Datasets:

Treza12

/

BreastCancerdataset

like 0

Case 1

Benign and Proliferative

Courses of Treatment. → 2022-02-11 Excision, Lt. (8H and 5H).. C. W. Lee · B. H. Choi (*). Department of Radiology, National Cancer Center,. Goyang, Republic of Korea. e-mail: [email protected]; [email protected]. Y. Kwon. Department of Radiology, Center for Breast Cancer, National. Cancer Center, Goyang, Gyeonggi, Republic of Korea. e-mail: [email protected]. Y. Kim. Department of Pathology, National Cancer Center,. Goyang, Gyeonggi, Republic of Korea. e-mail: [email protected]. . 20. . ­. . 1.3.1. . Pathology Report. • Breast, left 8 o’clock, excision:. –. – Intraductal papilloma with usual ductal. hyperplasia.. • Breast, left 5 o’clock, excision:. –. – Sclerosing adenosis.. 2. 

Important Radiologic. Findings. 1. 2. 1.3. 

Patient History and Progress. Female/37 years old, pre-menopause.. Screen detected mass lesion on left breast. 8 o’clock and 5 o’clock direction.. Outside result of biopsy: Papillary neoplasm.. No family history.. No comorbidities.. 1.2. 

Case 1

Carcinoma In Situ

Carcinoma In Situ. Eun Sook Lee, Chan Wha Lee, Youngmi Kwon,. Yunju Kim, and Bo Hwa Choi. 1. . 1.1. . Courses of Treatment. Operation + Postoperative radiation therapy +. Tamoxifen 20 mg/day for 5 years.. 1.3.1. . Operation. 5. 6. 1.3.2. . Pathology Report. Ductal carcinoma in situ, pathological TN cat­. egory (AJCC 2017): pTisN0(sn). . 1. Size of tumor: 5.2 cm (pTis).. . 2. Nuclear grade: high.. E. S. Lee et al.. 53. . . Carcinoma In Situ. 54. . 3. Necrosis: present.. . 4. Architectural pattern: papillary/cribriform/. solid/comedo.. . 5. Surgical margins:. . (a) deep margin: 6 mm,. . (b) superficial margin: subareolar margin:. (see Note 1).. . 6. Lymph nodes: no metastasis in one axillary. lymph node (pN0(sn)) (sentinel LN: 0/1).. . 7. Microcalcification: present, tumoral.. Note: 1. The subareolar margin of the mastec­. tomy specimen (slide 11) is close to ductal carci­. noma in situ (<1 mm), but this margin submitted. for frozen diagnosis (Fro 2) is free of tumor.. Result. Intensity Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Equivocal (2+). Ki-67. Positive in. 16% of tumor. cells. 2. 

Important Radiologic. Findings. 1 2 3. 4. E. S. Lee. Center for Breast Cancer, National Cancer Center,. Goyang, Kyonggi-do, Republic of Korea. e-mail: [email protected]. C. W. Lee (*) · B. H. Choi. Division of Diagnostic Radiology, Center for Breast. Cancer, National Cancer Center,. Goyang, Republic of Korea. e-mail: [email protected]; [email protected]. Y. Kwon. Department of Radiology, Center for Breast Cancer,. National Cancer Center, Goyang, Gyeonggi,. Republic of Korea. e-mail: [email protected]. Y. Kim. Department of Pathology, National Cancer Center,. Goyang, Gyeonggi, Republic of Korea. e-mail: [email protected].

Patient History and Progress. Female/47 years old, pre-menopause.. Screen detected a mass lesion on left breast in. 10 o’clock direction.. No family history of breast cancer or other. cancers.. S/P Uterine myomectomy.. 1.2. 

Case 1

HR(+) HER2(+) Breast Cancer

. 1.1. . Courses of Treatment. Neoadjuvant chemotherapy (#6 cycles of. docetaxel and carboplatin and trastuzumab. and pertuzumab)  +  Operation  +  Post-­. operative radiation therapy  +  Tamoxifen. 20 mg/day.. 7. 1.3.1. . Pathology Report. Invasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of invasive component: 0.2 cm (pT1a).. 3. Size of intraductal component: 1.0 cm.. 4. Histologic grade:1/3 (tubule formation: 2/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 4/10 HPF).. 5. Intraductal component: present, extratumoral. (99%) (nuclear grade: high, necrosis: pres­. ent, architectural pattern: cribriform/solid/. comedo, extensive intraductal component:. present).. 6. Surgical margins:. S. Park. Department of Surgery, Wonkwang University. Sanbon Hospital, Gunpo, Republic of Korea. R. Song · E.-G. Lee (*). Division of Surgery, Center for Breast Cancer,. National Cancer Center, Goyang, Republic of Korea. e-mail: [email protected]; [email protected]. Y. Kim. Department of Pathology, National Cancer Center,. Goyang, Gyeonggi, Republic of Korea. e-mail: [email protected]. B. H. Choi · C. W. Lee. Division of Diagnostic Radiology, Center for Breast. Cancer, National Cancer Center,. Goyang, Republic of Korea. e-mail: [email protected]; [email protected]. E. S. Lee. Center for Breast Cancer, National Cancer Center,. Goyang, Kyonggi-do, Republic of Korea. e-mail: [email protected]. 300. . . . (a) superior margin: 18 mm,. . (b) inferior margin: 17 mm,. . (c) medial margin: 10 mm,. . (d) lateral margin: 10 mm,. . (e) deep margin: 4 mm,. . (f) superficial margin: 14 mm.. 7. Lymph nodes:. . (a) metastasis in one out of five axillary. lymph nodes (ypN1mi(sn)) (sentinel. LN: 1/5),. . (b) perinodal extension: absent,. . (c) size of metastatic carcinoma: 1 mm.. 8. Arteriovenous invasion: absent.. 9. Lymphovascular invasion: absent.. . 10. Tumor border: infiltrative.. . 11. Microcalcification: present, non-tumoral.. . 12. Pathological TN category (AJCC 2017):. ypT1aN1mi(sn).. Result. Intensity Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (7/8). 3. 1/3-2/3. C-erbB2. Equivocal (2+). Ki-67. Positive in 1%. of tumor cells. S. Park et al.. 301. . . HR(+) HER2(+) Breast Cancer. 302. F. ig. 5. a. b. . 2. 

Important Radiologic. Findings. 1 2 3 4 5. 6. 1.3. 

Patient History and Progress. Female/47 years old, pre-menopause.. Screen detected mass lesion on left breast 5. o’clock direction.. No family history.. No comorbidities.. 1.2. 

Case 1

HR(+) HER2(-) Breast Cancer

HR(+) HER2(−) Breast Cancer. Yunju Kim, Bo Hwa Choi, Eun-Gyeong Lee,. Ji Young You, and Youngmi Kwon. 1. . 1.1. . Courses of Treatment. Operation + Letrozole 2.5 mg/day. 1.3.1. . Operation. Left total mastectomy, sentinel lymph node. 2. Histologic grade: 2/3 (tubule formation: 2/3,. nuclear pleomorphism: 2/3, mitotic count:. 2/3, 11/10 HPF).. 3. Intraductal component: present, intratu­. moral/extratumoral (30%) (nuclear grade:. low, necrosis: absent, architectural pattern:. cribriform/solid, extensive intraductal com­. ponent: present).. 4. Skin and nipple: dermal involvement of tumor.. 5. Surgical margins: deep margin: 7 mm.. 6. Lymph nodes:. . (a) metastasis in one out of seven axillary. lymph nodes (pN1mi) (sentinel LN: 1/7),. Y. Kim. Department of Pathology, National Cancer Center,. Goyang, Gyeonggi, Republic of Korea. e-mail: [email protected]. B. H. Choi. Division of Diagnostic Radiology, Center for Breast. Cancer, National Cancer Center,. Goyang, Republic of Korea. e-mail: [email protected]. E.-G. Lee. Division of Surgery, Center for Breast Cancer,. National Cancer Center, Goyang, Republic of Korea. e-mail: [email protected]. J. Y. You. Division of Breast and Endocrine, Department of. General Surgery, Korea University Medical Center,. Seoul, Republic of Korea. e-mail: [email protected]. Y. Kwon (*). Department of Radiology, Center for Breast Cancer,. National Cancer Center, Goyang, Gyeonggi,. Republic of Korea. e-mail: [email protected]. 174. . (b) perinodal extension: present,. . (c) size of metastatic carcinoma: 0.2 mm.. 7. Arteriovenous. invasion:. present,. peritumoral.. 8. Lymphovascular. invasion:. present,. peritumoral.. 9. Tumor border: infiltrative.. . 10. Microcalcification:. present,. tumoral/. non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT2N1mi.. Result. Intensity. Positive. %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative (1+). Ki-67. Positive in 4% of

Important Radiologic. Findings. See Figs. 1, 2 and 3.. 1.3. 

Patient History and Progress. Female/87 years old, post-menopause.. Screen detected mass lesion on left breast sub­. areolar area.. No family history.. Hypertension, diabetes mellitus, arrhythmia,. total knee replacement, cerebrovascular accident.. 1.2. 

Case 1

HR(−) HER2(+) Breast Cancer

HR(−) HER2(+) Breast Cancer. Youngmi Kwon, Yunju Kim, Bo Hwa Choi,. Ji Young You, Ran Song, Jeayeon Woo,. and Soojin Park. 1. . 1.1. . pertuzumab) + Operation + Post-operative radia­. tion therapy + Trastuzumab.. Result. Intensity. Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in 42%. of tumor cells. 1.4.1. . Operation. 8. 1.4.2. . Pathology Report. No residual tumor with stromal fibrosis.. . 1. Post-chemotherapy status.. . 2. Lymph nodes: no metastasis in six axillary. lymph nodes (ypN0) (sentinel LN: 0/1, non-­. sentinel LN: 0/5).. . HR(−) HER2(+) Breast Cancer. 432. 2. 

Important Radiologic Findings. 1 2 3. 4. Y. Kwon. Department of Radiology, Center for Breast Cancer,. National Cancer Center, Goyang, Gyeonggi,. Republic of Korea. e-mail: [email protected]. Y. Kim. Department of Pathology, National Cancer Center,. Goyang, Gyeonggi, Republic of Korea. e-mail: [email protected]. B. H. Choi. Division of Diagnostic Radiology,. Center for Breast Cancer, National Cancer Center,. Goyang, Gyeonggi, Republic of Korea. e-mail: [email protected]. J. Y. You. Division of Breast and Endocrine,. Department of General Surgery,. Korea University Medical Center, Seoul,. Republic of Korea. e-mail: [email protected]. R. Song · J. Woo. Division of Surgery, Center for Breast Cancer,. National Cancer Center, Goyang, Gyeonggi, Republic. of Korea. e-mail: [email protected]; [email protected]. S. Park (*). Department of Surgery, Wonkwang University. Sanbon Hospital, Gunpo, Gyeonggi,. Republic of Korea. e-mail: [email protected]. 428. . ­. . . Y. Kwon et al.. 429. F. ig. 4. . After Neoadjuvant. Chemotherapy. 5 6. 7

Patient History and Progress. Female/59 years old, post-menopause.. Self-detected mass lesion on right breast 12. o’clock direction.. No family history.. S/P Tuberculosis.. 1.2. 

Case 1

HR(−) HER2(−) Breast Cancer

HR(−) HER2(−) Breast Cancer. Eun Sook Lee, Chan Wha Lee, Youngmi Kwon,. Jeayeon Woo, and Yunju Kim. 1. . 1.1. . Courses of Treatment. Neoadjuvant chemotherapy (#4  cycles of. doxorubicin. and. cyclophosphamide. +. #4  cycles of docetaxel) + Operation + Post-. operative radiation therapy.. 1.3.1. . Operation. 7. 1.3.2. . Pathology Report. Breast, left, lumpectomy:. . 1. No residual tumor with stromal degeneration.. . (a) Post-chemotherapy status.. . (b) Lymph nodes: no metastasis in four axil­. lary lymph nodes (ypN0(sn)) (sentinel. LN: 0/1, non-sentinel LN: 0/3).. . 2. Fibroadenomatous change.. Result. Intensity. Positive. %. Estrogen. receptor. Negative (2/8). 1. <1%. Progesterone. receptor. Negative (2/8). 1. <1%. C-erbB2. Negative (0). Ki-67. Positive in 65%. of tumor cells. . ­. . . HR(−) HER2(−) Breast Cancer. 578. . 2. 

Important Radiologic Findings. 1 2. 3. E. S. Lee. Center for Breast Cancer, National Cancer Center,. Goyang, Kyonggi-do, Republic of Korea. e-mail: [email protected]. C. W. Lee. Division of Diagnostic Radiology, Center for Breast Cancer,. National Cancer Center, Goyang, Republic of Korea. e-mail: [email protected]. Y. Kwon. Department of Radiology, Center for Breast Cancer,. National Cancer Center, Goyang, Republic of Korea. e-mail: [email protected]. J. Woo. Division of Surgery, Center for Breast Cancer,. National Cancer Center, Goyang, Republic of Korea. e-mail: [email protected]. Y. Kim (*). Department of Pathology, National Cancer Center,. Goyang, Gyeonggi, Republic of Korea. e-mail: [email protected]. . © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023. E. S. Lee (ed.), A Practical Guide to Breast Cancer Treatment,. https://doi.org/10.1007/978-981-19-9044-1_8. 576. . . E. S. Lee et al.. 577. 1.2.1. . After Neoadjuvant. Chemotherapy. 4 5. 6. 1.3. 

Patient History and Progress. Female/40 years old, pre-menopause.. Screen detected a mass lesion at 1 o’clock. direction of the left breast.. No family history.. No comorbidities.. BRCA 1 and 2 mutation: Not detected,. CHEK2 VUS (variant of uncertain).. 1.2. 

Case 1

Local Recurrence

Local Recurrence. Yunju Kim, Eun-Gyeong Lee, Ran Song,. and Eun Sook Lee. 1. . 1.1. . Courses of Treatment. Right breast IDC → Neoadjuvant chemotherapy. → Operation → Adjuvant therapy → Right. breast recurrence (IDC).. 1.2.1. . Primary Treatment. 1 2 3. 4. Neoadjuvant Chemotherapy. Neoadjuvant chemotherapy #4 cycles of doxoru­. bicin and cyclophosphamide followed by #4. cycles of docetaxel and trastuzumab.. Operation. ­. 5. Pathology Report. Invasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of tumor: 0.4 cm (ypT1a).. Y. Kim. Department of Pathology, National Cancer Center,. Goyang, Gyeonggi, Republic of Korea. e-mail: [email protected]. E.-G. Lee · R. Song. Division of Surgery, Center for Breast Cancer,. National Cancer Center, Goyang, Republic of Korea. e-mail: [email protected]; [email protected]. E. S. Lee (*). Center for Breast Cancer, National Cancer Center,. Goyang, Kyonggi-do, Republic of Korea. e-mail: [email protected]. © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023. E. S. Lee (ed.), A Practical Guide to Breast Cancer Treatment,. https://doi.org/10.1007/978-981-19-9044-1_9. . 718. . . . . . . 3. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 1/3, 1/10HPF).. 4. Intraductal component: present, intratumoral/. extratumoral (10%) (nuclear grade: high,. Y. Kim et al.. 719. necrosis: absent, architectural pattern: cribri­. form, extensive intraductal component: absent).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) Superior margin: 40 mm.. . (b) Inferior margin: 30 mm.. . (c) Medial margin: 5 mm.. . (d) Lateral margin: 15 mm.. . (e) Deep margin: 1 mm from invasive ductal. carcinoma.. 7. Lymph nodes: no metastasis in two axillary. lymph nodes (ypN0(sn)) (sentinel LN: 0/2).. 8. Vascular invasion: absent.. 9. Lymphatic invasion: present, intratumoral.. . 10. Tumor border: infiltrative.. . 11. Microcalcification:. present,. tumoral/. non-tumoral.. . 12. Pathologic stage (AJCC 2010): ypT1aN0(sn).. Result. Intensity. Positive %. Estrogen. receptor. Weak (2/7). 1. <10%. Progesterone. receptor. Negative (0/7). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in 7%. of tumor cells. Adjuvant Therapy. Postoperative radiation therapy.. Trastuzumab for 1 year + Tamoxifen 20 mg/. day for 8.9 years.. 1.2.2. . Treatments After Recurrence. 6 7. 8. Neoadjuvant Therapy. Neoadjuvant. chemotherapy. #6. cycles. of. docetaxel and trastuzumab and pertuzumab.. Operation. 9. Pathology Report. No residual tumor with stromal degeneration.. . . . ­. Local Recurrence. 720. . . . . . 1. Post-chemotherapy status.. . 2. Post-lumpectomy status.. Result. Intensity. Positive %. Estrogen. receptor. Negative (2/8). 1. <1%. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in 18%. of tumor cells. Adjuvant Therapy. Postoperative radiation therapy.. Trastuzumab and pertuzumab.. 2. 

Patient History and Progress. Female/41 years old, pre-menopause.. Screen detected mass lesion on lower medial. and lower outer portion of right breast.. Family history of breast cancer, maternal aunt.. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 1.2. 

Case 1

Metastatic Breast Cancer

Metastatic Breast Cancer. Youngmi Kwon, Yunju Kim, Bo Hwa Choi,. Eun-Gyeong Lee, Ji Young You, and Eun Sook Lee. 1. . 1.1. . Courses of Treatment. Left breast cancer  →  Operation  +  Adjuvant. therapy → Chest wall recurrence → Palliative. therapy. →. Pleural. fissure. recur­. rence → Palliative therapy.. 1.2.1. . Primary Treatment. Operation. Mar. 2007 Left modified radical mastectomy.. Pathology: Invasive ductal carcinoma, stage. pT1N0, Size of tumor: 1.5  *  1.0  cm, Lymph. node: 0/21.. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Equivocal (2+). Ki-67. Positive in 11%. of tumor cells. Adjuvant Therapy. Adjuvant Chemotherapy #5 cycles (Fluorouracil. & Epirubicin & Cyclophosphamide).. Concurrent Trastuzumab therapy #9 cycles.. Zoladex for 2 years + Tamoxifen 20 mg/day. for 5 years.. Y. Kwon. Department of Radiology, Center for Breast Cancer,. National Cancer Center, Goyang, Gyeonggi,. Republic of Korea. e-mail: [email protected]. Y. Kim. Department of Pathology, National Cancer Center,. Goyang, Gyeonggi, Republic of Korea. e-mail: [email protected]. B. H. Choi. Division of Diagnostic Radiology, Center for Breast Cancer,. National Cancer Center, Goyang, Republic of Korea. e-mail: [email protected]. E.-G. Lee. Division of Surgery, Center for Breast Cancer,. National Cancer Center, Goyang, Republic of Korea. e-mail: [email protected]. J. Y. You. Division of Breast and Endocrine, Department of. General Surgery, Korea University Medical Center,. Seoul, Republic of Korea. e-mail: [email protected]. E. S. Lee (*). Center for Breast Cancer, National Cancer Center,. Goyang, Kyonggi-do, Republic of Korea. e-mail: [email protected]. 862. 1.2.2. . Treatments After Recurrence. Chest Wall Recurrence. >2/3. Progesterone. receptor. Strong (7/8). 3. 1/3–2/3. Result. Intensity. Positive %. C-erbB2. Equivocal (2+). Ki-67. Positive in. 21% of tumor. cells. SISH. Negative. Operation. Apr. 2014 Left chest wall wide excision and. bilateral salpingo-oophorectomy.. Pathology: Invasive ductal carcinoma, clini­. cally recurrent, size of tumor: 1.0 cm, residual.. Adjuvant Therapy. Post-operative radiation therapy to chest wall+. Letrozole 2.5 mg/day for 5 years.. Pleural Fissure Recurrence. Mar. 2022 PET-CT: R/O pleural/fissural seedings. in left hemithorax.. See Figs. 2 and 3.. Palliative Therapy

Patient History and Progress. Female/49 years old, post-menopause.. No family history.. 1.2. 

Case 10

Benign and Proliferative

Courses of Treatment. →2021-11-09 excision (Lt. 3H SA, Lt. nipple. mass).. Pathology Report. • Breast, “left subareolar 3 o’clock”, excision:. –. – Atypical ductal hyperplasia.. • Breast, “left nipple mass,” excision:. –. – Nipple adenoma (florid papillomatosis).. . . C. W. Lee et al.. 29. . . 11. 

Important Radiologic. Findings. 16. 17. 10.3. 

Bloody discharge from left nipple.. No family history.. No comorbidities.. 10.2. 

Case 10

Carcinoma In Situ

10.1. . Courses of Treatment. Operation + Tamoxifen 20 mg/day for 5 years.. Operation. 47. 48. Pathology Report. Ductal carcinoma in situ, pathological TN cat­. egory (AJCC 2017): pTisN0(sn). . 1. Size of tumor: 2.0 cm (pTis).. . 2. Nuclear grade: low.. . 3. Necrosis: absent.. . 4. Architectural pattern: solid.. . 5. Skin: no involvement of tumor.. . 6. Surgical margins:. . (a) deep margin: 2 mm,. . (b) superficial margin: 2 mm.. E. S. Lee et al.. 73. . ­. tumoral.. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Intermediate. (6/8). 3. 10%-1/3. C-erbB2. Negative (1+). Ki-67. Positive in 1%. of tumor cells. Carcinoma In Situ. 74. . . ­. E. S. Lee et al.. 75. 11. 

Important Radiologic. Findings. 43 44 45. 46. 10.3. 

Patient History and Progress. Female/52 years old, pre-menopause.. Screen detected microcalcification on mid. inner portion left breast.. Outside result of biopsy:. Left 9:30 o’clock, ductal carcinoma in situ.. Right 11  o’clock, flat epithelial atypia with. microcalcification.. No family history.. BRCA 1 and 2 mutation: Not detected.. 10.2. 

Case 10

HR(+) HER2(+) Breast Cancer

10.1. . Courses of Treatment. Neoadjuvant chemotherapy (#6 cycles of. docetaxel and carboplatin and trastuzumab. and pertuzumab)  +  Operation  +  Post-­. operative radiation therapy  +  Trastuzumab. emtansine  +  Letrozole 2.5  mg/day with. goserelin.. S. Park et al.. 329. . . ­. HR(+) HER2(+) Breast Cancer. 330. . 58. Pathology Report. . 1. Invasive Ductal Carcinoma.. . (a) Post-chemotherapy status.. . (b) Size of tumor: 3.0 cm (ypT2).. . (c) Histologic grade: 2/3 (tubule formation:. 3/3, nuclear pleomorphism: 3/3, mitotic. count: 1/3, 3/10 HPF).. . (d) Intraductal component: present, intratu­. moral/extratumoral (5%) (nuclear grade:. high, necrosis: present, architectural pat­. tern: cribriform/solid/comedo, extensive. intraductal component: absent).. . (e) Skin: dermal involvement of tumor.. . (f) Nipple: no involvement of tumor.. . (g) Surgical margins:. • deep margin: (see Note 1),. • superficial margin: (see Note 2).. S. Park et al.. 331. F. i. g. . 55. (white arrow) in the left. breast. Hypermetabolic. lymph nodes at the left. axilla, internal. mammary chain, and. supraclavicular area. (black arrows). . (h) Lymph nodes:. • metastasis in seven out of nine axil­. lary lymph nodes (ypN2a) (sentinel. LN: 1/3, axillary LN: 6/6),. • perinodal extension: present,. • size of metastatic carcinoma: 10 mm.. . (i) Arteriovenous invasion: absent.. . (j) Lymphovascular invasion: present, intra­. tumoral/peritumoral.. . (k) Tumor border: infiltrative.. . (l) Microcalcification:. present,. tumoral/. non-tumoral.. . (m) Pathological TN category (AJCC 2017):. ypT2N2a.. HR(+) HER2(+) Breast Cancer. 332. . . . 2. Fibroadenoma. Note: 1. The deep margin of the lumpectomy. specimen (slides 1 and 2) is close to invasive duc­. tal carcinoma (<1 mm) but this margin submitted. for frozen diagnosis (Fro 5) is free of tumor.. 2. The superficial margin of the lumpectomy. specimen (slide 1) is close to invasive ductal car­. cinoma (<1 mm) but this margin submitted for. frozen diagnosis (Fro 6) is free of tumor.. Result. Intensity. Positive. %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Weak (3/8). 2. <1%. C-erbB2. Positive (3+). Ki-67. Positive in 4% of. tumor cells. S. Park et al.. 333. . 11. 

Important Radiologic. Findings. 52 53 54 55 56. 57. 10.3. 

Patient History and Progress. Female/32 years old, pre-menopause.. Self-detected skin changes and mass lesion on. left breast.. Family history of breast cancer, maternal aunt.. No comorbidities.. BRCA 1 and 2 mutation: Not detected, NBN. and PALB2 VUS (variant of uncertain).. 10.2. 

Case 10

HR(+) HER2(-) Breast Cancer

Courses of Treatment. Operation. +. Adjuvant. chemotherapy. (#4  cycles of docetaxel & cyclophospha­. mide). +. Post-operative. radiation. ther­. apy + Tamoxifen 20 mg/day.. Operation. Left breast conserving surgery, axillary lymph. 5. Surgical margins:. . (a) superior margin: 10 mm,. . (b) inferior margin: 30 mm,. . (c) medial margin: (see note),. . (d) lateral margin: 19 mm,. . (e) deep margin: 11 mm,. . (f) superficial margin: 2 mm.. 6. Lymph nodes:. . (a) metastasis in one out of seventeen axil­. lary lymph nodes (pN1a) (sentinel LN:. 1/3, axillary LN: 0/14),. . (b) perinodal extension: absent,. . (c) size of metastatic carcinoma: 5 mm.. 7. Arteriovenous invasion: absent.. 8. Lymphovascular. invasion:. present,. peritumoral.. 9. Tumor border: pushing.. . 10. Microcalcification: absent.. . 11. Pathological TN category (AJCC 2017):. pT2N1a.. Note: 1. The medial margin of the lumpec­. tomy specimen (slide 7) is close to ductal. carcinoma in situ (2  mm) but this margin. submitted for frozen diagnosis (Fro 6) is free. of tumor.. Result. Intensity. Positive %. Estrogen receptor. Intermediate (6/8). 2. 1/3–2/3. Progesterone receptor. Intermediate (6/8). 2. 1/3–2/3. C-erbB2. Negative (1+). Ki-67. Positive in 19% of tumor cells. Y. Kim et al.

Important Radiologic. Findings. See Figs. 48, 49, 50 and 51.. 10.3. 

No comorbidities.. 10.2. 

Case 10

HR(−) HER2(+) Breast Cancer

10.1. . Courses of Treatment. Neoadjuvant chemotherapy (#6 cycles of. docetaxel and carboplatin and trastuzumab and. pertuzumab)  +  Operation  +  Trastuzumab and. pertuzumab.. Operation. 77. a. b. . . Y. Kwon et al.. 469. Pathology Report. No residual tumor with stromal degeneration.. . 1. Post-chemotherapy status.. . 2. Lymph nodes: no metastasis in six axillary. lymph nodes (ypN0(sn)) (sentinel LN: 0/1,. non-sentinel LN: 0/5).. Result. Intensity. Positive %. Estrogen. receptor. Negative (2/8). 1. <1%. Progesterone. receptor. Negative (2/8). 1. <1%. C-erbB2. Positive (3+). Ki-67. Positive in. 33% of tumor. cells. 11. 

Important Radiologic. Findings. 69 70 71. 72. . . . HR(−) HER2(+) Breast Cancer. 466. . Y. Kwon et al.. 467. 10.3. . After Neoadjuvant. Chemotherapy. 73 74 75. 76. . ­. . ­. . HR(−) HER2(+) Breast Cancer. 468. 10.4. 

Patient History and Progress. Female/36 years old, pre-menopause.. Self-detected palpable mass lesion on left. breast 9 o’clock direction.. Family history of breast cancer, aunt. (paternal).. S/P Tuberculosis, s/p salpingectomy.. BRCA 1 and 2 mutation: Not detected, ATM. VUS (variant of uncertain).. 10.2. 

Case 10

HR(−) HER2(−) Breast Cancer

10.1. . Courses of Treatment. Neoadjuvant chemotherapy (#4  cycles of. doxorubicin and cyclophosphamide  +  #4. cycles of paclitaxel and cisplatin) + Operation. + Post-operative radiation therapy  +  ada­. gloxad simolenin plus capecitabine.. Operation. 73. E. S. Lee et al.. 609. . . . HR(−) HER2(−) Breast Cancer. 610. . ­. . . E. S. Lee et al.. 611. . . ­. ­. HR(−) HER2(−) Breast Cancer. 612. Pathology Report. Invasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of tumor: 1.9 cm (ypT1c).. 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 21/10HPF).. 4. Intraductal component: absent.. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) Superior margin: 8 mm.. . (b) Inferior margin: 25 mm.. . (c) Medial margin: 10 mm.. . (d) Lateral margin: 20 mm.. . (e) Deep margin: <1 mm from invasive duc­. tal carcinoma (slide 2).. . (f) Superficial margin: 3 mm.. 7. Lymph nodes: no metastasis in three axillary. lymph nodes (ypN0(sn)) (sentinel LN: 0/1,. axillary LN: 0/2).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular. invasion:. present,. intratumoral.. . 10. Tumor border: infiltrative.. . 11. Microcalcification: present, non-tumoral.. . 12. Pathological TN category (AJCC 2017):. ypT1cN0(sn).. Result. Intensity. Positive. %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Negative (1+). Ki-67. Positive in 86%. of tumor cells. 11. 

Important Radiologic. Findings. 66 67. 68. After Neoadjuvant. Chemotherapy. 69 70 71. 72. 10.3. 

Patient History and Progress. Female/56 years old, post-menopause.. Self-detected palpable mass lesion on right. breast.. No family history.. Asthma.. 10.2. 

Case 10

Local Recurrence

10.1. . Courses of Treatment. Right breast IDC→ Operation → Adjuvant ther­. apy → Right breast recurrence (IDC).. Primary Treatment. 76 77. 78. Operation. ­. ­. 79. 80. Pathology Report. . 1. Invasive ductal carcinoma.. . (a) Size of tumor: 1.8 cm (pT1c).. . (b) Histologic grade: 2/3 (tubule formation:. 3/3, nuclear pleomorphism: 2/3, mitotic. count: 1/3, 5/10HPF).. . (c) Intraductal component: present, intratu­. moral/extratumoral (10%) (nuclear grade:. low,. necrosis:. present,. architectural. ­. pattern: cribriform/solid, extensive intra­. ductal component: absent).. . (d) Skin: no involvement of tumor.. . (e) Surgical margins:. . ­. . . Local Recurrence. 746. a. b. . a. b. . • Deep margin: <1  mm from invasive. ductal carcinoma (slide 3).. • Superficial margin: (see note 1).. . (f) Lymph nodes:. • Metastasis in one out of five axillary. lymph nodes (pN1mi(sn)) (see note 2). (sentinel LN: 1/4, non-sentinel LN: 0/1).. • Perinodal extension: absent.. • Size of metastatic carcinoma: 1.2 mm.. . (g) Arteriovenous invasion: absent.. . (h) Lymphovascular invasion: present, intra­. tumoral/peritumoral.. . (i) Tumor border: infiltrative.. . (j) Microcalcification: present, non-tumoral.. . (k) Pathological TN category (AJCC 2017):. pT1cN1mi(sn).. . 2. Intraductal papilloma.. Note: 1. The superficial margin of the lumpec­. tomy specimen (slide 3) is close to ductal carci­. noma in situ (<1 mm), but this margin submitted. for frozen diagnosis (Fro 2) is free of tumor.. 2. Micrometastasis is present only in the per­. manent section of Fro 3.. Result. Intensity. Positive %. Estrogen. receptor. Strong (7/8). 2. >2/3. Progesterone. receptor. Strong (7/8). 2. >2/3. C-erbB2. Negative (1+). Ki-67. Positive in 5%. of tumor cells. Adjuvant Therapy. Tamoxifen 20 mg/day for 3.5 years.. Treatments After Recurrence. 81. 82. Operation. 83. 84. Y. Kim et al.. 747. . . . ­. Adjuvant Therapy. Adjuvant chemotherapy #4 cycles of doxorubicin. and cyclophosphamide followed by #4 cycles of. docetaxel.. Plan for postoperative radiation therapy.. Plan for letrozole with goserelin.. Local Recurrence. 748. . 11. 

Patient History and Progress. Female/42 years old, pre-menopause.. Screen detected mass lesion on right breast 5. o’clock direction.. Outside result of biopsy: Invasive ductal. carcinoma.. No family history.. s/p myomectomy.. 10.2. 

Case 10

Metastatic Breast Cancer

10.1. . Courses of Treatment. Left breast cancer → Operation → Adjuvant. therapy → Ipsilateral breast and lung recur­. rence → Palliative therapy → Progression on. lung, left breast.. Primary Treatment. See Figs. 31, 32, and 33.. Operation. Dec. 2020 Left breast conserving surgery, senti­. nel lymph node biopsy.. Pathology: Invasive ductal carcinoma, stage. pT2N0(sn).. Size of tumor: 2.1 cm, lymph node: 0/1.. Y. Kwon et al.. Progesterone. receptor. Negative. (0/8). 0. 0. C-erbB2. Negative. (1+). Ki-67. Positive. in 68%. of tumor. cells. Adjuvant Therapy. Adjuvant chemotherapy #4 cycles (Docetaxel &. cyclophosphamide).. Treatments After Recurrence. Mar. 2021 PET-CT. . 1. R/O malignancy vs post-op change in left. breast upper outer periphery (2h′). rec) follow-up or further evaluation.. . 2. A few solid nodules in BLL; lung metastasis. cannot be excluded.. Negative. (0/8). 0. 0. Progesterone. receptor. Negative. (0/8). 0. 0. C-erbB2. Negative (1+). Ki-67. Positive in. 77% of tumor. cells. → Chemotherapy #6 cycles (albumin-bound. paclitaxel & atezolizumab): Progressive disease. on lung, breast.. Metastatic Breast Cancer. 878. <1%. Progesterone. receptor. Negative. (0/8). 0. 0. C-erbB2. Equivocal. (2+). Ki-67. Positive in. 52% of. tumor cells. SISH. Negative. Palliative Chemotherapy and Radiation. Chemotherapy #5 cycles (Doxorubicin &. Cisplatin).. Radiation therapy to lung~

Patient History and Progress. Female/53 years old, post-menopause.. No family history.. S/p cholecystectomy, s/p knee giant cell tumor. excision, s/p interstitial mammoplasty.. S/p otitis media operation.. 10.2. 

Case 11

Benign and Proliferative

11.1. . Courses of Treatment. →2021-10-29 excision, Rt.. Benign and Proliferative Case Series. 30. . ­. . . Pathology Report. Diagnosis. • Breast, right, excision:. –. – Intraductal papilloma.. 12. 

Important Radiologic. Findings. 18. 11.3. 

Patient History and Progress. Female/39 years old, pre-menopause.. Serous discharge from right nipple.. No family history.. Asthma, hyperthyroidism.. 11.2. 

Case 11

Carcinoma In Situ

11.1. . Courses of Treatment:. Operation. Operation. ­. 50. 51. Pathology Report. <First operation>. . 1. Ductal Carcinoma In Situ, Pathological TN. Category (AJCC 2017): pTis. . (a) Size of tumor: 0.3 cm (pTis).. . (b) Nuclear grade: low.. . (c) Necrosis: absent.. . (d) Architectural pattern: micropapillary/. cribriform.. . (e) Skin: no involvement of tumor.. . (f) Surgical margins:. • superior margin: 10 mm,. • inferior margin: 2 mm from ductal car­. cinoma in situ (slide 3),. • medial margin: 10 mm,. • lateral margin: <1  mm from lobular. carcinoma in situ (slide 5),. • deep margin: 2 mm,. • superficial margin: 2 mm.. . (g) Microcalcification: present, tumoral/non-. tumoral.. . 2. Lobular Carcinoma In Situ. . (a) Size of tumor: 0.2 cm.. . (b) Nuclear grade: low.. . (c) Necrosis: absent.. . (d) Architectural pattern: solid.. Result. Intensity Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Equivocal (2+). Ki-67. Positive in 3%. of tumor cells. <Second operation>. No residual tumor with foreign body. reaction.. . 1. Post-excision status.. . Carcinoma In Situ. 76. . . 12. 

Important Radiologic. Findings. 49. 11.3. 

Patient History and Progress. Female/44 years old, pre-menopause.. Screen detected mass lesion on right breast 8. o’clock direction.. Outside result of biopsy:. Right breast, 8 o’clock, (1) adenosis, (2) fibro­. cystic change, (3) flat epithelial atypia.. Family history, Father: Prostate cancer.. S/P Percutaneous closure of congenital ven­. tricular septal detected.. 11.2. 

Case 11

HR(+) HER2(+) Breast Cancer

11.1. . Courses of Treatment. Operation  +  Adjuvant chemotherapy (#4. cycles of doxorubicin and cyclophospha­. mide). +. Post-operative. radiation. ther­. apy + Trastuzumab + Letrozole 2.5 mg/day.. 63. Pathology Report. . 1. Invasive Ductal Carcinoma.. . (a) Size of tumor: 1.1 cm (pT1c).. . (b) Histologic grade: 2/3 (tubule formation:. 3/3, nuclear pleomorphism: 2/3, mitotic. count: 1/3, 2/10HPF).. . (c) Intraductal component: present, intratu­. moral (20%) (nuclear grade: low, necro­. sis:. absent,. architectural. pattern:. cribriform, extensive intraductal compo­. nent: absent).. S. Park et al.. 335. . . . (d) Surgical margins:. • superior margin: 30 mm,. • inferior margin: 2  mm from invasive. ductal carcinoma (slide 5),. • medial margin: 15 mm,. • lateral margin: 10 mm,. • deep margin: 2 mm,. • superficial margin: 10 mm.. . (e) Arteriovenous invasion: absent.. . (f) Lymphovascular invasion: absent.. . (g) Tumor border: infiltrative.. . (h) Microcalcification: present, non-tumoral.. . (i) Pathological TN category (AJCC 2017):. pT1cNx.. . 2. Intraductal papilloma. HR(+) HER2(+) Breast Cancer. 336. a. b. . Lymph node, right sentinel, excision: No. metastasis in five axillary lymph nodes (pN0(sn)). (right sentinel LN: 0/5).. . 1. Post-excision status.. Result. Intensity. Positive. %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Weak (4/8). 2. 1–10%. C-erbB2. Positive (3+). Ki-67. Positive in 17%. of tumor cells. 12. 

Important Radiologic. Findings. 59 60 61. 62. HR(+) HER2(+) Breast Cancer. 334. . . 11.3. 

Patient History and Progress. Female/60 years old, post-menopause.. Screen detected microcalcification on upper. outer portion of right breast.. No family history.. Hypertension.. 11.2. 

Case 11

HR(+) HER2(-) Breast Cancer

Courses of Treatment. Operation. +. Adjuvant. chemotherapy. (#4  cycles of docetaxel & cyclophospha­. mide). +. Post-operative. radiation. ther­. apy + Letrozole 2.5 mg/day.. Operation. Left breast conserving surgery, sentinel lymph. 5. Surgical margins:. . (a) superior margin: 5 mm,. . (b) inferior margin: 15 mm,. . (c) medial margin: 15 mm,. . (d) lateral margin: 25 mm,. . (e) deep margin: 10 mm,. . (f) superficial margin: positive for invasive. ductal carcinoma (slide 3).. 6. Lymph nodes:. . (a) metastasis in one out of four axillary. lymph nodes (pN1a(sn)) (sentinel LN:. 0/3, intramammary LN: 1/1),. . (b) perinodal extension: absent,. . (c) size of metastatic carcinoma: 3.5 mm.. 7. Arteriovenous invasion: absent.. 8. Lymphovascular invasion: absent.. 9. Tumor border: infiltrative.. . 10. Microcalcification: present, non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT2N1a(sn).. Result. Intensity. Positive %. Estrogen receptor. Strong (7/8). 2. >2/3. Progesterone receptor. Intermediate (5/8). 2. 10%–1/3. C-erbB2. Negative (0). Ki-67. Positive in 8% of tumor cells. HR(+) HER2(−) Breast Cancer

Important Radiologic. Findings. See Figs. 53, 54, 55 and 56.. 11.3. 

Dyslipidemia.. 11.2. 

Case 11

HR(−) HER2(+) Breast Cancer

11.1. . operative radiation therapy + Trastuzumab.. Operation. 86. Pathology Report. Invasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of tumor: 1.5 cm (ypT1c).. 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 5/HPF).. 4. Intraductal component: present, intratumoral/. extratumoral (40%) (nuclear grade: high, necro­. sis: present, architectural pattern: solid/comedo,. extensive intraductal component: present).. 5. Skin and nipple: no involvement of tumor.. 6. Surgical margins:. . (a) deep margin: 2 mm,. . (b) superficial margin: 2 mm.. 7. Lymph nodes: no metastasis in six axillary. lymph nodes (ypN0) (sentinel LN: 0/3, non-­. sentinel LN: 0/3).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular invasion: present, intratumoral.. . 10. Tumor border: infiltrative.. . 11. Microcalcification:. present,. tumoral/. non-tumoral.. . 12. Pathological TN category (AJCC 2017):. ypT1cN0.. Result. Intensity. Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in. 77% of tumor. cells. HR(−) HER2(+) Breast Cancer. 474. . Y. Kwon et al.. 475. 12. 

Important Radiologic. Findings. 78 79 80. 81. . ­. HR(−) HER2(+) Breast Cancer. 470. . After Neoadjuvant. Chemotherapy. 82 83 84. 85. . . Y. Kwon et al.

Patient History and Progress. Female/56 years old, post-menopause.. Self-detected palpable mass lesion on right. breast.. No family history.. Diabetes mellitus, hepatitis C virus carrier.. 11.2. 

Case 11

HR(−) HER2(−) Breast Cancer

11.1. . Courses of Treatment. Neoadjuvant chemotherapy (#4 cycles of doxo­. rubicin and cyclophosphamide + #4 cycles of. docetaxel) + Operation + Post-operative radia­. tion therapy + Adjuvant capecitabine.. Operation. 82. Pathology Report. Invasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of tumor: 0.2 cm (ypT1a).. 3. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 6/10HPF).. 4. Intraductal component: absent.. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) Superior margin: 20 mm.. . (b) Inferior margin: 5 mm.. . (c) Medial margin: 10 mm.. . (d) Lateral margin: 20 mm.. . (e) Deep margin: 2 mm.. . (f) Superficial margin: 2 mm.. 7. Lymph nodes: no metastasis in three axillary. lymph nodes (ypN0(sn)) (sentinel LN: 0/3).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular invasion: absent.. . 10. Tumor border: infiltrative.. . 11. Microcalcification:. present,. ­. tumoral/. non-tumoral.. . 12. Pathological TN category (AJCC 2017):. ypT1aN0(sn).. Result. Intensity. Positive. %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (2/8). 1. <1%. C-erbB2. Negative (0). Ki-67. Positive in 2% of. tumor cells. E. S. Lee et al.. 615. . ­. . . HR(−) HER2(−) Breast Cancer. 616. . . ­. E. S. Lee et al.. 617. 12. 

Important Radiologic. Findings. 74 75 76. 77. E. S. Lee et al.. 613. . . . HR(−) HER2(−) Breast Cancer. 614. . After Neoadjuvant. Chemotherapy. 78 79 80. 81. 11.3. 

Patient History and Progress. Female/50 years old, pre-menopause.. Screen detected mass lesion on upper outer. portion of right breast.. Family history of breast cancer, mother and. aunt (paternal).. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 11.2. 

Case 11

Local Recurrence

11.1. . Courses of Treatment. Right breast IDC → Operation → Adjuvant. therapy → Right breast recurrence (IDC).. Primary Treatment. Operation. Nov. 2008 Right breast conserving surgery, senti­. nel lymph node biopsy (outside).. Pathology Report. Invasive Ductal Carcinoma. . 1. Size of tumor: 1.3 cm (pT1c).. . 2. Lymph nodes: no metastasis in four axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/4).. . 3. Pathologic stage (AJCC 2010): pT1cN0(sn).. Result. Intensity Positive %. Estrogen. receptor. Positive. Progesterone. receptor. Positive. C-erbB2. Negative. Ki-67. Positive in 5–10%. of tumor cells. Adjuvant Therapy. Adjuvant chemotherapy #4 cycles of doxorubicin. and cyclophosphamide.. Postoperative radiation therapy.. Tamoxifen 20 mg/day for 1.8 years.. Treatments After Recurrence. 85 86. 87. Y. Kim et al.. 749. . . . Operation. ­. 88. Pathology Report. Invasive Ductal Carcinomas (×2). 1. Post-chemotherapy status.. 2. Post-lumpectomy status.. 3. Size of tumor: 0.8 cm and 0.3 cm (ypT1b).. 4. Histologic grade: 2/3 (tubule formation: 2/3,. nuclear pleomorphism: 2/3, mitotic count:. 2/3, 12/10HPF).. 5. Intraductal component: present, intratu­. moral/intratumoral (10%) (nuclear grade:. low, necrosis: absent, architectural pattern:. cribriform, extensive intraductal component:. absent).. 6. Skin: no involvement of tumor.. 7. Surgical margins:. . (a) Deep margin: 6 mm.. . (b) Superficial margin: 10 mm.. Local Recurrence. 750. a. b. . 8. Lymph nodes: no metastasis in one axillary. lymph node (ypN0)(sn) (sentinel LN: 0/1).. 9. Vascular invasion: absent.. . 10. Lymphatic invasion: absent.. . 11. Tumor border: infiltrative.. . 12. Microcalcification: absent.. . 13. Pathologic stage (AJCC 2010): ypT1bN0(sn).. Result. Intensity Positive %. Estrogen. receptor. Strong (7/8). 2. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Equivocal (2+). (SISH negative). Ki-67. Positive in 21% of. tumor cells. Adjuvant Therapy. Tamoxifen 20 mg/day for 5 years with goserelin.. 12. 

Patient History and Progress. Female/45 years old, post-menopause.. Screen detected mass lesion on right breast 10. o’clock direction.. No family history.. S/P bilateral salpingo-oophorectomy (right. ovary borderline tumor).. BRCA 1 and 2 mutation: Not detected.. 11.2. 

Case 11

Metastatic Breast Cancer

Courses of Treatment. Both breasts cancer → Operation → Adjuvant. therapy → Right axillary lymph node. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Weak (3/8). 2. <1%. C-erbB2. Equivocal. (2+). Result. Intensity. Positive %. Ki-67. Positive in. 22% of. tumor cells. SISH. Equivocal. HER2/CEP17 gene ratio: 1.93.. Left> Invasive ductal carcinoma, stage. pT2N0(sn).. Size of tumor: 2.1 cm, lymph node: 0/2.. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Weak (4/8). 2. 1–10%. C-erbB2. Equivocal (2+). Ki-67. Positive in 34%. of tumor cells. SISH. Tumor. heterogeneity. HER2/CEP17 gene ratio: 2.03.. Adjuvant Therapy. Adjuvant chemotherapy #2 cycles (Docetaxel &. cyclophosphamide) → Trastuzumab for 1 year +. Letrozole 2.5 mg/day for 2.1 years.. Treatments After Recurrence. Right Axillary Lymph Nodes Recurrence. receptor. Negative (0/8). 0. 0. C-erbB2. Equivocal (2+). Ki-67. Positive in. 25% of tumor. cells. SISH. Positive. Neoadjuvant Chemotherapy. Chemotherapy. #5. cycles. (Docetaxel. &. Carboplatin & Trastuzumab & Pertuzumab).. Operation. Mar. 2022 Right axillary lymph node dissection.. Pathology: No metastasis in four axillary. lymph nodes.. Adjuvant Therapy. Trastuzumab & Pertuzumab + Post-operative. radiation therapy (axillary and subclavian area).. 12. 

Case 12

Benign and Proliferative

12.1. . Courses of Treatment. →2021-10-29 excision, Lt.. Pathology Report. Diagnosis. • Breast, left, excision:. –. – Intraductal papilloma (#1. 2  o’clock, #2.. 5  o’clock & #3. 9  o’clock) with (1) usual. ductal hyperplasia, (2) apocrine metaplasia.. C. W. Lee et al.. 31. 13. 

Important Radiologic. Findings. 19. 20. 12.3. 

Patient History and Progress. Female/70 years old, post-menopause.. Screen detected mass lesion on left breast. 2 o’clock and 5 o’clock and 9 o’clock direction.. No family history.. s/p Right breast conserving surgery (right. breast cancer), hypertension, diabetes mellitus.. 12.2. 

Case 12

Carcinoma In Situ

12.1. . Courses of Treatment. Operation + Tamoxifen 20 mg/day for 5 years.. Operation. ­. ­. 55. 56. Pathology Report. Ductal carcinoma in situ, pathological TN cat­. egory (AJCC 2017): pTisN0(sn). . 1. Size of tumor: 1.0 cm (pTis).. . 2. Nuclear grade: high.. . 3. Necrosis: present.. . 4. Architectural. pattern:. cribriform/solid/. comedo.. . 5. Surgical margins:. . (a) deep margin: 10 mm,. . (b) superficial margin: 12 mm.. . 6. Lymph nodes: no metastasis in two axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/1, left. intramammary LN: 0/1).. . 7. Microcalcification: present, non-tumoral.. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative. (1+). Ki-67. Positive in. 16% of. tumor cells

Important Radiologic. Findings. 52 53. 54. 12.3. 

Patient History and Progress. Female/49 years old, pre-menopause.. Screen detected mass lesion on right breast. 4:30 and 9 o’clock direction.. Outside result of biopsy:. Left breast 4: 30 o’clock, ductal carcinoma in. situ.. Left breast 9 o’clock, intraductal papilloma.. Family history of breast cancer, sister at her. 48 years old.. E. S. Lee et al.. 77. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 12.2. 

Case 12

HR(+) HER2(+) Breast Cancer

12.1. . Courses of Treatment. Neoadjuvant chemotherapy (#1 cycle of. docetaxel and carboplatin and trastuzumab. and pertuzumab followed by #5 cycles of. docetaxel and carboplatin)  +  Operation  +. Adjuvant chemotherapy (doxorubicin and. cyclophosphamide) + Post-­. operative radiation. therapy + Letrozole 2.5 mg/day.. 69. Pathology Report. Invasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of tumor: 0.3 cm (ypT1a).. 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 2/3, 11/10HPF).. 4. Intraductal component: present, intratu­. moral/extratumoral (50%) (nuclear grade:. high, necrosis: absent, architectural pattern:. micropapillary, extensive intraductal compo­. nent: present).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) superior margin: 10 mm,. . (b) inferior margin: (see Note 1),. . (c) medial margin: (see Note 2),. . (d) lateral margin: 20 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: 2 mm.. 7. Lymph nodes: no metastasis in one axillary. lymph node (ypN0(sn)) (sentinel LN: 0/1).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular invasion: absent.. . 10. Tumor border: infiltrative.. . 11. Microcalcification:. present,. tumoral/. non-tumoral.. . 12. Pathological TN category (AJCC 2017):. ypT1aN0(sn).. HR(+) HER2(+) Breast Cancer. 338. . Note: 1. The inferior margin of the lumpec­. tomy specimen (slide A3) is close to ductal carci­. noma in situ (2 mm) but this margin submitted. for frozen diagnosis (Fro 2) is free of tumor.. 2. The medial margin of the lumpectomy. specimen (slide 1) is close to ductal carcinoma in. situ (<1 mm) but this margin submitted for frozen. diagnosis (Fro 3) is free of tumor.. Result. Intensity. Positive %. Estrogen receptor. Strong (8/8). 3. >2/3. Progesterone receptor. Weak (3/8). 1. 1–10%. C-erbB2. Negative (1+). Equivocal (2+) in core needle biopsy. Ki-67. Positive in 4% of tumor cells. SISH. Positive. S. Park et al.. 339. . . HR(+) HER2(+) Breast Cancer. 340. a. b. . 13. 

Important Radiologic. Findings. 64 65 66 67. 68. S. Park et al.. 337. . . 12.3. 

Patient History and Progress. Female/63 years old, post-menopause.. Screen detected mass lesion on left breast 10. o’clock direction.. No family history.. s/p Idiopathic thrombocytopenic purpura. (2020).. 12.2. 

Case 12

HR(+) HER2(-) Breast Cancer

Courses of Treatment. Operation. +. Adjuvant. chemotherapy. (#4  cycles of docetaxel & cyclophospha­. mide). +. Post-operative. radiation. ther­. apy + Tamoxifen 20 mg/day.. Operation. Right breast conserving surgery, sentinel lymph. extratumoral (30%) (nuclear grade: low,. necrosis: present, architectural pattern: solid,. extensive intraductal component: present).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) superior margin: 3 mm,. . (b) inferior margin: 17 mm,. . (c) medial margin: 10 mm,. . (d) lateral margin: <1 mm from ductal carci­. noma in situ (slides 10 and 11),. . (e) deep margin: 5 mm,. . (f) superficial margin: positive for ductal. carcinoma in situ (slide 8).. 6. Lymph nodes: no metastasis in five axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/2,. non-sentinel LN: 0/3).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular. invasion:. present,. peritumoral.. 9. Tumor border: pushing.. . 10. Microcalcification: absent.. . 11. Pathological TN category (AJCC 2017):. pT2N0(sn).. Result. Intensity. Positive %. Estrogen receptor. Weak (4/8). 1. 10%–1/3. Progesterone receptor. Intermediate (5/8). 2. 10%–1/3. C-erbB2. Negative (0). Ki-67. Positive in 4% of tumor cells. Y. Kim et al.

Important Radiologic. Findings. See Figs. 58, 59, 60 and 61.. 12.3. 

S/P hysterectomy, dyslipidemia, diabetes mel­. litus, s/p cervical spine disc operation.. 12.2. 

Case 12

HR(−) HER2(+) Breast Cancer

12.1. . Invasive Ductal Carcinoma with medullary. pattern. 1. Size of tumor: 2.9 cm (pT2).. 2. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 5/HPF).. 3. Intraductal component: present, intratu­. moral/extratumoral (30%) (nuclear grade:. high, necrosis: present, architectural pattern:. Y. Kwon et al.. 477. . solid/comedo, extensive intraductal compo­. nent: present).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) superior margin: 10 mm,. . (b) inferior margin: 5 mm,. . (c) medial margin: 20 mm,. . (d) lateral margin: 15 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: 2 mm.. 6. Lymph nodes: no metastasis in four axillary. lymph nodes (pN0(sn)) (sentinel LN (fro­. zen): 0/4, sentinel LN (A): 0/0, non-sentinel. LN: 0/0).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular. invasion:. present,. intratumoral.. 9. Tumor border: infiltrative.. . 10. Microcalcification:. present,. tumoral/. non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT2N0(sn).. Result. Intensity. Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in. 52% of tumor. cells. HR(−) HER2(+) Breast Cancer. 478. 13. 

Important Radiologic. Findings. 87 88 89

Patient History and Progress. Female/66 years old, post-menopause.. Self-detected palpable mass lesion on left. breast.. No family history.. Hypertension, thyroidectomy (hyperthyroid­. ism), s/p salpingectomy.. 12.2. 

Case 12

HR(−) HER2(−) Breast Cancer

12.1. . Courses of Treatment. Neoadjuvant chemotherapy (#4 cycles of doxo­. rubicin and cyclophosphamide  +  #4 cycles of. docetaxel) + Operation + Adjuvant capecitabine.. Operation. ­. ­. ­. 89. 90. Pathology Report. Invasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of tumor: 0.5 cm (ypT1a).. 3. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 1/3, 1/10HPF).. 4. Intraductal component: absent.. 5. Surgical margins:. . (a) Deep margin: 2 mm.. . (b) Superficial margin: 8 mm.. 6. Lymph nodes: no metastasis in three axil­. lary lymph nodes (ypN0(sn)) (sentinel LN:. 0/3).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular. invasion:. present,. intratumoral.. 9. Tumor border: infiltrative.. . 10. Microcalcification: present, non-tumoral.. . 11. Pathological TN category (AJCC 2017):. ypT1aN0(sn).. Result. Intensity. Positive. %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Negative (0). Ki-67. Positive in 6% of. tumor cells. E. S. Lee et al.. 619. . . HR(−) HER2(−) Breast Cancer. 620. 13. 

Important Radiologic. Findings. 83 84. 85. . . . HR(−) HER2(−) Breast Cancer. 618. . ­. . . After Neoadjuvant. Chemotherapy. 86 87. 88. 12.3. 

Patient History and Progress. Female/47 years old, post-menopause.. Screen detected a mass lesion on right breast. 10 o’clock direction.. Family history of breast cancer, aunt (mater­. nal) and cousin.. Family history of ovarian cancer, aunt.. Lupus (follow-up), s/p bilateral salpingo-­. oophorectomy, s/p unilateral thyroidectomy.. BRCA 1 mutation carrier.. 12.2. 

Case 12

Local Recurrence

12.1. . Courses of Treatment. Right breast DCIS → Operation → Right breast. recurrence (microinvasive ductal carcinoma).. Primary Treatment. 89 90. 91. Operation. ­. 92. Pathology Report. Ductal carcinoma in situ. . 1. Size of tumor: 2.3 cm (pTis).. . 2. Nuclear grade: low.. . 3. Necrosis: absent.. . 4. Architectural pattern: cribriform, solid and. papillary.. . 5. Skin: no involvement of tumor.. . 6. Surgical margins:. . (a) Superior margin: 20 mm.. . (b) Inferior margin: 20 mm.. . (c) Medial margin: 30 mm.. . (d) Lateral margin: 50 mm.. . (e) Deep margin: 2 mm.. . 7. Lymph nodes: no metastasis in 5 axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/4,. right intramammary LN (Fro 6): 0/1).. Y. Kim et al.. 751. . . ­. . . . ­. . 8. Microcalcification:. present,. tumoral/. non-tumoral.. . 9. Pathologic staging: pTisN0(sn).. Result. Intensity. Positive %. Estrogen. receptor. Strong (7/7). 3. >2/3. Progesterone. receptor. Strong (6/7). 3. 1/3–2/3. C-erbB2. Equivocal (2+). Ki-67. Positive in 10%. of tumor cells. Treatments After Recurrence. 93. Operation. 94. 95. Local Recurrence. 752. a. b. . a. b. . Pathology Report. . 1. Microinvasive Ductal Carcinoma involving. lactiferous duct.. . (a) Post-lumpectomy status.. . (b) Size of invasive component: <0.1  cm. (pT1mi(Paget)).. . (c) Size of intraductal component: 1.3 cm.. . (d) Histologic grade: 2/3 (tubule formation:. 3/3, nuclear pleomorphism: 2/3, mitotic. count: 1/3, 6/10HPF).. . (e) Intraductal component: present, intratu­. moral/extratumoral. (99%). (nuclear. grade: low, necrosis: present, architec­. tural pattern: micropapillary/cribriform,. extensive. intraductal. component:. present).. . (f) Nipple: involvement of lactiferous duct. (slide 10).. . (g) Skin: no involvement of tumor.. . (h) Surgical margins:. Y. Kim et al.. 753. • Deep margin: 3 mm.. • Superficial margin: 4 mm.. . (i) Arteriovenous invasion: absent.. . (j) Lymphovascular invasion: absent.. . (k) Tumor border: infiltrative.. . (l) Microcalcification: present, tumoral.. . (m) Pathologic. stage. (AJCC. 2010):. pT1mi(Paget).. . 2. Lobular carcinoma in situ, 0.3 cm.. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Intermediate. (6/8). 2. 1/3–2/3. C-erbB2. Equivocal (2+). Ki-67. Positive in 13%. of tumor cells. Adjuvant Therapy. Tamoxifen 20 mg/day for 5 years.. 13. 

Patient History and Progress. Female/55 years old, peri-menopause.. Screen detected mass lesion on right breast 9. o’clock direction.. Family history of prostate cancer, father.. s/p hysterectomy, HPV infection.. 12.2. 

Case 12

Metastatic Breast Cancer

12.1. . Courses of Treatment. Left breast cancer → Operation → Adjuvant. therapy → Ipsilateral axillary lymph node. recurrence → Contralateral breast cancer.. Primary Treatment. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Intermediate. (6/8). 2. 1/3–2/3. C-erbB2. Equivocal (2+). Ki-67. Positive in 26%. of tumor cells. SISH. Negative. Adjuvant Therapy. Anastrozole 1 mg/day for 4.3 years.. Treatments After Recurrence. Ipsilateral Axillary Lymph Node. Recurrence. Progesterone. receptor. Weak (4/8). 3. <1%. C-erbB2. Negative (0). Ki-67. Positive in. 31% of. tumor cells. Neoadjuvant Chemotherapy. Chemotherapy. #8. cycles. (Adriamycin. +. Cyclophosphamide #4 → weekly paclitaxel #4).. Y. Kwon et al.. Contralateral Breast Cancer. See Figs. 41 and 42.. Aug. 2021 Right breast biopsy.. Pathology: Ductal carcinoma.. Operation. Oct. 2021 Right total mastectomy, sentinel lymph. node biopsy.. Pathology: Ductal carcinoma in situ, stage. pTisN0(sn).. Size of tumor: 1.6 cm, lymph node: 0/4.. Result. Intensity. Positive %. Estrogen. receptor. Strong (0/8). 0. 0. Progesterone. receptor. Weak (0/8). 0. 0. C-erbB2. Equivocal. (2+). Ki-67. Positive in. 12% of. tumor cells. → Exemestane 25 mg/day~. Adjuvant Therapy. Exemestane 25 mg/day~. Metastatic Breast Cancer. 882. 13. 

Patient History and Progress. Female/78 years old, post-menopause.. No family history.. Hypertension, diabetes mellitus.. 12.2. 

Case 13

Benign and Proliferative

13.1. . Courses of Treatment. →2021-10-26 excision, Rt.. . Benign and Proliferative Case Series. 32. . Pathology Report. • Breast, right 12 o’clock, excision:. –. – Flat. epithelial. atypia. with. microcalcification. • Breast, right 2 o’clock, excision:. –. – Atypical. ductal. hyperplasia. with. microcalcification.. 14. 

Important Radiologic. Findings. 21. 22. 13.3. 

Patient History and Progress. Female/45 years old, pre-menopause.. Screen detected microcalcification on upper. center of right breast.. No family history.. No comorbidities.. 13.2. 

Case 13

Carcinoma In Situ

. Courses of Treatment. Operation + Tamoxifen 20 mg/day for 5 years.. Operation. 58. 59. Pathology Report. <First operation>. Ductal carcinoma in situ, pathological TN cat­. egory (AJCC 2017): pTis. . 1. Size of tumor: 0.5 cm (pTis).. . 2. Nuclear grade: low.. . 3. Necrosis: absent.. . 4. Architectural pattern: papillary/cribriform.. . 5. Surgical margins: positive for ductal carci­. noma in situ.. . 6. Microcalcification:. present,. tumoral/non-. tumoral.. Carcinoma In Situ. 80. . . . Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (7/8). 2. >2/3. C-erbB2. Negative (0). Ki-67. Positive in. 1% of tumor. cells. <Second operation>. No residual tumor with foreign body reaction.. . 1. Post-excision status.. E. S. Lee et al.. 81. 14. 

Important Radiologic. Findings. 57. 13.3. 

Patient History and Progress. Female/61 years old, post-menopause.. Screen detected mass lesion on left breast. 10 o’clock direction.. Outside result of biopsy: Left breast. 10 o’clock, papillary neoplasm.. Family history of breast cancer, sister.. No comorbidities.. BRCA 1 and 2: Not check.. 13.2. 

Case 13

HR(+) HER2(+) Breast Cancer

13.1. . Courses of Treatment. Operation  +  Adjuvant chemotherapy (#4. cycles. of. docetaxel. and. cyclophospha­. mide). +. Post-operative. radiation. ther­. apy + Trastuzumab + Letrozole 2.5 mg/day.. 73. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 2.1 cm (pT2).. 2. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 15/10 HPF).. S. Park et al.. 341. . . . 3. Intraductal component: present, intratu­. moral/extratumoral (10%) (nuclear grade:. low, necrosis: present, architectural pattern:. solid/comedo, extensive intraductal compo­. nent: absent).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) superior margin: 10 mm,. . (b) inferior margin: 10 mm,. . (c) medial margin: 5 mm,. . (d) lateral margin: 5 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: 2 mm.. 6. Lymph nodes: no metastasis in one axillary. lymph node (pN0(sn)) (sentinel LN: 0/1).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular. invasion:. present,. intratumoral.. 9. Tumor border: infiltrative.. . 10. Microcalcification:. present,. tumoral/. non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT2N0(sn).. Result. Intensity. Positive. %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (7/8). 3. 1/3–2/3. C-erbB2. Positive (3+). Ki-67. Positive in 42%. of tumor cells. HR(+) HER2(+) Breast Cancer. 342. a. b. . 14. 

Important Radiologic. Findings. 70 71. 72. 13.3. 

Patient History and Progress. Female/53 years old, post-menopause.. Screen detected mass lesion on left breast 1:30. o’clock direction.. No family history.. Hypertension, arrhythmia, s/p myomectomy.. 13.2. 

Case 13

HR(+) HER2(-) Breast Cancer

Courses of Treatment. Operation. +. Adjuvant. chemotherapy. (#4 cycles of doxorubicin & cyclophosphamide. followed by #4  cycles of docetaxel)  +  Post-­. operative radiation therapy  +  Letrozole. 2.5 mg/day.. Operation. sive intraductal component: absent).. 4. Skin and nipple: dermal involvement of. tumor.. 5. Surgical margins: (see note).. . (a) deep margin: <1 mm from invasive duc­. tal carcinoma (slide 3).. . (b) superficial margin: 2 mm.. 6. Lymph nodes:. HR(+) HER2(−) Breast Cancer. 8. Lymphovascular. invasion:. present,. intratumoral.. 9. Tumor border: infiltrative.. . 10. Microcalcification: present, tumoral.. . 11. Pathological TN category (AJCC 2017):. pT3N2a.. Note: 1. The medial border of the mastectomy. specimen (slide 10) is close to invasive ductal. carcinoma (<1 mm).. HR(+) HER2(−) Breast Cancer. Intermediate (6/8). 2. 1/3–2/3. C-erbB2. Negative (1+). Ki-67. Positive in 26% of tumor cells. 14. 

Important Radiologic. Findings. See Figs. 63, 64, 65 and 66.. 13.3. 

S/P Tuberculosis, S/P appendectomy.. 13.2. 

Case 13

HR(−) HER2(+) Breast Cancer

13.1. . Courses of Treatment. Neoadjuvant chemotherapy (#6 cycles of. docetaxel and carboplatin and trastuzumab and. pertuzumab) + Operation + Post-operative radia­. 2. Size of tumor: 0.3 cm (ypT1a).. 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 4/HPF).. 4. Intraductal component: present, intratu­. moral/extratumoral (30%) (nuclear grade:. high, necrosis: present, architectural pattern:. cribriform/solid, extensive intraductal com­. ponent: present).. . Y. Kwon et al.. 483. 5. Skin and nipple: no involvement of tumor.. 6. Surgical margins:. . (a) deep margin: 2 mm,. . (b) superficial margin: 2 mm.. 7. Lymph nodes: no metastasis in six axillary. lymph nodes (ypN0) (sentinel LN: 0/3, non-­. sentinel LN: 0/3).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular. invasion:. present,. intratumoral.. . 10. Tumor border: infiltrative.. . 11. Microcalcification:. present,. tumoral/. non-tumoral.. . 12. Pathological TN category (AJCC 2017):. ypT1aN0.. Result. Intensity. Positive %. Estrogen. receptor. Negative. (0/8). 0. 0. Progesterone. receptor. Negative. (0/8). 0. 0. C-erbB2. Positive. (3+). Result. Intensity. Positive %. Ki-67. Positive in. 4% of. tumor cells. 14. 

Important Radiologic. Findings. 92 93. 94. . Y. Kwon et al.. 479. 95 96 97. 98. 13.4. 

Patient History and Progress. Female/44 years old, pre-menopause.. Self-detected palpable mass lesion on left. breast 11 o’clock direction.. No family history.. No comorbidities.. 13.2. 

Case 13

HR(−) HER2(−) Breast Cancer

13.1. . Courses of Treatment. Neoadjuvant chemotherapy (#4  cycles of. doxorubicin and cyclophosphamide  +  #4. cycles of docetaxel)  +  Operation  +  Post-. operative radiation therapy  +  Adjuvant. capecitabine.. Operation. 98. Pathology Report. Invasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of tumor: 1.5 cm (ypT1c).. 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 2/3, 12/10HPF).. 4. Intraductal component: present, intratu­. moral/extratumoral (5%) (nuclear grade:. high, necrosis: absent, architectural pattern:. solid, extensive intraductal component:. absent).. 5. Surgical margins:. . (a) Superior margin: 15 mm.. . (b) Inferior margin: 20 mm.. . (c) Medial margin: 5 mm (see note 1).. . (d) Lateral margin: 15 mm.. . (e) Deep margin: 3 mm.. . (f) Superficial margin: 10 mm.. 6. Lymph nodes: no metastasis in two axillary. lymph nodes (ypN0(sn)) (sentinel LN: 0/1,. non-sentinel LN: 0/1).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular. invasion:. present,. intratumoral.. 9. Tumor border: infiltrative.. . 10. Microcalcification: present, non-tumoral.. . 11. Pathological TN category (AJCC 2017):. ypTlcN0 (sn).. Result. Intensity. Positive. %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Negative (0). Ki-67. Positive in 16%. of tumor cells. E. S. Lee et al.. 621. . . . HR(−) HER2(−) Breast Cancer. 622. . . ­. . E. S. Lee et al.. 623. . . HR(−) HER2(−) Breast Cancer. 624. 14. 

Important Radiologic. Findings. 91 92. 93. After Neoadjuvant. Chemotherapy. 94 95 96. 97. 13.3. 

Patient History and Progress. Female/67 years old, post-menopause.. Self-detected mass lesion on left breast.. No family history.. Hepatitis C virus carrier, arrhythmia.. 13.2. 

Case 13

Local Recurrence

13.1. . Courses of Treatment. Right breast microinvasive ductal carcinoma →. Operation → Right breast recurrence (DCIS).. Primary Treatment. 96 97. 98. . . . Local Recurrence. 754. a. b. . a. b. . Operation. ­. 99. 100. Pathology Report. Microinvasive Ductal Carcinoma. 1. Size of invasive component: <0.1  cm. (pT1mi).. 2. Size of intraductal component: 4.5 cm.. 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 2/3, 11/HPF).. 4. Intraductal component: present, intratu­. moral/extratumoral (98%) (nuclear grade:. high, necrosis: present, architectural pattern:. micropapillary/cribriform, extensive intra­. ductal component: present).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) Deep margin: <1 mm from ductal carci­. noma in situ (slide 3).. . (b) Superficial margin: <1 mm from ductal. carcinoma in situ (slide 10).. 7. Lymph nodes: no metastasis in three axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/3). 8. Arteriovenous invasion: absent.. 9. Lymphovascular invasion: absent.. . 10. Tumor border: infiltrative.. . 11. Microcalcification:. present,. tumoral/. non-tumoral.. . 12. Pathologic stage (AJCC 2010): pT1miN0(sn).. Result. Intensity. Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in 35%. of tumor cells. Y. Kim et al.. 755. Treatments After Recurrence. 101. Operation. 102. Pathology Report. Ductal Carcinoma In Situ. . 1. Post-nipple-sparing mastectomy status.. . 2. Size of tumor: 1.0 cm (rpTis(Paget)).. . 3. Nuclear grade: high.. . 4. Necrosis: present.. . 5. Architectural pattern: micropapillary/cribri­. form/comedo.. . 6. Nipple: involvement of lactiferous duct with. Paget’s disease.. . 7. Surgical margins:. . (a) Superior margin: 5 mm.. . (b) Inferior margin: 5 mm.. . (c) Medial margin: 5 mm.. . (d) Lateral margin: 5 mm.. . (e) Deep margin: 2 mm.. . (f) Superficial margin: 2 mm.. . 8. Microcalcification: present, tumoral.. . 9. Pathological TN category (AJCC 2017):. rpTis.. Result. Intensity. Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (2/8). 1. <1%. C-erbB2. Positive (3+). Ki-67. Positive in 19%. of tumor cells. 14. 

Patient History and Progress. Female/42 years old, pre-menopause.. Screen detected mass lesion on right breast 3. o’clock direction and bloody discharge from. right nipple.. Outside result of biopsy: Ductal carcinoma in. situ.. No family history.. No comorbidities.. BRCA 1 and 2 mutation: not detected.. 13.2. 

Case 13

Metastatic Breast Cancer

13.1. . Courses of Treatment. Right breast cancer → Operation → Adjuvant. therapy → Ipsilateral axillary lymph node. recurrence.. Primary Treatment. Estrogen. receptor. Intermediate. (6/8). 1. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative (0). Ki-67. Positive in. 18% of tumor. cells. Adjuvant Therapy. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative (1+). Ki-67. Positive in. 44% of tumor. cells. See Figs. 45 and 46.. Neoadjuvant Chemotherapy. Neoadjuvant. chemotherapy. #8. cycles. (Adriamycin. +. Cyclophosphamide. #4. →. Docetaxel #4).. Operation. Oct. 2021 Right axillary tail wide excision and. bilateral salpingo-oophorectomy.. Pathology: DUCTAL CARCINOMA IN. SITU, stage yrpTis, size of tumor: 0.2 cm.. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative (0). Ki-67. Positive in. 2% of. tumor cells. Adjuvant Therapy. Post-operative radiation therapy + Letrozole

Patient History and Progress. Female/39 years old, post-menopause.. Family history of ovarian cancer, paternal. aunt.. BRCA. 1. mutation: VUS. (variant. of. uncertain).. S/p bilateral salpingo-oophorectomy.. 13.2. 

Case 14

Benign and Proliferative

14.1. . Courses of Treatment. →2021-10-15 excision, Rt.. Pathology Report. • Breast, right, excision:. –. – Atypical ductal hyperplasia involving. intraductal papilloma with marked cautery. artifact.. C. W. Lee et al.. 33. . . 15. 

Important Radiologic. Findings. 23. 24. 14.3. 

Patient History and Progress. Female/60 years old, post-menopause.. Screen detected mass lesion on right breast. 9 o’clock direction.. Family history of breast cancer, mother.. s/p Total hysterectomy (leiomyoma) and Left. salpingo-oophorectomy.. 14.2. 

Case 14

Carcinoma In Situ

14.1. . Courses of Treatment:. Operation. Operation. 61. 62. Pathology Report. <First operation>. Ductal carcinoma in situ, pathological TN cat­. egory (AJCC 2017): pTis. . 1. Size of tumor: 0.3 cm (pTis).. . 2. Nuclear grade: low.. . 3. Necrosis: absent.. . 4. Architectural pattern: papillary.. . 5. Surgical margins:. . (a) superior margin: 5 mm,. . (b) inferior margin: 7 mm,. . (c) medial margin: 20 mm,. . (d) lateral margin: positive for ductal carci­. noma in situ (slide 5),. . (e) deep margin: positive for ductal carci­. noma in situ (slide 5),. . (f) superficial margin: 5 mm.. . 6. Microcalcification: present, tumoral.. Result. Intensity. Positive %. Estrogen. receptor. Weak (4/8). 2. 1%–10%. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Negative (1+). Ki-67. Positive in 1%. of tumor cells. <Second operation>. No residual tumor with foreign body reaction.. . 1. Post-excision status.. Note: Atypical ductal hyperplasia is pres­. ent only in the frozen section of Fro 1. . Carcinoma In Situ. 82. . . . 15. 

Important Radiologic. Findings. 60. 14.3. 

Patient History and Progress. Female/54 years old, pre-menopause.. Screen detected microcalcification on upper. inner portion of left.. No family history.. Taking medication for bladder dysfunction.. 14.2. 

Case 14

HR(+) HER2(+) Breast Cancer

14.1. . Courses of Treatment. Operation  +  Adjuvant chemotherapy (#4. cycles of doxorubicin and cyclophosphamide. followed by #4 cycles of docetaxel and trastu­. zumab)  +  Post-operative radiation ther­. apy + Trastuzumab + Tamoxifen 20 mg/day.. 77. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 1.5 cm (pT1c(m)).. 2. Histologic grade: 2/3 (tubule formation: 2/3,. nuclear pleomorphism: 3/3, mitotic count:. 2/3, 11/10 HPF).. S. Park et al.. 343. . . . 3. Intraductal component: present, intratu­. moral/extratumoral (50%) (nuclear grade:. high, necrosis: present, architectural pattern:. cribriform/solid/comedo, extensive intra­. ductal component: present).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) superior margin: 10 mm,. . (b) inferior margin: 10 mm,. . (c) medial margin: 10 mm,. . (d) lateral margin: 5 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: 2 mm.. 6. Lymph nodes:. . (a) metastasis in one out of one axillary. lymph node (pN1mi(sn)) (sentinel LN:. 1/1),. . (b) perinodal extension: present,. . (c) size of metastatic carcinoma: 2 mm.. 7. Arteriovenous invasion: absent.. HR(+) HER2(+) Breast Cancer. 344. a. b. c. d. . 8. Lymphovascular. invasion:. present,. intratumoral.. 9. Tumor border: infiltrative.. . 10. Microcalcification:. present,. tumoral/. non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT1c(m)N1mi(sn).. Invasive Ductal Carcinoma. . 1. Size of tumor: 0.6, 0.5 and 0.5 cm.. . 2. Histologic grade: 2/3 (tubule formation: 2/3,. nuclear pleomorphism: 2/3, mitotic count:. 2/3, 11/10 HPF).. . 3. Intraductal component: absent.. . 4. Skin: no involvement of tumor.. S. Park et al.. 345. . 5. Surgical margins:. . (a) superior margin: 10 mm,. . (b) inferior margin: 10 mm,. . (c) medial margin: 5 mm,. . (d) lateral margin: 5 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: 2 mm.. . 6. Arteriovenous invasion: absent.. . 7. Lymphovascular invasion: absent.. . 8. Tumor border: infiltrative.. . 9. Microcalcification: present, tumoral.. Result. Intensity. Positive. %. Estrogen. receptor. IDC—strong. (8/8). 3. >2/3. In situ—negative. (2/8). 1. <1%. Progesterone. receptor. IDC—strong. (8/8). 3. >2/3. In situ—negative. (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in 17%. of tumor cells. 15. 

Important Radiologic. Findings. 74 75. 76. 14.3. 

Patient History and Progress. Female/51 years old, peri-menopause.. Screen detected mass lesion on portion of. lower of right breast.. Family history of breast cancer, sister.. Hypothyroidism (taking on synthroid).. BRCA 1 and 2 mutation: Not detected.. 14.2. 

Case 14

HR(+) HER2(-) Breast Cancer

14.1. . Courses of Treatment. Neoadjuvant therapy (Palbociclib 125 mg/day. &. tamoxifen. 20. mg/day. with. gosere­. lin)  +  Operation  +  Post-operative radiation. therapy. +. Letrozole. 2.5. mg/day. with. goserelin.. Operation. Left breast conserving surgery, sentinel lymph. . (a) superior margin: 5 mm.. . (b) inferior margin: (see note 1).. . (c) medial margin: (see note 2).. . (d) lateral margin: (see note 3).. . (e) deep margin: <1  mm from mucinous. carcinoma (slide 1).. . (f) superficial margin: <1  mm from muci­. 11. Microcalcification:. present,. tumoral/. non-tumoral.. . 12. Pathological TN category (AJCC 2017):. ypT1cN0(sn).. Note: 1. The inferior margin of the lumpec­. tomy specimen (slide 4) is close to mucinous. carcinoma (<1 mm) but this margin submitted. for frozen diagnosis (Fro 3) is free of tumor.. 2. The medial margin of the lumpectomy speci­. men (slide 3) is close to mucinous carcinoma. (1 mm) but this margin submitted for frozen. diagnosis (Fro 4) is free of tumor.. 3. The lateral margin of the lumpectomy speci­. men (slide 7) is close to ductal carcinoma in. situ (<1 mm) but this margin submitted for. frozen diagnosis (Fro 11) is free of tumor.. Result. Intensity. Positive. %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative (0). Ki-67. Positive in 3% of. tumor cells. 15. 

Important Radiologic. Findings. See Figs. 68, 69, 70, 71 and 72.. 14.3. 

Patient History and Progress. Female/43 years old, pre-menopause.. Screen detected mass lesion on left breast 1. and 3 o’clock direction.. No family history.. No comorbidities.. 14.2. 

Case 14

HR(−) HER2(+) Breast Cancer

14.1. . Courses of Treatment. Neoadjuvant chemotherapy (#3 cycles of. docetaxel and trastuzumab and pertuzumab after. followed #3 cycles of trastuzumab and pertu­. zumab #4) + Operation + Post-operative radia­. tion therapy + Trastuzumab emtansine.. Operation. Microinvasive Ductal Carcinoma. 1. Size of invasive component: <0.1  cm. (pT1mi).. 2. Size of intraductal component: 2.5 cm.. 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 4/HPF).. 4. Intraductal component: present, intratu­. moral/extratumoral (99%) (nuclear grade:. high, necrosis: present, architectural pattern:. cribriform/solid/comedo, extensive intra­. ductal component: present).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) superior margin: (see Note 1),. . (b) inferior margin: (see Note 2),. . (c) medial margin: positive for ductal carci­. noma in situ (Fro 3) (see Note 3),. . (d) lateral margin: 10 mm,. . (e) deep margin: <1 mm from ductal carci­. noma in situ (slide 8),. . (f) superficial margin: 2 mm.. 7. Lymph nodes:. . (a) metastasis in four out of nine axillary. lymph nodes (pN2a),. . (b) perinodal extension: present,. . (c) size of metastatic carcinoma: 19 mm.. 8. Arteriovenous invasion: absent.. 9. Lymphovascular invasion: present, intratumoral.. . 10. Tumor border: infiltrative.. . 11. Microcalcification:. present,. tumoral/. non-tumoral.. . 12. Pathological TN category (AJCC 2017):. pT1miN2a.. Note: 1. The superior margin of the lumpec­. tomy specimen (slide 1) is close to ductal carci­. noma in situ (<1 mm) but this margin submitted. for frozen diagnosis (Fro 1) is free of tumor.. 2. The inferior margin of the lumpectomy. specimen (slide 5) is close to ductal carcinoma in. situ (2 mm) but this margin submitted for frozen. diagnosis (Fro 2) is free of tumor.. 3. Ductal carcinoma in situ is present only in. the permanent section of Fro 3.. Result. Intensity. Positive %. Estrogen. receptor. Negative. (2/8). 1. <1%. Progesterone. receptor. Negative. (0/8). 0. 0. C-erbB2. Positive. (3+). Ki-67. Positive. in 41% of. tumor. cells. 15. 

Important Radiologic. Findings. 100 101 102. 103. . HR(−) HER2(+) Breast Cancer. After Neoadjuvant. Chemotherapy. 104 105 106. 107. HR(−) HER2(+) Breast Cancer. 486. 14.4. 

Patient History and Progress. Female/74 years old, post-menopause.. Screen detected mass lesion on right breast 12. o’clock direction.. No family history.. S/P retroperitoneum, excision (paragang­. lioma).. 14.2. 

Case 14

HR(−) HER2(−) Breast Cancer

14.1. . Courses of Treatment. Operation  +  Adjuvant chemotherapy (#4. cycles of doxorubicin and cyclophosphamide. + #12 cycles of paclitaxel)  +  Post-­. operative. radiation therapy.. Operation. 103. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 3.0 cm (pT2).. 2. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 3/HPF).. . E. S. Lee et al.. 625. . . ­. . 3. Intraductal component: present, intratu­. moral/extratumoral (5%) (nuclear grade:. high, necrosis: present, architectural pattern:. solid/comedo, extensive intraductal compo­. nent: absent).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) Superior margin: 10 mm.. . (b) Inferior margin: 10 mm.. . (c) Medial margin: 10 mm.. . (d) Lateral margin: 10 mm.. . (e) Deep margin: 1 mm from invasive ductal. carcinoma (slide 2).. . (f) Superficial margin: 2 mm.. 6. Lymph nodes: no metastasis in two axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/2).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular. invasion:. present,. intratumoral.. 9. Tumor border: infiltrative.. . 10. Microcalcification:. present,. tumoral/. non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT2N0(sn).. Result. Intensity. Positive. %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Negative (1+). Ki-67. Positive in 56%. of tumor cells. HR(−) HER2(−) Breast Cancer. 626. . 15. 

Important Radiologic. Findings. 99 100 101. 102. 14.3. 

Patient History and Progress. Female/43 years old, pre-menopause.. Self-detected palpable mass lesion on right. breast.. Family history of breast cancer, grandmother.. s/p Right breast, mammotome excision, s/p. right ear, benign excision.. BRCA 1 and 2 mutation: Not detected.. 14.2. 

Case 14

Local Recurrence

14.1. . Courses of Treatment. Right breast infiltrating ductal carcinoma →. Operation → Left breast recurrence (IDC).. Primary Treatment. 103. 104. Operation. Aug. 2003 Right breast conserving surgery, axil­. lary lymph node dissection, left breast mass. excision.. Pathology Report. <Right>. Infiltrating Ductal Carcinoma. 1. Size of tumor: 2 cm (pT1c).. 2. Histologic grade: 2/3 (tubule formation: 2/3,. nuclear pleomorphism: 2/3, mitotic count:. 2/3).. 3. Ductal carcinoma in situ: present, intratu­. moral (5%) (nuclear grade: low, necrosis:. absent, architectural pattern: solid, extensive. intraductal component: absent).. 4. Skin: no involvement of tumor.. 5. Surgical margins: clear. . (a) Superior margin: 30 mm.. . (b) Inferior margin: 35 mm.. . (c) Medial margin: 35 mm.. . (d) Lateral margin: 25 mm.. . (e) Deep margin: 10 mm.. 6. Lymph nodes:. . (a) Metastasis in 2 out of 22 axillary lymph. nodes (pN1a) (sentinel LN: 1/2, axillary. LN: 1/20).. . (b) Perinodal extension: absent.. . (c) Size of metastatic carcinoma: 6 mm.. 7. Vascular invasion: absent.. 8. Lymphatic invasion: absent.. 9. Tumor border: infiltrative.. . 10. Microcalcification: absent.. . 11. Pathologic staging: pT1cN1a.. Result. Intensity. Positive %. Estrogen. receptor. Intermediate (5/7) 2. 1/3–2/3. Progesterone. receptor. Weak (2/7). 1. <10%. C-erbB2. Equivocal (2+). Ki-67. Positive in 2%. of tumor cells. <Left>. Ductal hyperplasia with organizing hematoma.. Adjuvant Therapy. Adjuvant chemotherapy #6 cycles of fluorouracil. and doxorubicin and cyclophosphamide.. Postoperative radiation therapy.. Tamoxifen 20 mg/day for 1.7 years followed. by anastrozole 1 mg/day for 1 year followed by. tamoxifen 20 mg/day for 2.3 years.. Treatments After Recurrence. 105 106. 107. . . Y. Kim et al.. 757. . ­. . . . ­. Operation. ­. 108. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 1.1 cm (pT1c).. 2. Histologic grade: 2/3 (tubule formation: 2/3,. nuclear pleomorphism: 2/3, mitotic count:. 2/3, 11/10HPF).. 3. Intraductal component: present, intratu­. moral/extratumoral (20%) (nuclear grade:. low, necrosis: absent, architectural pattern:. cribriform, extensive intraductal component:. absent).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) Superior margin: 10 mm.. . (b) Inferior margin: 10 mm.. . (c) Medial margin: 10 mm.. . (d) Lateral margin: 10 mm.. Local Recurrence. 758. . (e) Deep margin: 2 mm.. . (f) Superficial margin: 2 mm.. 6. Lymph nodes: no metastasis in one axillary. lymph node (pN0(sn)) (sentinel LN: 0/1).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular invasion: absent.. 9. Tumor border: infiltrative.. . 10. Microcalcification:. present,. tumoral/. non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT1cN0(sn).. Result. Intensity. Positive %. Estrogen. receptor. Weak (4/8). 2. 1–10%. Progesterone. receptor. Weak (4/8). 2. 1–10%. C-erbB2. Negative (0). Ki-67. Not informative. Adjuvant Therapy. Postoperative radiation therapy.. Anastrozole 1 mg/day for 5 years.. 15. 

Patient History and Progress. Female/72 years old, post-menopause.. Screen detected mass lesion on right breast 1. o’clock direction and left 9 o’clock direction.. No family history.. Diabetes mellitus.. BRCA 1 and 2 mutation: Not detected, ATM. and POLE VUS (variant of uncertain).. . . ­. Local Recurrence. 756. 14.2. 

Case 14

Metastatic Breast Cancer

Courses of Treatment. Right breast cancer → Operation → Adjuvant. therapy → Ipsilateral axillary lymph node. recurrence.. Primary Treatment. Estrogen. receptor. Intermediate. (6/8). 2. 1/3–2/3. Progesterone. receptor. Strong (7/8). 2. >2/3. C-erbB2. Negative (0). Ki-67. Positive in. 35% of tumor. cells. Adjuvant Therapy. Tamoxifen 20 mg/day for 0.75 year.. Treatments After Recurrence. Progesterone. receptor. Strong. (8/8). 3. >2/3. C-erbB2. Negative. (0). Ki-67. Positive. in 27%. of tumor. cells. Neoadjuvant Chemotherapy. Neoadjuvant. chemotherapy. #8. cycles. (Adriamycin & Cyclophosphamide #4 →. Docetaxel #4).. Operation. May 2018 Right axillary lymph node dissection. and bilateral salpingo-oophorectomy.. Pathology: Metastatic ductal carcinoma in 1. out of 9 lymph nodes, size of metastasis: 9 mm.. Result. Intensity. Positive %. Estrogen. receptor. Strong (7/8). 2. >2/3. Progesterone. receptor. Negative (2/8). 1. <1%. C-erbB2. Negative (0). Ki-67. Positive in 2%. of tumor cells. Adjuvant Therapy. Post-operative radiation therapy + Tamoxifen. 20 mg/day~. 15. 

Hepatitis B carrier.. 14.2. 

Case 15

Benign and Proliferative

15.1. . Courses of Treatment. →2021-10-12 excision, Lt.. Benign and Proliferative Case Series. 34. . . Pathology Report. • Breast, left, excision:. –. – Atypical ductal hyperplasia, focal. –. – Fibroadenomatous change.. 16. 

Important Radiologic. Findings. 25. 26. 15.3. 

Patient History and Progress. Female/33 years old, pre-menopause.. Screen detected mass lesion on left breast. 3 o’clock direction.. Family history of pancreatic cancer, maternal. grandmother.. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 15.2. 

Case 15

Carcinoma In Situ

15.1. . Courses of Treatment. Operation + Postoperative radiation therapy +. Tamoxifen 20 mg/day for 5 years.. Operation. 67. 68. E. S. Lee et al.. 83. 2. Nuclear grade: high.. 3. Necrosis: present.. 4. Architectural pattern: micropapillary/cribri­. form/solid/comedo.. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) superior margin: 5 mm,. . (b) inferior margin: 15 mm,. . (c) medial margin: 10 mm,. . (d) lateral margin: 20 mm,. Carcinoma In Situ. 84. a. b. . . ­. . (e) deep margin: 1  mm from ductal carci­. noma in situ (slide 1),. . (f) superficial margin: 15 mm.. 7. Lymph nodes: no metastasis in two axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/2).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular invasion: absent.. . 10. Tumor border: infiltrative.. . 11. Microcalcification: present, ­. tumoral/non-. tumoral.. Result. Intensity. Positive %. Estrogen. receptor. Strong (7/8). 3. 1/3–2/3. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in. 11% of tumor. cells. 16. 

Important Radiologic. Findings. 63 64 65. 66. 15.3. 

Patient History and Progress. Female/52 years old, pre-menopause.. Screen detected mass lesion on right breast. 1 o’clock direction.. No family history.. No comorbidities.. 15.2. 

Case 15

HR(+) HER2(+) Breast Cancer

15.1. . Courses of Treatment. Operation  +  Adjuvant chemotherapy (#4. cycles of doxorubicin and cyclophospha­. mide). +. Post-operative. radiation. ther­. apy + Trastuzumab + Tamoxifen 20 mg/day.. 82. . ­. ­. . HR(+) HER2(+) Breast Cancer. 346. . . Pathology Report. . 1. Invasive Ductal Carcinoma with apocrine. differentiation.. . (a) Size of tumor: 1.3 cm (pT1c).. . (b) Histologic grade: 2/3 (tubule formation:. 3/3, nuclear pleomorphism: 2/3, mitotic. count: 1/3, 5/10 HPF).. . (c) Intraductal component: present, intratu­. moral/extratumoral (15%) (nuclear grade:. low, necrosis: absent, architectural pat­. tern: solid, extensive intraductal compo­. nent: absent).. . (d) Skin: no involvement of tumor.. S. Park et al.. 347. a. b. . . (e) Surgical margins:. • nipple margin: positive for ductal car­. cinoma in situ (Fro 1),. • superior margin: 10 mm,. • inferior margin: 15 mm,. • medial margin: 20 mm,. • lateral margin: (see note),. • deep margin: 5 mm,. • superficial margin: <1 mm from inva­. sive ductal carcinoma (slide 2).. . (f) Lymph nodes: no metastasis in one axil­. lary lymph node (pN0(sn)) (sentinel LN:. 0/1).. . (g) Arteriovenous invasion: absent.. . (h) Lymphovascular invasion: absent.. . (i) Tumor border: infiltrative.. . (j) Microcalcification:. present,. tumoral/. non-tumoral.. . (k) Pathological TN category (AJCC 2017):. pT1cN0(sn).. . 2. Fibroadenoma. . 3. Capillary hemangioma. Note: 1. The lateral margin of the lumpectomy. specimen (slide 13) is close to ductal carcinoma. in situ (3 mm) but this margin submitted for fro­. zen diagnosis (Fro 5) is free of tumor.. Result. Intensity. Positive. %. Estrogen. receptor. Strong (7/8). 2. >2/3. Progesterone. receptor. Strong (7/8). 2. >2/3. C-erbB2. Positive (3+). Ki-67. Positive in 12%. of tumor cells. HR(+) HER2(+) Breast Cancer. 348. 16. 

Important Radiologic. Findings. 78 79 80. 81. 15.3. 

Patient History and Progress. Female/42 years old, pre-menopause.. Self-detected palpable mass lesion on right. breast 6 o’clock direction.. Family history of breast cancer, maternal aunt.. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 15.2. 

Case 15

HR(+) HER2(-) Breast Cancer

15.1. . Courses of Treatment. Operation  +  Post-operative radiation ther­. apy + Anastrozole 1 mg/day.. Operation. Left breast conserving surgery, sentinel lymph. (a) superior margin: 35 mm.. . (b) inferior margin: 10 mm.. . (c) medial margin: 15 mm.. . (d) lateral margin: 5 mm.. . (e) deep margin: 12 mm.. . (f) superficial margin: 4 mm.. 6. Lymph nodes: no metastasis in two axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/2).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular invasion: absent.. 9. Tumor border: infiltrative.. . 10. Microcalcification:. present,. tumoral/. non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT1bN0(sn).. Y. Kim et al.. 2. 10%–1/3. C-erbB2. Negative (1+). Ki-67. Positive in 19% of tumor cells. HR(+) HER2(−) Breast Cancer. 220. 16. 

Important Radiologic. Findings. See Figs. 74, 75, 76 and 77.. 15.3. 

Patient History and Progress. Female/58 years old, post-menopause.. Screen detected mass lesion on left breast 12. o’clock direction.. No family history.. Hypertension, dyslipidemia, s/p transobtura­. tor tape for stress urinary incontinence.. 15.2. 

Case 15

HR(−) HER2(+) Breast Cancer

15.1. . 116. Pathology Report. Invasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of tumor: 1.9 cm (ypT1c).. 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 2/3, 12/10HPF).. 4. Intraductal component: absent.. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) superior margin: 30 mm,. . (b) inferior margin: 55 mm,. . (c) medial margin: 20 mm,. . (d) lateral margin: 15 mm,. . (e) deep margin: 1 mm from invasive ductal. carcinoma (slide 2),. . (f) superficial margin: 10 mm.. 7. Lymph nodes:. . (a) metastasis in two out of seven axillary. lymph nodes (ypN1a) (sentinel LN: 1/2,. axillary LN: 1/5),. . (b) perinodal extension: absent,. . (c) size of metastatic carcinoma: 5 mm.. 8. Arteriovenous invasion: absent.. 9. Lymphovascular invasion: present, intratu­. moral/peritumoral.. . 10. Tumor border: infiltrative.. . 11. Microcalcification: present, non-tumoral.. . 12. Pathological TN category (AJCC 2017):. ypT1cN1a.. Result. Intensity Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in. 25% of tumor. cells. Y. Kwon et al.. 493. . HR(−) HER2(+) Breast Cancer. 494. 16. 

Important Radiologic. Findings. 109 110 111. . After Neoadjuvant. Chemotherapy. 113 114. 115. . HR(−) HER2(+) Breast Cancer. 492

Patient History and Progress. Female/61 years old, post-menopause.. Self-detected palpable mass lesion on right. breast 12 o’clock direction.. No family history.. Hypertension.. HR(−) HER2(+) Breast Cancer. 488. . Y. Kwon et al.. 489. 15.2. 

Case 15

HR(−) HER2(−) Breast Cancer

15.1. . Courses of Treatment. Operation + operation.. Operation. ­. 107. Pathology Report. . 1. Invasive Ductal Carcinoma.. . (a) Size of invasive component: 0.4  cm. (pT1a).. . (b) Size of intraductal component: 4.0 cm.. . (c) Histologic grade: 3/3 (tubule formation:. 3/3, nuclear pleomorphism: 3/3, mitotic. count: 3/3, 30/10HPF).. E. S. Lee et al.. 627. . . . HR(−) HER2(−) Breast Cancer. 628. . . (d) Intraductal component: present, intratu­. moral/extratumoral (90%) (nuclear grade:. high, necrosis: present, architectural pat­. tern: solid/comedo, extensive intraductal. component: present).. . (e) Skin: no involvement of tumor.. . (f) Surgical margins:. • Superior margin: 30 mm.. • Inferior margin: 5 mm.. • Medial margin: 15 mm.. • Lateral margin: <1  mm from ductal. carcinoma in situ (slide 15).. • Deep margin: positive for ductal carci­. noma in situ (slides 4 and 14).. • Superficial margin: <1 mm from duc­. tal carcinoma in situ (slide 13).. . (g) Arteriovenous invasion: absent.. . (h) Lymphovascular invasion: absent.. . (i) Tumor border: infiltrative.. . (j) Microcalcification: present, tumoral.. . (k) Pathological TN category (AJCC 2017):. pT1aNx.. . 2. Intraductal papilloma with:. . (a) Usual ductal hyperplasia.. . (b) Apocrine metaplasia.. . (c) Epithelial displacement.. Result. Intensity. Positive. %. Estrogen. receptor. Negative (2/8). 1. <1%. Progesterone. receptor. Negative (2/8). 1. <1%. C-erbB2. Negative (1+). Ki-67. Positive in 23%. of tumor cells. Operation. ­. 108. E. S. Lee et al.. 629. . Pathology Report. . 1. No residual carcinoma with foreign body. reaction.. . (a) Post-excision status.. . 2. Intraductal papilloma with usual ductal. hyperplasia.. 16. 

Important Radiologic. Findings. 104 105. 106. 15.3. 

Patient History and Progress. Female/74 years old, post-menopause.. Self-detected bloody discharge on the nipple. of the left breast.. No family history.. S/P hysterectomy (due to myoma), hyperten­. sion, s/p shoulder calcific tendinitis operation.. 15.2. 

Case 15

Local Recurrence

15.1. . Courses of Treatment. Right breast IDC → Operation → Adjuvant. therapy →Left breast and axillary lymph node. recurrence (IDC) → Left axillary lymph node. recurrence.. Primary Treatment. 109. 110. Operation. 111. Pathology Report. Invasive Ductal Carcinomas (×2).. 1. Size of tumor: 2.1 cm, 0.7 cm (pT2(m)).. 2. Histologic grade: 2 (tubule formation: 2/3,. nuclear pleomorphism: 3/3, mitotic count:. 1/3, 8/10HPF).. . . Y. Kim et al.. 759. a. b. . . 3. Intraductal component: present, intratu­. moral/extratumoral (3%) (nuclear grade:. high, necrosis: present, architectural pattern:. comedo and cribriform, extensive intraductal. component: absent).. 4. Skin and nipple: no involvement of tumor.. 5. Surgical margins: free from tumor.. . (a) Deep margin: 5 mm.. . (b) Superficial margin: 15 mm.. 6. Lymph nodes:. . (a) Metastasis in one out of nine axillary. lymph nodes (pN1a) (sentinel LN: 1/1,. axillary LN: 0/8).. . (b) Perinodal extension: absent.. . (c) Size of metastatic carcinoma: 5 mm.. 7. Vascular invasion: absent.. 8. Lymphatic invasion: absent.. 9. Neural invasion: present.. . 10. Tumor border: infiltrative.. . 11. Microcalcification: present, tumoral.. . 12. Pathologic stage (AJCC 2010): pT2(m)N1a.. Result. Intensity. Positive %. Estrogen. receptor. Strong (7/7). 3. >2/3. Progesterone. receptor. Weak (3/7). 2. <10%. C-erbB2. Positive (3+). Ki-67. Positive in 29%. of tumor cells. Adjuvant Therapy. Adjuvant chemotherapy #4 cycles of doxorubicin. and cyclophosphamide followed by #4 cycles of. docetaxel and trastuzumab for 1 year.. Anastrozole 1 mg/day for 1.3 years.. Treatments After Recurrence. 112 113. 114. Neoadjuvant Chemotherapy. Neoadjuvant chemotherapy #2  cycles of cyclo­. phosphamide and methotrexate and fluorouracil. (stop d/t no response).. Local Recurrence. 760. . . ­. Operation (First Recurrence). 115. Pathology Report. Invasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of tumor: 2.3 cm (ypT2).. 3. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 6/10HPF).. 4. Intraductal component: present, intratu­. moral/extratumoral (30%) (nuclear grade:. low, necrosis: present, architectural pattern:. solid/comedo, extensive intraductal compo­. nent: present).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) Deep margin: <1 mm from invasive duc­. tal carcinoma (slide 7).. . (b) Superficial margin: 2 mm.. 7. Lymph nodes:. . (a) Metastasis in one out of one axillary. lymph node (ypN1a(sn)) (axillary LN. (#A): 1/1, axillary LN (Fro 1): 0/0, axil­. lary LN #2: 0/0).. . (b) Perinodal extension: present.. . (c) Size of metastatic carcinoma: 20 mm.. 8. Arteriovenous invasion: absent.. 9. Lymphovascular. invasion:. present,. intratumoral.. . 10. Tumor border: infiltrative.. . 11. Microcalcification:. present,. ­. tumoral/. non-tumoral.. . 12. Pathological TN category (AJCC 2017):. ypT2N1a(sn).. Result. Intensity Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative (1+). Ki-67. Positive in 41%. of tumor cells. Adjuvant Therapy. Adjuvant chemotherapy #4 cycles of cyclophos­. phamide and docetaxel.. Operation (Second Recurrence). Oct. 2021 Left axillary lymph node dissection.. Pathology Report. . 1. Post-lumpectomy status.. . 2. Lymph nodes:. . (a) Metastasis in three out of five axillary. lymph nodes (left axillary LN (Fro 1):. 0/1, “left axillary LN”: 3/4).. Y. Kim et al.. 761. a. b. c. d. . . (b) Perinodal extension: present.. . (c) Size of metastatic carcinoma: 5 mm.. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative (1+). Ki-67. Positive in 6%. of tumor cells. Adjuvant Therapy. Postoperative radiation therapy.. Letrozole 2.5 mg/day for 5 years.. 16. 

Patient History and Progress. Female/63 years old, post-menopause.. Self-detected mass lesion on right breast 9. o’clock direction.. Family history of breast cancer, mother.. Hypertension, s/p Left leg fracture operation.. BRCA 1 and 2 mutation: Not detected.. 15.2. 

Case 15

Metastatic Breast Cancer

15.1. . Courses of Treatment. Right breast cancer → Operation → Adjuvant. therapy → Ipsilateral axillary lymph node. recurrence.. Primary Treatment. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative (1+). Ki-67. Positive in. 31% of tumor. cells. Adjuvant Therapy. Tamoxifen 20 mg/day for 5.2 years.. Treatments After Recurrence. See Figs. 50 and 51.. Metastatic Breast Cancer. Progesterone. receptor. Strong. (8/8). 3. >2/3. C-erbB2. Negative. (0). Operation. Dec. 2020 Right axillary lymph node sampling.. Pathology: Metastatic ductal carcinoma in 1. out of 7 lymph nodes, size of metastasis: 11 mm.. Adjuvant Therapy. Letrozole 2.5 mg/day~. 16. 

Patient History and Progress. Female/74 years old, post-menopause.. No family history.. Hypertension.. 15.2. 

Case 16

Benign and Proliferative

16.1. . Courses of Treatment. →2021-09-13 needle biopsy.. Pathology Report. Diagnosis. • Breast, right, needle biopsy:. –. – Ductal carcinoma in situ.. Nuclear grade: low.. Necrosis: present.. C. W. Lee et al.. 35. . ­. . Benign and Proliferative Case Series. 36. . Architectural pattern: micropapillary/. cribriform/comedo.. Microcalcification: present, tumoral.. →2021-10-08 Rt. BCS + Lt. mastopexy.. Pathology Report. Diagnosis. . 1. Breast, right, lumpectomy: Microinvasive. Ductal Carcinoma.. . (a) Size of tumor: <0.1 cm (pT1mi).. . (b) Size of in situ component: 4.0 cm.. . (c) Histologic grade: not applicable.. . (d) Intraductal component: present, intratu­. moral/extratumoral. (>95%). (nuclear. grade: high, necrosis: present, architec­. tural pattern: micropapillary/cribriform/. solid/comedo, extensive intraductal com­. ponent: present).. . (e) Skin: no involvement of tumor.. . (f) Surgical margins:. • Nipple margin: positive for ductal car­. cinoma in situ (Fro 10) (see Note 1).. • Superior margin: (see Note 2).. • Inferior margin: 20 mm.. • Medial margin: (see Note 3).. • Lateral margin: 5 mm.. • Deep margin: <1 mm from ductal car­. cinoma in situ (slides 1 & 2).. • Superficial margin: 10 mm. . (g) Lymph nodes: no metastasis in three axil­. lary lymph nodes (pN0(sn)) (sentinel LN:. 0/3).. . (h) Arteriovenous invasion: absent.. . (i) Lymphovascular invasion: absent.. C. W. Lee et al.. 37. . (j) Tumor border: infiltrative.. . (k) Microcalcification: present, tumoral.. . (l) Pathological TN category (AJCC 2017):. pT1miN0(sn).. Note: 1. Ductal carcinoma in situ is. present only in the permanent section of. Fro 10.. . 2. The superior margin of the lumpectomy spec­. imen (slide 3) is positive for ductal carcinoma. in situ but this margin submitted for frozen. diagnosis (Fro 2) is free of tumor.. . 3. The medial margin of the lumpectomy speci­. men (slide 6) is close to ductal carcinoma in. situ (2 mm) but this margin submitted for fro­. zen diagnosis (Fro 4) is free of tumor.. . 4. Histologic mapping has been done.. Result. Intensity Positive%. Estrogen. receptor. Strong (2/8). 1. <1%. Progesterone. receptor. Strong (0/8). 0. 0. C-erbB2. Negative (3+). Ki-67. Positive in. 20% of tumor. cells. Diagnosis. • Breast, left, excision:. –. – Usual ductal hyperplasia, focal.. Postoperative radiotherapy for right. breast.. 17. 

Important Radiologic. Findings. 27 28. 29. 16.3. 

Patient History and Progress. Female/59 years old, post-menopause.. Screen detected mass lesion on right breast. 7 o’clock direction.. No family history.. s/p Total hysterectomy, s/p left nephrectomy. (donor), s/o cholecystectomy.. 16.2. 

Case 16

Carcinoma In Situ

16.1. . Courses of Treatment:. Operation. Operation. 73. 74. Pathology Report. Ductal carcinoma in situ, pathological TN cat­. egory (AJCC 2017): pTis(Paget)N0 (sn). . 1. Size of tumor: 1.5 cm (pTis(Paget)).. . 2. Nuclear grade: high.. . 3. Necrosis: present.. Carcinoma In Situ. 4. Architectural. pattern:. cribriform/solid/. comedo.. . 5. Nipple: Paget disease with involvement of. lactiferous duct.. . 6. Surgical margins:. . (a) deep margin: 10 mm,. . (b) superficial margin: 10 mm.. . 7. Lymph nodes: no metastasis in one axillary. lymph node (pN0(sn)) (sentinel LN: 0/1).. . 8. Microcalcification:. present,. tumoral/non-. tumoral.. Result. Intensity. Positive %. Estrogen. receptor. Negative (2/8). 1. <1%. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in. 30% of tumor. cells. 17. 

Important Radiologic. Findings. 69 70 71. 72. E. S. Lee et al.. 85. . . . ­. 16.3. 

Patient History and Progress. Female/75 years old, post-menopause.. Screen detected microcalcification on left. breast 12 o’clock direction.. Outside result of biopsy: Left breast 12 o’clock,. fibrosis.. Family history of breast cancer, mother.. Hypertension.. BRCA 1 and 2: Not examination.. 16.2. 

Case 16

HR(+) HER2(+) Breast Cancer

16.1. . Courses of Treatment. Operation  +  Adjuvant chemotherapy (#4. cycles. of. docetaxel. and. cyclophospha­. mide). +. Post-operative. radiation. ther­. apy + Trastuzumab + Letrozole 2.5 mg/day.. 87. Pathology Report. . 1. Invasive Ductal Carcinoma.. . (a) Size of tumor: 1.1 cm (pT1c).. . (b) Histologic grade: 3/3 (tubule formation:. 3/3, nuclear pleomorphism: 3/3, mitotic. count: 2/3, 10/10 HPF).. . (c) Intraductal component: present, extratu­. moral (30%) (nuclear grade: high, necro­. sis:. present,. architectural. pattern:. papillary/cribriform, extensive intraductal. component: present).. . (d) Skin: no involvement of tumor.. . (e) Surgical margins:. • superior margin: (see note),. • inferior margin: 15 mm,. • medial margin: 6 mm,. • lateral margin: 10 mm,. • deep margin: 3 mm,. • superficial margin: 11 mm.. . S. Park et al.. 349. . (f) Lymph nodes: no metastasis in two axil­. lary lymph nodes (pN0(sn)) (sentinel LN:. 0/2).. . (g) Arteriovenous invasion: absent.. . (h) Lymphovascular invasion: absent.. . (i) Tumor border: infiltrative.. . (j) Microcalcification: present, tumoral.. . (k) Pathological TN category (AJCC 2017):. pT1cN0(sn).. . 2. Intraductal papilloma with usual ductal. hyperplasia.. . . HR(+) HER2(+) Breast Cancer. 350. Note: 1. The superior margin of the lumpec­. tomy specimen (slide 3) is close to ductal carci­. noma in situ (2 mm) but this margin submitted. for frozen diagnosis (Fro 3) is free of tumor.. Result. Intensity. Positive. %. Estrogen. receptor. Strong (7/8). 2. >2/3. Progesterone. receptor. Strong (7/8). 2. >2/3. C-erbB2. Positive (3+). Ki-67. Positive in 10%. of tumor cells. . a. b. . S. Park et al.. 351. 17. 

Important Radiologic. Findings. 83 84 85. 86. 16.3. 

Patient History and Progress. Female/54 years old, peri-menopause.. Self-detected palpable mass lesion on right. breast 6 o’clock direction.. No family history.. Diabetes. mellitus,. S/P. hysterectomy,. agoraphobia.. 16.2. 

Case 16

HR(+) HER2(-) Breast Cancer

16.1. . Courses of Treatment. Operation  +  Post-operative radiation ther­. apy + Tamoxifen 20 mg/day.. Operation. Left breast conserving surgery, sentinel lymph. cribriform/solid, extensive intraductal com­. ponent: present).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) superior margin: 20 mm.. . (b) inferior margin: (see note).. . (c) medial margin: 10 mm.. . (d) lateral margin: 15 mm.. . (e) deep margin: positive for ductal carci­. noma in situ (slide 6).. . (f) superficial margin: 15 mm.. 7. Lymph nodes: no metastasis in three axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/2,. non-sentinel LN: 0/1).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular invasion: absent.. . 10. Tumor border: infiltrative.. . Intensity. Positive. %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Intermediate. (6/8). 1. >2/3. C-erbB2. Negative (1+). Ki-67. Positive in 3% of

Important Radiologic. Findings. See Figs. 79, 80, 81 and 82.. 16.3. 

Patient History and Progress. Female/51 years old, peri-menopause.. Screen detected mass lesion on left breast 2. o’clock direction.. No family history.. No comorbidities.. 16.2. 

Case 16

HR(−) HER2(+) Breast Cancer

16.1. . Courses of Treatment. Operation + adjuvant chemotherapy (#4 cycles of. docetaxel and cyclophosphamide)  +  Post-­. operative radiation therapy + Trastuzumab.. Operation. 121. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 1.5 cm (pT1c).. 2. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 4/HPF).. HR(−) HER2(+) Breast Cancer. 496. a. b. . 3. Intraductal component: present, intratu­. moral/extratumoral (30%) (nuclear grade:. high, necrosis: present, architectural pattern:. cribriform/solid/comedo, extensive intra­. ductal component: present).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) superior margin: 10 mm,. . (b) inferior margin: 10 mm,. . (c) medial margin: (see note),. . (d) lateral margin: 10 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: 2 mm.. 6. Lymph nodes: no metastasis in three axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/1,. non-sentinel LN: 0/2).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular. invasion:. present,. intratumoral.. 9. Tumor border: infiltrative.. . 10. Microcalcification:. present,. tumoral/. non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT1cN0(sn).. Result. Intensity. Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in. 64% of tumor. cells. Y. Kwon et al.. 497. 17. 

Important Radiologic. Findings. 117 118 119. 

Patient History and Progress. Female/57 years old, post-menopause.. Self-detected palpable mass lesion on left. breast.. No family history.. Hypothyroidism (taking on synthroid).. 16.2. 

Case 16

HR(−) HER2(−) Breast Cancer

16.1. . Courses of Treatment. Neoadjuvant chemotherapy (#4  cycles of. doxorubicin and cyclophosphamide  +  #4. cycles of docetaxel)  +  Operation  +  Post-. operative radiation therapy.. Operation. 117. Pathology Report. No residual tumor with foamy histiocytic. collection. . 1. Post-chemotherapy status.. . 2. Lymph nodes: no metastasis in six axillary. lymph nodes (ypN0) (sentinel LN: 0/2, non-­. sentinel LN: 0/4).. . 3. Microcalcification: present, non-tumoral.. Result. Intensity. Positive. %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Equivocal (2+). Ki-67. Positive in 88%. of tumor cells. SISH. Negative. HR(−) HER2(−) Breast Cancer. 632. . ­. . . . E. S. Lee et al.. 633. . 17. 

Important Radiologic. Findings. 109 110 111. 112. HR(−) HER2(−) Breast Cancer. 630. . . . ­. E. S. Lee et al.. 631. . After Neoadjuvant. Chemotherapy. 113 114 115. 116. 16.3. 

Patient History and Progress. Female/42 years old, pre-menopause.. Self-detected palpable mass lesion on left. breast.. No family history.. s/p Cholecystectomy, s/p appendectomy, s/p. vocal cord operation.. 16.2. 

Case 16

Local Recurrence

16.1. . Courses of Treatment. Left breast DCIS → Operation → Adjuvant. therapy → Left breast recurrence (DCIS).. Primary Treatment. 116. 117. Operation. 118. Pathology Report. Ductal Carcinoma In Situ. . 1. Size of tumor: 3.0 cm (pTis).. . 2. Nuclear grade: low.. . 3. Necrosis: present.. . 4. Architectural pattern: micropapillary/cribri­. form/comedo.. Local Recurrence. 762. . 5. Skin: no involvement of tumor.. . 6. Surgical margins:. . (a) Nipple margin: positive for atypical duc­. tal hyperplasia (Fro 1) (see note 1).. . (b) Superior margin: (see note 2).. . (c) Inferior margin: 20 mm.. . (d) Medial margin: 5 mm.. . (e) Lateral margin: 15 mm.. . (f) Deep margin: 2 mm.. . (g) Superficial margin: 2 mm.. . 7. Microcalcification:. present,. tumoral/. non-tumoral.. . 8. Pathologic stage (AJCC 2010): pTis.. Note: 1. Atypical ductal hyperplasia is present. only in the permanent section of Fro 1.. 2. The superior margin of the lumpectomy. specimen (slide 1) is positive for ductal carci­. noma in situ, but this margin submitted for frozen. diagnosis (Fro 2) is free of tumor.. Result. Intensity Positive %. Estrogen. receptor. Intermediate. (6/8). 2. 1/3–2/3. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in 36%. of tumor cells. . ­. . a. b. . Y. Kim et al.. 763. Adjuvant Therapy. Postoperative radiation therapy.. Tamoxifen 20 mg/day for 5 years.. Treatments After Recurrence. 119. 120. Operation. 121. Pathology Report. Ductal Carcinoma In Situ.. . 1. Post-lumpectomy status.. . 2. Size of tumor: 0.5 cm (rpTis).. . 3. Nuclear grade: high.. . 4. Necrosis: absent.. . 5. Architectural. pattern:. micropapillary/. cribriform.. . 6. Skin and nipple: Paget’s disease.. . 7. Surgical margins:. . (a) Superior margin: 5 mm.. . (b) Inferior margin: 5 mm.. . (c) Medial margin: 5 mm.. . (d) Lateral margin: 5 mm.. . (e) Deep margin: 2 mm.. . (f) Superficial margin: 2 mm.. . 8. Microcalcification:. present,. tumoral/. non-tumoral.. . 9. Pathological TN category (AJCC 2017):. rpTis(Paget).. . ­. . ­. Result. Intensity. Positive %. Estrogen. receptor. Negative (2/8). 1. <1%. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in 58%. of tumor cells. 17. 

Patient History and Progress. Female/43 years old, pre-menopause.. Screen detected mass lesion on left breast 7. o’clock direction.. Outside result of biopsy: Ductal carcinoma in. situ.. No family history.. No comorbidities.. 16.2. 

Case 16

Metastatic Breast Cancer

16.1. . Courses of Treatment. Left breast cancer → Operation → Adjuvant. therapy → Ipsilateral axillary lymph node. recurrence.. Primary Treatment. pT2N1a(sn).. Size of tumor: 2.5  cm and 1.0  cm, lymph. node: 1/2, size of metastatic carcinoma: 2.1 mm.. Result. Intensity Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (7/8). 3. 1/3–2/3. C-erbB2. Equivocal (2+). Ki-67. Positive in. 49% of tumor. cells. SISH. Negative. Oncotype Dx RS scores: 29.. Adjuvant Chemotherapy. Adjuvant. chemotherapy. (Adriamycin. +. Cyclophosphamide #2 → weekly Paclitaxel #12).. Treatments After Recurrence. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative (1+). Ki-67. Positive in. 46% of tumor. cells. Neoadjuvant Endocrine Therapy. Tamoxifen 20 mg/day + zoladex.. Operation. Bilateral salpingo-oophorectomy → Progressive. disease (Lt. axillary lymph node).. Adjuvant Therapy. Letrozole 2.5 mg/day.. Progesterone. receptor. Negative. (0/8). 0. 0. C-erbB2. Equivocal. (2+). Ki-67. Positive in. 31% of. tumor cells. SISH. Positive. Adjuvant Therapy. Post-operative radiation therapy + Letrozole. 2.5 mg/day~. 17. 

Patient History and Progress. Female/46 years old, post-menopause.. No family history.. S/p myomectomy & bilateral salpingo-. oophorectomy.. 16.2. 

Case 17

Benign and Proliferative

17.1. . Courses of Treatment. →2021-09-17 excision, Rt.. Pathology Report. Diagnosis. • Breast, right, excision:. –. – Atypical ductal hyperplasia involving. mammary cyst.. –. – Usual ductal hyperplasia, focal with. microcalcification.. 18. 

Important Radiologic. Findings. 30. 31. . Benign and Proliferative Case Series. 38. . 17.3. 

Patient History and Progress. Female/39 years old, pre-menopause.. Screen detected mass lesion on right breast 9. o’clock direction.. No family history.. s/p appendectomy (cecal cancer), s/p hyster­. ectomy, and bilateral salpingo-oophorectomy.. s/p partial hepatectomy.. 17.2. 

Case 17

Carcinoma In Situ

17.1. . Courses of Treatment. Operation + Tamoxifen 20 mg/day for 5 years.. Operation. 79. 80. Pathology Report. Ductal carcinoma in situ, pathological TN cat­. egory (AJCC 2017): pTis(Paget)N0(sn). . 1. Size of tumor: 1.5 cm (pTis(Paget)).. . 2. Nuclear grade: high.. . 3. Necrosis: present.. . 4. Architectural. pattern:. cribriform/solid/. comedo.. . 5. Nipple: Paget disease with involvement of. lactiferous duct.. . 6. Surgical margins:. . (a) deep margin: 10 mm,. . (b) superficial margin: 10 mm.. . 7. Lymph nodes: no metastasis in one axillary. lymph node (pN0(sn)) (sentinel LN: 0/1).. . 8. Microcalcification:. present,. tumoral/non-. tumoral.. . Carcinoma In Situ. 88. . a. b. . . Result. Intensity. Positive %. Estrogen. receptor. Weak (3/8). 1. 1%–10%. Progesterone. receptor. Weak (4/8). 3. <1%. C-erbB2. Positive (3+). Ki-67. Positive in. 11% of. tumor cells. E. S. Lee et al.. 89. a. b. . . Carcinoma In Situ. 90. 18. 

Important Radiologic. Findings. 75 76 77. 78. 17.3. 

Patient History and Progress. Female/40 years old, pre-menopause.. Screen detected nodule and microcalcification. on upper outer portion of right breast.. No family history.. No comorbidities.. 17.2. 

Case 17

HR(+) HER2(+) Breast Cancer

17.1. . Courses of Treatment. Operation  +  Adjuvant chemotherapy (#4. cycles of doxorubicin and cyclophospha­. mide) + Trastuzumab + Tamoxifen 20 mg/day.. ­. ­. ­. 92 93. 94. Pathology Report. [Right].. . 1. Ductal carcinoma in situ.. . (a) Size of tumor: 0.7 cm (pTis).. . (b) Nuclear grade: low.. . (c) Necrosis: present.. . (d) Architectural pattern: solid/comedo.. . (e) Surgical margins: (see note).. . (f) Lymph nodes: not submitted (pNx).. . (g) Microcalcification: absent.. . (h) Pathological TN category (AJCC 2017):. pTisNx.. . 2. Fibrocystic change.. . ­. . HR(+) HER2(+) Breast Cancer. 352. . Note: 1. The nearest resection margin of the. excision specimen (slides A1 and A2) is close to. ductal carcinoma in situ (<1 mm) but this margin. submitted for frozen diagnosis (Fro 13) is free of. tumor.. [Left].. . 1. Invasive Ductal Carcinoma.. . (a) Size of tumor: 1.4 cm (pT1c).. . (b) Histologic grade: 2/3 (tubule formation:. 3/3, nuclear pleomorphism: 2/3, mitotic. count: 1/3, 4/10 HPF).. . (c) Intraductal component: present, intratu­. moral/extratumoral (5%) (nuclear grade:. low, necrosis: absent, architectural pat­. tern: cribriform, extensive intraductal. component: absent).. . (d) Skin: no involvement of tumor.. S. Park et al.. 353. . (e) Surgical margins:. • nipple margin: positive for ductal car­. cinoma in situ (Fro 3) (see note),. • deep margin: 27 mm,. • superficial margin: <1 mm from inva­. sive ductal carcinoma (slide 2).. . (f) Lymph nodes: no metastasis in three axil­. lary lymph nodes (pN0(sn)) (sentinel LN:. 0/3).. . (g) Arteriovenous invasion: absent.. . (h) Lymphovascular invasion: absent.. . (i) Tumor border: infiltrative.. . a. b. . HR(+) HER2(+) Breast Cancer. 354. a. b. c. d. . . S. Park et al.. 355. . (j) Microcalcification: present, tumoral.. . (k) Pathological TN category (AJCC 2017):. pT1cN0(sn).. . 2. Fibroadenoma.. Note: 1. Ductal carcinoma in situ is present. only in the permanent section of Fro 3.. Result. Intensity. Positive. %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (7/8). 3. 1/3–2/3. C-erbB2. Equivocal (2+). Ki-67. Positive in 19%. of tumor cells. SISH. Positive. 18. 

Important Radiologic. Findings. 88 89 90. 91. 17.3. 

Patient History and Progress. Female/38 years old, post-menopause.. Self-detected palpable mass lesion on left. breast 1 o’clock direction.. Family history of prostate cancer, maternal. father.. S/P salpingo-oophorectomy (2022).. BRCA 2 mutation carrier.. 17.2. 

Case 17

HR(+) HER2(-) Breast Cancer

Courses of Treatment. Operation  +  Post-operative radiation ther­. apy + Tamoxifen 20 mg/day.. Operation. Left breast conserving surgery, sentinel lymph. sive intraductal component: present).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) superior margin: 5 mm.. . (b) inferior margin: (see note 1).. . (c) medial margin: 5 mm.. . (d) lateral margin: (see note 2).. . (e) deep margin: 1 mm from invasive ductal. carcinoma (slide 5).. . (f) superficial margin: 3 mm.. 7. Lymph nodes: no metastasis in one axillary. lymph node (pN0(i+)(sn)) (see note 3) (sen­. tinel LN: 0/1).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular invasion: absent.. . 10. Tumor border: infiltrative.. . 11. Microcalcification: present, non-tumoral.. . 12. Pathological TN category (AJCC 2017):. 3. A few isolated tumor cells are present only in. the permanent section of Fro 5.. Result. Intensity. Positive %. Estrogen receptor. Strong (8/8). 3. >2/3. Progesterone receptor. Weak (4/8). 1. 10%–1/3. C-erbB2. Negative (0). Ki-67. Positive in 1% of tumor cells. Y. Kim et al.

Important Radiologic. Findings. See Figs. 84, 85, 86 and 87.. 17.3. 

o’clock direction.. No family history.. S/P Lumbar spine disc herniation operation,. s/p pain block in lumbar spine.. S/p hormone replacement due to amenorrhea.. 17.2. 

Case 17

HR(−) HER2(+) Breast Cancer

17.1. . Courses of Treatment. Operation + Adjuvant chemotherapy (#4 cycles. of doxorubicin and cyclophosphamide  +  #4. cycles of docetaxel and trastuzumab)  +  Post-­. operative radiation therapy + Trastuzumab.. Operation. 126. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 1.8 and 1.5 cm (pT1c(2)).. 2. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 3/HPF).. Y. Kwon et al.. 499. . 3. Intraductal component: present, intratu­. moral/extratumoral (50%) (nuclear grade:. high, necrosis: present, architectural pattern:. solid/comedo, extensive intraductal compo­. nent: present).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) superior margin: (see note),. . (b) inferior margin: 10 mm,. . (c) medial margin: 5 mm,. . (d) lateral margin: 30 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: 2 mm.. 6. Lymph nodes:. . (a) metastasis in one out of three axillary. lymph nodes (pN1a(sn)) (sentinel LN:. 1/2, axillary LN: 0/1),. . (b) perinodal extension: present,. . (c) size of metastatic carcinoma: 9 mm.. 7. Arteriovenous invasion: absent.. 8. Lymphovascular. invasion:. present,. intratumoral.. 9. Tumor border: infiltrative.. . 10. Microcalcification:. present,. tumoral/. non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT1c(2)N1a(sn).. Result. Intensity. Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in 20%. of tumor cells. HR(−) HER2(+) Breast Cancer. 500. 18. 

Important Radiologic. Findings. 122 123 124. 125. . HR(−) HER2(+) Breast Cancer. 498. . . . 17.3. 

Patient History and Progress. Female/41 years old, pre-menopause.. Self-detected palpable mass lesion on left. breast.. Family history of breast cancer, aunt. (maternal).. S/P Lumbar spine disc operation.. BRCA 1 and 2 mutation: Not detected,. MUTYH VUS (variant of uncertain).. 17.2. 

Case 17

HR(−) HER2(−) Breast Cancer

17.1. . Courses of Treatment. Operation  +  Adjuvant chemotherapy (#2. cycles of doxorubicin and cyclophosphamide,. refuse) + Post-operative radiation therapy.. Operation. 122. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 1.3 cm (pT1c).. 2. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 5/HPF).. HR(−) HER2(−) Breast Cancer. . E. S. Lee et al.. 635. 3. Intraductal component: present, intratu­. moral/extratumoral (10%) (nuclear grade:. high, necrosis: present, architectural pattern:. solid/comedo, extensive intraductal compo­. nent: absent).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) Superior margin: 10 mm.. . (b) Inferior margin: (see note).. . (c) Medial margin: 10 mm.. . (d) Lateral margin: 10 mm.. . (e) Deep margin: 2 mm.. . (f) Superficial margin: 2 mm.. . . HR(−) HER2(−) Breast Cancer. 636. 6. Lymph nodes: no metastasis in one axillary. lymph node (pN0(sn)) (sentinel LN: 0/1).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular. invasion:. present,. intratumoral.. 9. Tumor border: infiltrative.. . 10. Microcalcification:. present,. tumoral/. non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT1cN0(sn).. Note: 1. The inferior margin of the lumpec­. tomy specimen (slides 4 and 5) is close to inva­. sive ductal carcinoma (3  mm) and ductal. carcinoma in situ (<1 mm), but this margin sub­. mitted for frozen diagnosis (Fro 2) is free of. tumor.. Result. Intensity. Positive. %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Equivocal (2+). Ki-67. Positive in 12%. of tumor cells. 18. 

Important Radiologic. Findings. 118 119 120. 121. 17.3. 

Patient History and Progress. Female/70 years old, post-menopause.. Screen detected mass at the upper outer quad­. rant of the left breast.. Family history of breast cancer, niece.. h/o Tuberculosis, s/p appendectomy, s/p. myomectomy.. BRCA 1 and 2 mutation: Not tested.. 17.2. 

Case 17

Local Recurrence

17.1. . Courses of Treatment. Right breast DCIS → Operation → Adjuvant. therapy → Right breast recurrence (mucinous. carcinoma).. Primary Treatment. 122. Operation. 123. Pathology Report. Ductal Carcinoma In Situ. . 1. Post-excisional biopsy status.. . 2. Size of tumor: 1.5 cm, residual.. . 3. Nuclear grade: high.. . 4. Necrosis: present.. . 5. Architectural. pattern:. cribriform/solid/. comedo.. . 6. Skin: no involvement of tumor.. . 7. Surgical margins:. . (a) Superior margin: 5 mm.. . (b) Inferior margin: 7 mm.. . (c) Medial margin: 15 mm.. . (d) Lateral margin: (see note).. . (e) Deep margin: 2 mm.. . (f) Superficial margin: 8 mm.. . 8. Microcalcification:. present,. tumoral/. non-tumoral.. Y. Kim et al.. 765. Note: 1. The lateral margin of the lumpectomy. specimen (slide 7) is close to ductal carcinoma in. situ (<1 mm), but this margin submitted for fro­. zen diagnosis (Fro 5) is free of tumor.. Result. Intensity. Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in 56%. of tumor cells. Adjuvant Therapy. Postoperative radiation therapy.. Treatments After Recurrence. 124 125. 126. Operation. 127. 128. Pathology Report. <Right>. Mucinous Carcinoma. 1. Post-lumpectomy status.. 2. Size of tumor: 1.1 cm (rpT1c).. 3. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, <1/10HPF).. 4. Intraductal component: present, extratumoral. (5%) (nuclear grade: low, necrosis: present,. architectural pattern: solid/comedo, exten­. sive intraductal component: absent).. 5. Skin and nipple: no involvement of tumor.. 6. Surgical margins:. . (a) Deep margin: 10 mm.. . (b) Superficial margin: 4 mm.. 7. Lymph nodes: no metastasis in five axillary. lymph nodes (rpN0(sn)) (sentinel LN: 0/2,. axillary LN: 0/2, intramammary LN: 0/1).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular invasion: absent.. . 10. Tumor border: infiltrative.. . 11. Microcalcification: absent.. . . . Local Recurrence. 766. . . Y. Kim et al.. 767. . 12. Pathological TN category (AJCC 2017):. rpT1cN0(sn).. Result. Intensity. Positive %. Estrogen. receptor. Intermediate. (6/8). 2. 1/3–2/3. Progesterone. receptor. Weak (4/8). 2. 1–10%. C-erbB2. Negative (0). Ki-67. Positive in 22%. of tumor cells. <Left>. . 1. Fibroadenoma.. . 2. Usual ductal hyperplasia with apocrine. metaplasia.. Adjuvant Therapy. Tamoxifen 20 mg/day for 5 years.. 18. 

Patient History and Progress. Female/43 years old, pre-menopause.. Screen detected mass lesion on right breast 7. o’clock direction.. Outside result of mammotome biopsy: ductal. carcinoma in situ.. No family history.. s/p Total thyroidectomy (thyroid cancer).. BRCA 2 VUS (variant of uncertain).. 17.2. 

Case 17

Metastatic Breast Cancer

17.1. . Courses of Treatment. Right breast cancer → Operation → Adjuvant. therapy → Ipsilateral axillary lymph node. recurrence.. Primary Treatment. Estrogen. receptor. Strong. (7/8). 3. 1/3–2/3. Progesterone. receptor. Strong. (7/8). 2. >2/3. C-erbB2. Negative. (0). Ki-67. Positive in. 15% of. tumor. cells. Adjuvant Therapy. Adjuvant chemotherapy #8 cycles (Adriamycin +. Cyclophosphamide #4 → Docetaxel #4).. Post-operative radiation therapy + Letrozole. 2.5 mg/day for 3 years.. Treatments After Recurrence. receptor. Negative (0/8). 0. 0. C-erbB2. Negative (0). Ki-67. Positive in. <1% of tumor. cells. Operation. Jun. 2021 Right axillary lymph node dissection.. Pathology: No metastasis in four axillary. lymph nodes.. Adjuvant Therapy. Exemestane 25 mg/day~. 18. 

Patient History and Progress. Female/69 years old, post-menopause.. Family history of breast cancer, daughter.. BRCA. 1. mutation: VUS. (variant. of. uncertain).. 17.2. 

Case 18

Benign and Proliferative

18.1. . Courses of Treatment. →2021-08-27 excision, Rt.. Pathology Report. Diagnosis. • Breast, right, excision:. –. – Atypical ductal hyperplasia with micro-. calcification.. Post-excision status.. –. – Intraductal papilloma.. C. W. Lee et al.. 39. . . 19. 

Important Radiologic. Findings. 32. 33. 18.3. 

Patient History and Progress. Female/57 years old, pre-menopause.. Screen detected mass lesion on right breast. 9 ~ 10 o’clock direction.. No family history.. No comorbidities.. s/p Right breast excision.. 18.2. 

Case 18

Carcinoma In Situ

18.1. . Courses of Treatment. Operation + Postoperative radiation therapy.. Operation. 83. 84. Pathology Report. Ductal carcinoma in situ, pathological TN cat­. egory (AJCC 2017): pTis. . 1. Size of tumor: 1.1 cm (pTis).. . 2. Nuclear grade: low.. . 3. Necrosis: present.. . 4. Architectural pattern: micropapillary/cribri­. form/solid.. . 5. Surgical margins:. . (a) superior margin: 20 mm,. . (b) inferior margin: (see Note 1),. . (c) medial margin: 5 mm,. . (d) lateral margin: (see Note 2),. . (e) deep margin: 2 mm,. . (f) superficial margin: 5 mm.. . 6. Microcalcification: present, non-tumoral.. Note: 1. The inferior margin of the lumpec­. tomy specimen (slide 5) is close to ductal car­. cinoma in situ (2 mm) but this margin submitted. for frozen diagnosis (Fro 3) is free of tumor.. 2. The lateral margin of the lumpectomy spec­. imen (slide 6) is close to ductal carcinoma in situ. (2  mm) but this margin submitted for frozen. diagnosis (Fro 7) is free of tumor.. Result. Intensity Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative (1+). Ki-67. Positive in 5%. of tumor cells. . . E. S. Lee et al.. 91. . . ­. 19. 

Important Radiologic. Findings. 81. 82. 18.3. 

Patient History and Progress. Female/64 years old, post-menopause.. Screen detected mass lesion on right breast. 8 o’clock direction.. Outside result of biopsy:. Right breast 8  o’clock, atypical intraductal. papillary neoplasm, favor ductal carcinoma in. situ.. No family history.. Hypertension, diabetes mellitus.. 18.2. 

Case 18

HR(+) HER2(+) Breast Cancer

18.1. . Courses of Treatment. Operation  +  Adjuvant chemotherapy (#4. cycles of doxorubicin and cyclophosphamide. followed by #4 cycles of docetaxel and trastu­. zumab)  +  Post-operative radiation ther­. apy  +  Trastuzumab  +  Letrozole 2.5  mg/day. with goserelin.. 99. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: up to 3.0  cm, multifocal. (pT2(Paget)).. . ­. HR(+) HER2(+) Breast Cancer. 356. . 2. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 23/10 HPF).. 3. Intraductal component: present, intratu­. moral/extratumoral (20%) (nuclear grade:. high, necrosis: present, architectural pattern:. papillary/solid/comedo, extensive intraductal. component: absent).. 4. Nipple: Paget’s disease.. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) superior margin: 12 mm,. . (b) inferior margin: (see Note 1),. . (c) medial margin: 15 mm,. . (d) lateral margin: 8 mm,. . (e) deep margin: <1 mm from ductal carci­. noma in situ (slide 3),. . (f) superficial margin: <2 mm from invasive. ductal carcinoma (slide 13).. 7. Lymph nodes:. . (a) metastasis in three out of four axillary. lymph nodes (pN1a(sn)) (see Note 2). (sentinel LN: 3/4),. . (b) perinodal extension: present,. . (c) size of metastatic carcinoma: 4 mm.. 8. Arteriovenous invasion: absent.. 9. Lymphovascular. invasion:. present,. peritumoral.. . 10. Tumor border: infiltrative.. . 11. Microcalcification:. present,. tumoral/. non-tumoral.. . 12. Pathological TN category (AJCC 2017):. pT2(Paget)N1a(sn).. Note: 1. The inferior margin of the lumpec­. tomy specimen (slide 3) is close to ductal carci­. noma in situ (<1 mm) but this margin submitted. for frozen diagnosis (Fro 8 and 9) is free of tumor.. 2. A few isolated tumor cells are present only. in the permanent section of Fro 5 for immunohis­. tochemical staining.. Result. Intensity. Positive. %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Positive (3+). Ki-67. Positive in 77%. of tumor cells. S. Park et al.. 357. . . HR(+) HER2(+) Breast Cancer. 358. a. b. . 19. 

Important Radiologic. Findings. 95 96 97. 98. 18.3. 

Patient History and Progress. Female/38 years old, pre-menopause.. Self-detected palpable mass lesion on portion. of outer half of left breast.. No family history.. Lumbar spine disc.. BRCA 1 and 2 mutation: Not examination.. 18.2. 

Case 18

HR(+) HER2(-) Breast Cancer

Courses of Treatment. Operation (1st & 2nd, Aug. 2010)  +  Post-­. operative radiation therapy  +  Tamoxifen. 20 mg/day.. Operation (3rd, Jan. 2021) + Adjuvant che­. motherapy (docetaxel & cyclophosphamide) +. Letrozole 2.5 mg/day.. Operation (1st, Aug. 2010). comedo.. . 5. Surgical margins:. . (a) superior margin: 30 mm.. . (b) inferior margin: positive (slide 3).. . (c) medial margin: 10 mm.. . (d) lateral margin: 10 mm.. . (e) deep margin: 2 mm.. . 6. Microcalcification:. present,. tumoral/. non-tumoral.. . 7. Pathologic stage (AJCC 2010): pTis.. Flat Epithelial Atypia. • With microcalcification.. Result. Intensity. Positive. %. Estrogen. receptor. Strong (7/7). 3. >2/3. Progesterone. receptor. Strong (6/7). 3. 1/3–2/3. C-erbB2. Equivocal (2+). Ki-67. Positive in 1% of. tumor cells. Operation (2nd, Aug. 2010). Left breast conserving surgery, sentinel lymph. with microcalcification.. Operation (3rd, Jan. 2021). Left total mastectomy, sentinel lymph node. biopsy, right total mastectomy (Figs. 99 and 100).. Pathology Report. [Right]. . 1. Fibroadenoma. . 2. Sclerosing adenosis with microcalcification.. [Left]. Invasive Ductal Carcinoma. 1. Post-lumpectomy status.. 2. Size of tumor: 2.0 cm (rpT1c).. Y. Kim et al.. . (a) deep margin: 3 mm.. . (b) superficial margin: 2 mm.. 7. Lymph nodes: no metastasis in two axillary. lymph nodes (rpN0(sn)) (axillary LN: 0/2).. 8. Arteriovenous. invasion:. present,. intratumoral.. 9. Lymphovascular invasion: present, intratu­. moral/peritumoral.. . 10. Tumor border: infiltrative.. . 11. Microcalcification: present, tumoral.. . 12. Pathological TN category (AJCC 2017):. rpT1cN0(sn).. Result. Intensity. Positive %. Estrogen receptor. Strong (8/8). 3. >2/3. Progesterone receptor. Intermediate (5/8). 3. 1–10%. C-erbB2. Negative (0). Ki-67. Positive in 8% of tumor cells. Y. Kim et al.

Important Radiologic. Findings. See Figs. 89, 90, 91, 92, 93, 94, 95 and 96.. 18.3. 

S/P unilateral salpingo-oophorectomy, s/p. hysterectomy, Hypertension.. 18.2. 

Case 18

HR(−) HER2(+) Breast Cancer

18.1. . Courses of Treatment. Neoadjuvant chemotherapy (#6 cycles of. docetaxel and carboplatin and trastuzumab and. pertuzumab) + Operation + Post-operative radia­. tion therapy + Trastuzumab.. . Y. Kwon et al.. 503. 3/3, 3/1HPF).. 4. Intraductal component: absent.. 5. Surgical margins:. . (a) superior margin: 40 mm,. . (b) inferior margin: 15 mm,. . (c) medial margin: 10 mm,. . (d) lateral margin: 15 mm,. . (e) deep margin: 5 mm,. . (f) superficial margin: 8 mm.. 6. Lymph nodes: no metastasis in two axillary. lymph nodes (ypN0(sn)) (sentinel LN: 0/1,. axillary LN: 0/1).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular. invasion:. present,. intratumoral.. HR(−) HER2(+) Breast Cancer. 504. a. b. . 9. Tumor border: infiltrative.. . 10. Microcalcification: present, non-tumoral.. . 11. Pathological TN category (AJCC 2017):. ypT1bN0(sn).. Result. Intensity. Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in. 41% of tumor. cells. 19. 

Important Radiologic. Findings. 127 128 129. 130. . Y. Kwon et al.. 501. . . . HR(−) HER2(+) Breast Cancer. 502. 18.3. . After Neoadjuvant. Chemotherapy. 131 132 133. 134. 18.4. 

Patient History and Progress. Female/61 years old, post-menopause.. Self-detected bloody discharge on nipple of. left breast.. No family history.. S/p hysterectomy.. 18.2. 

Case 18

HR(−) HER2(−) Breast Cancer

18.1. . Courses of Treatment. Neoadjuvant chemotherapy (#4  cycles of. doxorubicin and cyclophosphamide  +  #4. cycles of paclitaxel)  +  Operation  +  Post-. operative radiation therapy  +  Adjuvant. capecitabine.. Operation. 130. Pathology Report. . 1. Invasive Ductal Carcinoma.. . (a) Post-chemotherapy status.. . (b) Size of tumor: 0.7 cm (ypT1b).. . (c) Histologic grade: 3/3 (tubule formation:. 3/3, nuclear pleomorphism: 3/3, mitotic. count: 3/3, 95/10HPF).. . (d) Intraductal component: absent.. . (e) Skin and nipple: no involvement of tumor.. . (f) Surgical margins:. • Superior margin: 20 mm.. • Inferior margin: 20 mm.. • Medial margin: 10 mm.. • Lateral margin: 10 mm.. • Deep margin: 1.5  mm from invasive. ductal carcinoma (slide 2).. • Superficial margin: 15 mm.. . (g) Lymph nodes: no metastasis in three axillary. lymph nodes (ypN0(sn)) (sentinel LN: 0/3).. . (h) Arteriovenous invasion: absent.. . (i) Lymphovascular invasion: absent.. . (j) Tumor border: infiltrative.. . (k) Microcalcification: present, non-tumoral.. . (l) Pathological TN category (AJCC 2017):. ypT1bN0(sn).. . 2. Sclerosing adenosis with microcalcification.. Note: 1. A few isolated tumor cells are present. only in the permanent section of Fro 7 for immu­. nohistochemical staining.. Result. Intensity Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Negative (0). Ki-67. Positive in 63%. of tumor cells. E. S. Lee et al.. 637. . HR(−) HER2(−) Breast Cancer. 638. . ­. . . ­. . E. S. Lee et al.. 639. . . . HR(−) HER2(−) Breast Cancer. 640. 19. 

Important Radiologic Findings. 123 124. 125. After Neoadjuvant. Chemotherapy. 126 127 128. 129. 18.3. 

Patient History and Progress. Female/57 years old, post-menopause.. Self-detected palpable mass lesion and skin. change on left breast.. Family history of breast cancer, aunt. (paternal).. No comorbidities.. BRCA 1 and 2 mutation: Not detected.. 18.2. 

Case 18

Local Recurrence

18.1. . Courses of Treatment. Left breast IDC→ Operation → Adjuvant. . therapy → Right breast recurrence (IDC).. Primary Treatment. Operation. May 2001 Left modified radical mastectomy. (outside).. Pathology Report. Invasive Ductal Carcinoma. . 1. Size of tumor: 3.0 cm (pT2).. . 2. Lymph nodes: two metastases in 24 axillary. lymph nodes (pN1) (sentinel LN: 0/2, axillary. LN: 0/2, intramammary LN: 0/1).. . 3. Pathological TN category: pT2N1.. Result. Intensity. Positive %. Estrogen. receptor. Negative. 0. 0. Progesterone. receptor. Negative. 0. 0. C-erbB2. Negative (0). Ki-67. Positive in 70%. of tumor cells. Adjuvant Therapy. Adjuvant chemotherapy #4 cycles of doxorubicin. and cyclophosphamide followed by #4 cycles of. docetaxel.. Treatments After Recurrence. 129 130. 131. . . Local Recurrence. 768. Operation. 132. Pathology Report. Invasive Ductal Carcinoma. 1. Post left mastectomy status.. 2. Size of tumor: 1.6 cm (pT1c).. 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 12/HPF).. 4. Intraductal component: present, intratu­. moral/extratumoral (30%) (nuclear grade:. high, necrosis: present, architectural pattern:. micropapillary/comedo,. extensive. intra­. ductal component: present).. 5. Nipple: involvement of lactiferous duct.. 6. Skin: no involvement of tumor.. 7. Surgical margins:. . (a) Deep margin: 2 mm.. . (b) Superficial margin: 2 mm.. 8. Lymph nodes:. . . Y. Kim et al.. 769. . (a) Metastasis in one out of four axillary. lymph nodes (pN1mi(sn)) (sentinel LN:. 1/3, non-sentinel LN: 0/1).. . (b) Perinodal extension: absent.. . (c) Size of metastatic carcinoma: 0.8 mm.. 9. Arteriovenous invasion: absent.. . 10. Lymphovascular. invasion:. present,. intratumoral.. . 11. Tumor border: infiltrative.. . 12. Microcalcification:. present,. tumoral/. non-tumoral.. . 13. Pathological TN category (AJCC 2017):. pT1cN1mi(sn).. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative (1+). Ki-67. Positive in 80%. of tumor cells. Adjuvant Therapy. Anastrozole 1 mg/day (stop d/t low compliance).. 19. 

Patient History and Progress. Female/71 years old, post-menopause.. Screen detected mass lesion on right breast.. No family history.. Diabetes mellitus, Grave’s disease.. BRCA 2 mutation carrier.. 18.2. 

Case 18

Metastatic Breast Cancer

18.1. . Courses of Treatment. Left breast cancer → Operation → Ipsilateral. chest wall recurrence → Neoadjuvant chemo­. therapy → operation → targeted therapy →. Ipsilateral lymph node recurrence.. Primary Treatment. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in. 23% of tumor. cells. Treatments After Recurrence. See Figs. 58 and 59.. Nov. 2018 Muscle, left breast biopsy.. Pathology: Invasive ductal carcinoma, clini­. cally recurrent.. Metastatic Breast Cancer. receptor. Intermediate. (5/8). 3. 1–10%. C-erbB2. Positive (3+). Ki-67. Positive in. 39% of tumor. cells. Neoadjuvant Chemotherapy. Chemotherapy. #3. cycle. (Docetaxel. &. Trastuzumab + Pertuzumab).. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Negative (2/8). 1. <1%. C-erbB2. Equivocal (2+). Ki-67. Positive in. 34% of tumor. cells. Adjuvant Therapy. Trastuzumab + Pertuzumab.. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Equivocal (2+). Ki-67. Positive in. 25% of tumor. cells. SISH. Positive. Operation. Jan. 2020 Left axillary lymph node dissection.. Pathology: Metastatic ductal carcinoma in. three out of eight axillary lymph nodes.. Y. Kwon et al.. 891. Size of metastatic carcinoma: 20 mm.. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Negative (2/8). 1. <1%. C-erbB2. Positive (3+). Ki-67. Positive in 30%. of tumor cells. Adjuvant Therapy. Post-operative radiation therapy + Letrozole. 2.5 mg/day~. 19. 

Patient History and Progress. Female/64 years old, post-menopause.. No family history.. Hypertension, diabetes mellitus.. 18.2. 

Case 19

Benign and Proliferative

19.1. . Courses of Treatment. →2021-08-03 excision, Lt.. Pathology Report. Diagnosis. • Breast, left 1 o’clock, excision:. –. – Fibroadenoma.. –. – Intraductal papilloma with usual ductal. hyperplasia.. • Breast, left 8 o’clock, excision:. –. – Intraductal papilloma with (1) usual ductal. hyperplasia, (2) microcalcification.. 20. 

Important Radiologic. Findings. 34 35. 36. Benign and Proliferative Case Series. 40. . . . C. W. Lee et al.. 41. 19.3. 

Patient History and Progress. Female/42 years old, pre-menopause.. Screen detected mass lesion on left breast. 8 o’clock direction.. Outside result of biopsy: papillary neoplasm.. No family history.. No comorbidities.. 19.2. 

Case 19

Carcinoma In Situ

19.1. . Courses of Treatment:. Operation. Operation. ­. 89. 90. Carcinoma In Situ. 92. Pathology Report. Right.. Ductal carcinoma in situ. . 1. Post-mammotome status.. . 2. Size of tumor: 0.3 cm, residual.. . 3. Nuclear grade: high.. . 4. Necrosis: absent.. . 5. Architectural pattern: cribriform/solid.. . 6. Skin and nipple: no involvement of tumor.. . 7. Surgical margins:. . (a) deep margin: 5 mm,. . (b) superficial margin: <1  mm from ductal. carcinoma in situ (slide 11).. . 8. Lymph nodes: no metastasis in two axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/2).. . 9. Microcalcification: present, tumoral.. Left.. Ductal carcinoma in situ, pathological TN cat­. egory (AJCC 2017): pTisN0(sn). . 1. Size of tumor: 6.0 cm (pTis).. . 2. Nuclear grade: low.. . 3. Necrosis: absent.. . 4. Architectural pattern: micropapillary/cribri­. form/solid.. . 5. Skin and nipple: no involvement of tumor.. . 6. Surgical margins: (see note).. . (a) deep margin: 1  mm from ductal carci­. noma in situ (slide 4),. . (b) superficial margin: <1  mm from ductal. carcinoma in situ (slide 8).. . 7. Lymph nodes: no metastasis in three axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/3).. . 8. Microcalcification: present, tumoral.. Note: 1. Atypical ductal hyperplasia is pres­. ent only in the permanent section of Fro 3.. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative (1+). Ki-67. Positive in. 14% of tumor. cells. . ­. . E. S. Lee et al.. 93. . ­. . Carcinoma In Situ. 94. . E. S. Lee et al.. 95. . 20. 

Important Radiologic. Findings. 85 86 87. 88. 19.3. 

Patient History and Progress. Female/48 years old, pre-menopause.. Screen detected diffuse non-mass lesions on. upper, central, and lower portion of left breast.. Screen detected microcalcification on inner. subareolar of right breast.. Outside result of excisional biopsy: bilateral. ductal carcinoma in situ.. No family history.. S/P L-spine operation.. BRCA 1 and 2 mutation: Not detected.. 19.2. 

Case 19

HR(+) HER2(+) Breast Cancer

19.1. . Courses of Treatment. Neoadjuvant chemotherapy (#6 cycles of. docetaxel and carboplatin and trastuzumab. and pertuzumab)  +  Operation  +  Post-­. operative radiation therapy + Trastuzumab +. Letrozole 2.5 mg/day.. 105. Pathology Report. Invasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of tumor: 1.5 cm (ypT1c).. S. Park et al.. 359. . . 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 2/3, 10/10 HPF).. 4. Intraductal component: absent.. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) superior margin: 20 mm,. . (b) inferior margin: 20 mm,. . (c) medial margin: 25 mm,. . (d) lateral margin: 10 mm,. . (e) deep margin: 13 mm,. . (f) superficial margin: 18 mm.. 7. Lymph nodes: no metastasis in one axillary. lymph node (ypN0(sn)) (sentinel LN: 0/0,. sentinel LN #2: 0/1).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular invasion: absent.. . 10. Tumor border: infiltrative.. . 11. Microcalcification: present, non-tumoral.. . 12. Pathological TN category (AJCC 2017):. ypT1cN0(sn).. Result. Intensity. Positive. %. Estrogen. receptor. Intermediate. (6/8). 2. 1/3–2/3. Progesterone. receptor. Negative (2/8). 1. <1%. C-erbB2. Positive (3+). Ki-67. Positive in 3% of. tumor cells. HR(+) HER2(+) Breast Cancer. 360. . . . S. Park et al.. 361. a. b. . 20. 

Important Radiologic. Findings. 100 101 102 103. 104. 19.3. 

Patient History and Progress. Female/71 years old, post-menopause.. Self-detected palpable mass lesion on left. breast 11 o’clock direction.. No family history.. Hypertension,. dyslipidemia,. s/p. appendectomy.. 19.2. 

Case 19

HR(+) HER2(-) Breast Cancer

Courses of Treatment. Operation + Tamoxifen 20 mg/day with leup­. rolide acetate.. Operation. Left nipple–areolar complex sparing mastectomy. with immediate implant reconstruction, sentinel. lymph node biopsy (Figs. 106 and 107).. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 1.7 cm and 0.5 cm (pT1c(2)).. 2. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 2/3, 11/10 HPF).. 3. Intraductal component: present, intratu­. moral/extratumoral (20%) (nuclear grade:. low, necrosis: present, architectural pattern:. cribriform/solid/comedo, extensive intra­. ductal component: present).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) deep margin: 2 mm.. . (b) superficial margin: 2 mm.. HR(+) HER2(−) Breast Cancer. . 10. Microcalcification:. present,. tumoral/. non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT1c(2)N0(sn).. Result. Intensity. Positive. %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Equivocal (2+). (SISH negative). Ki-67. Positive in 9% of. tumor cells. Y. Kim et al.

Important Radiologic. Findings. See Figs. 101, 102, 103, 104 and 105.. 19.3. 

No comorbidities.. 19.2. 

Case 19

HR(−) HER2(+) Breast Cancer

19.1. . Operation. 140. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 2.1 cm (pT2).. 2. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 12/3, 2/10HPF).. 3. Intraductal component: present, extratumoral. (5%) (nuclear grade: high, necrosis: present,. architectural pattern: solid/comedo, exten­. sive intraductal component: absent).. 4. Surgical margins:. . (a) superior margin: 10 mm,. . (b) inferior margin: 20 mm,. . (c) medial margin: 10 mm,. . (d) lateral margin: 10 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: 5 mm.. 5. Lymph nodes: no metastasis in two axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/2).. 6. Arteriovenous invasion: absent.. 7. Lymphovascular. invasion:. present,. peritumoral.. 8. Tumor border: infiltrative.. 9. Microcalcification:. present,. tumoral/. non-tumoral.. . 10. Pathological TN category (AJCC 2017):. pT2N0(sn).. Result. Intensity. Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in 39%. of tumor cells. . ­. . Y. Kwon et al.. 507. a. b. . 20. 

Important Radiologic. Findings. 136 137 138. 139

Patient History and Progress. Female/52 years old, pre-menopause.. Self-detected palpable mass lesion on left. breast 1 and 2 o’clock direction.. No family history.. Hepatitis B virus carrier, liver cirrhosis.. Y. Kwon et al.. 505. 19.2. 

Case 19

HR(−) HER2(−) Breast Cancer

19.1. . Courses of Treatment. Operation  +  adjuvant chemotherapy (#4. cycles of doxorubicin and cyclophospha­. mide + #3 cycles of paclitaxel-stop d/t drug-­. induced. pneumonitis). +. Post-operative. radiation therapy.. Operation. 134. Pathology Report. Invasive Ductal Carcinoma. 1. Size of tumor: 2.2 cm (pT2).. 2. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 4/HPF).. 3. Intraductal component: present, intratu­. moral/extratumoral (20%) (nuclear grade:. high, necrosis: present, architectural pattern:. solid/comedo, extensive intraductal compo­. nent: absent).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) Superior margin: 10 mm.. . (b) Inferior margin: 10 mm.. . (c) Medial margin: 10 mm.. . (d) Lateral margin: 10 mm.. . (e) Deep margin: 2 mm.. . (f) Superficial margin: 2 mm.. 6. Arteriovenous invasion: absent.. 7. Lymphovascular invasion: absent.. 8. Tumor border: infiltrative.. 9. Microcalcification: present, tumoral/non-. tumoral.. . 10. Pathological TN category (AJCC 2017):. pT2Nx.. Result. Intensity. Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Negative (1+). Ki-67. Positive in 91%. of tumor cells. E. S. Lee et al.. 641. . . . HR(−) HER2(−) Breast Cancer. 642. . 20. 

Important Radiologic Findings. 131 132. 133. 19.3. 

Patient History and Progress. Female/63 years old, post-menopause.. Screen detected mass lesion on right breast 10. o’clock direction.. No family history.. Hepatitis B virus carrier, h/o Tuberculosis.. 19.2. 

Case 19

Local Recurrence

19.1. . Courses of Treatment. Left breast IDC → Adjuvant therapy.. Primary Treatment. 133 134 135 136. 137. Neoadjuvant Chemotherapy. Neoadjuvant chemotherapy #4 cycles of doxoru­. bicin and cyclophosphamide followed by. #4 cycles of docetaxel and trastuzumab.. Operation. ­. ­. 138. 139. Pathology Report. <Right>. Complex. sclerosing. lesion. with. microcalcification.. <Left>. Invasive Ductal Carcinoma, associated with. complex sclerosing lesion. 1. Post-chemotherapy status.. 2. Size of invasion component: 1.3  cm. (ypT1c(m)).. 3. Size of intraductal component: 1.6 cm.. . Local Recurrence. 770. architectural pattern: micropapillary/cribri­. form, extensive intraductal component:. present).. 6. Skin: no involvement of tumor.. 7. Surgical margins:. . (a) Superior margin: 15 mm.. . (b) Inferior margin: 4 mm.. . (c) Medial margin: (see NOTE 1).. . (d) Lateral margin: 50 mm.. . (e) Deep margin: 7 mm.. . (f) Superficial margin: 14 mm.. Y. Kim et al.. 771. 8. Lymph nodes:. . (a) Metastasis in two out of eight axillary. lymph nodes (ypN1a(sn)) (sentinel LN:. 2/2, axillary LN: 0/6).. . (b) Perinodal extension: present.. . (c) Size of metastatic carcinoma: 3 mm.. 9. Arteriovenous invasion: absent.. . 10. Lymphovascular. invasion:. present,. peritumoral.. . 11. Tumor border: infiltrative.. . 12. Microcalcification:. present,. tumoral/. non-tumoral.. . 13. Pathologic stage (AJCC 2010): ypT1c(m). N1a(sn).. . a. b. . a. b. . Local Recurrence. 772. Note 1: The medial margin of the lumpectomy. specimen (slide 4) is <1 mm from invasive ductal. carcinoma, but this margin submitted for frozen. diagnosis (Fro 6) is free of tumor.. Result. Intensity. Positive %. Estrogen. receptor. Weak (4/8). 2. 1–10%. Progesterone. receptor. Weak (4/8). 2. 1–10%. C-erbB2. Positive (3+). Ki-67. Positive in 1%. of tumor cells. Adjuvant Therapy. Postoperative radiation therapy.. Trastuzumab for 1 year.. Tamoxifen 20 mg/day for 5 years.. 20. 

Patient History and Progress. Female/52 years old, pre-menopause.. Screen detected mass lesion on right breast. subareolar area and left breast subareolar area.. No family history.. Hypertension.. 19.2. 

Case 19

Metastatic Breast Cancer

19.1. . Courses of Treatment. Right breast cancer → Operation → Adjuvant. therapy → Ipsilateral axillary lymph node. recurrence → Operation → Endocrine therapy. → Progressive disease.. Primary Treatment. Positive %. Estrogen. receptor. Strong (7/8). 3. 1/3–2/3. Progesterone. receptor. Strong (7/8). 3. 1/3–2/3. C-erbB2. Negative (0). Ki-67. Positive in. 26% of. tumor cells. Adjuvant Therapy. Adjuvant chemotherapy #8 cycles (Adriamycin. & Cyclophosphamide #4 → Docetaxel #4).. Post-operative radiation therapy + Tamoxifen. 20 mg/day for 3.8 years.. Treatments After Recurrence. Progesterone. receptor. Weak (4/8). 2. 1–10%. C-erbB2. Negative (0). Ki-67. Positive in. 6% of tumor. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Intermediate. (5/8). 2. 10%–1/3. C-erbB2. Negative (1+). Ki-67. Positive in 7%. of tumor cells. Adjuvant Therapy. Letrozole 2.5 mg/day for 0.75 year → Progressive. disease.. See Figs. 64 and 65.. Mar. 2022 Right axillary lymph node biopsy.. Pathology: Metastatic ductal carcinoma.. Result. Intensity. Positive %. Estrogen. receptor. Weak (3/8). 1. 1–10%. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Negative (1+). Ki-67. Positive in. 11% of tumor. cells. Palliative Chemotherapy

Patient History and Progress. Female/45 years old, post-menopause.. No family history.. S/p bilateral salpingo-oophorectomy.. 19.2. 

Case 2

Benign and Proliferative

2.1. . Courses of Treatment. → 2022-02-14 Excision, Lt.. 2.3.1. . Pathology Report. • Breast, left, excision:. –. – Atypical ductal hyperplasia with micro­. -. calcification.. –. – Intraductal papilloma with usual ductal. hyperplasia.. 3. 

Important Radiologic. Findings. 3. 2.3. 

Patient History and Progress. Female/47 years old, pre-menopause.. Screen detected mass lesion on left breast. 2 o’clock direction.. Outside result of biopsy: Intraductal papilloma.. No family history.. No comorbidities.. 2.2. 

Case 2

Carcinoma In Situ

2.1. 

Important Radiologic. Findings. 7. 8. 2.3. . Course of Treatment:. Operation. 2.3.1. . Operation. 9. 10. 2.3.2. . Pathology Report. Lobular carcinoma in situ. . 1. Size of tumor: 0.2 cm2.. . 2. Nuclear grade: low.. . 3. Necrosis: absent.. . 4. Architectural pattern: solid.. . 5. Surgical margin: 2 mm from nearest margin.. . ­. E. S. Lee et al.. 55. . a. b. . Carcinoma In Situ. 56. . . . 3. 

Patient History and Progress. Female/47 years old, pre-menopause.. Nipple discharge on left breast.. Family history of breast cancer, mother and. sister, aunt, cousin sister.. Thrombocytopenia (Follow-up at outside. hospital).. BRCA 2 VUS (variant of uncertain).. 2.2. 

Case 2

HR(+) HER2(+) Breast Cancer

2.1. . Courses of Treatment. Neoadjuvant chemotherapy (#6 cycles of. docetaxel and carboplatin and trastuzumab. and pertuzumab)  +  Operation  +  Post-­. operative radiation therapy  +  Trastuzumab. emtansine + Tamoxifen 20 mg/day.. 12. 2.3.1. . Pathology Report. . 1. Microinvasive ductal carcinoma.. . (a) Post-chemotherapy status.. . (b) Size of tumor: <0.1 cm (ypT1mi).. HR(+) HER2(+) Breast Cancer. 304. . . . S. Park et al.. 305. . (c) Histologic grade: 2/3 (tubule formation:. 3/3, nuclear pleomorphism: 2/3, mitotic. count: 2/3, 11/10 HPF).. . (d) Intraductal component: absent.. . (e) Skin: no involvement of tumor.. . (f) Surgical margins:. • superior margin: 2 mm from microin­. vasive ductal carcinoma (Fro 6),. • inferior margin: 30 mm,. • medial margin: >10 mm,. • lateral margin: >10 mm,. • deep margin: 2 mm,. • superficial margin: 2 mm.. . a. b. . ­. HR(+) HER2(+) Breast Cancer. 306. . (g) Lymph nodes: no metastasis in two axil­. lary lymph nodes (ypN0(sn)) (sentinel. LN: 0/2).. . (h) Arteriovenous invasion: absent.. . (i) Lymphovascular invasion: absent.. . (j) Tumor border: infiltrative.. . (k) Microcalcification:. present,. tumoral/. non-tumoral.. . (l) Pathological TN category (AJCC 2017):. ypT1miN0(sn).. . (m) Related slides:. . 2. Sclerosing adenosis with microcalcification.. Result. Intensity. Positive. %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Equivocal (2+). Ki-67. Positive in 2% of. tumor cells. 3. 

Important Radiologic. Findings. 8 9 10. 11. 2.3. 

Patient History and Progress. Female/42 years old, pre-menopause.. Screen detected mass lesion on left breast. 1:30 and 2 o’clock direction.. No family history.. S/P Cervical spine disc operation.. 2.2. 

Case 2

HR(+) HER2(-) Breast Cancer

Courses of Treatment. Operation  +  Post-operative radiation ther­. apy + Anastrozole 1 mg/day.. 2.3.1. . Operation. Left breast conserving surgery, sentinel lymph. low, necrosis: absent, architectural pattern:. cribriform, extensive intraductal component:. absent).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) superior margin: 20 mm,. . (b) inferior margin: 15 mm,. . (c) medial margin: 20 mm,. . (d) lateral margin: 10 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: 2 mm.. 6. Lymph nodes: no metastasis in one axillary. lymph node (pN0(sn)) (sentinel LN: 0/1).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular invasion: absent.. 9. Tumor border: infiltrative.. . 10. Microcalcification:. present,. tumoral/. non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT1bN0(sn).. Y. Kim et al.

Important Radiologic. Findings. See Figs. 5, 6, 7 and 8.. HR(+) HER2(−) Breast Cancer. 3. >2/3. C-erbB2. Negative (0). Ki-67. Positive in 5% of tumor cells. 2.3. 

Hepatitis B virus carrier, dyslipidemia.. 2.2. 

Case 2

HR(−) HER2(+) Breast Cancer

2.1. . Courses of Treatment. Neoadjuvant chemotherapy (#2 cycles of. docetaxel and carboplatin and trastuzumab and. pertuzumab + #4 cycles of docetaxel and trastu­. zumab and pertuzumab)  +  Operation  +  Post-­. operative radiation therapy  +  Trastuzumab. emtansine.. 2.4.1. . Operation. 17. 2.4.2. . Pathology Report. Invasive Ductal Carcinoma. 1. Post-chemotherapy status.. 2. Size of invasive component: 0.6 cm, multifo­. cal (pT1b).. 3. Size of intraductal component: 3.0 cm.. 4. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 2/3, 10/10HPF).. 5. Intraductal component: present, extratumoral. (80%) (nuclear grade: high, necrosis: pres­. ent, architectural pattern: solid/comedo,. extensive intraductal component: present).. 6. Skin: no involvement of tumor.. 7. Surgical margins:. . (a) subareolar margin: positive for ductal. carcinoma in situ (Fro 6),. . (b) superior margin: 10 mm,. . (c) inferior margin: positive for ductal carci­. noma in situ (Fro 3) (see note),. . (d) medial margin: 5 mm,. . (e) lateral margin: (see note),. . (f) deep margin: (see note),. . (g) superficial margin: <1 mm from ductal. carcinoma in situ (slide 7).. . Y. Kwon et al.. 437. 8. Lymph nodes: no metastasis in two axillary. lymph nodes (ypN0(sn)) (sentinel LN: 0/2).. 9. Arteriovenous invasion: absent.. . 10. Lymphovascular invasion: absent.. . 11. Tumor border: infiltrative.. . 12. Microcalcification: present, non-tumoral.. . 13. Pathological TN category (AJCC 2017):. ypT1bN0(sn).. Result. Intensity. Positive %. Estrogen. receptor. Negative. (0/8). 0. 0. Progesterone. receptor. Negative. (0/8). 0. 0. C-erbB2. Positive. (3+). Ki-67. Positive in. 79% of. tumor cells. 3. 

Important Radiologic Findings. 9 10 11. 434. 2.3. . After Neoadjuvant. Chemotherapy. 13 14 15. 16. . Y. Kwon et al.. 435. . ­. . . HR(−) HER2(+) Breast Cancer. 436. 2.4. 

Patient History and Progress. Female/68 years old, post-menopause.. A self-detected skin change and nipple retrac­. tion on left breast.. No family history.. Hypothyroidism.. 2.2. 

Case 2

HR(−) HER2(−) Breast Cancer

2.1. . Courses of Treatment. Neoadjuvant chemotherapy (#4  cycles of. doxorubicin and cyclophosphamide + #4. cycles of docetaxel) + Operation + Post-. operative radiation therapy.. 2.3.1. . Operation. 15. 2.3.2. . Pathology Report. No residual tumor with stromal fibrosis. . 1. Post-chemotherapy status.. . 2. Lymph nodes:. . (a) No metastasis in ten axillary lymph node. (ypN0) (sentinel LN: 0/3, non-sentinel. LN: 0/7).. Result. Intensity. Positive. %. Estrogen. receptor. Negative (2/8). 1. <1%. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Equivocal (2+). SISH (−). Ki-67. Positive in 67%. of tumor cells. E. S. Lee et al.. 581. . . . HR(−) HER2(−) Breast Cancer. 582. . ­. 3. 

Important Radiologic. Findings. 8 9 10. 11. E. S. Lee et al.. 579. . . . HR(−) HER2(−) Breast Cancer. 580. . 2.2.1. . After Neoadjuvant. Chemotherapy. 12 13. 14. 2.3. 

Patient History and Progress. Female/49 years old, pre-menopause.. Self-detected palpable mass lesion on right. breast.. No family history.. No comorbidities.. 2.2. 

Case 2

Local Recurrence

2.1. . Courses of Treatment. Left breast IDC → Operation → Adjuvant. . therapy → Left breast recurrence (IDC).. 2.2.1. . Primary Treatment. 10. Operation. Nov. 2008 Left breast conserving surgery, senti­. nel lymph node biopsy (outside).. Pathology Report. Invasive Ductal Carcinoma. . 1. Size of tumor: 0.4 cm (pT1a).. . 2. Lymph nodes: no metastasis in three axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/3).. . 3. Pathologic stage (AJCC 2010): pT1aN0(sn).. Result. Intensity. Positive %. Estrogen. receptor. Negative. Progesterone. receptor. Negative. C-erbB2. Positive. Adjuvant Therapy. Postoperative radiation therapy.. Y. Kim et al.. 721. . . . 2.2.2. . Treatments After Recurrence. 11. 12. Operation. ­. 13. Pathology Report. Invasive Ductal Carcinoma, clinically recurrent. 1. Post-lumpectomy status.. 2. Size of tumor: 0.8 cm (rpT1b).. 3. Histologic grade: 3/3 (tubule formation: 3/3,. nuclear pleomorphism: 3/3, mitotic count:. 3/3, 27/10HPF).. 4. Intraductal component: absent, extratumoral. (20%) (nuclear grade: high, necrosis: absent,. architectural pattern: micropapillary/cribri­. form, extensive intraductal component: absent).. 5. Surgical margins:. . (a) Deep margin: 1.5 mm.. . (b) Superficial margin: 7 mm.. 6. Lymph nodes: no metastasis in one axillary. lymph node (rpN0(sn)) (sentinel LN: 0/1).. 7. Arteriovenous invasion: absent.. 8. Lymphovascular invasion: absent.. 9. Tumor border: infiltrative.. . 10. Microcalcification: present, tumoral.. . 11. Pathologic stage (AJCC 2017): rpT1bN0(sn).. Local Recurrence. 722. . . ­. Result. Intensity. Positive %. Estrogen. receptor. Negative (0/8). 0. 0. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in 50%. of tumor cells. Adjuvant Therapy. Adjuvant chemotherapy #4 cycles of docetaxel. with concurrent trastuzumab for 2 years.. 3. 

Patient History and Progress. Female/54 years old, peri-menopause.. Screen detected mass lesion on left breast. . 2 o’clock direction.. No family history.. No comorbidities.. 2.2. 

Case 2

Metastatic Breast Cancer

Courses of Treatment. Right breast cancer  →  Operation  +  Adjuvant. therapy → Lung metastasis → Palliative therapy. → Progression on rib and lung  →  Palliative. therapy → Progression on liver  →  Palliative. therapy.. 2.2.1. . Primary Treatment. Radiologic Finding. Estrogen. receptor. Strong (6/7). 2. >2/3. Progesterone. receptor. Negative (0/7). 0. 0. C-erbB2. Negative (0). Ki-67. Positive in 15%. of tumor cells. Adjuvant Therapy. Post-operative radiation therapy  +  Tamoxifen. 20 mg/day for 2.5 years.. Letrozole 2.5 mg/day for 1 year: stop due to. skin rash → Change to Tamoxifen 20 mg/day for. 1.5 years.. Metastatic Breast Cancer. Treatments After Recurrence. Lung Metastasis. Letrozole 2.5 mg/day for 3 years → Progressive. disease on right 8th rib, lung.. Sep. 2017 CT chest r/o lung metastasis.. See Figs. 5 and 6.. Operation. Apr. 2019 Right upper lobe lung wedge. resection.. Pathology: Metastatic ductal carcinoma from. breast.. Size of tumor: 0.9 × 0.7 × 0.5 cm.. Radiation Therapy. Radiation therapy to Right 8th rib.. Progression on Liver. Fulvestrant 250  mg  1/month  +  Palbociclib. 100  mg/day: Progressive disease on liver →. Exemestane 25 mg/day + Everolimus 5 mg/day. → Palliative chemotherapy (weekly Paclitaxel #6. cycles): Progressive disease on liver →. Doxorubicin & Cyclophosphamide.

Case 20

Benign and Proliferative

20.1. . Courses of Treatment. →2021-05-10 excision, Lt.. Pathology Report. Diagnosis. • Breast, left, excision:. –. – Atypical ductal hyperplasia.. –. – Fibrocystic change with microcalcification.. 21. 

Important Radiologic. Findings. 37. 38. . Benign and Proliferative Case Series. 42. . 20.3. 

Patient History and Progress. Female/44 years old, pre-menopause.. Screen detected microcalcification on upper. outer portion of left breast.. Family history of breast cancer, sister.. No comorbidities.. 20.2. 

Case 20

Carcinoma In Situ

20.1. . Courses of Treatment. First Operation + Tamoxifen 20  mg/day for. 4 months.. Second Operation.. Carcinoma In Situ. 96. . ­. . Operation. First operation: Breast conserving surgery, senti­. nel lymph node biopsy (left).. Second operation: Skin sparing mastectomy. with latissimus dorsi flap reconstruction (left).. Third operation: Excision (right).. 93. 94. Pathology Report. Left.. <First operation>. Invasive ductal Carcinoma, pathologic stage. (AJCC 2010): pT1aN0(sn). 1. Size of invasive component: 0.5 cm (pT1a).. 2. Size of intraductal component: 4.0 cm.. 3. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 1/3, 5/10HPF).. 4. Intraductal component: present, intratumoral/. extratumoral (90%) (nuclear grade: low,. necrosis: absent, architectural pattern: solid. and papillary, extensive intraductal compo­. nent: present).. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) superior margin: 3  mm from atypical. ductal hyperplasia (slide 1),. . (b) inferior margin: (see Note 1),. . (c) medial margin: (see Note 2),. . (d) lateral margin: 40 mm,. . (e) deep margin: positive for ductal carci­. noma in situ (slide 9),. . (f) superficial margin: 3 mm.. 7. Lymph nodes: no metastasis in seven axillary. lymph nodes (pN0(sn)) (sentinel LN: 0/7,. axillary LN: 0/0).. 8. Vascular invasion: absent.. 9. Lymphatic invasion: absent.. . 10. Tumor border: pushing.. . 11. Microcalcification: present, non-tumoral.. Note: 1. Atypical ductal hyperplasia is. present only in the permanent section of Fro. 3. The inferior margin of the lumpectomy. specimen (slides 2, 5, 7, 9, and 11) is positive. for ductal carcinoma in site 2. The medial. margin of the lumpectomy specimen (slide. 3) is close to ductal carcinoma in situ (1 mm). but this margin submitted for frozen diagno­. sis (Fro 4) is free of tumor.. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (8/8). 3. >2/3. C-erbB2. Negative (1+). Ki-67. Positive in. 29% of tumor. cells. <Second operation>. E. S. Lee et al.. 97. . . Carcinoma In Situ. 98. . 1. Atypical ductal hyperplasia, focal.. . (a) Post-lumpectomy status.. . 2. No residual tumor with foreign body reaction.. Right.. <Third operation>. Ductal carcinoma in situ, pathological TN cat­. egory (AJCC 2017): pTis. . 1. Size of tumor: 0.5 cm (pTis).. . 2. Nuclear grade: low.. . 3. Necrosis: absent.. . 4. Architectural. pattern:. micropapillary/. cribriform.. . 5. Skin: no involvement of tumor.. . 6. Surgical margins:. . (a) superior margin: 10 mm,. . (b) inferior margin: 10 mm,. . (c) medial margin: <1 mm from ductal carci­. noma in situ (slide 6),. . (d) lateral margin: 5 mm,. . (e) deep margin: 2 mm,. . (f) superficial margin: 2 mm.. . 7. Microcalcification:. present,. tumoral/non-. tumoral.. Result. Intensity. Positive %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Strong (7/8). 3. >2/3. C-erbB2. Negative (0). Ki-67. Positive in. <1% of. tumor cells. <Fourth operation>. No residual tumor with foreign body reaction.. . 1. Post-excision status.. 21. 

Important Radiologic. Findings. 91. 92. 20.3. 

Patient History and Progress. Female/48 years old, pre-menopause.. Screen detected mass lesion on left breast 3. o’clock direction at first visit.. Pain on right breast at second visit.. No family history.. No comorbidities.. NGS: negative.. 20.2. 

Case 20

HR(+) HER2(+) Breast Cancer

20.1. . Courses of Treatment. Operation  +  Adjuvant chemotherapy (#4. cycles of doxorubicin and cyclophosphamide. followed by #11 cycles of weekly pacli­. taxel). +. Post-operative. radiation. ther­. apy + Trastuzumab + Letrozole 2.5 mg/day.. 110. Pathology Report. Invasive Ductal Carcinoma. 1. Post-mammotome excision status.. 2. Size of tumor: 2.1 cm (pT2).. HR(+) HER2(+) Breast Cancer. 362. . . 3. Histologic grade: 2/3 (tubule formation: 3/3,. nuclear pleomorphism: 2/3, mitotic count:. 2/3, 10/10 HPF).. 4. Intraductal component: absent.. 5. Skin: no involvement of tumor.. 6. Surgical margins:. . (a) superior margin: 5 mm,. . (b) inferior margin: 6 mm,. . (c) medial margin: 5 mm,. . (d) lateral margin: 5 mm,. . (e) deep margin: 4 mm,. . (f) superficial margin: 6 mm.. 7. Lymph nodes: no metastasis in one axillary. lymph node (pN0(sn)) (sentinel LN: 0/1).. 8. Arteriovenous invasion: absent.. 9. Lymphovascular invasion: absent.. . 10. Tumor border: infiltrative.. . 11. Microcalcification: present, tumoral.. . 12. Pathological TN category (AJCC 2017):. pT2N0(sn).. Result. Intensity. Positive. %. Estrogen. receptor. Strong (8/8). 3. >2/3. Progesterone. receptor. Negative (0/8). 0. 0. C-erbB2. Positive (3+). Ki-67. Positive in 15%. of tumor cells. S. Park et al.. 363. . . HR(+) HER2(+) Breast Cancer. 364. a. b. . 21. 

Important Radiologic. Findings. 106 107 108. 109. 20.3. 

Patient History and Progress. Female/75 years old, post-menopause.. Screen detected mass lesion on right breast 8. o’clock direction.. No family history.. Asthma (follow-up).. 20.2. 

Case 20

HR(+) HER2(-) Breast Cancer

Courses of Treatment. Operation  +  Post-operative radiation ther­. apy + Tamoxifen 20 mg/day.. Operation. Left breast conserving surgery, sentinel lymph. extensive intraductal component: present).. 4. Skin: no involvement of tumor.. 5. Surgical margins:. . (a) superior margin: 15 mm.. . (b) inferior margin: 20 mm.. . (c) medial margin: 15 mm.. . (d) lateral margin: 5 mm.. . (e) deep margin: 5 mm.. . tumoral/. non-tumoral.. . 11. Pathological TN category (AJCC 2017):. pT1bN0(sn).. Note: 1. Atypical ductal hyperplasia is. present in the permanent section of Fro 1.. Y. Kim et al.. 2. 1/3–2/3. C-erbB2. Equivocal (2+). Ki-67. Positive in 21% of tumor cells. SISH. Negative. HR(+) HER2(−) Breast Cancer. 238. 21. 

Important Radiologic. Findings. See Figs. 108, 109, 110, 111 and 112.. 20.3. 

o’clock direction.. No family history.. S/P Tuberculosis, S/P duodenal adenoma. excision.. 20.2.