Clinical Data
L breast cancer

Nature of Specimen
L modified radical mastectomy

Macroscopic
Labelled "L modified radical mastectomy", the specimen consists of the left breast, 210mm from medial to lateral, 130mm from superior to inferior and 70mm from superficial to deep bearing an ellipse of skin 200x75-4mm with an unremarkable nipple. There is an attached axillary dissection 90x60x20mm. The superficial superior margin is inked blue, the superficial inferior margin green and the deep margin black. The specimen is bi-valved, hinged medially, into superficial and deep halves to reveal a firm irregular grey-white scirrous lesion 45x30x32mm in the 2 o'clock position, 50mm from the nipple in the upper outer quadrant.

The tumour extends to within 18mm of the deep margin (inked black), 8mm of the superficial superior margin (inked blue) in the superficial half and is well clear of the superficial inferior margin. It lies 8mm below the skin. In the deep half of the breast 25mm inferior and deep to the main tumour a second separate firm poorly defined grey tumour 23x15x15mm, is identified on parasaggital sectioning (lesion B), abutting the deep margin and extending to within 30mm of the superficial inferior margin.

Three lymph nodes are involved by tumour, including the most lateral node in the axillary dissection.
... [detailed list of samples & sections ("Blocks") 1A to 1AS ] ... Please see accompanying photograph.

Microscopic
Sections show inflitrating ductal carcinoma (Grade 3). 48x33mm with perineural (Block 1J) and vascular (Block 1I, 1R) invasion. The carcinoma invades to 7mm of the dermis. The skin and nipple are not involved. the second tumour deposit invades skeletal muscle on the deep surface of the specimen and reaches to 3mm from the soft tissue margin

(Blocks 1K, 1M, 1N) and shows vascular invasion. The carcinoma is diffusely strongly positive in the oestrogen receptor positive, and in the cytokeratin 7, focally weakly positive in the progesterone receptor and equivocal (2+) in the HER2. FISH for HER2 has been ordered.

There is focal high grade intraduct carcinoma (Block 1Y).

Metastatic carcinoma is seen in three of eighteen lymph nodes.

Conclusion:
Infiltrating ductal carcinoma (Grade 3): 48x33mm, vascular and perineural invasion, outlying invading skeletal muscle; metastases to three of eighteen lymph nodes.

Left mastectomy and axillary clearance.

Addenum

Clinical Details
Breast ca. with modal metastases. HER-2 IHC 2+. HER-2 FISH testing at request of Dr A Field.

Results
HER-2 FISH result (PathVysion HER-2 DNA probe kit): NEGATIVE (Non amplified)

Mean HER-2 copy number per cell: 2.15

HER-2/chr17 ratio: 1.02
(3925) T-04000 M-85003 M-85002