HISTOPATHOLOGY REPORT

LABORATORY: National Health Laboratory Service
LAB NUMBER: H24-123456
DATE RECEIVED: 02 December 2024
DATE REPORTED: 05 December 2024

PATIENT: Susan Anderson, 48-year-old female
DOB: 1976-05-18
REFERRING DOCTOR: Dr. Maria Gonzalez, Surgeon

CLINICAL INFORMATION:
48-year-old female with palpable left breast mass at 10 o'clock position.
Mammogram: BI-RADS 4B, irregular mass with spiculated margins.
Ultrasound: 18mm hypoechoic mass, suspicious features.
Core biopsy performed under ultrasound guidance.

SPECIMEN:
Left breast core biopsy, 10 o'clock position

MACROSCOPIC DESCRIPTION:
Received in formalin labeled "Left breast 10 o'clock core biopsy".
Six cores of grey-white tissue, each measuring 10-15mm in length.
Entirely submitted in one cassette.
AE1

MICROSCOPIC DESCRIPTION:
Sections show breast tissue with an infiltrating carcinoma of no special type
(NST, previously known as invasive ductal carcinoma). The tumor is composed
of nests, cords, and trabeculae of pleomorphic epithelial cells with moderate
nuclear atypia and occasional mitotic figures. There is associated desmoplastic
stromal reaction. High-grade ductal carcinoma in situ (DCIS) is present,
comprising approximately 25% of the tumor component with comedonecrosis.
Normal breast lobules are seen at the periphery of the cores.

IMMUNOHISTOCHEMISTRY:
- Estrogen Receptor (ER): POSITIVE (95% of tumor cells, strong intensity)
  Allred score: 8/8
- Progesterone Receptor (PR): POSITIVE (80% of tumor cells, moderate intensity)
  Allred score: 7/8
- HER2: NEGATIVE (Score 1+)
- Ki-67 Proliferation Index: 15%

TUMOR GRADING (Nottingham):
- Tubule formation: 3 (minimal)
- Nuclear pleomorphism: 2 (moderate)
- Mitotic count: 1 (low: 5 mitoses per 10 HPF)
- TOTAL SCORE: 6 - GRADE 2 (Moderately differentiated)

DIAGNOSIS:
LEFT BREAST, CORE BIOPSY (10 O'CLOCK POSITION):
- INVASIVE CARCINOMA OF NO SPECIAL TYPE (INVASIVE DUCTAL CARCINOMA)
- Nottingham Grade 2 (moderately differentiated)
- ER positive (95%), PR positive (80%), HER2 negative (1+)
- Ki-67: 15%
- Associated high-grade DCIS present

COMMENT:
The immunoprofile indicates a Luminal A-like molecular subtype, which generally
has a favorable prognosis and is responsive to hormonal therapy. The HER2 result
(1+) is unequivocally negative; no further testing required per ASCO/CAP guidelines.

Recommend multidisciplinary team discussion for treatment planning.
Sentinel lymph node biopsy and definitive surgery are advised.
Consider Oncotype DX testing to guide adjuvant chemotherapy decision in this
grade 2, ER+, HER2-, node-negative (pending surgical staging) tumor.

REPORTED BY: Dr. William Chen, Anatomical Pathologist
REVIEWED BY: Dr. Angela Smith, Consultant Pathologist (Breast)