Case 42

A 56-year-old female with a 6.3 cm infiltrative mass in the right breast.

1.What is the nuclear grading of this lesion?

Nuclear grading

• grade 1
• grade 2
• grade 3

Table from CAP protocol; https://documents.cap.org/protocols/Breast.DCIS.Bx_1.0.1.0.REL_CAPCP.pdf?_gl=1*8743mk*_ga*MTI2Mjc4MjcwMS4xNzE5NjcwNTUw*_ga_97ZFJSQQ0X*MTczODI1MzYwMC4yNy4wLjE3MzgyNTM2MDEuMC4wLjA.

Answer

The tumor cells are more of 1.5x to 2.5x comparing with RBCs. However, the nucleoli is readily seen. This case was called intermediate grade.

2. What is the Nottingham Histologic Score (Elston-Ellis modification of Bloom-Richardson grading system) of the part below:

   
   

   

   
   

   

   
   

   

   
   

   

   
   

   

   
   

Answer

In this case, glandular differentiation is 3 (<10% of tubular formation).

Mitotic rate is grade 2 (0-8; 9-17; >18/10 HPF). It seems that if you can see at least 1 mitosis in one field after looking at 5 fields, it's probably a grade 2. if it's 2 mitosis/field, grade 3. For nucleus, it's a grade 2, as it lacks marked pleomorphism and prominent nucleoli.

References: https://tumourclassification.iarc.who.int/chaptercontent/32/18

https://documents.cap.org/protocols/Breast.DCIS.Bx_1.0.1.0.REL_CAPCP.pdf?_gl=1*8743mk*_ga*MTI2Mjc4MjcwMS4xNzE5NjcwNTUw*_ga_97ZFJSQQ0X*MTczODI1MzYwMC4yNy4wLjE3MzgyNTM2MDEuMC4wLjA.

Ping, Z., Xia, Y., Shen, T. et al. A microscopic landscape of the invasive breast cancer genome. Sci Rep 6, 27545 (2016). https://doi.org/10.1038/srep27545

Case credit: UCSD Pathology

Author: Wangpan Jackson Shi, MD