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 LumB, SPECIMENS: A. SENTINEL LYMPH NODE #1. B. SENTINEL LYMPH NODE 2 RIGHT AXILLA. C. SENTINEL LYMPH NODE 3 RIGHT AXILLA. D. SENTINEL LYMPH NODE 4 RIGHT AXILLA. E. SENTINEL LYMPH NODE #5. F. RIGHT BREAST. G. ADDITIONAL LATERAL TISSUE RIGHT BREAST. H. ADDITIONAL SUPERIOR RIGHT BREAST TISSUE. SPECIMEN(S): A. SENTINEL LYMPH NODE #1. B. SENTINEL LYMPH NODE 2 RIGHT AXILLA. C. SENTINEL LYMPH NODE 3 RIGHT AXILLA. D. SENTINEL LYMPH NODE 4 RIGHT AXILLA. E. SENTINEL LYMPH NODE #5. F. RIGHT BREAST. G. ADDITIONAL LATERAL TISSUE RIGHT BREAST. H. ADDITIONAL SUPERIOR RIGHT BREAST TISSUE. INTRAOPERATIVE CONSULTATION DIAGNOSIS: TPA, B, C, D, E. Sentinel lymph nodes #1, 2, 3, 4, 5, biopsies: No tumor seen. By Dr, called to Dr. at. (A,B),. C, D) and al. (E). GROSS DESCRIPTION: A. SENTINEL LYMPH NODE #1. Received is a tan-pink fatty lymph node (1.8 X 0.9 X 0.3 cm). The specimen is serially sectioned, touch. prep was performed. The specimen is submitted is cassettes A1-A3. B. SENTINEL LYMPH NODE #2 RIGHT AXILLA. Received is a tan-pink fatty lymph node X 6 x .3 cm). The specimen is serially sectioned and touch. preps are taken. The specimen is submitted in toto in B. C. SENTINEL LYMPH NODE #3 RIGHT AXILLA. Received are two tan-pink lymph nodes (1.0 X 0.3 x 0.2 cm and 1.4x.6x. .5 cm). The specimen. is. serially sectioned and touch preps are taken. The specimen is submitted as follows: C1: one lymph node, trisected. C2: one lymph node serially sectioned. D. SENTINEL LYMPH NODE #4 RIGHT AXILLA. Received is a tan-pink lymph node (1.0 x .6 : x .3 cm). The specimen is serially sectioned and touch. preps are taken. The specimen is submitted in toto in cassette D. E. SENTINEL LYMPH NODE #5. Received is a tan-pink lymph node (.9 x 7 x .2 cm). The specimen is serially sectioned and touch preps. are taken. The specimen is submitted in toto in cassette E. F./ RIGHT/BREAST. Received fresh labeled with the patient name, designated "right breast", is a simple mastectomy. specimen weighing 1181 grams and measuring overall 28 x 23 x 4.5 cm. The specimen is received. with orientation, a suture indicating the axillary aspect. The overlying beige-tan ellipse of skin measures. 21 x 11 cm. The surface demonstrates three areas of brown hyperpigmentation, the largest measuring. 1 X 0.6 cm to the smallest measuring 0.5 x 0.3 cm. A light tan raised lesion is noted at 3 o'clock on the. skin measuring 0.5 x 0.5 cm. The light tan areola measures 2.3 cm in diameter, the everted nipple. measures 1 cm in diameter. The deep margin is inked black. The specimen is serially sectioned from. axilla to medial aspect and shows a firm beige-tan lesion in the upper outer quadrant at approximately. 10 o'clock approaching the deep surgical margin at a distance of 4.3 cm. The lesion measures 2.2 x. 1.9 x 1.5 cm. An ill defined white firm fibrous area is also demonstrated at approximately 12 o'clock. measuring 1.5 x 1.2 x 1 cm. This area is located 5.5 cm from the lesion. An ill defined irregular dense. white area is shown in the lower inner quadrant measuring 2.5 x 2 x 2 cm. This area is located. approximately 10.5 cm from the lesion. The remainder of the breast parenchyma shows dark yellow. adipose tissue. A portion of the specimen was submitted for tissue procurement. Representative. sections are submitted as follows: F1-F4: the lesion in the upper outer quadrant. F5: deep margin overlying lesion. F6-F8: sections of white firm fibrous tissue at 12 o'clock. F9-F16: multiple sections of ill defined firm area in lower inner quadrant. F17-F18: representative sections of upper inner quadrant. F19-F21: representative sections of the lower outer quadrant. F22-F23: additional sections from the upper outer quadrant adjacent to lesion. F24: section of nipple. F25: section of skin demonstrating the raised tan lesion at 3 o'clock. F26: additional section of skin. F27-F28: possible lymph nodes. G. ADDITIONAL LATERAL TISSUE RIGHT BREAST. Received in formalin in a container labeled with the patient name, designated "additional lateral tissue",. is a fragment of dark yellow adipose tissue measuring 8 x 2.2 x 0.5 cm. The exterior surface is inked. black. The entire specimen is submitted in cassettes G1-G4. H. ADDITIONAL SUPERIOR RIGHT BREAST TISSUE. Received in formalin in a container labeled with the patient name designated "additional superior right. breast tissue", is a fragment of yellow adipose tissue measuring 3 X 2.2 X 1 cm. The entire specimen. is. submitted in cassettes H1 and H2. DIAGNOSIS: A. SENTINEL LYMPH NODE #1, EXCISION: - ONE LYMPH NODE, NEGATIVE FOR TUMOR (0/1). B. SENTINEL LYMPH NODE #2, RIGHT AXILLA, EXCISION: - ONE LYMPH NODE, NEGATIVE FOR TUMOR (0/1). C. SENTINEL LYMPH NODE #3, RIGHT AXILLA, EXCISION: - TWO LYMPH NODES, NEGATIVE FOR TUMOR (0/2). D. SENTINEL LYMPH NODE #4, RIGHT AXILLA, EXCISION: - ONE LYMPH NODE, NEGATIVE FOR TUMOR (0/1). E. SENTINEL LYMPH NODE #5, EXCISION: ONE LYMPH NODE, NEGATIVE FOR TUMOR (0/1). F. RIGHT BREAST, SIMPLE MASTECTOMY: - TWO FOCI OF INVASIVE DUCTAL CARCINOMA,. TUMOR SIZE 2.2 x 1.9 x 1.5 CM. AND 1 X 1 CM. RESPECTIVELY,. SBR GRADE III IN LARGE TUMOR FOCUS. - DUCTAL CARCINOMA IN-SITU, COMEDO AND SOLID TYPES, HIGH. NUCLEAR GRADE WITH MICROCALCIFICATIONS. - MARKED FIBROCYSTIC DISEASE AND ADENOSIS WITH EXTENSIVE. MICROCALCIFICATIONS. - SURGICAL RESECTION MARGINS, NEGATIVE FOR TUMOR. - FOCAL SEBORRHEIC KERATOSIS OF SKIN. - SEE TEMPLATE. Note: There are two foci of invasive ductal carcinoma identified: the large one is present in the upper. outer quadrant measuring 2.2 cm. This focus is SBR grade III. Another smäll tumor focus is present in. the central area at the 12 o'clock position measuring 1 x 1 cm. This focus of tumor is SBR grade I, with. tubular formation. Ductal carcinoma in-situ containing microcalcifications is associated with the large. focus of invasive carcinoma. In addition microcalcifications are also present in mutifoci of adenosis and. fibrocystic disease. G. ADDITIONAL LATERAL TISSUE RIGHT BREAST, EXCISION: - BENIGN ADIPOSE TISSUE, NEGATIVE FOR TUMOR. H. ADDITIONAL SUPERIOR RIGHT BREAST TISSUE, EXCISION: - BENIGN ADIPOSE TISSUE, NEGATIVE FOR TUMOR. SYNOPTIC REPORT - BREAST. Specimens Involved. Specimens: F: RIGHT BREAST. Specimen Type: Mastectomy. Needle Localization: Laterality: Right,. Invasive tumor: Present. Multifocality: Yes. WHO CLASSIFICATION. Invasive ductal carcinoma, NOS 8500/3. Specimen size: Size of Invasive focus 2.2cm. Additional dimensions: 1.9cm x 1.5cm. Tumor Site: Upper outer quadrant. Central. Margins: Negative. Distance from closest margin: 4.3cm. Tubular score: 3 (<10% tubule). Nuclear grade: 3. Mitotic score (Olympus 40x): 2 (7-13/10. Modified Scarff Bloom Richardson Grade: III (8-9 points). Necrosis: Absent. Vascular/Lymphatic Invasion: None identified. Lobular neoplasia: None. Lymph nodes: Sentinel lymph node only. Lymph node status: Negative 0/6. DCIS present. Margins uninvolved by DCIS. DCIS Quantity: Estimate % 15. DCIS type: Comedo. Solid. DCIS location: Associated with invasive tumor. Nuclear grade: High. Necrosis: Present. Location of CA++: DCIS. Benign epithelium. Pathological staging (pTN): pT 2NN0. SYNOPTIC REPORT - BREAST, ER/PR RESULTS. Specimens Involved. Specimens: F: RIGHT BREAST. SPECIMEN: Other. simple mastectomy. Block Number: F1. ER: Positive - Allred Score: 8 = Proportion score: 5 + Intensity Score 3. PR: Negative - Allred Score: 0 = Proportion Score 0 + Intensity Score 0. COMMENT: The Allred score for estrogen and progesterone receptors is calculated by adding the sum of the. proportion score (0 = no staining, 1 = <1% of cells staining, 2 = 1 - 10% of cells staining, 3 = 11-30% of. cells staining, 4 = 31-60% of cells staining, 5 = >60% of cells staining) to the intensity score (1 = weak. intensity of staining, 2 = intermediate intensity of staining, 3 = strong intensity of staining), with a scoring. range from 0 to 8. ER/PR positive is defined as an Allred score of >2 and ER/PR negative is defined as an Allred score of. less than or equal to 2. Methodology: Fixation Type and Length: Tissue was fixed in 10% neutral buffered formalin (. for no less than 8 and no longer than 24 hours. Antibody and Assay Metnodology: Mouse anti-human ER and PR, (. Comment: This assay can be used to select invasive breast cancer patients for hormone therapy (1). ER and PR analysis was performed on this case by immunohistochemistry utilizing the ER (ER 1D5,. 1:100) and PR (PGR 136, 1:100) antibody provided by. following the manufacturer's instructions. listed in the package insert. This assay was not modified, and adherence to all instruction and. guidelines were strictly followed. Interpretation of the ER/PR immunohistochemical staining. characteristics is guided by published results in the medical literature (1), information provided by the. reagent manufacturer and by internal review of staining performance within the. 1. Harvey JM, et al. Estrogen receptor status by immunohistochemistry is superior to the ligand-binding. assay for predicting response to adjuvant endocrine therapy in breast cancer. Clin Oncol. 17:1474-. 1481, 1999. CLINICAL HISTORY: Patient is a. year old white female who underwent an ultrasound guided core biopsy on. which. revealed invasive ductal carcinoma of right breast with extensive pleomorphic malignant appearing. microcalcifications on mammogram. The patient opted for a right simple mastectomy and sentinel. lymph node biopsy after consideration. PRE-OPERATIVE DIAGNOSIS: Right breast cancer. ADDENDUM: SYNOPTIC REPORT - BREAST HER-2 RESULTS. Specimens Involved. Specimens: F: RIGHT BREAST. HER2 Status Results, Immunohistochemistry Evaluation. SPECIMEN. Surgical Excision. Block Number: Block. F1. Interpretation: Equivocal. Intensity: 2+. % Tumor Staining: 50%. FISH Ordered YES DATE. METHODOLOGY. Methodologv: Fixation Type and Length: Tissue was fixed in 10% neutral buffered formalin (. ) for no less than 8 and no longer than 24 hours. Antibody and Assay Methodology: Rabbit anti-human HER2, HerceptestTM (FDA-approved test kit),. Control. Slides Examined: External kit-slides provided by manufacturer (cell lines with high, low and negative. HER2 protein expression), and in-house known HER2 amplified control tissue were evaluated along. with the test tissue. These control slides run along side of this patient's sample showed appropriate. staining. Adequacy of Specimen: Adequate, well preserved, clear-cut invasive carcinoma identified for. HER2 evaluation. Scoring Criterion and Scoring System: IHC Level of Expression(Score) /Tumor Cell Membrane Staining Pattern. Negative (0)/Absence of Staining. Negative (1+)/Faint Incomplete membrane Staining, >10% of Cells. Equivocal (2+)/Weak complete membrane Staining, >10% of Cells. Positive (3+)/Strong complete membrane Staining, >10% of Cells. Equivocal Category for HER2 IHC results: A HER2, 2+ staining result that is interpreted as equivocal. may not indicate gene amplification. A FISH test for HER2 gene amplification will be ordered for all. HER2 IHC 2+ results. COMMENT. This assay can be used to select invasive breast cancer patients for Trastuzumab (Hereptin) therapy. (1,2). Clinical Trials have shown that Trastuzumab substantially increases the likelihood for an objective. response and overall survival for patients with metastatic HER2-positive breast cancer, regardless of. whether HER2 tumor status was determined as IHC 3+ or FISH positive. Trastuzumab added to. adjuvant chemotherapy substantially increase disease-free survival and decreases the risk of disease. recurrence by about 50% for patients with early-stage HER2 protein over-expressed or gene amplified. invasive breast cancer (3). HER2 analysis was performed on this case by immunohistochemistry utilizing the FDA approved. (TM) test kit following the manufacturer's instructions listed in the package insert. This. assay was not modified, and adherence to all instruction and guidelines were strictly followed. Interpretation of the HER2 immunohistochemical staining characteristics is guided by published results. in the medical literature (4), information provided by the reagent manufacturer and by internal review of. staining performance within the Institute Pathology Department. HER2 TEST VALIDATION. This HER2 immunohistochemical assay has been validated according to the recently revised. recommendations and guidelines from the NCCN HER2 testing in Breast Cancer Task Force, and the. jointly issued recommendations and guidelines from ASCO and the CAP (5). 80 randomly selected. breast cancer samples were tested for HER2 by IHC as outline above and interpreted as, negative. (score 0/1+) equivocal (score 2+) and positive (score 3+) without knowledge of the previous reported. results. These cases were also blindly read using two different FISH assay as amplified or non-amplified and. the HER2/CEP17 ratios were recorded. After analyzing these results, there was 100% concordance. between the IHC and FISH results for cases that were interpreted as either positive or negative by IHC. 9 of the 80 cases were interpreted as equivocal by IHC and of these 3/9 (33%) were non-amplified by. FISH and 6/9 (66%) were found to be amplified. Pathology Department Immunohistochemistry laboratory takes full responsibility for this tests. performance and has programs in place to regularly monitor the proficiency and the interpretation of. HER2 assays. The laboratory also participates in external quality assurance HER2 programs including. the CAP proficiency testing program. REFERENCE. 1. Carlson RW, Anderson BO, Burstein HJ, et al., NCCN breast cancer clinical practice guidelines in. oncology. J Natl Compr Canc Netw. 2005;3:238-289. 2. Carlson RW, Brown E, Burstein HJ, et al., NCCN Task Force Report: adjuvant therapy for breast. cancer. J Natl Compr Canc Netw. 2006;4:S1-S26. 3. Romond EH, Perez EA, Bryant J, et al. Trastuzumab plus adjuvant chemotherapy for operable. HER2-positive breast cancer. N Eng J Med 2005;353(16):1673-84. 4. Leong ASY, Formby M, Haffajee Z, et al. Refinement of immunohistologic parameters for Her2/neu. scoring validation by FISH and CISH. Appl Immunohistochem Mol Morphol. 2006;14:384-389. 5. Wolff AC, Hammond EH, Schwartz JN, et al., American Society of Clinical Oncology/College of. American Pathologists Guideline Recommendations for Human Epidermal Growth Factor Recepto 2. Testing in Breast Cancer. Arch of Path and Lab Med 2007; 131:18-43. The followings are ER and PR results of the second tumor focus measuring 1 cm. at the central area of. breast tissue. SYNOPTIC REPORT - BREAST, ER/PR RESULTS. Specimens Involved. Specimens: F: RIGHT BREAST. SPECIMEN: Surgical Excision. Block Number: F7. ER: Positive - Allred Score: 8 = Proportion score: 5 + Intensity Score 3. PR: Positive - Allred Score: 7 = Proportion Score 4 + Intensity Score 3. COMMENT: The Allred score for estrogen and progesterone receptors is calculated by adding the sum of the. proportion score (0 = no staining, 1 = <1% of cells staining, 2 = 1 - 10% of cells staining, 3 = 11-30%. of. cells staining, 4 = 31-60% of cells staining, 5 = >60% of cells staining) to the intensity score (1 = weak. intensity of staining, 2 = intermediate intensity of staining, 3 = strong intensity of staining), with a scoring. range from 0 to 8. ER/PR positive is defined as an Allred score of >2 and ER/PR negative is defined as an Allred score of. less than or equal to 2. Methodoloav: Fixation Type and Length: Tissue was fixed in 10% neutral buffered formalin (. ) for no less than 8 and no longer than 24 hours. Antibody and Assay Methodology: Mouse anti-human ER and PR, (Dako, Carpenteria, CA). Comment: This assay can be used to select invasive breast cancer patients for hormone therapy (1). ER and PR analysis was performed on this case by immunohistochemistry utilizing the ER (ER 1D5,. 1:100) and PR (PGR 136, 1:100) antibody provided by. following the manufacturer's instructions. listed in the package insert. This assay was not modified, and adherence to all instruction and. guidelines were strictly followed. Interpretation of the ER/PR immunohistochemical staining. characteristics is guided by published results in the medical literature (1), information provided by the. reagent manufacturer and by internal review of staining performance within the Institute Pathology. Department. 1. Harvey JM, et al. Estrogen receptor status by immunohistochemistry is superior to the ligand-binding. assay for predicting response to adjuvant endocrine therapy in breast cancer. J Clin Oncol. 17:1474-. 1481, 1999. SYNOPTIC REPORT - BREAST HER-2 RESULTS. Specimens Involved. Specimens: F: RIGHT BREAST. HER2 Status Results, Immunohistochemistry Evaluation. SPECIMEN. Surgical Excision. Block Number: Block. F7. Interpretation: Negative. Intensity: 1+. % Tumor Staining: 10%. FISH Ordered NO DATE. METHODOLOGY. Methodology: Fixation Type and Length: Tissue was fixed in 10% neutral buffered formalin (Pharmco. Inc. Brookfield, CT) for no less than 8 and no longer than 24 hours. Antibody and Assay Methodology: Rabbit anti-human HER2, HerceptestTM (FDA-approved test kit), (. Control. Slides Examined: External kit-slides provided by manufacturer (cell lines with nign, low and negative. HER2 protein expression), and in-house known HER2 amplified control tissue were evaluated along. with the test tissue. These control slides run along side of this patient's sample showed appropriate. staining. Adequacy of Specimen: Adequate, well preserved, clear-cut invasive carcinoma identified for. HER2 evaluation. Scoring Criterion and Scoring System: IHC Level of Expression(Sco /Tumor Cell Membrane Staining Pattern. Negative (0)/Absence of Staining. Negative (1+)/Faint Incomplete membrane Staining, >10% of Cells. Equivocal (2+)/Weak complete membrane Staining, >10% of Cells. Positive (3+)/Strong complete membrane Staining, >10% of Cells. Equivocal Category for HER2 IHC results: A HER2, 2+ staining result that is interpreted as equivocal. may not indicate gene amplification. A FISH test for HER2 gene amplification will be ordered for all. HER2 IHC 2+ results. COMMENT. This assay can be used to select invasive breast cancer patients for Trastuzumab (Hereptin) therapy. (1,2). Clinical Trials have shown that Trastuzumab substantially increases the likelihood for an objective. response and overall survival for patients with metastatic HER2-positive breast cancer, regardless of. whether HER2 tumor status was determined as IHC 3+ or FISH positive. Trastuzumab added to. adjuvant chemotherapy substantially increase disease-free survival and decreases the risk of disease. recurrence by about 50% for patients with early-stage HER2 protein over-expressed or gene amplified. invasive breast cancer (3). HER2 analysis was performed on this case by immunohistochemistry utilizing the FDA approved. (TM) test kit following the manufacturer's instructions listed in the package insert. This. assay was not modified, and adherence to all instruction and guidelines were strictly followed. Interpretation of the HER2 immunohistochemical staining characteristics is guided by published results. in the medical literature (4), information provided by the reagent manufacturer and by internal review of. staining performance within the Pathology Department. HER2 TEST VALIDATION. This HER2 immunohistochemical assay has been validated according to the recently revised. recommendations and guidelines from the NCCN HER2 testing in Breast Cancer Task Force, and the. jointly issued recommendations and guidelines from ASCO and the CAP (5). 80 randomly selected. breast cancer samples were tested for HER2 by IHC as outline above and interpreted as, negative. (score 0/1+) equivocal (score 2+) and positive (score 3+) without knowledge of the previous reported. results. These cases were also blindly read using two different FISH assay as amplified or non-amplified and. the HER2/CEP17 ratios were recorded. After analyzing these results, there was 100% concordance. between the IHC and FISH results for cases that were interpreted as either positive or negative by IHC. 9 of the 80 cases were interpreted as equivocal by IHC and of these 3/9 (33%) were non-amplified by. FISH and 6/9 (66%) were found to be amplified. Institute Pathology Department Immunohistochemistry laboratory takes full responsibility for this tests. performance and has programs in place to regularly monitor the proficiency and the interpretation of. HER2 assays. The laboratory also participates in external quality assurance HER2 programs including. the CAP proficiency testing program. REFERENCE. 1. Carlson RW, Anderson BO, Burstein HJ, et al., NCCN breast cancer clinical practice guidelines in. oncology. J Nati Compr Canc Netw. 2005;3:238-289. 2. Carlson RW, Brown E, Burstein HJ, et al., NCCN Task Force Report: adjuvant therapy for breast. cancer. J Natl Compr Canc Netw. 2006;4:S1-S26. 3. Romond EH, Perez EA, Bryant J, et al. Trastuzumab plus adjuvant chemotherapy for operable. HER2-positive breast cancer. N Eng J Med 2005;353(16):1673-84. 4. Leong ASY, Formby M, Haffajee Z, et al. Refinement of immunohistologic parameters for Her2/neu. scoring validation by FISH and CISH. Appl Immunohistochem Mol Morphol. 006;14:384-389. 5. Wolff AC, Hammond EH, Schwartz JN, et al., American Society of Clinical Oncology/College of. American Pathologists Guideline Recommendations for Human Epidermal Growth Factor Recepto 2. Testing in Breast Cancer. Arch of Path and Lab Med 2007; 131:18-43. PathVysion HER-2 DNA Probe Kit. Analytical Interpretation of Results: HER-2 NOT AMPLIFIED. Clinical Interpretation of results. Amplification of the HER-2 gene was evaluated with interphase fluorescence in-situ. hybridization (FISH) on formalin-fixed paraffin embedded tissue sections using a chromosome. 17 centromeric probe and a HER-2 probe that spans the entire HER-2 gene in the Pathology. Core Facility by Dr.. A majority of tumors cells displayed moderate polysomy 17. with 2 to 4 chromosome 17 signals and 2 to 4 HER-2 signals, with a HER-2/CEP 17 Ratio </=2.0,. consistent with no amplification of the HER2/neu gene. Block used F1. Source of case: RPCI. Tissue fixation. formalin-fixed tissue. Outside Case No: NA. Tissue source. breast Results interpreted: HER2/CEP17 ratio: 1.46. This ratio is derived by dividing the total number of LSI HER-2/neu signals by the total number of. CEP17 signals in at least 20 interphase nuclei with nonoverlapping nuclei in the neoplastic. mammary epithelial cells. Cells with no signals or with signals of only one color are disregarded. Method of ratio enumeration: manual count. Limitations. The Vysis PathVysion Kit is not intended for use to screen for or diagnose breast cancer. It is. intended to be used as an adjunct to other prognostic factors currently used to predict disease-free. and overall survival in stage II, node-positive breast cancer patients. In making decisions regarding. adjuvant CAF treatment, all other available clinical information should also be taken into. consideration, such as tumor size, number of involved lymph nodes, and steroid receptor status. treatment decision for stage II, node-positive breast cancer patients should be based on HER-. 2/neu. gene amplification status alone. Overview of this test. FDA APPROVED REAGENT. PathVysion HER-2 DNA Probe Kit is FDA approved for selection of. patients for whom Herceptin therapv is being considered. These tests were performed in the. under the direction. of Dr.. The results of these studies should always be interpreted in the context of the. clinical, morphological, and immunophenotypic diagnosis. Microscopic/Diagnostic Dictation: M.D.. Pathologist. Final Review: M.D., Pathologist,. Final: M.D., Pathologist, 1. Addendum:., Pathologist,. Addendum Final:., Pathologist,. Addendum: M.D., Pathologist, 1. Addendum Final: M.D., Pathologist,. Addendum: M.D., Pathologist,. Addendum Final:, M.D., Pathologist, 1. Addendum:., Pathologist,. Addendum Final:, M.D., Pathologist,. Addendum: M.D., Pathologist,. Addendum Final:, M.D., Pathologist,.

expanded version (tokens=6698) : 
 Histological classification:
- Type of cancer: Invasive ductal carcinoma (IDC)
- Subtype: Luminal B

Description of the breast tumor:
- Two foci of invasive ductal carcinoma identified: larger focus in the upper outer quadrant measuring 2.2cm, and smaller focus in the central area measuring 1cm
- SBR grade III in the larger tumor focus
- Ductal carcinoma in situ (DCIS) present, predominantly comedo and solid types with high nuclear grade and microcalcifications

Necrosis: Absent in invasive tumor, present in DCIS

Tumor infiltrating lymphocytes: Not mentioned

Histological grade: SBR grade III in the larger tumor focus

Nuclear grade: High in DCIS

Lymphovascular invasion: None identified

Calcification: Present in the form of microcalcifications in DCIS

Receptor status:
- Estrogen receptor (ER): Positive (Allred score: 8)
- Progesterone receptor (PR): Negative (Allred score: 0)

Ancillary testing results:
- HER2/neu status by immunohistochemistry: Negative (score 1+ with 10% tumor staining)
- HER2/CEP17 ratio by fluorescence in-situ hybridization: Non-amplified (ratio of 1.46)

Other findings:
- Marked fibrocystic disease and adenosia with extensive microcalcifications
- Margin status

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=6867) : 
 Histological classification: Luminal B invasive ductal carcinoma (IDC). Tumor: Two foci of IDC (2.2cm, SBR grade III) and DCIS (high nuclear grade with microcalcifications). No necrosis or lymphovascular invasion. ER-positive (Allred score 8), PR-negative. HER2-negative by immunohistochemistry (score 1+ with 10% tumor staining) and non-amplified by HER2/CEP17 ratio (1.46). Significant fibrocystic disease with extensive microcalcifications. Negative surgical resection margins.


