptor antigens in sections of formalin-fixed,. paraffin-embedded tissue on an automated slide stainer. platform used in conjunction with an indirect biotin. streptavidin detection system. This test is indicated as. and aid in the management, prognosis, and prediction of. therapy outcome of breast cancer. The significance of PR is. its role in determining the functionality of estrogen. receptors in breast cancer cells. The presence of estrogen. does not guarantee a response to endocrine therapy. One way. to evaluate the functionality of the ER present in breast. carcinoma is to determine if the proteins regulated by ER. are expressed. PR receptor is such a protein, and has. historically been-used to monitor the functionality of ER. The. measures the percentage of positively stained. nuclei of the tumor cells. Note: False negatives are possible. Positive staining for. receptor in the normal glands if present is a good internal. control, and increases the likelihood that a negative result. is a true negative. Ki-67 = Rabbit Monoclonal (clone 30-9). Anti-Ki-67 primary antibody is directed against the. C-terminal portion of the Ki-67 antigen, which is expressed. in the nuclei of proliferating cells (normal and. neoplastic). The antibody identifies proliferating activity. in sections of formalin-fixed, paraffin-embedded tissue on. an automated slide stainer platform used in conjunction with. an indirect biotin streptavidin detection system. Assessment of tumor proliferative activity, IHC staining of. tumor cell nuclei, can be used for prognosis and therapy. planning. Ideal for use with small breast cancer specimens. The percentage of positively stained tumor nuclei is. reported. The. is an indirect biotin melhod. Interpretation utilizes the. instrument. The. is a. Tissue Fixation. ER/PR testing guidelines were released which include. fixation recommendations. All tissue should be fixed in. neutral buffered formalin as soon as possible. Excisional. and mastectomy specimen tissue should be fixed for a minimum. of 6 and maximum of 72 hours. For tissue not fixed within. the optimal time period or if fixation time is unknown it. should be noted on report. Any negative Her2 IHC result. without optimal fixation time should have Her2 FISH testing. performed. FISH, HER2/neu refl to IHC: CYTOGENETIC RESULTSCylogenetic. Reference #: Test Setup Date: est. Completion Date: Specimen Source: Left breast. Clinical History: Invasive ductal carcinoma;. HER2 IHC: Not AvailableInterphase Cells: 30 Metaphase Cells: OFISH RESULTS:POSITIVE HER2 oncogene amplification detected. by FISH analysisRatio of HER2 to D17Z1 is 8.0 (average. count: HER2: 14.9, D17Z1: 1.9)nuc. sh(D17Z1x1. 3,HER2x5. 25)(3OJINTERPRETATION and COMMENTS; The. HER2 FISH assay (Abbott Molecular) revealed amplification of. the HER2 oncogene.A ratio of >2.2 is considered to indicate. amplification. Slides from this sample were evaluated by an in-house. pathologist and deemed adequate for HER2 FISH analysis. The. formalin fixation time was between 6 hours and 48 hours per. the submitting facility. Controls were performed and. provided the anticipated results. The imaging method was. manual. This case has been reviewed by at least 2 observers. Results from this test are intended for use as an adjunct to. prognosis in stage II, node positive breast cancer patients. Clinically relevant amplification has been documented only. when an invasive component is involved. Clinical correlation. is recommended. This test is also indicated as an aid in the. assessment of patients for whom Herceptin. treatment is being considered. The performance characteristics of this assay have been. determined by. Performance characteristics. refer to the analytical performance of the. test.Reference:\ Wolff et al. Arch Pathol Lab Med. Hospital of Origin: QC Pathologist: ADDENDUM REPORT. ADDENDUM REPORT NUMBER TWO. FISH RESULTS: Specimen Source: Left breast (. A1)POSITIVE HER2 oncogene amplification detected by FISH. analysisRatio of HER2 to D17Z1 is 8.0 (average count: HER2: 14.9, D17Z1: 1.9)nuc sh(D17Z1x1. 3,HER2x5. 25)(30][Specific. testing information from this report has been added to the. microscopic description). ADDENDUM REPORT NUMBER ONE. BREAST PROGNOSTIC PANEL: (test results on block A1). TEST RESULT REFERENCE RANGES. Estrogen Receptor: POSITIVE (91%) = 1% is Positive. < 1% is Negative. Staining Intensity: Strong. Progesterone Receptor: POSITIVE (53%) = 1% is Positive. < 1% is Negative. Staining Intensity: Strong. Ki-67 (MIB1) Proliferation Marker: HIGH (33%) > 20% is High. 10-20% is Borderline. < 10% is Low. These results were interpreted by I. Indiana. An additional addendum report will tollow when. Her-2-neu tests are completed. [Specific testing information and references have been added. to the microscopic description). The original diagnosis remains unchanged. EXAMINATION: MRI BRFAST. .ATERAL \. Completed: FULL RESULT: Indication: Newly diagnosed left breast cancer. Comparison: Multiple mammograms dating back to. FINDINGS: Bilateral breast MRI was performed with and without contrast. CAD-stream. computer-aided detection system was utilized. to obtain multiplanar and 3-D reconstruction images. Subtraction images. were created from dynamic contrast data. All. images were evaluated at a work station. The right breast demonstrates no abnormal areas of enhancement or. adenopathy. On the left, axillary lymph nodes are more hypervascular than on the. right but morphologically they are similar and. symmetric. In the anterior upper-outer quadrant of the left breast, there is a. 1.5 x 1.1 x 1.3 cm irregular enhancing mass. consistent with the patient's known malignancy. Multiple scattered nodules are identified throughout the left breast. #1-3 cm superior, posterior and medial to the known malignancy is a. 6 x 5 x 7 mm enhancing nodule. Review of the. prior mammograms demonstrates that this was not present prior to this. year's mammogram and therefore is highly. suspicious for a satellite lesion. #2--Approximately 1 cm posterior to the known malignancy is a 3 mm. nodular area of enhancement. #3--2.3 cm inferior and lateral to the known malignancy is a 5 mm. nodule These are all suspicious for satellite. lesions. #4--In the far lateral aspect of the breast, there is a 1-2 mm. enhancing nodule. #5--Even more laterally, is a 3-4 mm enhancing nodule. This contains a. fatty hilum and these latter two nodules are. likely lymph nodes given their far lateral location and appearance. #6--In the posterior medial left breast a 3 mm enhancing nodule is seen. #7- in the far medial skin of the left breast there is a 4 x 2 x 4 mm. enhancing nodule. This could represent either a. benign or malignant skin tesion and therefore clinical correlation is. recommended. Interspersed between the known malignancy and the suspected satellite. lesions, are vague areas of subthreshold nodular. enhancement. A 1.6 and 1.4 cm area of this type of enhancement is seen in. the medial breast. Comparison of the MIP. projections show that these of. .Il areas of scattered enhancement and. nodularity are very asymmetric to the right and. therefore may relate to additional disease Inclusion of all of the. areas of enhancement shows that a large percentage. of the breasts may be involved with disease measuring up to 8.0 x 6.8 cm. Multicentric disease should be excluded. If breast conservation therapy. is considered, then biopsy of one or more of the. nodules will be needed. The 7 mm lesion, 3 cm from the known malignancies. (#1) would likely be visible by ultrasound and. amenable to biopsy. Some of the smaller more posterior nodules in the. medial breast may not be visible by ultrasound. IMPRESSION: 1. The patient's known malignancy is identified in the anterior. upper-outer quadrant and measures 1.5 cm. There are. multiple scattered renhancing nodules seen within the breast that are. suspicious for satellite lesions. Biopsies as. clinically indicated should be performed. HISTORY. Allergies: NKDA. Current Meds: see attached list please. BP-. VITAL SIGNS: P. PHYSICAL. See proprocedure record. WNL. Abnormal. N/A. Mental Status. HEENT. Heart. Lunga. Abdomen. Pelvic Extremities Syndrome ear thritis, ostro arthritis. PMH: Surgical Hx: left brease biopsy. Family. Hx: - breast caneer. Abnormal (explain) Pathology Invasive dectal carcinonia. Lab/X-Ray: CC/Present Illness Normal left breastcancer, Sibronualgia, Signeris syndrome, rheumatoid. Admit / Pre-Op Diagnosia: Treatment. Plan: with central hode mapping. M.D. Time -. H&P Date. lignature. Surgery Date.

expanded version (tokens=4044) : 
 Histological classification: 
- Left axillary sentinel lymph node: Metastatic carcinoma, size - 0.3 cm
- Left breast mastectomy: Residual invasive ductal carcinoma, size - 2.5 cm
- Multifocal areas of ductal carcinoma in situ (DCIS) present in uninvolved quadrants of breast, high grade comedo carcinoma type, largest area - approximately 1.0 cm.

Necrosis: Shaggy, necrotic cavity consistent with previous biopsy site located adjacent to residual invasive ductal carcinoma.

Tumor infiltrating lymphocytes: No mention in the report.

Histological grade: Grade I (Architectural score: 2/3, Nuclear score: 2/3, Mitotic score: 1/3, Total score: 5/9)

Lymphovascular invasion: No mention in the report.

Calcification: No mention in the report.

Receptor status:
- Estrogen receptor (ER): Positive (91%), staining intensity - strong
- Progesterone receptor (PR): Positive (53%), staining intensity - strong
- Ki-67 (MIB1) proliferation marker: High (33%)

IHC and ancillary testing results:
- HER2 FISH analysis: Positive HER2 oncogene amplification detected, ratio of HER2 to D17Z1 - 8.0
- Therapeutic panel results: ER-Positive (91%), PR-Positive (

prompt : Please generate a succinct report in 75 words from the above information. Exclude any filler words or sentences. If something is not mentioned or specified, exclude it from the report. Low verbosity.

final output (tokens=4230) : 
 Histological analysis revealed a subtype LumA breast cancer. Left axillary sentinel lymph node contained metastatic carcinoma measuring 0.3 cm. Left breast mastectomy showed residual invasive ductal carcinoma, size 2.5 cm, with multifocal areas of high-grade comedo DCIS present. Histological grade was Grade I (architectural score: 2/3, nuclear score: 2/3, mitotic score: 1/3). ER and PR were positive with strong staining intensity (ER: 91%, PR: 53%). HER2 FISH analysis indicated positive HER2 oncogene amplification (HER2:D17Z1 ratio - 8.0).

