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 Basal, Patient Location: Date of Service: Date Received: Room: Bed: A copy of this report will be faxed to: FINAL SURGICAL PATHOLOGY REP. Diagnosis: A. LEFT BREAST, TOTAL MASTECTOMY (PROPHYLACTIC): - Multiple intraductal papillomas with atypical ductal hyperplasia (ADH). - Radial scar, 8 mm in diameter. - Fibrosis, cysts, apocrine metaplasia, and sclerosing adenosis. - Skin with seborrheic keratosis. - No invasive carcinoma is identified. - Unremarkable intramammary lymph node. B. & C) RIGHT BREAST AND AXILLARY LYMPH NODES, MODIFIED RADICAL. MASTECTOMY: - Invasive high-grade sarcomatoid (metaplastic) carcinoma, with areas of. matrix-producing carcinoma. - Invasive tumor measures 95 mm in diameter. - Lymphatic invasion is identified near the periphery of the tumor. - Resection margins are widely free of invasive carcinoma. - Invasive carcinoma is present 40 mm from the closest margin (inferior),. and is at least 50 mm from all other margins. - Twenty-two axillary lymph nodes, no tumor present. PATHOLOGIC TUMOR STAGING SYNOPSIS: Type and grade (invasive): High-grade sarcomatoid carcinoma, with areas of. matrix-producing carcinoma (subtypes of metaplastic carcinoma). Primary tumor: pT3. Regional lymph nodes: pNO. Distant metastasis: pMX. Pathologic stage: IIB. Lymphovascular invasion: Identified near periphery of tumor. Margin status: Negative (RO). Printed: This report continues (FINAL). FINAL SURGICAL PATHOLOGY REPORT. COMMENT: The majority of the invasive carcinoma is characterized by solid sheets of. high-grade malignant cells. In some areas, tumor cells have prominent spindle cell. morphology, whereas in other areas, the malignant cells retain vaguely epithelioid. (rounded) shapes, but have highly anaplastic nuclear features. Prominent tumor-. associated necrosis is present, and no discernable glandular differentiation is evident. The morphologic appearance of these areas is compatible with designation as. sarcomatoid (metaplastic) carcinoma. Other areas of tumor contain malignant cells. present in close proximity to blue-gray chondromyxoid or hyaline matrix, compatible. with at least focal matrix-producing carcinoma, another subtype of metaplastic breast. carcinoma. Immunohistochemical staining shows some scattered tumor cells to be positive for. p63 and CK5/6, in support of designation as metaplastic carcinoma. This Is in. accordance with IHC staining performed on the previous biopsy. In addition,. some tumor cells are positive for smooth muscle actin, a feature not uncommon in. metaplastic sarcomatoid carcinoma, representing immunohistochemical evidence of. differentiation towards a myoepithelial phenotype. Staining for. and S100. are negative in tumor cells. Focally, the invasive carcinoma is seen in association with a fibroepithelial neoplasm, a. portion of which appears to be necrotic. The stroma of the fibroepithelial neoplasm. does not show striking hypercellularity, except for a few areas in which there is. granulation tissue. The lack of stromal cellularity within this lesion argues that the. fibroepithelial neoplasm is best regarded as fibroadenoma, even though the lesion has. some architectural features of phyllodes tumor. In some areas, high-grade malignant. cells are seen to line the ducts/clefts of the fibroadenoma, suggesting that the. carcinoma is invading into the fibroadenoma. Another possibility is that the carcinoma. has arisen out of the epithelial component of the fibroadenoma, which is considered. less likely. Sarcomatoid carcinomas are highly malignant tumors with capability to metastasize to. distant sites (hematogenous metastasis to sites such as liver, lung, brain, etc.), even. though some studies have shown that metastasis to axillary lymph nodes are. significantly less frequent than in more typical cases of breast carcinoma (i.e. invasive. Printed: This report continues. FINAL SURGICAL PATHOLOGY REPORT. ductal carcinoma, NOS). Dr. i Dr. have reviewed. representative slides from this case, and concur with the diagnosis of metaplastic. breast carcinoma. Pathology Consultation Report. Printed: This report continues. FINAL SURGICAL PATHOLOGY REPORT. Breast (AJCC Cancer Invasive Staging Tumor Handbook, Staging 7th Ed., Information and CAP protocol, Oct 2009). This staging also incorporates: Previous biopsy: Breast profile. Total breast, axillary lymph nodes, and. Specimen type: contralateral breast. Modified radical mastectomy and contralateral. Specimen procedure: prophylactic mastectomy. Axillary dissection. Lymph node sampling: Single intact specimen. Specimen integrity: Right. Specimen. Specimen (other than mastectomy): laterality: size. INVASIVE TUMOR FEATURES: 95 mm. Invasive tumor size: Upper outer quadrant. Invasive tumor site: Single focus of invasive carcinoma. Invasive tumor focality: Sarcomatoid (metaplastic) carcinoma, with areas. Histologic type: of matrix producing carcinoma. 3 (high-grade). Total Nottingham Grade: 3 of 3. Tubule formation: 3 of 3. Nuclear Pleomorphism: 3 of 3. Mitotic count for Nottingham: Greater than 20 mitosis per 10 high power fields. Mitotic count: N/A. Other Grading System: Not identified. Lymphatic invasion: MARGIN STATUS FOR INVASIVE COMPONENT: 40 mm. Distance of tumor from margins: Inferior. Closest margin: Invasive and in situ carcinoma are present at. Other margins: least 50 mm from all other margins. DCIS not present. IN-SITU CARCINOMA (DCIS) FEATURES: FINAL SURGICAL PATHOLOGY REPORT. LOBULAR CARCINOMA IN-SITU (LCIS): Absent. Skin: Unremarkable. Nipple: Unremarkable. Skeletal Muscle: Not present. INVASIVE PATHOLOGIC TUMOR STAGING (pTNM). Primary tumor (pT): pT3. Regional lymph nodes (pN): pNO. Distant metastasis (pM): pMX. RECEPTOR STATUS AND HER2/NEU: ProPath, CM11-1333. Estrogen receptors: Negative (0% positive cells). Progesterone receptors: Negative (0% positive cells). Her2/neu: Not overexpressed (IHC score 0). Ki-67 proliferative index: 50% positive cells. Source of Specimen: A. Left Breast total mastectomy. B. Right Breast total mastectomy. C. Additional Axillary Contents. Clinical History/Operative Dx: Cancer, female breast, upper-outer. Gross Description: A. The specimen is labeled left simple mastectomy and is received in formalin. It consists of a. mastectomy specimen which weighs 1430 grams. A white suture at one end of the skin ellipse designates. the lateral portion of the excision. With this orientation the specimen measures 26 cm from medial to. lateral, 17.5 cm from superior to inferior, and is up to 6 cm from superficial to deep. There is an overlying. broad ellipse of tan-white skin which measures 26 x 15 cm. In the central slightly medial portion of the. skin there is a 4 cm areola with a protuberant 1.2 cm nipple. The medial-inferior skin displays a 0.7 cm. plaque-like brown skin lesion. No other skin lesions are present. The anterior-superior margin is inked blue,. the anterior-inferior margin is inked green, and the posterior margin, which consists of predominantly. smooth fascial tissue, is inked black. The breast is serially sectioned at close intervals to reveal coarsely. lobulated fatty tissue and scattered tan-white fibrous parenchyma. The fibrous parenchyma contains. multiple punctate areas of fine nodularity throughout the breast with scattered blue-dome cysts. There are. no areas which have a stellate or retracted appearance. There are no lymph nodes identified in the. Printed: This report continues (FINAL). FINAL SURGICAL PATHOLOGY REPORT. axillary portion of the tissue. Representative sections are submitted. Section summary: A1) nipple and tissue just deep to nipple,. A2) inferior skin lesion,. A3) representative breast tissue upper-inner quadrant,. A4) representative breast tissue lower-inner quadrant,. A5) representative breast tissue upper-outer quadrant,. A6) representative breast tissue lower-outer quadrant,. A7) representative tissue central breast including representative deep margin. Following review of the initial slides, additional representative sections from the central portion of the. breast tissue are submitted from medial to lateral in cassettes A8-A12. A lymph node and random sections. of breast tissue are submitted in cassette A13. B. The specimen is labeled right modified radical mastectomy and is received without fixative. It consists. of a mastectomy specimen which weighs 1681 grams. A suture marks the axillary tissue. With this. orientation the breast measures 26 cm from medial to lateral, 16 cm from superior to inferior, and 6.5 cm. from superficial to deep. The axillary portion measures 9 x 7 x 3 cm. The breast has an overlying broad. ellipse of tan skin measuring 25 x 16 cm. There is a medial and slightly inferiorly located poorly. delineated 4 cm areola with a protuberant 1.2 cm nipple. The central skin surface bulges outward in the. periareolar area over a distance approximately 8 cm. The skin is otherwise tan-white and unremarkable. Sections of the bulging anterior skin reveal a partially hemorrhagic cavitary lesion which measures 7 cm. from medial to lateral, 7 cm from superior to inferior, and up to 3.5 cm from superficial to deep. The. cavitary space is filled with gray-tan tissue which has a finely lobulated appearance. Just inferior to the. cavitary space along the lateral edge there is creamy tan-white moderately firm fibrous breast. parenchyma. Representative tissue obtained for research purposes. Following fixation the anterior-. superior margin is inked blue, the anterior-inferior margin is inked green, and the posterior margin, which. consists predominantly of smooth fascial tissue, is inked black. The breast is serially sectioned from the. posterior surface at close intervals to reveal the cavitary lesion described above. The breast parenchyma. is otherwise tan-white and has fine palpable nodularity most notable in the lower-inner quadrant. The. creamy tan-white tissue at the posterior edge of the hemorrhagic lesion is 5 cm from the closest superior. margin, 4 cm from the closest inferior margin, 5.5 cm from the closest deep margin, 7.5 cm from the. closest medial margin, and 13 cm from the closest lateral margin. At its greatest dimension which is. superior-inferior the creamy white tissue at the posterior edge of the cavitary lesion measures 6.5 cm. Representative sections are submitted. Section summary: B1) nipple and tissue just deep to nipple,. B2) representative skin with closest approach of hemorrhagic cavitary lesion,. B3) medial edge of hemorrhagic lesion,. B4-B5) sections cavitary lesion progressing centrally,. B6-B8) central-posterior portion of cavitary lesion with firm white tissue,. B9-B10) representative sections from lateral portion of hemorrhagic lesion,. B11) possible intramammary node 2.5 cm lateral to hemorrhagic lesion,. B12) representative breast tissue upper-inner quadrant (medial to hemorrhagic lesion),. B13) representative tissue lower-inner quadrant of breast (medial to hemorrhagic lesion),. Pathology Consultation Report. This report continues (FINAL). Printed: FINAL SURGICAL PATHOLOGY REPORT. B14) representative breast tissue upper-outer quadrant (lateral to hemorrhagic lesion),. B15) representative breast tissue lower-outer quadrant (lateral to hemorrhagic lesion),. B16) deep surgical margin closest to posterior edge of cavitary lesion,. B17-B19) nodal tissue trimmed from largest predominantly fatty (3.9 cm) node,. B20-B21) second largest node serially sectioned,. B22) single node serially sectioned,. B23) two nodes bivalved (one inked),. B24) two node, one inked and trisected, one trisected,. B25) four possible nodes intact,. B26) two nodes bivalved (one inked),. B27) smaller possible nodes intact. Following review of the initially submitted sections, additional sections of the tumor are submitted as. follows: B28-B32) polypoid necrotic appearing portion of tumor,. B33) breast tissue surrounding tumor,. B34-B35) representative sections of solid tan portion of tumor. (. C. The specimen is labeled additional axillary contents right axilla and is received in formalin. It consists. of a 1.8 cm fragment of fibrofatty tissue. On dissection there are two intact nodes, the larger node. measuring 1.5 x 1.1 x 0.6 cm and the smaller node 0.6 cm in maximum dimension. The larger node is. sectioned and submitted in cassette C1. The smaller node is bivalved and submitted in cassette C2. (DS). Microscopic Description: A. Microscopic sections have been examined. The microscopic findings are reflected in the diagnosis. rendered. B. Microscopic sections have been examined. The microscopic findings are reflected in the diagnosis. rendered. IHC stains: p63, CK5/6, SMA,. S100. See comment for staining results. Appropriate positive and negative controls reviewed. C. Microscopic sections have been examined. The microscopic findings are reflected in the diagnosis. rendered. Pathology Consultation Report. Printed: REPRINT: Orig. printing on.

expanded version (tokens=3448) : 
 Histological classification:

A. LEFT BREAST, TOTAL MASTECTOMY (PROPHYLACTIC):
- Multiple intraductal papillomas with atypical ductal hyperplasia (ADH)
- Radial scar, 8 mm in diameter
- Fibrosis, cysts, apocrine metaplasia, and sclerosing adenosis
- Skin with seborrheic keratosis
- No invasive carcinoma is identified
- Unremarkable intramammary lymph node 

B. & C) RIGHT BREAST AND AXILLARY LYMPH NODES, MODIFIED RADICAL MASTECTOMY:
- Invasive high-grade sarcomatoid (metaplastic) carcinoma, with areas of matrix-producing carcinoma
- Invasive tumor measures 95 mm in diameter
- Lymphatic invasion is identified near the periphery of the tumor
- Resection margins are widely free of invasive carcinoma
- Invasive carcinoma is present 40 mm from the closest margin (inferior), and is at least 50 mm from all other margins
- Twenty-two axillary lymph nodes, no tumor present

Histological grade: High-grade

Nuclear grade: Not specified

Tumor infiltrating lymphocytes: Not mentioned

Necrosis: Prominent tumor-associated necrosis is present

Lymphovascular invasion: Identified near periphery of tumor

Calcification: Not mentioned

Receptor status: 
- Estrogen receptors

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=3599) : 
 The pathology report reveals a high-grade sarcomatoid (metaplastic) carcinoma in the right breast, with areas of matrix-producing carcinoma. The tumor measures 95 mm in diameter and shows lymphatic invasion near its periphery. No invasive carcinoma is found in the left breast, but multiple intraductal papillomas with atypical ductal hyperplasia are present. The total mastectomy margins are clear, and no tumor is detected in the axillary lymph nodes. Further testing indicates negative estrogen receptor status.

