乳癌　診断記載例

Breast, right upper outer quadrant (C area), excision: - Invasive carcinoma of no special type     Pathologic stage: pT1b(m) pN0(sn)     Size of tumor: 0.7 cm in greatest dimension     Focality: Multicentric (2)     Histological grade: Grade 3 (3-2-1)     Lymphovascular invasion: Not identified (L0 V0)     Immunohistochemistry       ER: Positive (100%)       PR: Positive (95%)       HER2: Negative (Score 1+)       Ki-67 labeling index: 3% (32/1000) - Ductal carcinoma in situ , intermediate nuclear grade Lymph node, axillary, dissection: - No evidence of malignancy (0 identified/2 examined).

*乳腺の局在をE, A, B, C, D, C' で表記するのは取り扱い規約（日本）独自の表記と思われる。
一般的な記載（日本以外の国）との対応は：
E → Central (乳輪下部 = 中央部)
E' → Nipple (乳頭）
A → Upper inner quadrant (superior medial)
B → Lower inner quadrant (inferior medial)
C → Upper outer quadrant (superior lateral)
D → Lower outer quadrant (inferior lateral)
C' → Tail of Spence

【断端陽性 = ink on carcinomaの例】For positive margins, specify extent:
+ Anterior: 5 mm
+ Posterior:
+ Superior: ...
+ Inferior
+ Medial
+ Lateral
+ Other

TNM classification of tumors of the breast

Primary tumor (pT):

the tumor size = the invasive component.
Paget's disease associated with a tumor is classified according to the size of the tumor.

pTX: Primary tumor cannot be assessed
 
pT0: No evidence of primary tumor

pTis (DCIS), ductal carcinoma in situ
pTis (LCIS), lobular carcinoma in situ → removed
pTis (Paget) Paget's disease of the nipple

T1mi: Microinvasion ≤1mm  (use the largest focus, not the sum)
pT1a: >1 mm ≤5 mm
pT1b: >5 mm ≤10 mm
pT1c: >10 mm ≤20 mm
pT2: >20 mm ≤50 mm
pT3: >50 mm
pT4a: invasion or adherence to pectoralis muscle
pT4b: ulceration, ipsilateral macroscopic satellite nodules, edema (peau d'orange)
pT4c: a+b
pT4d: Inflammatory carcinoma

T4d: Inflammatory carcinoma, characterized by diffuse brawny
induration of the skin of the breast with an erysipeloid edge,
usually without an underlying palpable mass.

Regional lymph nodes (pN): I

f solely sentinal, should be designated (sn), e.g. pN1(sn)
However, If ≥6 nodes are removed, this modifier should not be used

pNX: Not removed for pathologic study or previously removed
pN0: No metastasis
pN0 (i+): isolated tumor cells (≤ 0.2 mm in greatest dimension)
pN0 (mol+): RT-PCR only
pN1mi: Micrometastasis (>0.2 mm, ≤2.0 mm, approximately 200 cells)
pN1a: 1-3 axillary at least one >2.0 mm
pN1b: Internal mammary nodes,
pN1c: a+b
pN2a: 4-9 ipsilateral axillary lymph nodes
pN2b: apparent internal mammary without axillary
pN3a: 10 or more ipsilateral axillary; or infraclavicular
pN3b: apparent internal mammary and axillary (pN2a + pN1b)
pN3c: Ipsilateral Supraclavicular lymph node

Anatomic Stage/Prognostic Groups

Stage 0   Tis
Stage IA   T1
Stage IB   T0-1 N1mi
Stage IIA   T0-1, N1; T2
Stage IIB   T2 N1; T3
Stage IIIA   T0-3 N2; T3 N1
Stage IIIB   T4 N0-2
Stage IIIC   N3
Stage IV   M1

Invasive breast carcinoma

Microinvasive carcinoma
Invasive carcinoma of no special type (NST)
    Pleomorphic carcinoma
    Carcinoma with osteoclast-like stromal giant cells
    Carcinoma with choriocarcinomatous features
    Carcinoma with melanotic features
Invasive lobular carcinoma
    Classic lobular carcinoma
    Solid lobular carcinoma
    Alveolar lobular carcinoma
    Pleomorphic lobular carcinoma
    Tubulolobular carcinoma
    Mixed lobular carcinoma
Tubular carcinoma
Cribriform carcinoma
Mucinous carcinoma
Carcinoma with medullary features
    Medullary carcinoma
    Atypical medullary carcinoma
    Invasive carcinoma NST with medullary features
Carcinoma with apocrine differentiation
Carcinoma with signet-ring-cell differentiation
Invasive micropapillary carcinoma
Metaplastic carcinoma of no special type
    Low-grade adenosquamous carcinoma
    Fibromatosis-like metaplastic carcinoma
    Squamous cell carcinoma
    Spindle cell carcinoma
    Metaplastic carcinoma with mesenchymal differentiation
        Chondroid differentiation
        Osseous differentiation
        Other types of mesenchymal differentiation
    Mixed metaplastic carcinoma
    Myoepithelial carcinoma
Papillary carcinoma
    Encapsulated papillary carcinoma with invasion
    Solid papillary carcinoma, invasive

Epithelial-myoepithelial tumors
Adenomyoepithelioma with carcinoma
Adenoid cystic carcinoma

Carcinoma with neuroendocrine features
    Neuroendocrine tumor, well-differentiated
    Neuroendocrine carcinoma poorly differentiated (small cell carcinoma)
    Carcinoma with neuroendocrine differentiation
Secretory carcinoma
Invasive papillary carcinoma
Acinic cell carcinoma
Mucoepidermoid carcinoma
Polymorphous carcinoma
Oncocytic carcinoma
Lipid-rich carcinoma
Glycogen-rich clear cell carcinoma
Sebaceous carcinoma