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, SPECIMENS: TESA-E2-A15C-01A-PR. A. WLE RIGHT BREAST NEEDLE LOCALIZATION. B. SENTINEL L.N. #1 RIGHT AXILLA. C. SENTINEL L.N. #2. D. SENTINEL L.N. #3. E. SENTINEL L.N. #4. SPECIMEN(S): A. WLE RIGHT BREAST NEEDLE LOCALIZATION. B. SENTINEL L.N. #1 RIGHT AXILLA. C. SENTINEL L.N. #2. D. SENTINEL L.N. #3. E. SENTINEL ..N. #4. GROSS DESCRIPTION: A. WLE RIGHT BREAST NEEDLE LOCALIZATION. Received fresh labeled with the patient's identification and "WLE right breast needle localization" is a previously. inked 70g, 8 x 5 x 4cm needle localized lumpectomy with radiograph. Ink code: anterior-yellow, posterior-black,. superior-blue, inferior-orange, medial-green, lateral-red. Specimen is serially sectioned from lateral to medial into 9. slices revealing a tan white firm stellate 1.9 x 1.6 x 1.5cm mass, 0.7cm from the closest posterior margin in slices 3-. 6. Representatively submitted: A1-A2: lateral margin slice 1. A3: next to mass slice 2. A4-A8: slice 3 with mass - deep margin A4. A9: mass with deep margin slice 4. A10: inferior margin slice 4. A11-A12: slice 5. A13: mass with deep margin slice 6. A14: slice 7. A15: slice 8. A16: medial margin slice 9. B. SLN #1 RIGHT AXILLA. Received fresh is a tan pink lymph node 0.5 x 0.5 x 0.5cm. The specimen is sectioned and a touch prep is taken. Toto B1. C. SLN #2 RIGHT AXILLA. Received fresh is a tan pink lymph node 0.8 x 0.6 x 0.6cm. The specimen is sectioned and a touch prep is taken. Toto C1. D. SLN #3 RIGHT AXILLA. Received fresh is a tan pink lymph node 0.9 x 0.5 x 0.5cm. The specimen is sectioned and a touch prep is taken. Toto D1. E. SLN #4 RIGHT AXILLA. Received fresh is a tan pink lymph node 0.6 x 0.6 x 0.5cm. The specimen is sectioned and a touch prep is taken. Toto E1. DIAGNOSIS: A. BREAST, RIGHT, WIDE LOCAL EXCISION: INVASIVE DUCTAL CARCINOMA, SBR GRADE 2, MEASURING 1.7-CM, INVOLVING SKELETAL MUSCLE. - INTERMEDIATE NUCLEAR GRADE, DUCTAL CARCINOMA IN SITU, CRIBRIFORM TYPE. - SURGICAL RESECTION MARGINS NEGATIVE FOR TUMOR. - BIOPSY SITE CHANGES WITH FIBROSIS AND GRANULATION TISSUE. - SEE SYNOPTIC REPORT. B. LYMPH NODE, SENTINEL #1, RIGHT AXILLA, EXCISION: - ONE LYMPH NODE, NEGATIVE FOR METASTASES (0/1). C. LYMPH NODE, SENTINEL #2, RIGHT AXILLA, EXCISION: - ONE LYMPH NODE, NEGATIVE FOR METASTASES (0/1). D. LYMPH NODE, SENTINEL #3, RIGHT AXILLA, EXCISION: - ONE LYMPH NODE, NEGATIVE FOR METASTASES (0/1). E. LYMPH NODE, SENTINEL #4, RIGHT AXILLA, EXCISION: - ONE LYMPH NODE, NEGATIVE FOR METASTASES (0/1). SYNOPTIC REPORT - BREAST. Specimen Type: Excision. Needle Localization: Yes For mass. Laterality: Right. Invasive Tumor: Present. Multifocality: No. WHO CLASSIFICATION. Invasive ductal carcinoma, NOS 8500/3. Tumor size: 1.7cm. Tumor Site: Not specified. Margins: Negative. Distance from closest margin: 0.3cm. inferior. Tubular Score; 2. Nuclear Grade: 2. Mitotic Score: 2. Modified Scarff Bloom Richardson Grade: 2. Necrosis: Absent. Vascular/Lymphatic Invasion: None identified. Lobular neoplasia: None. Lymph nodes: Sentinel lymph node only. Lymph node status: Negative 0/4. DCIS present. Margins uninvolved by DCIS. DCIS Quantity: Estimate 1%. DCIS Type: Cribriform. DCIS Location Associated with invasive tumor. Nuclear grade: Intermediate. Necrosis: Absent. ER/PR/HER2 Results. ER: Positive. PR: Positive. HER2: Pending. Performed on Case: Pathological staging (pTN): pT 1c N 0. CLINICAL HISTORY: None provided. PRE-OPERATIVE DIAGNOSIS: None provided. INTRAOPERATIVE CONSULTATION: A. GROSS EXAMINATION: WLE right breast- 1. 9cm mass 0.7cm from closest deep margin. Diagnosis called to Dr. at. by Dr. TPB-TPC-TPD-TPE: Negative for carcinoma. Diagnosis called to Dr. at. by Dr. ADDENDUM: SYNOPTIC REPORT - BREAST HER-2 RESULTS. Specimen: Surgical Excision. Block Number: A9. Interpretation: EQUIVOCAL. Intensity: 2+. % Tumor Staining: 20%. Fish Ordered: Yes on Date. METHODOLOGY: Tissue was fixed in 10% neutral buffered formalin for no less than 8 and no longer than 24 hours. Her2 analysis. was performed using the FDA approved Dako HercepTest (TM) test kit. 1 using rabbit anti-. human HER2. This assay was not modified. External kit-slides provided by the 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. Adequate, well preserved, clear-cut invasive carcinoma was identified for HER2 evaluation. Interpretation of the HER2 immunohistochemical stain is guided by published results in the medical literature,. information provided by the reagent manufacturer and by internal review of staining performance. This assay has been validated according to the 2007 joint recommendations and guidelines from ASCO and CAP. and from the NCCN HER2 testing in Breast Cancer Task Force. The Pathology Department takes full responsibility. for this test's performance. 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 2 chromosome 17. signals and 2 HER-2 signals, with a HER-2/CEP 17 Ratio </=2.0, consistent with no. amplification of the HER2/neu gene. Block used. A9. Source of case: Tissue fixation formalin-fixed tissueOutside Case No: NA. Tissue source breast Results interpreted: yes. HER2/CEP17 ratio: 1.02. 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® theranv 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. ONCOTYPE DX BREAST CANCER ASSAY. RESULTS: Recurrence Score: 19. CLINICAL EXPERIENCE: Patients with a recurrence score of: 19 in the clinical validation study had an average. rate of Distant Recurrence at 10 years of 12%. ER Score: 10.2 Positive. PR Score: 8.8 Positive. Her2 Score: 8.9 Negative. Interpretation: ER. Negative < 6.5. Positive >= 6.5. PR Negative < 5.5 Positive >= 5.5. Her2 Negative <10.7 Positive >=1 11.5 Equivocal = 10.7 - 11.4. See separate. report for further information. Microscopic/Diagnostic Dictation: Pathologist,. Final Review: Pathologist,. Final: Pathologist,. Addendum: Pathologist,. Addendum Final: Pathologist,. Addendum: Pathologist,. Addendum Final: Pathologist,. Addendum: Pathologist, 1. Addendum Final: Pathologist,.

expanded version (tokens=2610) : 
 Histological Classification: The report indicates a Luminal A subtype of breast cancer. The specimen received is a needle-localized lumpectomy, which reveals invasive ductal carcinoma and ductal carcinoma in situ, the cribiform type.

Tumor Characteristics: The invasive ductal carcinoma is determined to be SBR grade 2, measuring 1.7 cm, with intermediate nuclear grade, located in the right breast, and involving skeletal muscle. The tumor is found to be ER and PR positive, and HER2 equivocal.

Necrosis: The report does not indicate the presence of necrosis in the tumor.

Lymphovascular Invasion: The report indicates that no lymphovascular invasion was identified in the sections examined.

Histological Grade: The invasive ductal carcinoma was graded as SBR grade 2.

Nuclear Grade: The nuclear grade of the invasive ductal carcinoma was determined to be intermediate.

Calcification: The report does not mention any calcifications.

Receptor Status: The tumor is found to be ER and PR positive and HER2 equivocal.

IHC and Ancillary Testing Results: The PathVysion HER-2 DNA Probe Kit results indicate that the HER-2 gene was not amplified, and the Oncotype DX Breast Cancer Assay revealed a recurrence score of 19, ER score of 10.2 positive, PR score of 8.8 positive, and HER2 score of 8.9 negative.

