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Category:

Understanding Pathology Results

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Question:  #1 11/15/2009		Q:	I am reading grade one breast cancer, er,pr positive, her2 negative has a higher risk of recurrance. Several websites have stated this. I find this strange. Why would this be the case?
		A:	not correct. grade 1-- slowest growning. ER/PR positive and HER2neu negative are the BEST prognostic factors and have low recurrence.
Question:  #2 11/15/2009		Q:	Dear Lilly, I have asked you questions before and appreciate all you do for us. I am reading about more of us with well differientiated tumors having a microscopic node involved. Is it just that the pathology is now more enhanced and test are discovering more cancer? I was er,pr positive, her2 neg. with three small tumors all in same quadrant. I had a mastectomy, chemo, and am on arimidex. I am reading that microscopic disease strongly increases your chance of recurrance, especially distant recurrance. I am three years out, but can''t get the node thing out of my mind, especially with what I am reading. What are my chances of recurrance? I really want to put this behind me. I was doing better until I read the recent article on Breastcancer.org about microscopic disease.
		A:	pathology accuracy is better today than ever. don't sweat over this... you are well passed the most worrisome milestone for recurrence-- which is the 2 year mark. your prognostic factors were great.
Question:  #3 11/15/2009		Q:	Surgical Pathology Report s/p partial mastectomy: IDC, two foci, 0.8 and 0.2, Bloom Richardson grade 2, EIC positive. IDC is present within 0.1cm of deep margin. DCIS present in 13/18 blocks and also present at or within margins. Atypical ductal hyperplasia. I am waiting for my initial oncology appt. I need SNB, but does this report sound like I am a candidate for re-excision? Thank you.
		A:	you need sentinel node biopsy and re-excision. correct. if you want us to do that for you, you are welcome to come our way too. 443-287-2778.
Question:  #4 11/15/2009		Q:	In Sept. 2007 had a bilateral mascetomy. Estrogen positive mass in right breast. One lymph node removed to test, it was negative. In August of this year I had an ultrasound due to pain in both breasts. The results read"benign appearing predominantly fatty replaced bilateral axillary lymph nodes are noted". "No solid or systic breast mass or evidence of chest wall recurrence is identified on either side". On the film there were numerous areas marked, some were horizonal and some were black spots gathered in areas. The two things that is concerning are, what are the black spot areas and I had only one lymph node removed and the reports reads fatty replaced bilateral axillary lymph nodes noted? There are again numerous areas marked. Can you help clarify this for me. It hangs in the back of my mind. I have four small children at home. I am also 57 years old. There is cancer history in my family. Several of my first cousins on my mothers side has had breast cancer. My mother died of colin cancer. Thank our for your help!
		A:	no way to guess without actually reviewing the films. when any nodes are removed, usually fat will replace the cavity that was created so i would not be alarmed about reading that. given you have had mastectomies, did you have reconstruction??? is the pain in the reconstructed breasts or are you talking about pain along the mastectomy incision and you did not have reconstruction done? it is known that mastectomy without reconstruction can result in chronic pain. an article was just pulbished last week about this phenomenon.
Question:  #5 11/15/2009		Q:	Could you tell me how often a diagnosis of atypical cells leads to actual breast cancer? Thank you.
		A:	between 20-30% of the time.
Question:  #6 11/8/2009		Q:	My 36 year old daughter had a mammotome core needle biopsies to right breast with the following dx: infiltrating ductal carcinoma, nottingham grade 3. Breast receptor studies are pending. The single longest contiguous segment is approx. 0.9cm and present on multiple bx. Shows poor tendency to form distinct tubules, intermediate nuclear grade, and displays a high mitotic index. Chronic inflammation. Foci ductal carcinoma in situ present. I''m trying to understand all this need to know what to we do next. What is the protocol for further evaluation and treatment?
		A:	next is to see a breast surgical oncologist at a comprehensive breast center. she will probably be a good candidate for a lumpectomy with sentinel node biopsy. she is young so genetic counseling should also be considered. post op she would meet with a medical oncologist and a radiation oncologist. too early to know if she needs chemo or not. lumpectomy and radiation go together however. if she were to carry a breast cancer gene however, consideration for bilateral mastectomy with reconstruction is usually discussed since the risk of recurrence for someone carrying a gene is much higher. for you, contact Mothers Supporting Daughters with Breast Cancer at 410-778-1982 www.mothersdaughters.org Call them this evening. they are always available to help.
Question:  #7 11/7/2009		Q:	Recent mastectomy for DCIS with a 2mm invasive. Both were grade 3. The 2mm invasive was removed during biopsy. 6 lymph nodes were removed. All were negative. I will be having a prophylactic mastectomy on my other breast. No family history of breast cancer. Should I consider any further treatment? What are my chances of a recurrance? The 2mm was estrogen posiive and progesterone negative.
		A:	doing bilateral mastectomy is aggressive treatment for dcis with 2 mm of invasive disease. your risk of breast cancer for the healthy breast should be less than 5 % though. so not gaining a lot in doing this if your doing it to reduce risk of getting breast cancer again. risk of local recurrence less than1%. risk of distant recurrence well under 5%. I personally have never seen chemo given for 2mm of invasive breast cancer but you should meet with a medical oncologist for a consultation anyway.
Question:  #8 11/1/2009		Q:	one last question. thank you.my lumpectomy pathology diagnosis was: biopsy site with focal fat necrosis and early reparative alteration. negative for residual neoplastic disease. a lumpectomy was performed because a sterotactic biospy revealed that dcis was found. but out of 30 plus calcifications. only 4 was dcis.and all the rest were fat necrosis. whats the chance that a stereotactic procedure removed all 4 calcifications that were dcis. p.s. a recent mammogram did reveal that i have no more calcifications. so the rest were removed during the lumpectomy. and were only the fat necrosis. im so grateful for your opinion on this.as i dont really want to have rads. if a mistake could of been made.
		A:	first, the fat necrosis would raise the question of whether at some point in time in your lifetime you had an injury there. not a big deal but could have contributed to the fat necrosis (not a contributor to the dcis). that said, it is rare but i have seen it happen that the stereotactic biopsy just happens to remove all of the dcis.
Question:  #9 11/1/2009		Q:	I had a mammogram done on October 16, 2009. I received a letter in the mail (NO call from my doctor!) that said additional imaging studies were needed. I called the hospital for the radiology report and that report says: "On the left, the breast is mainly unchanged but there is an irregular density seen within the anterior central portion of the breast on the craniocaudal view. This area appears slightly different when compared to previous exanmination. This is of questionable significance, but I would suggest that the patient return for at least one compression spot view. It should be noted that this was isolated by CAD." I have tried to contact my doctor to discuss this report, but he has not returned my call. I do have another mammogram scheduled for November 3, but would like to know if you can explain this in simple terms. Do you think this could be breast cancer? Thank you for your time in replying.
		A:	if this density appears to be "solid" and has an irregular border then it would be concerning. also of interest however is that the computer (CAD) noted it and not necessarily the radiologist who was reading the images himself. be sure that you are getting these additional views at a facility that offers: 1) digital mammography; 2) being read by a breast imaging radiologist who specializes in breast imaging. (not a general radiologist who reads other types of xrays too. you want this level of specialization.) ask if a bi-rad score was assigned yet or not. if a 4b, then it is likely to be cancer.
Question:  #10 10/17/2009		Q:	My wife 39 biopsy pathalogy reprt showed well differentiated PR93%ER+81% and low grade nottingham score of 5, tubule 2 nuclear 2 mitotic 1 location by axillary tail undetectable by mamo and undectable 6mos ago by mamo ,br MRI and ultrasound. what are the chances of node involvement and her2-or+ and overall survival
		A:	with a low grade as this is good change she will luck out with being HER2neu negative. very strong for hormone receptors. that's great news. the diameter of the tumor wasn't mentioned. this too influences risk of going to nodes. if under 2cms (20mm) then very low risk. If you want her to have surgery with us you are welcome to bring her our way. 443-287-2778.
Question:  #11 10/17/2009		Q:	If DCIS and LCIS were discovered when doing a lumpectomy which did not result in clear margins, would the next course of action be a mastectomy/double mastectomy?
		A:	margins do not have to be free of LCIS; just DCIS. LCIS is a marker for risk and is NOT cancer. DCIS is however noninvasive breast cancer. if the breast still looks pretty good after lumpectomy and only 1 or 2 margins are still involved then it usually is reasonable to try a re-excision. if a large portion of the breast was already removed though or if there are say 4 margins positive out of 6 then consideration for mastectomy with reconstruction is given. if you want to come our way, do. just call 443-287-2778. this is an important decision.
Question:  #12 9/5/2009		Q:	I had a vacuum assisted biopsy with a clip placed in early August due to clustered microcalcifications. Results were benign but they did find part of a radial scar. I had an excisional biopsy with the wire because of the radial scar on August 20th. The results came back as proliferative fibrocystic change, prominent apocrine metaplasia, no evidence of atypia or malignancy. My concern is that they didn''t find any more of the radial scar. Could they have missed the right area? I have a post-op on the 9th. I asked the surgeon about this over the phone and he mumbled something I didn''t understand. They took two samples - 17.6g and 4.2g. Do I need to be watched more closely? Should I be worried about the surgeon not excising the rest of the radial scar? Thank you!
		A:	i don't know if he did or didn't get it all out. the specimen should have been xrayed in mammography before it was sent over to the pathology dept though. so ask the radiologist if this was done. getting a post op mammogram would help too in a few more weeks to see what it can tell the radiologist regarding this issue. you should be followed more closely going forward. your risk is slightly higher than average. not a big risk but up a little.
Question:  #13 9/4/2009		Q:	i was diagnosed with poorly differentiated infiltrating ductal carcinoma. The tumor measured 2.5cm nottingham score=9 g-III. The margins of excision is positive for carcinoma. after receivng the diagnosis after the biospy I had a bilateral mastectomy with sentinal node removal(9 nodes were tested) the tests on the nodes were negative for cancer. I was later referred to an oncologist who stated that I would need 24 weeks of chemotherapy due to the possibility of a "rogue cell". I hacve looked into the oncotype DX test and was wondering if this test should be done and if chemotherapy should be the first option of treaament
		A:	if the tumor was hormone receptor positive and HER2neu negative then there is a possibility that oncotypeDX might be a test your oncologist will consider for you to help determine the risk of your specific cancer recurring and therefore a better sense of whether you can skate through with just hormonal therapy or need the chemo .
Question:  #14 8/29/2009		Q:	Are hormone receptor test results affected by the quality of the tissue sample obtained? Overall, how accurate are these tests believed to be? My vacuum assisted core biopsy indicated low mitotic activity (1/3, Nottingham), but the post-mastectomy path report was 3/3 on mitotic (9 total vs. 7 on the core biopsy.) Tissue necrosis was reported as high in the core biopsy report, so I suspect the sample caught a lot of dead tissue. I am now on Femara but am wondering if I should ask for the hormone receptor status to be rechecked, or if this is even possible at this point. The core biopsy showed the sample as ER+ (78%) PR- (0%) and her negative, high proliferation. My copy of the post-mastectomy path report gives no indication hormone receptor status was re-tested. I am now Dx with stage 4 (initial Dx, not recurrence) lobular breast cancer, though the initial Dx based on the biopsy was infiltrating ductile cancer.
		A:	a core biopsy is merely a tiny sample and when it comes to hormone receptors it may not be representative of the whole. if a hormone receptor were negative on biopsy it is to be redone by obtaining more tissue from the breast cancer surgery specimen. it's not unusual when looking at more tissue that it is determined to be positive. if however the biopsy was hormone receptor positive then it does not need to be redone. such things as mitotic rate can be different from biopsy to whole specimen and is to be rechecked at time of surgery. you mentioned stage IV which means that the disease has spread onto other organs. it is advantageous to have tissue sampled from where the cancer has spread to-- this would be either liver, lungs, bone or brain to be stage IV-- because we have learned that for reasons that remain unclear, hormone receptors and HER2neu receptor can be different in mets tissue than it was in the original specimen.
Question:  #15 8/29/2009		Q:	MY friendis post op simple mass. triple negitive bc stage3, grade3, 0 lymph nodes Tumor size 5,7cm & grew from 2.1 in about 4-6 wks. Has had ct and liver scan both neg. Starting chemo by 9/11/09. I understand that this ca very agressive and recurance is high in the first 2yrs. Can you tell anything more and more about her survival for the next 5 yrs an beyond thank you
		A:	its good that nodes were negative. the biggest challenge is going to be that it is triple negative, ommitting several drug therapy options-- herceptin and hormonal therapy. chemotherapy is designed to kill rapidly growing cells so aggressive tumors usually respond better than others. after chemo she will have radiation to the chest all as well to further reduce risk of local recurrence. you can visit www.cancer.org to look at survival stats but frankly, she isn't a number... she's your friend.
Question:  #16 8/28/2009		Q:	Hi Lillie, My pathology report from a fna says: Cellular specimen. Epithelial cells with ild nuclear atypia singly and in small clusters admixed with fatty strom, and stromal cells. Findings are suspicious for a low nuclear grade ductal carcinoma. Differential diagnosis includes radial sclerosing lesion, sclerosing adenosis. Surgical excision is recommended. What are the chances that it is cancer? Do the differential diagnosis suggest cancer as well? Thanks so much for your help and knowledge.
		A:	a little hard to guess since it was an FNA and not a core biopsy. that said, in general anticipate the odds being about 30% for DCIS to be present. remember if it is this is very very treatable. noninvasive disease. the only time we can use the word "cure." L
Question:  #17 8/16/2009		Q:	dear lillie my mother is a her-2+3 on IHC,HER FISH EXAM WAS 2.9,WHICH AS I UNDERSTOOD ,IS AN AMPLIFICATION MY QUESTION IS THERE A RELATION BETWEEN THE FISH RATIO AND THE RESPONSE TO TATGETED THERAPY ESPECIALLY TO TYKERB ,I MEAN IS THERE EVIDENCE THAT THE MORE THE NUMBER IS, THE MORE THE RESPONSE WOULD BE??//(DOES IT MAKE SENSE?) THANK YOU
		A:	no studies have been done, like they have for hormone receptors degree of positivity to answer this question for HER2neu positivity. it would seem logical to think though that the higher the degree the better effective the drug but this has never been proven. L
Question:  #18 8/9/2009		Q:	I had a 4 mm area of clustered calcifications removed using the vacuum assisted core biopsy. 12 cores were taken using a 9 gauge needle. They were able to get the calcifications in 3 cores and they were totally removed. In another core, they found a part of a very small radial scar. Radial stars seem to come with a lot of controversy as to whether they should be excised or not. The doctor who did the biopsy said he''d tell his wife to follow up in 6 months. Another doctor, after talking to the pathologist, said she''d excise it if it were her. I''m seeing a breast surgeon on the 26th to get her opinion. The second doctor said I have complex tissue. There is no atypia but the report also reads there is "columnal cell alteration" and "prolific fibrocystic change with associated microcalcifications". I read one study that said they find cancer in 4% of cases upon excising radial stars with no atypia. Another stated that no cancer was found when 12 or more cores were taken using larger needles. Is there a greater chance they missed something since they only retrieved a piece of a small radial star? Are radial stars usually excised these days. I read they used to always be excised. Thank you for your opinion.
		A:	the standard of care is to excision radial scars.
Question:  #19 8/8/2009		Q:	Hi, I''m 36 yrs old and have had breast cancer twice, first time at 29, I''m BRCA2 +, I finished treatment in Dec. 07. Before treatment I had a PET scan and it noted a single hypermetabolic right internal mammary chain lymph node compatible with metastatic disease.My surgeon never got this report and at a follow up visit for the mastectomy I mentioned the lymph node and he said he didn''t know about it but that he didn''t think he would have removed it, so what does the path report mean when it said Angiolymphatic invasion: suspicious, and later says intramammary lymph node is not identified. Does that mean they didn''t remove it? If so, what would make it suspicious for angiolymphatic invasion?The tumor was small 1.5 cm, and I had my lymph nodes removed from under arm the first time I had it. I''ve worried about that lymph node for a while now, I had radiation the first time so it was not offered this time. I have had a clean PET scan since then, is there a magic number where I can say..it''s been ____ years, if there were remaining cancer cells it would have shown up by now? The tumor was triple negative, and I''ve since had the left mastectomy and ovaries removed. Thank you very much for answering my questions.
		A:	good probability that if it were to have been cancer it would have declared itself by now. and if a repeat scan some time later showed nothing there then it is no longer an issue of concern. if you had chemo, the chemo might have killed the cells there too. these node are NOT ones usually removed at time of surgery. Frankly they aren't even visible during the surgery. they have to become VERY invasive into your thoracic cavity to access these. usually the treatment for nodes in this location that are found to have cancer is chemo and radiation (to that specific location). Not sure if you did bilateral but am assuming so since your risk of breast cancer in both breast beng BRCA positive is very high. each year is another year to celebrate. Regarding your question about angiolymphatic invasion, that means that the pathologist saw these lymphatic vessels and blood vessels within the tumor. so the tumor certainly had the ability to travel, but it doesn't need to took advantage of that opportunity. L
Question:  #20 8/3/2009		Q:	My Friend has been going through chemo and has developed a blood platelet count of 8 and is now hopitalized is she going to be ok
		A:	Hopefully she will be. She'll probably get transfused platelets and watched very carefully for signs of bleeding. Once her counts return to normal, she will be back to her baseline. It's good they caught this and it is usually reversible.
Question:  #21 7/27/2009		Q:	Have there been any studies done to suggest that patients with a high oncotype test score should have a different staging? For example: someone with a stage 1 breast cancer with a oncotype test score above 35.
		A:	Not that I know of. Staging has to do with size of tumor, nodal involvement and location. Stage 1 is tumor size under 2 cm, Axillary node negative, no metastases known. There is no room in current staging to include an oncotype score. ds
Question:  #22 7/27/2009		Q:	I am 49 years old and was dx with DCIS with .3cm microinvasion. I am ER/PR -, Her2 is pending. I had a mastectomy with 2 sentinal nodes removed. The path report shows 0/2 positive for mets. However, there is a small foci of atypical cells in one of the nodes. What are these atypical cells? They did further testing on them (not sure what tests but delayed results for 1 week) and determined there were no malignant cells found. Are these atypical cells precursors to mets? I am Stage I, grade 3. Does this warrant chemo? Also, the cancer was found in the lower inner quandrant of my lt breast. I found research showing that the risk of death doubles even in early stages because of undetected mets to the internal mammary chain lymph nodes. I asked my surgeon if he would sample these and he would not. He said he would need a thoracic surgeon to crack my sternum to get at them and with being a stage I he didn''t feel it was necessary. Is it unreasonable to ask for a biopsy of these nodes? Can''t this be done with a thoracoscope? Thanks for your response!!
		A:	I can't really tell you without the path report and/or speaking with the pathologist. THey could be nothing, but without the report, I can't say. You should talk with your doctors and have them explain everything including answering these important questions. Best regards.
Question:  #23 7/18/2009		Q:	please can you help me understand the following on my pathology results. 1.there is very extensive vessel space infiltration by tumour and multiple tumour emboli in small capillaries and veins are present in breast tissue. 2. there is also a small intramammary node. there are numerous firm pale nodes in the axilla. thanks in advance
		A:	this is written a bit differently that how i traditionally see reports. but the bottom line is that it sounds like there is vascular invasion of the cancer cells. this means that the pathologist saw blood vessels, little tiny ones, running through the tumor itself. this gives it the ability to use the blood stream to travel to other parts of the body. there was also the presence of a node but it doesn't say in what you typed if the node had cancer in it or not.
Question:  #24 7/18/2009		Q:	I am 44 and had stage IIA Hodgkin’s Disease in 1985 with radiation to neck/chest/abdomen and spleenectomy. I have recently been diagnosed with DCIS grade 3 PR & ER positive breast cancer in the left breast and MRI has showed 2 areas of suspicion in the right breast. I am scheduled for bi-lateral mastectomies and reconstruction expanders in 2 days. PET scan and breast MRI have shown clear chest wall and nodes clear. PET scan and subsequent abdomen CT have detected 3 nodular densities in the mesentery area (13 mm, 10m & 10mm in size). CT showed a complex cyst on the right ovary. Liver, gallbladder, kidneys all look fine. The PET scan and subsequent ultrasound reveled multnodular goiter (about 1cm) in my thyroid. After mastectomies, I will have an ultrasound guided biopsy of the nodes in the mesentery and a needle biopsy of the thyroid. I know these areas (abdomen& thyroid) are not the normal location for spread of breast cancer. If the thyroid and/or abdomen nodes prove positive, does this mean the BC has metastasized (with the grim prognosis that comes with that), or is it an unfortunate coincidence of radiation affects and if so, would these be treated as a separate cancer (with the better prognosis)? I have been in this constant state of tests and waiting for 8 weeks and the continuing worry of each test reveling another concern is wearing.
		A:	so sounds like you fell into the 28% of women who had mantle radiation as a young person who subsequently developed breast cancer as a result. the disease though is DCIS which is NONinvasive breast cancer so there isn't any logic in why all these scans have been done when DCIS can't spread anywhere, not even to the lymph nodes under your arm. so rest easier. if everyone had scans done (they way we used to do it, and that standard of care was changed in 1998 to discontinue routinely doing scans like this when diagnosed unless there are known positive axillary nodes) most patients would have something show up somewhere that looked abnormal and when chased down was found to be nothing of concern.
Question:  #25 7/13/2009		Q:	Lillie can you tell me a little about the touch prep method used by pathologists to examine sentinel node for mets? I had emailed you in the past about my sent node biopsy which was originally reported as neg, but was reported to me later as positive (2.5mm) (I did not have lobular cancer) Anyhow, I was under the impression that my original biopsy was with H&E stain and later positive upon IHC, but one of my docs told me that touch prep was used. If this is the case, what would be next step-would it be H&E or IHC? I''ve been confused about this. (10/10 nodes ultimately turned out negative). What is the most accurate method-isn''t it the IHC? Thanks again!
		A:	Generally speaking frozen sections are used during the operation/procedure to quickly assess the lymph node status to see if the sentinel nodes are positive. If positive, more nodes can be taken at the same time. It saves a second surgery. However, it is not as definitive as the final pathology stains(they usually do many ),because of the use of formalin fixed paraffin embedded sections which take much longer to process, and it can happen that the intraop nodal evaluation is negative, but the final pathology after surgery is positive, which is what I think happened with you. So it isn't the staining per se that makes the difference, but the fixation and preparation of the tissues as the most accurate one takes a few days to perform and therefore cannot be done intraoperatively. HOpe that makes sense.
Question:  #26 7/12/2009		Q:	Hello Lillie-What is the touch prep method of examining sentinel node for mets? I think the pathologist where I had sentinel node biopsy done used this. My node was originally reported as neg, but 2 days later reported as positive (with 10/10 neg) I had asked you before why my 2.5mm mets in node could have been not seen initially...(I did not have lobular-you mentioned sometimes lobular ca can turn out to be initially neg on bx) Anyhow, question is, how is touch prep different from frozen section, and if they do touch prep initially, is it standard to then go ahead with h/e or IHC later? Thanks again!
		A:	The sentinel node on touch prep is very accurate but not 100 percent. This is why the node is then examined by pathologist more closely in the days following surgery. The touch prep looks at a limited part of the node while the pathologist will section the node and look closer at all of it. It is standard to look more closely at the sentinel node after surgery to be more accurate. This can be disappointing when you are one of the few whose results reverse. ds
Question:  #27 7/13/2009		Q:	Hi I just posted the histopathology report. Also forgot to mention that the tumor is er/pr positive. Thanks.
		A:	That is a more favorable sign, but as I said, need a more formal evaluation and additional information. Best.
Question:  #28 7/13/2009		Q:	Hi I am a little disturbed regarding my mothers reports. She was diagnosed about three weeks back and has already undergone surgery. Following is her Histopathology Report. Apart from this as a prep up for the surgery, she has already undergone bone scan and abdomen ultrasound which came out to be normal. Just want to know how good are her chances of survival ? HISTOPATHOLOGY REPORT Specimen- Right Modified Radical Mastectomy specimen Gross Examination: Specimen measuring 22.0 X 18.0 X 4.5cm. Covering nipple-bearing skin ellipse measures 14.0 X 9.0 cm and shows a small scar in the medial part measuring 0.6 cm. Serial slicing shows a solid gray white tumour in the lower inner and outer quadrants measuring 2.5 X 2.3 X 2.0cm. Edge of the tumour is 1.0 cm from deep, 5.0cm from inferior, 3.0 cm from medial, 9.5cm from superior and 7.0cm from lateral resected margin. Tumor is 1.5cm from overlaying skin. Breast tissue superior to the tumour shows irregular gray white areas. Deep surface shows skeletal muscle. Multiple lymph nodes are dissected from axillary tissue, largest measuring 1.5 X 1.5 X 0.7cm. Microscopic Examination: Sections show an Infiltrating duct Carcinoma NST, MRB Grade 2, with fiboblastic stromal desmoplasia, Intratumoral lymphovascular invasion is seen. Surrounding breast shows duct ectasia, apocrine metaplasia, adenosis and foci of atypical epithelial hyperplasia. Skin , nipple and resected margins-radial and deep and free of tumor. Nipple shows duct ectasia with distortion of lactiferous ducts. Seven out of thirty three right axillary lymph nodes show tumor metastasis(07/33) with extracapsular spill in three nodes and a soft tissue deposit. Pathological stage: pT2 pN2a M0 Nottinghams Prognostic Index: 5.5
		A:	Hi there. Can't answer your question over the internet. THis requires a complete history and examination to assess other risk factors including and especially things like estrogen/progesterone receptor expression, HER2 receptor expression, age, other illnesses, etc. That said, her positive lymph nodes are a bad sign and she will likely be recommended chemotherapy. If everything else is truly normal, she has potentially curable disease, but again, can't give you any more than that without her being formally evaluated. Hope that helps.
Question:  #29 7/13/2009		Q:	dearest lillie my mother is a MBC patient,she showed remarkable improvement when she first started herceptin with chemo,then stabilized before her disease started to progress and got switched to tykerb.her her-2 status was assessed first when she was first diagnosed on her primary tumor by IHC done in three different labs one of them is a large oncology center ,and then was reassessed again on the metastatic tumor .the result was always +3 MEMBRANOUS ,ON ALMOST 100% OF CELLS.ABOUT A WEEK AGO I PERFORMED THE CISH TEST ON HER METASTATIC PRETREATMENT SAMPLE ,THE RESULT CAME AS FOLLOW:INTRICATE 20 CELLS FROM THE INVASIVE AREAS:THE HER -2 SCORE 32 CEN 17 19,RATIO 1 AMPLIFICATION NEG SHOULD SHE REPEAT THE CISH,AND IF THIS SHOULD REMAIN THE SAME WOULD THAT MEAN SHE IS NOT ELIGIBLE FOR ANTI -HER-2 TREATMENT DESPITE HER PREVIUOS CLINICAL IMPROVEMENT? THANK YOU
		A:	Hi, CISH is not an approved test for HER2 yet, though FISH is. Though the techniques are similar, the quantification could be difficult due to counting the number of HER2 positive vs. the reference ch.17 probe. If this really was CISH, then I would discount it. If it really was FISH, that is a different matter and may bear repeating. In general however, here at Hopkins we do not routinely do FISH testing if the stain is 3+, and given your mother's good clinical response, I'm not sure why the FISH would even have been ordered.
Question:  #30 7/5/2009		Q:	After my annual mammogram showed an increase of microcalcifications, I was sent for a magnification view & the radiologist then recommended a biopsy. A Mammotone biopsy was performed 2 weeks ago w/ a Final Diagnosis of focal atypical lobular hyperplasia & fibrocystic change w/ associated microcalcifications. The Microscopic Deion reads: Some breast ducts are cystically dilated. Scattered microcalcifications are noted. Focally, there is lobular distention. Within this region the distended lobules are filled w/ epithelial cells. Some of these cells demonstrate intracytoplasmic vacuoles. The general surgeon who performed the biopsy did not think another biopsy was warranted and recommended another mammogram in 6 months. He also commented that he didn''t think this put me at greater risk for breast cancer. This seems to be contrary to what I''ve been reading. I am 55 years old w/ no family history of breast cancer. I had my first child at 41 & later underwent fertility treatments. I also just recalled finding a small bit of dried discharge on one of my nipples some time ago that I dismissed. (I can''t remember if it was the same one that was biopsied.) My question is should I try to find a breast specialist and /or get a second opinion?
		A:	the key word in your path report was "atypical" cells. this is a risk factor for breast cancer. so time to see a breast specialist. yes.