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DETAIL TEST SPCH Malignant neoplasm left breast. Core biopsies showed invasive ductal adenocarcinoma. Patient with history of atypical hyperplasia excised. DETAIL TEST SPCPT Container A-B:88307/FR Container C-D:88305/FR Carcinoma in blocks D10, D12-13. DETAIL TEST SPGD A. "Sentinel node #1, hot, not blue", received fresh and placed in formalin. A 1.5 x 0.7 x 0.5 cm lymph node is bisected and submitted entirely in A1. A cytokeratin stain has been prospectively requested on A1. B. "Sentinel node #2, hot, not blue", received fresh and placed in formalin. A 2.5 x 2.0 x 0.6 cm lymph node is bisected and submitted entirely in B1-2. A cytokeratin immunostain have been prospectively requested on B1-2. C. "Re-excision of medial margin", received fresh and placed in formalin. A 7.0 x 5.0 x 1.0 cm fragment of adipose tissue is oriented with a stitch on the final margin, which is inked blue and the opposite inked black. No masses are identified. Representative sections are submitted in Blocks C1-5. D. "left partial mastectomy", received fresh and placed in formalin. An 9.0 (ML) x 8.5 (SI) x 3.0 (AP) cm excisional breast biopsy is oriented short suture-superior, long suture-lateral, and white suture-anterior. The specimen is inked anterior-blue, posterior-black, superior-red, and inferior-yellow. Sectioning from lateral to medial demonstrates an approximately 1.3 x 0.5 x 0.3 cm blue dyed, firm mass in the central lateral portion of the biopsy, located 0.8 cm from the black margin, 2.0 cm from the blue margin, 3.0 cm from the red margin, and 4.0 cm from the yellow margin. Radiograph demonstrate a small clip immediately medial to this mass is a larger clip near the medial margin. Approximately half of the specimen is submitted as follows: BLOCK SUMMARY: D1- tangential lateral margin D2-10- representative sections lateral to mass D11-14- mass D15- small clip D16-26- representative sections medial to mass (large clip in 25) D27- tangential medial margin Dr. White/Dr. Green/slides to Dr. Brown
DETAIL TEST SPMI Microscopic examination is performed. DETAIL TEST SPDX A. "SENTINEL NODE # 1 HOT NOT BLUE" (LYMPH NODE DISSECTION): NO EVIDENCE OF MALIGNANCY IN ONE LYMPH NODE EXAMINED (0/1). CYTOKERATIN IMMUNOHISTOCHEMICAL STAIN IS NEGATIVE. B. "SENTINEL NODE # 2 HOT NOT BLUE" (LYMPH NODE DISSECTION): NO H&E EVIDENCE OF MALIGNANCY IN ONE LYMPH NODE EXAMINED (0/1). CYTOKERATIN IMMUNOHISTOCHEMICAL STAIN FOR BLOCK B2 IS NEGATIVE. AN ADDENDUM WILL BE ISSUED FOR CYTOKERATIN IMMUNOHISTOCHEMICAL STAIN ON BLOCK B1 FOLLOWING REPROCESSING. C. "REEXCISION OF MEDIAL MARGIN": BENIGN BREAST TISSUE. NO EVIDENCE OF MALIGNANCY. D. "LEFT PARTIAL MASTECTOMY": INVASIVE ADENOCARCINOMA OF THE BREAST. HISTOLOGIC TYPE: DUCTAL. NOTTINGHAM COMBINED HISTOLOGIC GRADE: 1 OF 3. TUBULE FORMATION SCORE: 1 NUCLEAR PLEOMORPHISM SCORE: 2 MITOTIC RATE SCORE: 1 GROSS TUMOR SIZE: 1.3 X 0.5 X 0.3 CM. SIZE OF INVASIVE COMPONENT: 1.1 CM IN MAXIMUM DIMENSION. LYMPHATIC/VASCULAR INVASION: ABSENT. MULTIFOCAL TUMOR: ABSENT. IN-SITU CARCINOMA: PRESENT. TYPE OF IN-SITU CARCINOMA: CRIBRIFORM. NUCLEAR GRADE OF IN-SITU CARCINOMA: 1 OF 3. NECROSIS: ABSENT. DCIS EXTENDING OUTSIDE INVASIVE TUMOR MASS: ABSENT. SIZE OF IN-SITU CARCINOMA: NOT APPLICABLE. STATUS OF NON-NEOPLASTIC BREAST TISSUE: BIOPSY SITE AND FIBROCYSTIC CHANGES. SIZE OF BIOPSY: 9.0 X 8.5 X 3.0 CM. MICROCALCIFICATIONS: PRESENT IN ASSOCIATION WITH CARCINOMA AND BENIGN BREAST TISSUE. SURGICAL MARGIN STATUS: NEGATIVE. ESTROGEN/PROGESTERONE RECEPTOR, CELL CYCLE, AND HER2/NEU ANALYSIS: PENDING. PARAFFIN BLOCK NUMBER D11. RESULTS WILL BE ISSUED IN A SEPARATE REPORT FROM THE IMAGE CYTOMETRY LAB. DETAIL TEST SPSTAGE PROCEDURE: Left partial mastectomy and lymph node dissection. PATHOLOGIC STAGE (AJCC 6th Edition): pT1c pN0 pMX NOTE: Information on pathology stage and the operative procedure is transmitted to this Institution's Cancer Registry as required for accreditation by the Commission on Cancer. Pathology stage is based solely upon the current tissue specimen being evaluated, and does not incorporate information on any specimens submitted separately to our Cytology section, past pathology information, imaging studies, or clinical or operative findings. Pathology stage is only a component to be considered in determining the clinical stage, and should not be confused with nor substituted for it. The exact operative procedure is available in the surgeon's operative report.