—  SHORT COURSE #09  — Recent Developments in Diagnostic and Therapeutic Approaches to Breast Diseases Daniel W. Visscher, M.D. Carol Reynolds, M.D. Click on each Case number below to display the text and references for that section Click on any thumbnail image for an enlarged view of that slide Click here to download handout in 1-per-page format (21.3MB) Click here to download handout in 6-per-page format (6.7MB) Case #1A - Atypical ductal hyperplasia with associated calcifications Clinical Summary This stereotactic core needle biopsy specimen is from a 57 year old woman with mammographically-detected microcalcifications. Is an open biopsy necessary? Case 1A - Figure 1 Case #1B - Atypical lobular hyperplasia with associated calcifications Clinical Summary This stereotactic core needle biopsy specimen is from a 62 year old woman with new mammographically-detected microcalcifications. What is your recommendation? Case 1B - Figure 1 Case 1B - Figure 2 Case 1B - Figure 3 Case #1C - Fibroepithelial lesion with increased cellularity and mitotic activity Clinical Summary This ultrasound-guided core needle biopsy specimen is from a 38 year old woman with a well-circumscribed solid mass by imaging. How would you report the findings and what is your recommendation? Case #1C - Figure 1 Case #1D - Intraductal papilloma Clinical Summary This core needle biopsy specimen was performed in a 52 year old woman with a subareolar mass. Ultrasound showed a solid, homogenously hypoechoic mass. What is your diagnosis? What is your recommendation? Case #1D - Figure 1 Case #1E - Radial scar Clinical Summary This specimen is from a 53 year old woman. What was the most likely mammographic abnormality that prompted this core needle biopsy? Case 1E - Figure 1 Case 1E - Figure 2 Case #1F - Columnar cell alteration with atypia Clinical Summary This stereotactic core needle biopsy specimen is from a 42 year old with mammographically-detected microcalcifications. What is your recommendation? Case 1F - Figure 1 Case 1F - Figure 2 Case #2 - So-called biopsy associated epithelial displacement in the setting of an intracystic papillary carcinoma Clinical Summary This 55 year old woman had undergone prior core needle biopsy that showed an “atypical papillary intraductal proliferation, suspicious for DCIS.” The subsequent excision showed DCIS arising in association with a papilloma. How would you interpret the cellular focus that was adjacent to a duct that contained DCIS? Case 2 - Figure 1 Case 2 - Figure 2 Case #3A - Microinvasive carcinoma (AJCC pT1mic) Clinical Summary This is an excisional biopsy from a 63-year-old woman with extensive ductal carcinoma in situ measuring 3.0 cm in greatest extent. In two microscopic fields the following changes were identified. What is the appropriate staging classification for this lesion? What is the clinical significance? Case 3A - Figure 1 Case 3A - Figure 2 Case #3B - Invasive micropapillary carcinoma Clinical Summary This is a 2.3 cm breast mass from a 61-year-old woman. Nine axillary lymph nodes were positive for metastatic carcinoma. How would you classify this lesion? Case 3B - Figure 1 Case 3B - Figure 2 Case #3C - "Fibromatosis-like" carcinoma (FibLCa) Clinical Summary This is a 56-year-old woman with mammographic density. What is your differential diagnosis? What additional studies would be appropriate to further classify this lesion? Case 3C - Figure 1 Case 3C - Figure 2 Case #3D - Solid Papillary (Endocrine) Ductal Carcinoma in Situ Clinical Summary This specimen is from a 78-year-old woman with unilateral nipple discharge. An open biopsy was performed. What is your diagnosis? Case 3D - Figure 1 Case 3D - Figure 2 Case #4 - Isolated tumor cells identified by cytokeratin stain only (AJCC pN0 [i +]) Clinical Summary This sentinel lymph node is from a 49 year old woman with 2.2 cm infiltrating lobular carcinoma. The sentinel lymph node was reported as “negative” at the time of intra-operative examination. Case 4 - Figure 1 - H&E Case 4 - Figure 2 - CYTOKERATIN Case #5 - Practical issues with Her2-neu testing Clinical Summary How would you score this Her-2/neu stain? What is the likelihood that this neoplasm has Her-2/neu amplification? Case 5 - Figure 1