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Breast malignant, males, children

Miscellaneous

Features to report for breast carcinoma


Reviewer: Monika Roychowdhury, M.D. (see Reviewers page)
Revised: 18 November 2012, last major update August 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

Editor’s note

Required features to report
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● Specimen type / procedure
● Lymph node sampling (specify)
● Specimen size (third dimension is not required)
● Laterality (if known)
● Tumor site (if known)
● Invasive tumor size (at least one dimension is required)
● Invasive tumor histologic type
● Invasive tumor grade (Nottingham modification of Bloom-Richardson), including tubule formation, nuclear pleomorphism and mitotic activity (should grade lobular carcinoma and colloid carcinoma, don’t need to grade medullary carcinoma)
Note: if another grading system is used, must still specify mitotic count
● TNM staging
● Number of lymph nodes examined, number involved by tumor, maximal metastasis size and presence of extracapsular spread
● Margins (distance of invasive and in-situ tumor from closest margin, specify margin)

Optional features to report, but recommended
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● Angiolymphatic invasion (note: tumor in dermal lymphatics may be due to benign mechanical transport, Hum Pathol 2005;36:310)
● Perineural invasion
● Involvement of nipple, skin (epidermis or dermis) and chest wall
● Multifocality
● Presence of microcalcifications and correlation with mammography
● Correlation of other findings with mammography
● Extent of margin involvement (if positive)
DCIS (particularly if no invasive carcinoma present): size, morphologic type (architectural pattern), nuclear grade (high, intermediate, low), presence of comedocarcinoma (necrosis) and % of carcinoma represented by DCIS (25% or more is “extensive”); also margin involvement (focal or diffuse and distance to margin), presence of microcalcifications (within DCIS or elsewhere) and correlate with mammographic findings
● For invasive carcinoma: % of cells staining for ER and PR and intensity of staining (weak, moderate, strong)
● For invasive carcinoma: HER2 staining (0/negative, 1+/weak, 2+/partial circumferential staining and 3+/strong circumferential staining visible at low power)
● Fibrocystic disease
● Presence of ADH, ALH or LCIS

Optional features to report
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Fibrotic focus
● Presence of extensive tumor necrosis
● Host lymphocytic response (Am J Surg Pathol 2003;27:194)

Quality of reporting
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● Improved in Australia after guidelines were issued; synoptic reports are more complete (Pathology 2009;41:361)

Templates
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Michigan Cancer Consortium

Micro images
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AFIP images:
        
DCIS close to inked margin     DCIS with a positive margin


DCIS at (or a basement membrane away from) the inked margin

Additional references
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Arch Pathol Lab Med 2000;124:1026, Association of Directors of Anatomic and Surgical Pathology (2004), Arch Pathol Lab Med 2009;133:15

End of Breast malignant, males, children > Miscellaneous > Features to report for breast carcinoma


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