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, This report is for inquiry only. The authorized report is available in the Department of. Pathology. Patient Information. Account. Patient-Name. Number. Female. y.o.). Result Date and Time. Result Narrative. Path No.: Client: (Age : F Collected: Soc. Sec. #: Physician (s) : Pre-Operative/Clinical History. Right breast CA. Specimen (s) Received. A: RIGHT BREAST NIPPLE MARGIN (SUTURE = DUCTS ADJACENT TO NIPPLE). B: LEFT BREAST, SUTURE = AXILLARY TAIL. C: RIGHT BREAST, STITCH MARKS AXILLARY TAIL. Gross Description. Specimen A, received fresh for frozen section labeled right breast nipple margin,. suture = duct adjacent to nipple, consists of a 2.0 x 1.3 x 0.3 cm nartion of. skin. The specimen is entirely submitted for frozen section in. Specimen B, received in formalin labeled left breast, suture - axillary tail. Specimen type. Simple mastectomy without axillary tail or. pectoralis muscle. The anterior aspect is inked yellow, the apparent nipple site. is inked blue, the posterior/deep margin is inked black and the anterior lateral. aspect is inked orange for orientation purposes. Specimen size/description: 16.0 cm ML x 11.5 cm SI x 2.7 cm AP, 205 gm. Laterality: Left. Cut surfaces: The cut surfaces are comprised. of approximately. 85% of markedly dense fibrous tissue to 15% of adipose tissue that is. predominantly at the periphery. A discrete lesion is not grossly identified. Detached within the container is a small unremarkable fibroadipose tissue. fragment that is 4.0 x 2.5 x 0.6 cm. Nipple/areolar complex: Absent. The apparent nipple site is inked blue. Skin: Absent. Lymph node sampling: None identified. Representative sections as follows: (B1. Nipple site (blue), perpendicular section. (B2), 3). Upper outer quadrant (B3 questionable lymph node bisected, inked. yellow). (B4, 5). Upper inner quadrant. (B6, 7). Lower outer quadrant. (B8, 9). Lower inner quadrant. (B10). Detached fibroadipose tissue fragment. Specimen C, received without fixative labeled right breast, stitch marks axillary. tail. Specimen type: Simple mastectomy without axillary tail or. pectoralis muscle. The anterior aspect is inked yellow, the posterior/deep margin. is inked black and anterior lateral aspect adjacent to the suture is inked orange. for orientation purposes. Specimen size/description: 16.5 cm ML X 12.0 cm SI x 2.8 cm AP, 205 gm. Laterality: Right. Tumor size: 1.7 x 1.5 x 1.3 cm. Tumor site: 12 o' clock position approximately 4.0 cm from the. apparent nipple site. Tumor description: Spiculated borders with a tan focally gritty. rubbery cut surface surrounded by markedly dense fibrous tissue. There is a. metallic clip centrally within the tumor. Deep margin (black) : 0.2 cm. Nipple/areolar complex: Absent. The apparent nipple site is inked blue. Skin: Absent. Lymph node sampling: Not identified. Other: The remaining cut surfaces are comprised of. approximately. 90% of dense fibrous tissue to 10% of adipose tissue predominantly. focused at the periphery. Representative sections as follows: (C1). Apparent nipple site (blue), perpendicular section. (C2). Deep margin (black) closest to tumor, perpendicular section. (C3-6). Tumor. (C7). Upper inner quadrant. (C8). Upper outer quadrant. (C9). Lower inner quadrant. (C10). Lower outer quadrant. Total fixation time in formalin: 30.0 hours. Intraoperative Consultation. Specimen A, frozen section diagnosis of "no malignancy seen" is rendered by Dr. Microscopic Description. Sections (AF1) demonstrate benign breast tissue including multiple large ducts. Neither atypical epithelial hyperplasia nor malignancy is seen. Sections (B1-B10) demonstrate breast parenchyma with benign fibrocystic disease,. apocrine metaplasia and benign intraductal epithelial hyperplasia. There is a. benign intramammary lymph node (B3) Neither atypical epithelial hyperplasia nor. malignancy is seen. Sections (C1, C7, C10) demonstrate breast parenchyma with benign fibrocystic. disease and benign intraductal epithelial hyperplasia. Sections (C2) of breast demonstrate invasive lobular carcinoma associated with. lobular carcinoma in situ. The invasive tumor cells demonstrate negative membrane. staining for E-cadherin immunostain. The invasive carcinoma to adjacent inked. deep margin distance (C2) is 1.5 mm. Summary of Pathologic Findings. Breast Carcínoma. Specimen: Total breast. Procedure: Nipple-sparing total mastectomy. Lymph node sampling: None with current specimen. Previous right axillary. sentinel lymph node biopsies. Specimen integrity: Single intact specimen. Specimen size: 16.0 x 11.5 x 2.7 cm. Laterality: Right breast. Tumor site: 12 o'clock position. Size of invasive component: 1.7 x 1.5 x 1.3 cm. Tumor focality: Single focus of invasive carcinoma. Macroscopic and microscopic extent of tumor: Skin: Not present. Nipple: Not present. Skeletal muscle: Not present. Histologic type: Invasive lobular. Combined histologic grade : ". Tubule formation: Score 3. Nuclear pleomorphism: Score 2. Mitotic count: Score 1 (less than 1 mitoses per 10 hpf, hpf area 0.274 mm2) . Total Nottingham score: Score 6 (grade II) . Lymph-vascular invasion: Absent. Ductal carcinoma in situ: Absent. Extensive intraductal component (EIC) : Not applicable. Extent: Not applicable. Lobular carcinoma in situ: Present. Deep margin: involved. Invasive carcinoma to deep margin distance is 1.5. mm. Lymph nodes: No lymph nodes submitted with current specimen. The results of the. previous right axillary sentinel. lymph node biopsies. are given below. Number of sentinel nodes examined: 5. Total number of nodes examined: 5. Number of nodes with macrometastasis: O. Number of nodes with micrometastasis: 0 (. Number of nodes with isolated tumor cells: 0 (. Size of largest metastatic deposit: Not applicable. Extracapsular extension: Not applicable. Method of evaluation of sentinel lymph nodes: Three 80 um interval H&E. stained sections and two 80 um interval cytokeratin AE1/AE3 immunohistochemical. stains on all sentinel lymph node blocks. TNM stage: pTIc pNO (sn) (i-). pMX. Ancillary studies (estrogen receptor, progesterone receptor, HER2/neu and. Ki-67) : Performed on this specimen, results pending. Microcalcification: Not identified. Diagnosis. SPECIMEN A, RIGHT BREAST, NIPPLE MARGIN, EXCISIONAL BIOPSY: BENIGN BREAST PARENCHYMA. NO ATYPICAL EPITHELIAL HYPERPLASIA OR MALIGNANCY SEEN. SPECIMEN B, LEFT BREAST, NIPPLE-SPARING TOTAL MASTECTOMY: 4 of 6. BENIGN FIBROCYSTIC DISEASE. BENIGN INTRADUCTAL EPITHELIAL HYPERPLASIA. SPECIMEN C, RIGHT BREAST, NIPPLE-SPARING TOTAL MASTECTOMY: INVASIVE LOBUALR CARCINOMA, GRADE II. LOBULAR CARCINOMA IN SITU. INVASIVE LOBULAR CARCINOMA CLOSESLY APPROACHES DEEP MARGIN (SEE. DESCRIPTION) . BENIGN FIBROCYSTIC DISEASE. / M.D. lectronically Reviewed and Signed Out By. , M.D. on. Comment. Positive and negative controls react satisfactorily. FDA required disclaimer: These tests were developed and their performance. characteristics determined by. They have not been cleared or. approved by the U.S. Food and Drug Administration. The FDA has determined that. such clearance or approval is not necessary. These tests are used for clinical. purposes and should not be regarded as investigational or for research. This. laboratory is certified under the Clinical Improvement Amendments of 1988 (CLIA). as qualified to perform high complexity clinical laboratory testing. College of American Pathologists (CAP) - required information for. predictive/prognostio markers: 1. Type of specimen fixation and detection. system: Tissue is fixed in 10% formalin. Indirect biotin-free detection kit. is. used. 2. Clones used: ER (clone 6F11). a; PR (clone PGR 636). 1; CD117 (polyclonal. Ii HER2 (clone 4B5,. FDA. approved) ; Ki-67 (clone K3,. p53 (clone DO7,. MSH6 (clone. BC-44,. ). MSH2. ie clone G219-1129) MLH1 (. clone G168-. 728), PMS2 (clone MRQ-28,. 3. Criteria for positive results: ER. and PR: >1% of tumor cells with nuclear staining; HER2: >30% of cells show. complete membrane staining; p53: >10% of tumor cells with nuclear staining;. Proteins: complete absence of tumor nuclear staining. CPT Code (s). A: B: C: Procedures/Addend. BREAST PANEL ADDENDUM. Addendum Diagnosis. IMMUNOHISTOCHEMICAL ASSAY RESULTS. Immunohistochemical assays are performed on paraffin embedded sections containing. the invasive carcinoma and analyzed with. computer assisted image. analysis system. Results are as follows: ESTROGEN RECEPTOR: Positive, 3+ intensity, 99% of cells. PROGESTERONE RECEPTOR: Positive, 3+ intensity, 78% of cells. of 6. HER-2 OVEREXPRESSION: Positive, 3+. Ki-67: Unfavorable (46%). Please see separate report for complete details of. analysis. Ki-67 proliferation index is reported as percent positive with less than or equal. to 20% representing favorable prognosis category and greater than 20%. representing unfavorable prognosis category. Her2 positivity requires greater. than 30% of tumor cells showing complete membrane staining; score of 2+ is. indeterminate (weak positive) and will be confirmed by FISH. A score of 3+ is. strong positive. Only the strong positive (3+) Her2 shows strong concordance. with clinical trial results for Herceptin. Her2 scores of 0 and 1+ (faint. incomplete staining) are considered negative. Criteria for ER/PR positive result: >1% of tumor cells with nuclear staining. Positive and negative controls react. satisfactorily. Tissue is fixed in 10% formalin. Indirect biotin-free detection. kit and high pH HIER are used. Antibody clones: Ki-67 (30-9,. ER (clone. SP1,. PR (clone 1E2,. 1, Her2 (clone 4B5,. FDA approved) . FDA required disclaimer: The immunohistochemical stain(s) is/are used for. clinical purposes. The FDA has determined that such clearance or approval is not. necessary. It should not be regarded as investigational or for research. This. laboratory is regulated under the Clinical Laboratory Improvement Amendments of. 1988 (CLIA) as qualified to perform high complexity clinical testing. M.D. , M.D.on. Result History. PATHOLOGY GENERAL ORDER (Orde. on. - Order Result History Report. PATHOLOG OODDE. Unknown, Provider. Original Order. Additional information. ASSE Bated. View Encounter. Priority and Order Details.

expanded version (tokens=3089) : 
 Histological Classification:
- Subtype LumA
- Invasive lobular carcinoma (Grade II)
- Lobular carcinoma in situ

Description of Necrosis: 
- No mention of necrosis in the report.

Tumor Infiltrating Lymphocytes:
- No mention of tumor infiltrating lymphocytes in the report.

Histological Grade:
- Combined histologic grade: 6 (Grade II)
- Tubule formation: Score 3
- Nuclear pleomorphism: Score 2
- Mitotic count: Score 1

Lymphovascular Invasion:
- Absent lymphovascular invasion.

Calcification:
- No mention of calcification in the report.

Receptor Status and IHC:
- Estrogen receptor: Positive, 3+ intensity, 99% of cells
- Progesterone receptor: Positive, 3+ intensity, 78% of cells
- HER2/neu overexpression: Positive, 3+
- Ki-67 proliferation index: Unfavorable (46%)

Ancillary Testing Results:
- E-cadherin immunostain: Negative membrane staining for invasive lobular carcinoma cells.

Other Findings:
- No atypical epithelial hyperplasia or malignancy seen in benign breast tissues.
- Benign fibrocystic disease and benign intraductal epithelial hyperplasia seen in left breast specimen.
- No lymph nodes submitted with the current specimen.
- Deep margin involved with invasive lobular carcinoma (distance

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=3246) : 
 Histology: Subtype LumA. Invasive lobular carcinoma (Grade II) with lobular carcinoma in situ. No necrosis or lymphovascular invasion observed. Histologic grade: 6 (Grade II). Receptor status: Estrogen receptor (ER) and progesterone receptor (PR) positive. HER2/neu overexpression detected. Ki-67 proliferation index unfavorable (46%). No mention of calcification, tumor infiltrating lymphocytes, or other ancillary testing results in report. Deep margin involved with invasive lobular carcinoma.

