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 LYMPH NODE 1 LEFT AXILLA. B. SENTINEL LYMPH NODE 2 LEFT AXILLA. C. SENTINEL LYMPH NODE 3 LEFT AXILLA. D. LEFT BREAST. DIAGNOSIS: A. SENTINEL LYMPH NODE #1 LEFT AXILLA, EXCISION: - METASTATIC ADENOCARCINOMA, IDENTIFIED IN ONE LYMPH NODE (MICROMETASTASES,. 1.8 MM IN GREATEST DIAMETER). B., C. SENTINEL LYMPH NODES #2-3, LEFT AXILLA, EXCISION: - TWO LYMPH NODES, NEGATIVE FOR MALIGNANCY (0/2). D. LEFT BREAST, MASTECTOMY: - WELL DIFFERENTIATED INFILTRATING DUCTAL CARCINOMA, (1.5. CM IN GREATEST DIAMETER, SBR GRADE 1). - MULTIFOCAL INTERMEDIATE GRADE DUCTAL CARCINOMA IN SITU (CRIBRIFORM,. MICROPAPILLARY, AND PAPILLARY PATTERNS). - PROLIFERATIVE TYPE FIBROCYSTIC CHANGES. - ATYPICAL DUCTAL HYPERPLASIA. - ATYPICAL LOBULAR HYPERPLASIA. - CHANGES CONSISTENT WITH PREVIOUS BIOPSY SITE, UPPER INNER. QUADRANT, WITH ORGANIZING HEMATOMA. - THREE ADDITIONAL LYMPH NODES, NEGATIVE FOR TUMOR (0/3). SEE. COMMENT. SPECIMEN(S): A. SENTINEL LYMPH NODE 1 LEFT AXILLA. B. SENTINEL LYMPH NODE 2 LEFT AXILLA. C. SENTINEL LYMPH NODE 3 LEFT AXILLA. D. LEFT BREAST. CLINICAL HISTORY: year old with left breast ca. GROSS DESCRIPTION: A. SENTINEL LYMPH NODE 1 LEFT AXILLA. Received fresh for touch prep evaluation labeled with the patient name designated "A - sentinel lymph. node #1 left axilla" is a beige-tan lymph node measuring 1.6 x 1.2 x 0.7 cm. The specimen is bisected,. touch preps are performed. The entire specimen is submitted in a cassette labeled A1. B. SENTINEL LYMPH NODE 2 LEFT AXILLA. Received fresh for touch prep evaluation labeled with the patient name designated "B - sentinel lymph. node #2 left axilla" is a fragment of yellow beige soft tissue measuring 2.2 x 1.8 x 0.5 cm. A tan lymph. node is identified and measures 0.6 x 0.5 X 0.4 cm. The lymph node is bisected, touch preps are. performed. The entire specimen is submitted in cassette labeled B1. C. SENTINEL LYMPH NODE 3 LEFT AXILLA. Received fresh for touch prep evaluation labeled with the patient name designated "C - sentinel lymph. node #3 left axilla" is a tan lymph node measuring 1.3 x 0.9 x 0.5 cm. The specimen is bisected, touch. preps are performed. The entire specimen is submitted in a cassette labeled C1. D. LEFT BREAST. Received fresh for tissue procurement labeled with the patient name designated "D - left breast" is a. mastectomy specimen weighing 228 grams measuring 15.3 x 15.0 X 3.0 cm. The axilla measures 5.0 x. 3.5 x 1.0 cm. The specimen is received with orientation, a black suture indicating the axillary tail. The. specimen is inked as follows: posterior deep margin, black; anterior, blue. The overlying ellipse of. beige-tan skin measures 8.0 x 2.5 cm. The light beige areola measures 2.0 cm in diameter. The. everted nipple measures 0.9 cm in diameter. The specimen is serially sectioned from medial to lateral. Cut section shows a firm, granular beige-tan mass in the lower outer quadrant approaching the deep. margin at a distance of 0.2 cm. The mass measures 1.5 x 1.3 x 1.2 cm and is located 4.5 cm from the. axilla. Extending from the area of the mass through the central portion and to the medial, beige-tan. fibrous parenchyma is demonstrated. In the upper inner quadrant there is a hemorrhagic well-. circumscribed area measuring 2.4 x 1.6 x 1.0 cm. This area approaches the deep margin at a distance. of 0.2 cm and is located 4.8 cm from the lesion. A portion of the specimen is submitted for tissue. procurement. Representative sections are submitted as follows: D1-D4: sections of the lesion and overlying posterior margin lower outer quadrant. D5-D9: representative sections of central fibrous tissue. D10-D17: the entire hemorrhagic area in the upper inner quadrant. D18-D20: representative sections from the upper outer quadrant. D21-D23: representative sections from the lower inner quadrant. D24-D25: sections of nipple. D26: representative section of skin. D27-D30: possible axillary lymph nodes. COMMENT: Re-examination of the original touch-prep examined at the time of the intra-operative consultation again. was interpreted as no evidence of malignant cells on this slide. The permanent sections from the lymph. node however, show a micrometastases, (1.8 mm). Gross examination of the breast reveals an ill. defined mass in the lower outer quadrant measuring 1.5 x 1.3 x 1.0 cm in greatest extent. In addition, in. the upper inner quadrant there is a hemorrhagic area measuring 2.4 x 1.6 x 1 cm. BREAST CANCER TEMPLATE: Specimen type: Mastectomy. Needle localization: Laterality: Left. INVASIVE TUMOR: Present. Multifocal: Histologic type: Ductal. Tumor Size (cm): 1.5 x 1.3 x 1.2 cm. Tumor site: Lower outer quadrant. Grade, Tubular: 2. Grade, Nuclear: 2. Grade, Mitotic: 1. Modified Scarff Bloom Richardson grade: I. Necrosis: Absent. Invasion Vasc/Lymphatic: None identified. DCIS COMPONENT: DCIS Quantity: Estimated 20%. DCIS Type: Cribriform, micropapillary and. papillary. DCIS Location: DCIS is associated with the. invasive tumor with separate foci. seen away from the invasive. tumor in the central region of the. breast. Nuclear grade: Intermediate. Necrosis: None identified. Location of Ca++: DCIS and benign epithelium. Margins: Negative. Distance from closest margin: DCIS extends to within 2 mm of. carcinoma extends to within 3 mm. of the deep margin. Specimens Involved. Specimens: D: LEFT BREAST. HER2 Status Results, Immunohistochemistry Evaluation. SPECIMEN. Surgical Excision. Block Number: Block. D4. TEST RESULTS. Interpretation: Negative. Intensity: 1+. % Tumor Staining: 40%. FISH ORDERED. 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 high, low and negative. 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. HER2 analysis was performed on this case by immunohistochemistry utilizing the FDA approved. 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 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. Lobular Neoplasia: Atypical lobular hyperplasia. Lymph nodes: Sentinel lymph nodes and axillary. lymph nodes one positive, (1/6). Micrometastases (1.8 mm in. greatest diameter, negative for. extranodal extension). Non-neoplastic areas: Atypical ductal hyperplasia,. atypical lobular hyperplasia,. columnar cell change with foci of. BREAST TUMOR BIOMARKERS TEMPLATE. Immunohistochemistry for ER/PR and Her-2 have been ordered on block D4, and the results will be. issued as an addendum. Pathologic Stage : pT1c pNimi. This assay can be 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. 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. ADDENDUM: BREAST ER/PR -1. Specimens Involved. Specimens: D: LEFT BREAST. SPECIMEN. Type: Surgical Excision. Block Number: D4. HORMONE RECEPTOR STATUS. Laboratory: Estrogen Receptor: Positive. Allred Score: 8 = Proportion score 5 + Intensity score 3. Progesterone Receptor: Positive. Allred Score: 8 = Proportion Score 5 + Intensity Score 3. 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 PR,. 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. Microscopic/Diagnosuc Dictation: PATHOLOGIST,. Microscopic/Diagnostic Dictation: PATHOLOGIST. Final Review: PATHOLOGIST,. Final: PATHOLOGIST,. Addendum:,. Addendum Review: PATHOLOGIST. Addendum Final: PATHOLOGIST. Addendum: PATHOLOGIST, 0: Addendum Review: PATHOLOGIS. Addendum Final: PATHOLOGIST, (.

expanded version (tokens=3737) : 
 Histological Classification:
- Left Axilla Sentinel Lymph Node #1: Metastatic Adenocarcinoma, identified in one lymph node (micrometastases, 1.8 mm in greatest diameter).
- Left Axilla Sentinel Lymph Nodes #2-3: Negative for malignancy (0/2).
- Left Breast: Well differentiated infiltrating ductal carcinoma, 1.5 cm in greatest diameter, SBR Grade 1.
- Left Breast: Multifocal intermediate grade ductal carcinoma in situ (cribriform, micropapillary, and papillary patterns).
- Left Breast: Proliferative type fibrocystic changes.
- Left Breast: Atypical ductal hyperplasia.
- Left Breast: Atypical lobular hyperplasia.
- Left Breast: Changes consistent with previous biopsy site, upper inner quadrant, with organizing hematoma.
- Left Breast: Three additional lymph nodes negative for tumor (0/3).

Histological Grade:
- Infiltrating ductal carcinoma: SBR Grade 1 (well differentiated).

Nuclear Grade:
- Infiltrating ductal carcinoma: Grade 2.

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

Lymphovascular Invasion:
- None identified.

Calcification:
- Calcifications seen in DCIS and benign epithelium.

Receptor Status:
- Estrogen Receptor (ER): Positive, Allred Score 8

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=3900) : 
 Left Axilla Sentinel Lymph Node #1: Micrometastatic adenocarcinoma (1.8 mm). Left Axilla Sentinel Lymph Nodes #2-3: Negative for malignancy. Left Breast: Well-differentiated infiltrating ductal carcinoma (1.5 cm, SBR Grade 1), multifocal intermediate grade ductal carcinoma in situ, fibrocystic changes, atypical ductal hyperplasia, and atypical lobular hyperplasia. Three additional lymph nodes negative for tumor. ER positive (Allred Score 8).

