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, SURGICAL PATHOLOGY REVISED REPORT. Diagnosis: Breast, right, mastectomy. Tumor type: invasive ductal carcinoma with extensive fibrosis (see comment). Nottingham combined histologic grade: 2. Tubule formation score: 2. Nuclear Pleomorphism Score: 3. Mitotic count score: 2. Focality of tumor: single focus. Tumor size (greatest dimension): 3.5 cm (see comment). Lymphovascular invasion: present (A8). In Situ Component: present. In Situ Component type/Architecture pattern: solid and cribriform. In Situ Component nuclear grade: 3. In Situ Component necrosis: none identified. In Situ Component extent/size: DCIS is present with tumor and focally away from tumor. Size is approximately 6 mm. Extensive intraductal component: Absent. The DCIS comprises approximately 2% of total tumor. Nipple involvement: none identified. Skin involvement: none identified. Margin status: nvasive component: >5 mm. in Situ component: >5 mm. Axillary lymph nodes: Total number with metastasis: 7. Total number examined: 10 (1 from part A, 9 from part B below). Size of largest metastasis: 1.3 cm (A14, A15). Extracapsular extension: present and extends into fibrous septae of surrounding fibroadipose tissue. Microcalcifications: associated with invasive carcinoma, ductal carcinoma in situ, and sclerosing adenosis. Other findings: - Fibrocystic changes with ductal epithelial hyperplasia. - Sclerosing adenosis. - Benign skeletal muscle. AJCC PATHOLOGIC TNM STAGE: pT2 pN2a. Note: This pathologic stage assessment is based on information available at the time of this report, and is subject to. change pending clinical review and additional information. B: Soft tissue, axillary contents, removal. - Six of nine lymph nodes with metastatic carcinoma (6/9). - Largest metastatic focus 1.3 cm. - Extracapsular extension is present. Comment: Although two foci of carcinoma were previously identified radiologically (2.0 cm and 1.5 cm) and sampled by core. biopsy, only one large focus of tumor is identified grossly in this mastectomy specimen. Gross examination has. been repeated several times and additional sections submitted with no second tumor nodule identified. A second firm. nodule was identified 3 cm away from the first, but microscopically it appeared to be sclerosing adenosis and this was. confirmed with positive immunostaining with p63 and smooth muscle myosin heavy chain (A17). The current single. focus of tumor is extremely fibrotic and measures 3.5 cm (which is equal to the two previously identified foci combined). Of the two foci initially seen, one was described as superficial and the other deep, but they were very close to each. other (10:00 and 9:00 to 10:00). The current large focus is located at 9:00 to 10:00 and extends from superficial to. deep. Histologically, the tumor demonstrates morphologic features consistent with both of the previous core biopsies. (predominant morphology is that of the "deep" core with some areas resembling the "superficial" core). The. different-appearing areas merge into each other and are part of the same nodule of tumor. Immunostain for e-cadherin was performed on a couple of areas that have lobular features (similar to the superficial. core biopsy); it is positive, confirming the ductal phenotype of the tumor (A8, B3). Immunostain for AE1/AE3 was. performed on block B8 and confirms no metastatic tumor in that lymph node. Immunohistochemical stains for ER, PR and HER2/Neu were performed with the following results. These stains were. performed on tumor that resembles the deep core biopsy, and results are similar to those from the deep core biopsy. (except HER2 is 1+ instead of 0, but still considered negative). Material from an additional block (with areas resembling. the superficial core) has been submitted to see if it stains similarly to the superficial core; the original superficial. core showed HER2 at 2+ and amplification by FISH. These results will be reported in an addendum. Estrogen receptor (: , clone SP1): Interpretation: Positive. Computer-assisted quantitative score: 100%. Progesterone receptor (. clone 1E2): Interpretation: Positive. Computer-assisted quantitative score: 12%. HER2/neu (Ventana, clone 4B5, FDA-approved): Interpretation: Negative (not overexpressed). Computer-assisted quantitative score: 1+. Site: right breast. Performed on block: A7. Fixation: 10% neutral buffered formalin. Fixation time: 6-48 hours. Reference range: Estrogen receptor and progesterone receptor: <1%=NEGATIVE, 1-10% WEAK POSITIVE, >10% POSITIVE. HER2/neu: 0,1=NEGATIVE FOR OVEREXPRESSION, 2=INDETERMINATE, 3=POSITIVE FOR OVEREXPRESSION. Comment: The quantitative scores reported above were obtained using the FDA-approved. The control slides for this case show appropriate staining. Some of the immunohistochemical reagents used in this case may be classified as analyte specific reagents (ASR) or. research use only (RUO) reagents. These were developed and have performance characteristics determined by the. These reagents have not been cleared or. approved by the US Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not. necessary. These tests are used for clinical purposes. They should not be regarded as investigational or for research. This. laboratory is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) as qualified to perform. high complexity clinical laboratory testing. Intraoperative Consult Diagnosis: Clinical History: with right breast cancer. Gross Description: Received are two appropriately labeled containers. Container A: Specimen fixation: formalin. Time in fixative: 9 hours. Type of mastectomy: modified radical. Weight of specimen: 970 grams. Size of specimen: 25 cm medial to lateral, 24 cm superior to inferior, and 3.5 cm anterior to posterior. Orientation of specimen: Inking: lateral=yellow, anterior=blue, posterior=black. Skin ellipse dimensions: 21.5 x 16.3 cm. Nipple/areola: 0.6 cm/3.4 cm, respectively. Axillary tail: absent. Biopsy site: not identified. Discrete Mass(es): present; one large firm mass is identified. The cut surface is tan with small areas of hemorrhage and. fat necrosis. The mass is well demarcated and lobular in shape. Number of discrete masses: one. Size of mass (es)/biopsy site: 3.5 x 2.9 x 1.8 cm. Location of mass(es): upper outer quadrant. Distance of mass/biopsy site from surgical margin: 2.4 cm from the black inked posterior margin and 4.5 cm from the. closest blue inked anterior margin. Gross involvement of skin or fascia/muscle by tumor: absent. Description of remaining breast: The remainder of the breast tissue is predominantly yellow lobulated fat which is. interspersed with delicate strands of white fibroconnective tissue. Other remarkable features: There is an arterial graft in the subareolar breast tissue that runs from the superior to. inferior aspects of the specimen. This graft is 11.7 cm long and 1.4 cm in diameter. Tissue submitted for special investigations: tumor and normal tissue are submitted for. Addendum: On further gross examination, a second mass is identified. The second mass is approximately 3 cm medial to. the first mass. The second mass is a well circumscribed, white firm nodule measuring 1.5 x 1.0 x 1.0 cm. This mass is 7.5. cm from the nearest blue inked anterior margin, 3.0 cm from the nearest black inked deep margin, and 3.0 cm from the. skin. There is no evidence of hemorrhage or necrosis associated with this mass. (Histologically, this mass is sclerosing. adenosis.). Block Summary: Inking: lateral=yellow, anterior=blue, posterior=black). A1 - perpendicular sections of nipple. A2 - areola, en face. A3 - representative section of mass with closest black inked posterior margin. A4 - representative section of breast tissue from closest anterior margin. A5-A9 - representative sections of mass. A10 - representative section of breast tissue from upper inner quadrant. A11 - representative section of breast tissue from lower inner quadrant. A12 - representative section of breast tissue from lower outer quadrant. A13 - representative section of breast tissue from upper outer quadrant. A14,A15 - intraparenchymal lymph node, serially sectioned. A16-A18- second mass, submitted entirely from lateral to medial. Container B holds a 9.5 x 5.4 x 3.5 cm mass of yellow/tan lobulated fat with associated connective tissue. This specimen. is unoriented. The specimen is dissected to identified lymph node candidates and multiple lymph node candidates. are identified. The largest candidate measures 3.1 x 1.9 x 1.0 cm. Block summary: 1,B2 - largest lymph node candidates, serially sectioned. B3 - one lymph node candidate, serially sectioned. B4 - one lymph node candidate, serially sectioned. B5 - one lymph node candidate, serially sectioned. B6 - three lymph node candidates. B7 - one lymph node candidate, serially sectioned. B8 - one lymph node candidate, serially sectioned. B9 - two lymph node candidates. B10 - three lymph node candidates. B11 - one lymph node candidate, bisected. B12 - one lymph node candidate. Grossing Pathologist: Light Microscopy: Light microscopic examination is performed by Dr. For cases in which immunostains are performed, the following applies: Appropriate internal and/or external positive and. negative controls have been evaluated. Some of the immunohistochemical reagents used in this case may be classified. as analyte specific reagents (ASR). These were developed and have performance characteristics determined by the. Anatomic Pathology Department,. These reagents have not been cleared or. oproved by the US Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not. necessary. These tests are used for clinical purposes. They should not be regarded as investigational or for research. This. laboratory is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) as qualified to perform. high complexity clinical laboratory testing. Resident Physician: Attending Pathologist: I have personally conducted the evaluation of the above specimens and have. rendered the above diagnosis(es). Procedures/Addenda: Addendum. Addendum. The following addendum is issued to report the results of estrogen receptor, progesterone receptor, and HER2/neu. immunohistochemical studies. Estrogen receptor (1. 1, clone SP1): Interpretation: Positive. Computer-assisted quantitative score: 94%. Progesterone receptor t. clone 1E2): Interpretation: Negative. Computer-assisted quantitative score: 0%. HER2/neu (. clone 4B5, FDA-approved): Interpretation: Positive (overexpressed). Computer-assisted quantitative score: 3+ (see note). NOTE: This block (A5) includes areas that show morphologies similar to both the superficial and deep cores. ER and PR are. relatively homogeneous throughout the tumor, regardless of morphology. Immunostain for HER2 is heterogeneous, but. staining does not correlate with any particular morphology. There is enough strong complete staining to interpret the. HER2 as 3+ (overexpressed); however, areas in this block range from no staining to strong and complete staining. Site: right breast. Performed on block: A5. Fixation: 10% neutral buffered formalin. Fixation time: 6-48 hours. Reference range: Estrogen receptor and progesterone receptor: <1%=NEGATIVE, 1-10% WEAK POSITIVE, >10% POSITIVE. HER2/neu: 0,1=NEGATIVE FOR OVEREXPRESSION, 2=INDETERMINATE, 3=POSITIVE FOR OVEREXPRESSION. Comment: The quantitative scores reported above were obtained using the FDA-approved. The control slides for this case show appropriate staining. Jome of the immunohistochemical reagents used in this case may be classified as analyte specific reagents (ASR) or. research use only (RUO) reagents. These were developed and have performance characteristics determined by the. These reagents have not. been cleared or approved by the US Food and Drug Administration (FDA). The FDA has determined that such clearance. or approval is not necessary. These tests are used for clinical purposes. They should not be regarded as investigational. or for research. This laboratory is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) as. qualified to perform high complexity clinical laboratory testing.

expanded version (tokens=3279) : 
 Histological classification: The pathology report indicates a diagnosis of invasive ductal carcinoma (IDC) with extensive fibrosis. There is also a component of ductal carcinoma in situ (DCIS) present.

Subtype: The subtype of IDC is identified as LumA.

Necrosis: No necrosis is identified in the DCIS component.

Tumor infiltrating lymphocytes: There is no mention of tumor infiltrating lymphocytes in the report.

Histological grade: The Nottingham combined histologic grade is 2. The components used to determine the grade include tubule formation score (2), nuclear pleomorphism score (3), and mitotic count score (2).

Tumor size: The largest dimension of the tumor is reported as 3.5 cm.

Lymphovascular invasion: Lymphovascular invasion is present.

Calcification: Microcalcifications are associated with the invasive carcinoma, DCIS, and sclerosing adenosis.

Receptor status: Estrogen receptor (ER) is positive, with a computer-assisted quantitative score of 100%. Progesterone receptor (PR) is positive, with a computer-assisted quantitative score of 12%. HER2/neu is negative, with a computer-assisted quantitative score of 1+.

IHC and ancillary testing results: Immunohistochemical stains for ER, PR, and HER2/neu were performed. Additional testing for e-cadherin and AE1/AE3 immunostains was

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=3449) : 
 Surgical pathology report reveals a LumA subtype invasive ductal carcinoma (IDC) with extensive fibrosis. Histologic grade is 2, tumor size is 3.5 cm, and lymphovascular invasion is present. DCIS component measures approximately 6 mm. Microcalcifications are associated with IDC, DCIS, and sclerosing adenosis. ER and PR are positive, while HER2 is negative. No tumor infiltrating lymphocytes mentioned. Additional findings include fibrocystic changes, sclerosing adenosis, and metastasis in 7 out of 10 examined axillary lymph nodes.

