Pathology Report of lobular carcinoma of the mammary gland.

1. Infiltrating Lobular Carcinoma of
the Breast
http://surgpathcriteria.stanford.edu/
breast/inflobcabr/grading.html

2. • Grading / Staging / Report
• Grading
• Although classic lobular carcinoma by definition is
scored as 3 for lack of tubule formation, cases will
receive scores of 1 for nuclear pleomorphism and
mitotic count will usually be low, resulting in an overall
score of grade I
• Bloom-Scarff-Richardson grading scheme is most
widely used
• Total score and each of the three components should
be reported
• Based on invasive area only

3. Tubule formation
Sco
re
>75% tubules 1
10-75% tubules 2
<10% tubules 3
Tubule formation
Sco
re
>75% tubules 1
10-75% tubules 2
<10% tubules 3

4. Nuclear pleomorphism
(most anaplastic area)
Sco
re
Small, regular, uniform
nuclei, uniform chromatin
1
Moderate varibility in size
and shape, vesicular, with
visible nucleoli
2
Marked variation,
vesicular, often with
multiple nucleoli
3

5. Mitotic figure count per
10 40x fields (depends
on area of field, see key
below)
Sco
re
0.0
96
m
m2
0.1
2
m
m
2
0.1
6
m
m
2
0.2
7
m
m
2
0.3
1
m
m2
0-3
0-
4
0-
5
0-
9
0-
11
1
4-7
5-
8
6-
10
10
-
19
12-
22
2
>7 >8
>1
0
>1
9
>22 3
Mitotic figure count per
10 40x fields (depends
on area of field, see key
below)
Sco
re
0.0
96
m
m2
0.1
2
m
m
2
0.1
6
m
m
2
0.2
7
m
m
2
0.3
1
m
m2
0-3
0-
4
0-
5
0-
9
0-
11
1
4-7
5-
8
6-
10
10
-
19
12-
22
2
>7 >8
>1
0
>1
9
>22 3
Mitotic figure count per
10 40x fields (depends
on area of field, see key
below)
Sco
re
0.0
96
m
m2
0.1
2
m
m
2
0.1
6
m
m
2
0.2
7
m
m
2
0.3
1
m
m2
0-3
0-
4
0-
5
0-
9
0-
11
1
4-7
5-
8
6-
10
10
-
19
12-
22
2
>7 >8
>1
0
>1
9
>22 3

6. • Olympus BX50, BX40 or BH2 or AO or Nikon with 15x
eyepiece: 0.096 mm2
• AO with 10x eyepiece: 0.12 mm2
• Nikon or Olympus with 10x eyepiece: 0.16 mm2
• Leitz Ortholux: 0.27 mm2
• Leitz Diaplan: 0.31 mm2
• Mitotic count figures based on original data presented for
Leitz Ortholux by Elston and Ellis 1991, with modifications
based on pubished and measured areas of view
• Evaluate regions of most active growth, usually in cellular
areas at periphery
• We employ strict criteria for identification of mitotic figures

7. • Staging
• TNM staging is the most widely used scheme for breast carcinomas but is not universally employed
• Critical staging criteria for regional lymph nodes
– Isolated tumor cell clusters
• Usually identified by immunohistochemistry
– Term also applies if cells identified by close examinationof H&E stain
• No cluster may be greater than 0.2 mm
• Multiple such clusters may be present in the same or other nodes
– Micrometastasis
– Greater than 0.2 mm, none greater than 2.0 mm
– Metastasis
• At least one carcinoma focus over 2.0 mm
– If one node qualifies as >2.0 mm, count all other nodes even with smaller foci as involved
• Critical numbers of involved nodes: 1-3, 4-9 and 10 and over
– Note extranodal extension
• Report
• Excisions: the following are important elements that must be addressed in the report for infiltrative breast carcinomas
– Grade
• Total score and individual components
– Size of neoplasm
• Give 3 dimensions or greatest dimension
• Critical cutoffs occur at 0.5 cm and at 2 cm
– Margins of resection
• Measure and report the actual distance of both invasive and in situ carcinoma
– Angiolymphatic invasion
• Indicate if confined to tumor mass, outside tumor mass or in dermis
– (Extensive DCIS is not currently felt to be a significant predictor of behavior)
– Results of special studies performed for diagnosis
– Results of prognostic special studies performed
• ER, PR, Proliferation marker, Her2neu
• If studies were performed on a prior specimen, refer to that report and give results
• Needle or core biopsies
– Provisional grade may be given but may defer to excision for definitive grade
– Presence of absence of angiolymphatic invasion
– Results of special studies performed for diagnosis
– Results of prognostic special studies if performed
• ER, PR, Proliferation marker, Her2neu
• State if studies are deferred for a later excision specimen
• Regional lymph nodes
– Report findings as described above