44 yo woman. On req: "faint grouped microcalcs." #breastimagers separate calcs and no calcs cores into separate containers (so helpful!). There was only one block of cores with calcs. Here are the #breastpath images. Thoughts? Next steps?
You are all thinking the way I did! For cases with calcs, I always review the imaging, and in particular the specimen radiograph, to see the morphology of the calcs I should look for. Check out the imaging from @DrJordanaP 👇
The tiny calc in the initial levels of the CNB are not the same as the calcs seen on imaging. We need to find those calcs --> LEVELS! (I haven't heard it called steps before! I like!) #breastradpath correlation is so important here!
I'm curious, for the pathologists, do you call it "steps" or "levels"?
We get levels x 3 upfront. Here are additional levels (level top left of each image).
Path discussion: The span of atypia is 4.5 mm. For me, the quality of the prolif falls short of LG DCIS. In these cases we diagnose as: severely atypical intraductal proliferation bordering on LG DCIS arising in association with FEA; calcs are associated with the atypia.
This highlights how important it is for pathologists to review imaging/spec radiograph esp for calcs! We need to ensure that our levels are rep of imaging. In this case initial levels only showed a bit of focal ?FEA with a small calc. You all knew to get levels/steps 😊🔬
Here are some teaching points about this case and a few papers highlighting importance of #breastradpath concordance and utility of a multidisciplinary conference (including one by our very own @BIDMC_BreastImg group).
2/ The biomarkers provide predictive information (how a patient may respond to targeted therapy) as well as prognostic information. It helps to organize patients into treatment groups that follow different algorithms and guidelines.
3/ Biomarkers are evaluated in routine clinical mgmt of patients with breast cancer. The 3 routinely tested:
Hormone receptors (HR): Estrogen receptor (ER) and Progesterone receptor (PR)
&
Human epidermal growth factor receptor 2 (HER2)
Hi #pathology tweeples! I just realized that the callus I have on my pinky is from using it to steady my hand as I dot 😂(with my green pen of course 😉). I must dot A LOT! 💪🔬
I have some #path (mostly) dotting related questions out of curiosity.
We are excited to share the first case in our #breastimaging and #breastpath correlation series! This case highlights challenges of imaging/management and the pathologic diagnosis.
56 yo woman with left breast focal asymmetry and calcifications. Screening mammogram. @DrJordanaP
Diagnostic mammogram and ultrasound were performed. A presumed ultrasound correlate was found with calcs and vascularity. What is the next step? What BI-RADS would give? @DrJordanaP
Breast excision. What is your diagnosis? Would you do stains? #breastpath
Thanks everyone! This is LCIS involving collagenous spherulosis. I did IHC. The e-cad was stronger than I expected but showed granular staining so I followed up with p120 and beta-catenin to illustrate the different stains.