HCLSIG/Terminology/PathRadCorrelation/ExamplePathReport2

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         DETAIL TEST   SPCH                                                                                                       
                                                                                                                                  
                   Left breast cancer.  Adult-onset diabetic.                                                                  
                                                                                                                                  
                                                                                                                                  
         DETAIL TEST   SPCPT                                                                                                      
                                                                                                                                  
                   Container A-D:88305/FR                                                                                         
                   Container E:88307/FR                                                                                           
                                                                                                                                  
                   Tumor in blocks E18, E20.                                                                                      
                                                                                                                                  
                                                                                                                                  
         DETAIL TEST   SPGD                                                                                                       
                                                                                                                                  
                   A. "Sentinel node #1", received fresh and placed in formalin.  A 2 x 1.4 x 1.2                                 
                   cm lymph node candidate with attached adipose tissue is sectioned and                                          
                   submitted in toto in block A1.  A cytokeratin stain is prospectively                                           
                   requested.                                                                                                     
                                                                                                                                  
                   B. "Sentinel node #2", received fresh and placed in formalin.  A 2.4 x 2 x 1.2                                 
                   cm aggregate of adipose tissue is dissected for lymph node candidates.                                         
                   Approximately three lymph node candidates are identified and submitted in                                      
                   B1.  Cytokeratin stain is prospectively requested.                                                             
                                                                                                                                  
                   C. "Sentinel node #3", received fresh and placed in formalin.  A 3 x 1.5 x 1                                   
                   cm lymph node candidate with attached adipose tissue is sectioned and                                          
                   submitted in C1-2.  A cytokeratin stain is prospectively requested on both                                     
                   blocks.                                                                                                        
                                                                                                                                  
                   D. "Sentinel node #4".  A 2 x 1.2 x 0.8 cm aggregate of adipose tissue is                                      
                   dissected for lymph node candidates.  One lymph node candidate 1.5 cm in                                       
                   greatest dimension is sectioned and submitted in toto in D1.  A cytokeratin                                    
                   stain is prospectively requested.                                                                              
                                                                                                                                  
                   Container will be dictated subsequentially.                                                                    
                                                                                                                                  
                   E. "Left breast cancer", received fresh and placed in formalin.  A 9.7 (M-L)                                  
                   x 7.7 (S-I) x 2.6 (A-P) cm lumpectomy specimen with a 5.0 x 0.4 cm attached                                    
                   skin ellipse.  The specimen is inked as follows: superior, inferior-yellow,                                    
                   anterior-blue, posterior-black.  The specimen is serially sectioned from                                       
                   medial to lateral to reveal a cut surface that is notable for a dense, fibrous                                 
                   mass that is discolored blue consistent with previous sentinel node mapping.                                   
                   There are punctate areas of hemorrhage in this area consistent with previous                                   
                   biopsy site and needle localization.  This firm area is consistent with the                                    
                   radiograph of the specimen indicating the presence of clip and                                                 
                   calcifications.  The firm area is 2.7 x 2.1 x 2.1 cm in approximate dimension. The                                 
                   remainder of the specimen is mature, yellow, lobulated adipose tissue and is                                   
                   grossly unremarkable.  The attached ellipse of skin is also grossly                                            
                   unremarkable.  Representative sections are submitted from medial to lateral in                                 
                   blocks E1-40.  Please note that block E16 contains the clip and blocks 20-25                                   
                   contains sections with calcification identified radiographically.                                              
                                                                                                                                  
                   J. Jones/slides to Dr. Smith                                                                     
                                                                                                                                  
                                                                                                                                  
         DETAIL TEST   SPMI                                                                                                       
                                                                                                                                  
                   Microscopic examination is performed.                                                                          
                                                                                                                                  
                                                                                                                                  
         DETAIL TEST   SPDX                                                                                                       
                                                                                                                                  
                   A. "SENTINEL NODE NUMBER ONE":                                                                                 
                                                                                                                                  
                       ONE LYMPH NODE, POSITIVE FOR METASTATIC CARCINOMA.                                                         
                       IMMUNOSTAINS FOR CYTOKERATIN ARE POSITIVE FOR CARCINOMA.                                                   
                                                                                                                                  
                                                                                                                                  
                   B. "SENTINEL LYMPH NODE NUMBER TWO":                                                                           
                                                                                                                                  
                       TWO LYMPH NODES, NEGATIVE FOR MALIGNANCY.                                                                  
                       IMMUNOSTAINS FOR CYTOKERATIN ARE NEGATIVE FOR CARCINOMA.                                                   
                                                                                                                                  
                                                                                                                                  
                   C. "SENTINEL LYMPH NODE NUMBER THREE":                                                                         
                                                                                                                                  
                       ONE LYMPH NODE, POSITIVE FOR METASTATIC CARCINOMA.                                                         
                       IMMUNOSTAINS FOR CYTOKERATIN ARE POSITIVE FOR CARCINOMA.                                                   
                                                                                                                                  
                                                                                                                                  
                   D. "SENTINEL LYMPH NODE NUMBER FOUR":                                                                          
                                                                                                                                  
                       ONE LYMPH NODE, NEGATIVE FOR MALIGNANCY.                                                                   
                       IMMUNOSTAINS FOR CYTOKERATINS ARE NEGATIVE FOR MALIGNANCY.                                                 
                                                                                                                                  
                   COMMENT: In total two of five lymph nodes are positive for metastatic                                          
                   carcinoma. Maximum size of an area of metastases within a lymph node is 2 mm,                                  
                   and the metastases are confined to the lymph node, not spreading into the                                      
                   adjacent soft tissue. The lymph node stage is pN1a. The stage of the primary                                   
                   tumor is pT2.                                                                                                  
                                                                                                                                  
                   E. "LEFT BREAST CANCER" (EXCISION):                                                                           
                                                                                                                                  
                       INVASIVE ADENOCARCINOMA OF THE BREAST.                                                                     
                          HISTOLOGIC TYPE: DUCTAL.                                                                                
                          NOTTINGHAM COMBINED HISTOLOGIC GRADE: 3 OF 3.                                                           
                             TUBULE FORMATION SCORE: 3                                                                            
                             NUCLEAR PLEOMORPHISM SCORE: 3                                                                        
                             MITOTIC RATE SCORE: 3                                                                                
                          GROSS TUMOR SIZE: 2.7 X 2.1 X 2.1 CM.                                                                       
                          LYMPHATIC/VASCULAR INVASION: PRESENT.                                                                   
                          MULTIFOCAL TUMOR: ABSENT.                                                                               
                       IN-SITU CARCINOMA: PRESENT.                                                                                
                          TYPE OF IN-SITU CARCINOMA: DUCTAL CARCINOMA IN-SITU, PAPILLARY,                                         
                                                     CRIBRIFORM, AND SOLID.                                                       
                          NUCLEAR GRADE OF IN-SITU CARCINOMA: 3 OF 3.                                                             
                          NECROSIS: PRESENT.                                                                                      
                          DCIS EXTENDING OUTSIDE INVASIVE TUMOR MASS: PRESENT.                                                    
                          SIZE OF IN-SITU CARCINOMA: SEE COMMENT, AT LEAST 3 CM.                                                  
                                                                                                                                  
                       STATUS OF NON-NEOPLASTIC BREAST TISSUE: FIBROCYSTIC DISEASE, WITH  CHANGES                                 
                                                               CONSISTENT WITH PRIOR BIOPSY.                                      
                       SIZE OF BIOPSY: 9.7 X 7.7 X 2.6 CM.                                                                        
                       MICROCALCIFICATIONS: FOCALLY PRESENT.                                                                      
                       SURGICAL MARGIN STATUS: CLOSE (DUCTAL CARCINOMA IN-SITU IS PRESENT WITHIN                                  
                                               1 MM OF THE BLUE INKED (MEDIAL ANTERIOR) MARGIN IN                                 
                                               BLOCKS 8, 12, 13 AND 17 AND PRESENT WITHIN 1 MM OF                                 
                                               THE LATERAL ANTERIOR MARGIN IN BLOCK 31.                                           
                                               IN-SITU CARCINOMA IS PRESENT WITHIN 1 MM OF THE                                    
                                               YELLOW INKED (MEDIAL INFERIOR) MARGIN IN BLOCK                                     
                                               15. IN SITU CARCINOMA IS NOT DEMONSTRATED DIRECTLY                                 
                                               IN ANY MARGIN).                                                                    
                       ESTROGEN/PROGESTERONE RECEPTOR, CELL CYCLE, EGFR AND HER2/NEU ANALYSIS:                                    
                         PERFORMED ON PRIOR BIOPSY.                                                                               
                                                                                                                                  
                   COMMENT:  Areas of ductal carcinoma in-situ extend outward beyond invasive                                     
                   carcinoma in multiple blocks.  Since this in situ carcinoma did not form a                                     
                   grossly appreciable mass, the exact dimensions are difficult to determine, but                                 
                   the in-situ carcinoma is at least 3 cm across, and probably somewhat larger                                    
                   than this.