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: A. SENTINEL NODE #1 LEFT AXILLA. B. SENTINEL NODE #2 LEFT AXILLA. C. LEFT BREAST MASS WITH NEEDLE LOCALIZATION cacF : Sik. breast, NOS C509 2/8/11. D. ADDITIONAL MARGIN LEFT BREAST. SPECIMEN(S): A. SENTINEL NODE #1 LEFT AXILLA. B. SENTINEL NODE #2 LEFT AXILLA. C. LEFT BREAST MASS WITH NEEDLE LOCALIZATION. D. ADDITIONAL MARGIN LEFT BREAST. GROSS DESCRIPTION: A. SENTINEL NODE #1 LEFT AXILLA. Received fresh is a tan pink lymph node 1.5 x 1.0 x 0.7cm. The specimen is serially sectioned and one. touch prep is taken. Toto A1. B. SLN #2 LEFT AXILLA. Received fresh is a tan pink lymph node 1.0 x 0.7 x 0.5cm. The specimen is serially sectioned and one. touch prep is taken. Toto B1. C. LEFT BREAST NEEDLE LOCALIZATION. Single stitch: Anterior. Double stitch: Lateral. Triple stitch: Superior. Received fresh is a 79g oriented WLE breast specimen 2.5cm from anterior to posterior, 7.5cm from. superior to inferior and 8.5cm from medial to lateral, with needle localization wire and attached. radiograph. The specimen is inked as follows: Anterior-Blue, Posterior-Black, Superior-Red, Inferior-. Orange, Medial-Green, Lateral-Yellow. The specimen is serially sectioned from lateral to medial in to 8. slices: slice 1 being most medial, slice 8 being most lateral. The cut surfaces reveal a gray white firm. well circumscribed mass 1.5 x 1.0 x 0.8cm, 0.6cm from the closest deep margin, 0.7cm from the. anterior margin and 0.8cm from the medial margin. The mass is located in slice 2 and 3. The remaining. cut surfaces reveal yellow lobulated adipose tissue interdispersed with gray white fibrous tissue. A. portion of the specimen is submitted for tissue procurement. Representative sections are submitted as. follows: C1-C5: medial margin perpendicular sections from superior to inferior slice 1. C6: superior margin slice 2. C7: mass with anterior and deep margin slice 2. C8: inferior margin slice 2. C9: superior margin slice 3. C10: mass with anterior margin slice 3. C11: mass with deep margin slice 3. C12: inferior margin slice 3. C13: next to mass with anterior margin slice 4. C14: next to mass with deep margin slice 4. C15: slice 5. C16: lateral margin perpendicular sections slice 8. As per attached diagram. D. ADDITIONAL MEDIAL MARGIN LEFT BREAST: Stitch at new margin. Received fresh is a 4g oriented tan pink fragment of fibrofatty tissue 5.0 x 2.0 x 1.0cm. The new true. margin is inked Black and the specimen is serially sectioned to reveal grossly unremarkable breast. parenchyma. Toto D1-D4. DIAGNOSIS: A. LYMPH NODE, SENTINE# 1, LEFT AXILLA, BIOPSY: - ONE LYMPH NODE, NEGATIVE FOR METASTASES (0/1). B. LYMPH NODE, SENTINE# 2, LEFT AXILLA, BIOPSY: - ONE LYMPH NODE, NEGATIVE FOR METASTASES (0/1). C. BREAST, LEFT, WIDE LOCAL EXCISION: - INVASIVE, LOBULAR CARCINOMA, SBR GRADE 2, MEASURING 1.5 CM. - SURGICAL MARGINS ARE NEGATIVE FOR TUMOR. - SEE SYNOPTIC REPORT AND SEE NOTE. D. BREAST, LEFT, ADDITIONAL MEDIAL MARGIN, EXCISION: - BREAST TISSUE, NO TUMOR SEEN. NOTE: The tumor is negative for E-cadherin, compatible with lobular phenotype. SYNOPTIC REPORT - BREAST. Specimen Type: Excision. Needle Localization: Yes - For mass. Laterality: Left. Invasive Tumor: Present. Multifocality: No. WHO CLASSIFICATION. Invasive lobular carcinoma 8520/3. Tumor size: 1.5cm. Tumor Site: Upper inner quadrant. Margins: Negative. Tubular Score: 3. Nuclear Grade: 2. Mitotic Score: 1. 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 0/2. DCIS not present. ER/PR/HER2 Results. ER: Positive. PR: Positive. HER2: Pending by FISH. Pathological staging (pTN): pT 1c N 0. SYNOPTIC REPORT - BREAST, ER/PR RESULTS. Specimen: Surgical Excision. Block Number: ER: Positive. Allred Score: 8 = Proportion Score 5. +. Intensity Score 3. PR: Positive. Allred Score: 8 = Proportion Score 5 + 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. METHODOLOGY: Tissue was fixed in 10% neutral buffered formalin for no less than 8 and no longer than 24 hours. Immunohistochemistry was performed using the mouse anti-human ER (ER 1D5, 1:100) and PR (PGR. 136, 1:100) provided by. following the manufacturer s instructions. This. assay was not modified. Interpretation of the ER/PR immunohistochemical stain is guided by published. results in the medical literature, information provided by the reagent manufacturer and by internal. review of staining performance. SYNOPTIC REPORT - BREAST HER-2 RESULTS. Specimen: Surgical Excision. Block Number: Interpretation: EQUIVOCAL. Intensity: 2+. % Tumor Staining: 20%. Fish Ordered: 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. 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. takes full responsibility for this test's performance. CLINICAL HISTORY: woman with Left Breast Ca: Invasive Ductal 11 o'clock. 1.7cm on mammogram. PRE-OPERATIVE DIAGNOSIS: Left Breast Ca. INTRAOPERATIVE CONSULTATION: TPA/TPB: Negative for tumor. Diagnosis called to Dr at. by Dr. C. GROSS INSPECTION: 1.5cm mass 0.6cm from the closest deep margin, 0.7cm from anterior. margin. Diagnosis called to Dr. at. by Dr. D. GROSS INSPECTION: New medial margin. Negative for tumor. Diagnosis called to Dr. at. 1 by. Dr. ADDENDUM: FISH for HER-2 amplification for this case was attempted multiple times using multiple blocks from this. case. In each instance the tissue would not remain on the slide for analysis. As a result of this one block. will be sent to another laboratory for further testing. This case was sent to the for second opinion for HER-2 FISH. The results reported below are the. verbatim results of this referral. HER2 Amp. Breast Cancer. FISH. Specimen. Tissue-Paraffin. Specimen ID. Source. Left breast. Reason For Referral. r/o HER2 gene amplification. Fixative. Formalin. Method: FISH using probes for HER2 (17q12) and a chromosome 17 centromere (D17Z1) control probe. (PathVysion,. Two technologists score signals in 60 total nuclei from invasive or. metastatic tumor and concurrent controls. nuc ish (D17Z1x2, Her2x3-5). The HER2 to D17Z1 ratio is 2.28. Interpretation: The invasive tumor nuclei have an amplified HER2D17Z1 ratio (per ASCO/CAP. The HER2D17Z1 ratio is 2.28. In our opinion, this result may not. guidelines). reflect centromere true HER2 and amplification. 3-5 copies of Most the HER2 nuclei gene. have 2 This copies result of the indicates chromosome the. 17 tumor has. additional copies of the HER2 gene (i.e., duplication), but does not have sufficient. copies to suggest high level HER2 amplification. It is not known if HER2. duplication is associated with HER2 over-expression in breast adenocarcinoma. ASCO/CAP reporting guidelines (Wolff et al, Arch Path Lab Med 131:18-43, 2007). A HER2D17Z1 ratio less than 1.8 indicates absence of HER2 gene amplification. A HER2D17Z1 ratio from 1.8-2.2 is equivocal for HER2 gene amplification. A HER2D17Z1 ratio greater than 2.2 indicates HER2 gene amplification. DISCLAIMER: This test was developed and its performance characteristics determined. by Laboratory Medicine and Pathology, It is intended as. an adjunct to existing prognostic clinical and pathologic information for breast cancer. patients. This test is not intended to diagnose or screen for breast cancer. Per ASCO/. CAP guidelines, HER2FISH test results are valid for non-decalcified paraffin embedded. specimens fixed in 10% neutral buffered formalin between 6 and 48 hours. Results from. specimens fixed outside these parameters should be interpreted accordingly. Consultant. Report Data. Microscopic/Diagnostic Dictation: M.D., Pathologist,. Microscopia/Diagnostic Dictation: M.D., Pathologist. Final Review: M.D., Pathologist,. Final:, M.D., Pathologist,. Addendum: M.D., Pathologist,. Addendum Final: M.D., Pathologist, I. Addendum: M.D., Pathologist. Addendum Review: M.D., Patnologi: Addendum Final: M.D., Pathologist,.

expanded version (tokens=2981) : 
 The breast pathology report indicates the following information:
- Histological classification: invasive lobular carcinoma
- Subtype: LumA
- Necrosis: absent
- Tumor infiltrating lymphocytes: none identified
- Histological grade: SBR grade 2, Modified Scarff Bloom Richardson Grade: 2
- Nuclear grade: 2
- Lymphovascular invasion: none identified
- Calcification: not mentioned
- Receptor status: ER-positive, PR-positive, HER2-equivocal by FISH
- IHC: ER (1D5) positive, PR (PGR 136) positive, HER2 negative
- Ancillary testing: FISH for HER-2 amplification was attempted multiple times using multiple blocks. The HER2 to D17Z1 ratio is 2.28, which is equivocal for HER2 gene amplification. The HER2 gene is amplified, but not at a level that suggests high level HER2 amplification. 

Additional details from the report include the diagnosis of a 1.5cm invasive lobular carcinoma with negative surgical margins. The breast specimen was oriented and serially sectioned to assess the location and size of the mass, with representative sections submitted for tissue procurement. Sentinel lymph node biopsies from the left axilla revealed negative results for metastases (0/1 and 0/1). The patient’s clinical history indicates a diagnosis of left breast cancer, invasive ductal carcinoma, with a

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=3129) : 
 The breast pathology report shows a LumA subtype invasive lobular carcinoma with tumor size 1.5cm and negative surgical margins. There was no lymphovascular invasion, necrosis, or tumor-infiltrating lymphocytes identified. ER and PR were positive, HER2-equivocal by FISH with an amplified HER2 gene, but not at a level suggesting high-level amplification. The patient's sentinel lymph node biopsies showed no metastases (0/1 and 0/1).

