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. RIGHT BREAST WITH AXILLARY CONTENTS LEVELS 1,2. B. ADDITIONAL AXILLARY CONTENTS. SPECIMEN(S): A. RIGHT BREAST WITH AXILLARY CONTENTS LEVELS 1,2. B. ADDITIONAL AXILLARY CONTENTS. GROSS DESCRIPTION: A. RIGHT BREAST WITH AXILLARY CONTENTS LEVELS 1,2. Received fresh labeled with the patient's identification and "right breast with axilla" is a 934g, 28 x 25 x. 5cm oriented (stitch in axilla) modified radical mastectomy with attached 19 x 9cm tan pink skin ellipse. and 1.3cm everted nipple. Ink code: anterior-superior: blue, anterior-inferior: orange, posterior-black. The specimen is serially sectioned from lateral to medial into 10 slices with nipple in slice 7, revealing a. 3 x 2.5 x 2cm tan white firm well circumscribed mass, 1.5cm from the skin margin and 3cm from the. deep margin in the UOQ and UC of slices 5-7. A surgical clip is identified in the UOQ of slice 8. The. axillary tail is 9 X 7 x 5cm. Dissection reveals 19 possible lymph nodes ranging from 0.7 x 0.5 x 0.5cm. to. 4 x 3 x 3cm. The largest lymph node is serially sectioned to reveal a tan white firm homogenous cut. surface. A portion of the specimen is submitted for tissue procurement. Representatively submitted: A1-A2: nipple slice 7. A3: UOQ slice 2. A4: LOQ slice 4. A5: UOQ slice 4. A6: mass UIQ slice 5. A7: LOQ slice 5. A8-A10: mass with clip ID in A9 slice 6. A11-A12: mass slice 6. A13: deep margin slice 6. A14: skin slice 6. A15: mass UC slice 7. A16: LC slice 7. A17: UIQ slice 8. A18: LIQ slice 8. A19: UIQ slice 9. A20: 4 lymph nodes. A21: 4 lymph nodes. A22: 4 lymph nodes. A23: 2 lymph nodes. A24: 1 lymph node. A25-A26: 1 lymph node. A27: 1 lymph node. A28-A29: 1 lymph node. A30-A32: representative section of largest lymph node. A33-A38: UIQ. B. ADDITIONAL AXILLARY CONTENTS. Received fresh are two tan pink-white firm lymph nodes 1.5 x 1.5 x 1cm and 2 x 1.5 x 1.5cm. B1-B2: 1 lymph node. B3-B4: 1 lymph node. DIAGNOSIS: A. BREAST, RIGHT, MODIFIED RADICAL MASTECTOMY: - TWO FOCI OF INVASIVE DUCTAL CARCINOMA, SBR GRADE 3, WITH. EXTENSIVE NECROSIS AND MICROCALCIFICATIONS. - TUMOR MEASURES 3 CM AND 1.5 CM. - MARGINS, FREE OF TUMOR. - DUCTAL CARCINOMA IN SITU (DCIS), SOLID TYPE, NUCLEAR GRADE 3,. WITH NECROSIS AND MICROCALCIFICATIONS. - SKIN AND NIPPLE, NO TUMOR SEEN. - METASTATIC CARCINOMA IN 5 OF 18 LYMPH NODES WITH. EXTRANODAL EXTENSION, LARGEST METASTASIS IS 4 CM (5/18). NOTE: Invasive carcinoma is present in the upper outer quadrant and upper inner quadrant. B. ADDITIONAL AXILLARY CONTENTS, EXCISION: - METASTATIC CARCINOMA IN 2 OF 2 LYMPH NODES WITH. EXTRANODAL EXTENSION (2/2). - LARGEST METASTASIS IS 2 CM. SYNOPTIC REPORT - BREAST. Specimen Type: Mastectomy. Needle Localization: Laterality: ( Right. Invasive Tumor: Present. Multifocality: Yes. WHO CLASSIFICATION. Invasive ductal carcinoma, NOS 8500/3. Tumor size: 3cm. Tumor Site: Upper outer quadrant. Upper inner quadrant. Margins: Negative. Tubular Score: 3. Nuclear Grade: 3. Mitotic Score: 3. Modified Scarff Bloom Richardson Grade: 3. Necrosis: Present. Vascular/Lymphatic Invasion: Present. Lobular neoplasia: None. Lymph nodes: Axillary dissection. Lymph node status: Positive 7 / 20 Extranodal extension. DCIS present. Margins uninvolved by DCIS. DCIS Quantity: Estimate 15%. DCIS Type: Solid. DCIS Location: Associated with invasive tumor. Nuclear grade: High. Necrosis: Present. Location of CA++. DCIS. ER/PR/HER2 Results. ER: Negative. PR: Negative. HER2: Negative by IHC. Pathological staging (pTN): pT 2 N 2. SYNOPTIC REPORT - BREAST, ER/PR RESULTS. Specimen: Surgical Excision. Block Number: A31. ER: Negative Allred Score: 2 = Proportion Score 1 + Intensity Score 1. PR: Negative Allred Score: 0 = Proportion Score 0 + Intensity Score 0. 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. CLINICAL HISTORY: None provided. PRE-OPERATIVE DIAGNOSIS: Right breast cancer. ADDENDUM: SYNOPTIC REPORT - BREAST, ER/PR RESULTS. Specimen: Surgical Excision. Block Number: A17 (smaller tumor). ER: Positive Allred Score: 3 = Proportion Score 2 + Intensity Score 1. PR: Positive Allred Score: 7 = Proportion Score 4 + 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: A17 (smaller tumor). Interpretation: EQUIVOCAL. Intensity: 2+. % Tumor Staining: 40%. 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. 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. 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 A17. Source of case: Tissue fixation. formalin-fixed tissue. Outside Case No: NA. Tissue source. breast Results interpreted: HER2/CEP17 ratio: 1.06. 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. 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® therans insidered. 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. Microscopic/Diagnostic DictationPathologist,. Final Review: Pathologist,. Final: Pathologist,. Addendum: Pathologist,. Addendum Final: Pathologist,. Addendum: Pathologist,. Addendum Final: Pathologist, 1.

expanded version (tokens=3127) : 
 Histological classification:

- Invasive ductal carcinoma, SBR grade 3, with two foci measuring 3cm and 1.5cm in size, present in the upper outer quadrant and upper inner quadrant of the right breast.
- Ductal carcinoma in situ (DCIS), solid type, nuclear grade 3, with necrosis and microcalcifications.
- Metastatic carcinoma in 5 of 18 lymph nodes with extranodal extension, largest metastasis is 4 cm (5/18).
- Metastatic carcinoma in 2 of 2 additional axillary lymph nodes with extranodal extension (2/2).

Subtype: LumB

Necrosis: Extensive necrosis observed in both invasive ductal carcinoma and DCIS.

Tumor infiltrating lymphocytes: Not mentioned in the report.

Histological grade: SBR grade 3 for invasive carcinoma, nuclear grade 3 for DCIS.

Receptor status:

- Estrogen receptor (ER): Negative in the main tumor (Allred score 2) and positive in the smaller tumor (Allred score 3).
- Progesterone receptor (PR): Negative in the main tumor (Allred score 0) and positive in the smaller tumor (Allred score 7).
- HER2: Negative by IHC, equivocal by HER2 FISH, with a HER2/CEP17 ratio of 1.06.

Ancillary testing results:

-

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=3275) : 
 The breast pathology report showed invasive ductal carcinoma subtype LumB with extensive necrosis and metastases in lymph nodes. DCIS was also present. The ER/PR status was negative in the larger tumor and positive in the smaller one, while HER2 was negative by IHC and equivocal by FISH. Histological grade for invasive carcinoma was SBR grade 3, nuclear grade 3 for DCIS. There was no mention of tumor-infiltrating lymphocytes or lymphovascular invasion.

