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2016-08-30 08:44:48

Interpretacja wyniku histopatologicznego - cd.

Kontynuacja pytania "Interpretacja wyniku histopatologicznego" z 26 sierpnia 2016 r.

 

Oto caly report patologa:


Final diagnosis
1. Right sentinel lymph node #1
- 1 lump node(s) negative for carcinoma (H&E and cytokeratin immunostain on each block) (0/1)
Note : No definite treatment effect or biopsy site identified.
2. Right breast partial mastectomy;
- invasive ductal carcinoma
- size: 0.15 cm
- poorly differentiated
- margins: negative
distance to margins main specimen: 4mm to anterior, >5mm to all other margins (See Note) (See additional margins)
- Stage (AJCC7thEd): ypT1a NO(sn), at least Stage 1A
- biopsy site identified
- please see synoptic summary
Note: Tumor bed extends to the posterior margin. No tumor bed is identified in the additional margins.
3. Additional Posterior Margin Right:
- benign breast tissue
4. Additional Medial Margin Right:
- ductal hyperplasia
5. Interior Right
- benign breast tissue
6. Lateral Margin Right
- benign breast tissue
7. Superior Margin Right
- benign breast tissue
8. Anterior Margin Right
- benign fibroadipose tissue
Synoptic Summary
Malignant Neoplasm of the Breast
Procedure: Excision mastectomy
Laterality: Right
Lymph Node Sampling; Sentinel lymph node biopsy
Invasive Component:
Invasive Tumor Type: Invasive ductal carcinoma
Tumor Size: 0.15 cm
Histologic Grade(Nottingham): Grate 3 (score 8 or 9)
Glands/Tubules: Score 3 (<10% tumor forms glands/tubules)
Nuclear Pleomorphism: Score 3 (Prominent nucleoli, variability, bizarre)
Mitotic Rate: Too small to grade
Lymphovascular Invasion: Not identified
Surgical Margins(Invasive): Not identified
Distance to margins main specimen: 4mm to anterior, 5 mm to all other margins (see note)
Additional margins: Negative
Tumor Focality: Unifocal
Intraepithelial (in situ) Component
In Situ Tumor Type: No in situ tumor identified
Treatment Response:
Treatment Resp-Breast: Probable/definite response in invasive carcinoma
Treatment Resp-LNs: No metastasis or fibrous scarring
Staging:
Stage (AJCC 7th Ed): ypT1a NO(sn), at least Stage1A
Predictive/Prognostic Markers:
Performed on: Prior specimen: X16-478
Estrogen receptor(ER)status: Negative (<1%)
Progesterone receptor (PR) status: Negative (<1%)
Her2 (Imminohisochemistry): 1: Negative
Her2(FISH): Not amplified
Her2:CEP17 ratio: 1.2
Her2 copy number: 2.8
Note: Tumor bed extends to the posterior margin. No tumor bed is identified in additional margins.

 

Odpowiedź:

 

W opisie znajduję niespójność: z jednej strony napisano, że ognisko raka inwazyjnego ma wielkość 0,15 cm, z drugiej, "Treatment Resp-Breast: Probable/definite response in invasive carcinoma", a wcześniej "Note : No definite treatment effect or biopsy site identified."
I jeszcze o marginesach: "4mm to anterior, >5mm to all other margins (See Note) i "Note: Tumor bed extends to the posterior margin. No tumor bed is identified in additional margins."

Na tej podstawie uznałabym, że jest to częściowa odpowiedź na chemioterapię, bo jednak jakieś "żywe" komórki raka znaleziono i że wymaga Pani uzupełniającej radioterapii z powodu tylnego marginesu.

W sumie efekt dotychczasowego leczenia uznałabym za dobry i patrzyła raczej optymistycznie w przyszłość, bacznie obserwując.

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