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 LEFT AXILLA. B. LEFT BREAST. C. UPPER OUTER QUADRANT LEFT BREAST. D. LEFT AXILLARY CONTENTS. SPECIMEN(S): A. SENTINEL LYMPH NODE #1 LEFT AXILLA. B. LEFT BREAST. C. UPPER OUTER QUADRANT LEFT BREAST. D. LEFT AXILLARY CONTENTS. AMENDMENT. This case has been amended to change ER/PR results from pending to final results in the breast synoptic report and. add ER/PR and Her2/neu synoptic reports. INTRAOPERATIVE CONSULTATION DIAGNOSIS: TPA: Sentinel lymph node #1, biopsy: Positive for carcinoma. Gross exam B: Left breast, mastectomy: Multiple tumors identified; closest is 1.5 cm from inferior/anterior aspect. By Dr called to Dr at. GROSS DESCRIPTION: A. SENTINEL LYMPH NODE #1 LEFT AXILLA. Received fresh is a tan-pink fragment of fibrofatty tissue (4.0 x 2.0 x 1.0 cm). Dissection reveals a firm presumptive. lymph node (1.4 x 1.0 x 0.8 cm). The specimen is serially sectioned and touch preps are taken. Submitted in toto in. A1. B. LEFT BREAST. Received fresh labeled "left breast" is a 1,184-gram simple mastectomy specimen (27.0 x 25.0 x 6.5 cm) with. a. stitch on the axillary tail. The specimen is partially surfaced with a tan-pink ellipse of skin (15.0 x 10.5 cm) with a 1. cm centrally located, partially flattened nipple and 3.5 cm areola rim. The skin surface is remarkable for a grey-white,. well-healed scar in the upper outer quadrant measuring 1 cm that is 8.0 cm from the nipple. The specimen is inked. and serially sectioned from medial to lateral into 14 slices; slice 1 being most medial, slice 14 being most lateral. The. nipple is located in slice 8. The cut surface reveals a grey-white, firm, stellate mass (6.0 x 5.5 x 4.0 cm) located in. the upper central and upper outer quadrants and present in slices 7, 8, 9, 10, and 11. This mass measures 1.5 cm. from all margins. A second lesion is located in the 7 o'clock position (0.8 x 0.6 x 0.5 cm) in slice 6. Lesion #2 is. located 0.6 cm from lesion #1, and measures 1.5 cm from the closest inferior margin. An ill-defined nodular area. (lesion 3) is located 4.5 cm superior to lesion #2 in slice 6 and more than 2.0 cm from the deep margin. A portion of. the specimen is submitted for tissue procurement. Gross examination did not reveal distinct 12:00 and 10:00 lesions. as designated on the request form. Lesions 2 and 3 may correspond to the 10:00 lesions as they did appear grossly. separate from the main tumor mass, although very close. The main mass appeared confluent grossly and may. encompass the 12:00 lesion. The remaining cut surfaces reveal predominantly yellow lobulated adipose. tissue. interspersed with grey-white fibrous tissue. Inked code: Superior anterior - blue, orange - inferior anterior,. black. posterior. Section code: B1: Nipple serially sectioned, slice 8. B2: Base of nipple, slice 8. B3: Nodular area above lesion #2, slice 6. B4: Lesion #2, slice 6. B5: Inferior margin, slice 6. B6: Deep margin, slice 6. B7: Superior margin, slice 7. B8-B11: Lesion #1 submitted from superior to inferior, slice 7. B12: Inferior margin, slice 7. B13: Deep margin, slice 7. B14-B16: Lesion #1 submitted from superior to inferior, slice 8. B17: Inferior margin, slice 8. B18: Deep margin, slice 8. B19-B21: Lesion #1 from superior to inferior, slice 9. B22: Deep margin, slice 9. B23: Deep margin, slice 10. B24: Skin with underlining scar, slice 11. B25-B26: Lesion #1 from superior to inferior, slice 11. B27: Deep margin, slice 11. B28: Area immediately adjacent to lesion #1, slice 12. C. UPPER OUTER QUADRANT LEFT BREAST. Received is an unoriented tan-pink fragment of fibrofatty tissue weighing 37 grams and measuring (7.0 x 6.0 x 2.0. cm). The specimen is serially sectioned to reveal predominantly yellow lobulated adipose tissue interspersed with. grey-white fibrous tissue. No lesion is grossly identified. Representative sections are submitted in cassettes C1-C4. D. LEFT AXILLARY CONTENTS. Received labeled "left axillary contents" are multiple tan-pink fragments of fibrofatty tissue aggregating to (10.0 x 9.0. x 3.0 cm). Dissection reveals 17 possible lymph nodes ranging from (0.5 x 0.5 x 0.5 cm to 2.5 x 1.5x1.0 cm). Section code: D1: Four possible lymph nodes. D2: Four possible lymph nodes. D3: Four possible lymph nodes. D4-D5: One lymph node serially sectioned. D6: One lymph node serially sectioned. D7: One lymph node bisected. D8: One lymph node trisected. D9: One lymph node serially sectioned. DIAGNOSIS: A. SENTINEL LYMPH NODE #1, LEFT AXILLA, BIOPSY: - METASTATIC CARCINOMA TO ONE LYMPH NODE (1/1). B. LEFT BREAST, MASTECTOMY: - MULTIFOCAL INVASIVE DUCTAL CARCINOMA, POORLY DIFFERENTIATED. (SBR GRADE 3), WITH MICROPAPILLARY FEATURES. - TUMOR SPANS AT LEAST 6 CM AND IS PRESENT IN CENTRAL AREA. AND UPPER OUTER QUADRANT. - DUCTAL CARCINOMA IN SITU, CRIBRIFORM TYPE, NUCLEAR GRADE 2,. MINOR COMPONENT. - MARGINS, NEGATIVE FOR CARCINOMA. EXTENSIVE LYMPHOVASCULAR INVASION. - SKIN AND NIPPLE, NEGATIVE FOR CARCINOMA. - SKELETAL MUSCLE, NEGATIVE FOR CARCINOMA. C. LEFT BREAST, UPPER OUTER QUADRANT, EXCISION: - FIBROADIPOSE TISSUE, NEGATIVE FOR CARCINOMA. D. LEFT AXILLARY CONTENTS, DISSECTION: - 1/17 LYMPH NODES WITH METASTATIC CARCINOMA WITH EXTRANODAL. EXTENSION (1/17). SYNOPTIC REPORT - BREAST. Specimen Type: Mastectomy. Needle Localization: Laterality: Left. Invasive tumor: Present. Multifocality: Yes. WHO CLASSIFICATION. Invasive ductal carcinoma, NOS 8500/3. Tumor size: Size of Invasive focus: 6cm. Tumor site: Upper outer quadrant. Central. Margins: Negative. Distance from closest margin: 1.5cm. deep. Tubular score: 3 (<10% tubule). Nuclear grade: 3. Mitotic score: 2. Modified Scarff Bloom Richardson Grade: 3 (8-9 points). Necrosis: Absent. Vascular/Lymphatic Invasion: Present. Extent: extensive. Lobular neoplasia: None. Lymph nodes: Sentinel lymph node and axillary dissection. Lymph node status: Positive 2 / 18 Extranodal extension. DCIS present. Margins uninvolved by DCIS. DCIS Quantity: Estimate 2%. DCIS type: Cribriform. DCIS location: Associated with invasive tumor. Nuclear grade: Intermediate. Necrosis: Absent. ER/PR/HER2 Results. ER: Positive. PR: Positive. HER2: Pending. Pathological staging (pTN): pT 3 N 1a. SYNOPTIC REPORT - BREAST, ER/PR RESULTS. Specimen: Surgical Excision. Block Number: B20. ER: Positive. Allred Score: 8 = Proportion score: 5 + Intensity Score 3. PR: Positive. Allred Score: 7 = Proportion Score 5 + Intensity Score 2. 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 Methodology: Mouse anti-human ER and. Comment: Inis assay can 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 Dako, 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. 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. HER2 Status Results, Immunohistochemistry Evaluation. Specimen: Breast Core Needle Biopsy. Block Number: B20. Interpretation: EQUIVOCAL. Intensity: 2+. % Tumor Staining: 50%. Fish Ordered: Yes on Date. METHODOLOGY. 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 Methodology: Rabbit anti-human HER2,. HerceptestTM (FDA-approved test kit),. Control Slides Examined: External kit-slides. provided by manufacturer (cell lines with nign, low ana negauve 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. (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 Dako HercepTest. (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. The 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. CLINICAL HISTORY: A year-old female with left multicentric disease, large 4.5 cm mass in upper outer quadrant 10 o'clock + IDC with. 3 small masses; 12 o'clock + IDC 5 mm mass. PRE-OPERATIVE DIAGNOSIS: None given. ADDENDUM: 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. by Dr. A majority of tumors cells displayed mild polysomy 17 with 2. to 3 chromosome 17 signals and 2 to 5 HER-2 signals, with a HER-2/CEP 17 Ratio </=2.0,. consistent with no amplification of the HER2/neu gene. Block used. B20. Source of case: Tissue fixation formalin-fixed tissueOutside Case No: NA. Tissue source breast Results interpreted: yes. HER2/CEP17 ratio: 1.65. 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. No. 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® therapy 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. Final Review: Pathologist. Final: Pathologist, 0. Amendment: Pathologist,. Amendment Review: Pathologist,. Amendment Final: Pathologis. Addendum: Pathologist,. Addendum Final: Patholoy.

expanded version (tokens=4563) : 
 Histological Classification: 
- Left breast: Multifocal invasive ductal carcinoma, poorly differentiated (SBR Grade 3), with micropapillary features.
- Left breast upper outer quadrant excision: Fibroadipose tissue, negative for carcinoma.
- Left axillary contents: One lymph node with metastatic carcinoma and extranodal extension.

Subtype: LumB

Description of Necrosis: Absent in all specimens examined.

Tumor Infiltrating Lymphocytes: Not mentioned in the report.

Histological grade: SBR Grade 3 (poorly differentiated)

Nuclear grade: Grade 3

Lymphovascular invasion: Extensive lymphovascular invasion is observed in the left breast mastectomy specimen.

Calcification: Not mentioned in the report.

Receptor status: ER positive, PR positive. HER2 equivocal (pending further testing).

IHC and Ancillary Testing results:
- ER (estrogen receptor): Positive, Allred Score 8.
- PR (progesterone receptor): Positive, Allred Score 7.
- HER2 (human epidermal growth factor receptor 2): Equivocal (IHC 2+), further testing (FISH) ordered.

Other Ancillary Testing Results:
- PathVysion HER-2 DNA Probe Kit: HER-2 not amplified (HER2/CEP17 ratio 1.65).

Note: This is a summary of the relevant information extracted from the breast pathology report

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=4687) : 
 Left breast: Multifocal invasive ductal carcinoma, poorly differentiated (SBR Grade 3), with micropapillary features. ER and PR positive. HER2 equivocal, further testing ordered. Extensive lymphovascular invasion observed. Sentinel lymph node #1 in the left axilla positive for metastatic carcinoma with extranodal extension. No necrosis or calcification reported.

