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Category:

Understanding Pathology Results

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Question:  #31 7/4/2009		Q:	Hi! Hope you can help. Brief history - Dx with Hodgkins Lymphoma in 1988 (28 years old). Had 50 radiation treatments from chin to abdomen. Stage IIIa. Was Dx with BC April 13th. Had bi-lateral mastectomy due to high risk of developing BC in other breast. Pathology reads: RIGHT BREAST (non-cancerous: Ductal hyperplasia w/o atypia, Sclerosing adenosis, Microscopic radial scar, Fibrocystic changes (Apocrine change, cysts), Columnar cell change, Focal microcalcifications associated w/benign acini and two benign lymph nodes. LEFT BREAST (with cancer): TUMOR SITE: Upper outer quadrant and lower outer quadrant. IDC w/Extensive intraductal component (DCIS), LCIS - classical type, NOTTINGHAM SCORE: 6/9, GRADE II (tubule formation 3, nuclear pleomorphism 2, mitotic count 1). Size of invasive components: 0.3cm, 0.15cm and 0.15 cm, three FOCI located in the lower outer quadrant. Staging: pT1a pN0 (-i) (sn) pMX. Margins uninvolved by IDC. Distance from closest (posterior)margin: > 10mm. Margins uninvolved by DCIS. Distance from closest (posterior) margin: 2mm. VENOUS INVASION: Absent. ADDITIONAL PATHOLOGICAL FINDINGS: Sclerosing adenosis, fibrocystic changes, columnar cell changes and biopsy site changes (1 o''clock region). DCIS focally involves large lactiferous ducts. Small fragment of skeletal muscle free of tumor. Skin free of tumor. NOTE: The two areas of DCIS appear histologically different. The DCIS in the upper outer quadrant (1 o''clock) shows high nuclear grade with extensive comedonecrosis while the DCIS from the lower outer quadrant (3 to 4 o''clock) is solid and cribiform patterns, intermediate nuclear grade with focal necrosis. The DCIS is extensive in the 3 to 4 o''clock region measuring at least 3 cm. The invasive carcinoma is located in the 3 to 4 o''clock region. 0/2 sentinel lymph nodes on the left. IDC 95% moderate to strong nuclear staining for ER and 85% moderate nuclear staining for PR. HER2 was negative. So, my questions: Most people tell me they are a stage then A or B. Am I A or B? My right breast had some weird things in it, any possibly precancerous? Since the report says my two areas of DCIS were different, does that mean one was more aggressive? The Nottingham Score was 6/9. That''s not good, right? My onc says no chemo - just Tamoxifen. I''m a stage one - makes sense? I really don''t get what I''m reading in my report. All these terms make it confusing if they are good or bad things. All in all, what do you think? Thank you so much!!!! I love this site!
		A:	yours was a stage 1. we don't start doing "As and Bs" until stage II. you had favorable prognostic factors. about 28% of women having had mantel radiation in the past develop breast cancer as a result. some would say that you may not even need hormonal therapy. worth getting a second opinion about that. your other breast actually contained no cells that showed premalignancy or increased risk. however it was smart to go bilateral because over time the mantel radiation effected both. take care. be well. L
Question:  #32 7/4/2009		Q:	Hi there and thank you, your site is very helpful. I am 48, diagnosed with breast cancer in April of this year. At the time, I told my doctor that I had extremely lumpy breast and that for me I believed that I should have a bilateral mastectomy. I had already had 4 biopsies, 3 on the right and 1 on the left. He had agreed but just before being rolled in the OR he noted that the tumor had shrunk, something to do about premenstrual swelling and then said he would prefer to do a lumpectomy with radiation. Everyone in that hospital seemed some happy for me that my husband and I went with this idea. Knowing that I had lumpy breast and discharge for some 20 years, I knew then that I should have gone through with the Bilateral mastectomy but didn''t have the nerve to speak up. Anyhow upon reviewing radiation treatment and its impacts to our bodies and the fact that it substantially reduces the possibility of tissue expander - and having a weak abdominal wall, not from being over weight but from pelvic and abdominal surgery and adhesions with hernia''s. I knew that the procedure that involves using skin muscle and tissue would never be an option for me and I wasn''t ready to be scared for life and to look at myself with no breast. Then I got the pathology report from the lumpectomy and it was confusing to say the least. Infiltrating tumor component, yes. Type: Infiltrating carcinoma exhibiting composite ductolobular cyto/histomorphologic features, pending IHC stains for phenotyping. Size/extent: 1.5 x 1.3 x 1.1 cm Histologic grade: 3 Nuclear grade: 2 Mitotic index: low (less than 5 mitotic figures per 10 HPF views Modified Scarff, Bloom and Richardson Anatomic Grade 6 of 9 Mammary Parenchymal angio - lymphovascular invasion by tumuor: not demonstrated emplying convential light microscopic review In Situ Tumor Component: Yes, predominately intratumoral Then in situ component: yes Type: composite of lobular and ductal carcinoma in situ (LCIS and DCIS) Size/extent of insitu component: 1.0 x .07 cm Location: Primarily intratumoral Van Nuys DCIS Category: Group 2 (non pleomorphic cell type with focal intraluminal comedonecrosis) Microcalcifications associated with the in situ tumor component: no Other info - estrogen/progesterone + - her 2 negative Low onco number no need for chemo Anyhow, I pushed for bilateral mastectomy and my results of the - skin sparing mastectomy are listed below this paragraph. I note that many of the disorders in this report slightly increase the risk of cancer developing again. I do believe that these conditions confirm that I would have had to experience multiple biopsies over time and that my problems with lumps and bumps all over each breast made it very difficult to figure out what is new or not or temporarily swollen due to menses. Also, it was noted that my left breast fibroglandular to fatty stromal ratio approaches 70% and on the right approached 75% So I wonder if after reading this information what my odds would have been for cancer to re-occur given that I have already had 2 kinds of cancer and 2 kinds of in situ components with in one tumor or closely near by and that I have what appears to be multiple proliferative breast tissue disorders. I would really appreciate any attention that you could give to this email. Representative sections all four quadrants of mastectomy and the nipple areolarcomplex/subareolar tissues who in summary proliferative breast tissue without associated cytologic atypia as further characterized by Discrete Microscopic Fibroadenoma formation/zones of evolving fibroadenomatosis, mutiple foci of sclerosing adenosis, terminal duct-lobular units exhibiting a mild degree of cystic lobular ductular involutional change, and fenestrated ductal epithelial hyperplasia of the usual cytologic type affecting isolated subterminal units No intraglandular, subepithelial, or stromal base There is no evidence of Malignancy Right breast All final soft tissue margins and the deep fascial plane of mastectomy have been cleared of an infiltrating and/or in situ tumor component by 10 mm or greater Representative sections, all four quadrants of mastectomy show poliferative breast tissue as further characterized by a mild degree of of cystic lobular acinar transformation, apocrine epithelial metaplasia, discrtee foci of sclerosing adenosis/evolving fibroadenomatosis, fenestrated ductal epithelial hyperplasia of the usual cytologic type affecting terminal duct - lobular apparti, and a mild degree of back mammary parenchymal stromal angiomatosis indicative of endogenous and or exodgenous hormone effect. Cicatrized fibrovascular and adipose tissue with reative foreign body giant cell response and incorporated along the deep edge at various points, structurally unremarkable skeletal muscle bunders of the right superficial pectoralis major musculature. No evidence of malignancy
		A:	you may be disappointed with my response to your question. First, you had stage 1 breast cancer with favorable prognostic factors. it's common to have a component of DCIS with infiltrating ductal carcinoma. don't consider yourself having had "2 kinds of cancer." average growing. non-aggressive. so lumpectomy with radiation followed by hormonal therapy (which would be the standard of care for this situation) would result in about a 5-10% risk of cancer recurring in the breast and about a 2- 5% risk of developing cancer one day in your other breast.so frankly, your risk would be low. there was reference to angiolymphatic invasion which could carry a risk of distant recurrence--- cancer popping up elsewhere in the body (NOT in the breast). sounds like you had a low oncotypeDX score however. some doctors would still recommend hormonal therapy however due to this pathology finding. what you have achieved for yourself i think is peace of mind and no longer needing to have mammograms going forward. Your true risk though of getting breast cancer again in your breasts following a lumpectomy with radiation and hormonal therapy would have been low.
Question:  #33 6/21/2009		Q:	I am about to have my last AC this week, and go on to 4 DD Taxol every two weeks, then rads. I have 1.2 cm IDC, no nodes, State 1, Grade III, Ki-67 61%, clean margins but triple neg. 9Suffered with neutropenia after each AC (only 1 febrile) and stay on antibiotics throughout chemo.) Nodule never tested for basal, and when I asked Onc if it could be tested, she said no need, as my treatment wouldn''t change anyway. Is this answer sufficient. Not been tested for Brca 1 as I was 62 at diagnose with no history of any cancer in both sides of family. I am concerned about not knowing if my nodule was basal or not, on the other hand, it it is and I knew, I might be even more apprehensive. Any suggestions? Thank you so much.
		A:	i would not be worrying about the basil issue. he is correct. treatment is the same. so glad you are nearly done AC and then will just have 4 treatments to go! smart to do too given the high Ki67 and triple neg status. take care.
Question:  #34 6/20/2009		Q:	Hi. A fine needle puncture under ultrasound guidance was performed on right breast after finding not a lump, but a hard area. The following is what was written on the pathology report and I can not understand the results other than they were positive for Carcinoma. Note that this was performed in Latin America and not the US. "Smear shows high cellularity, with abundant epithelial cell groups with marked nuclear superposition, marked cytological atypia, "dirty" background with necrosis and loose cells with cytoplasm. Isolated mitosis and prominent nucleoli are seen. DIAGNOSIS: Positive for Carcinoma." What does this all mean and is there some information missing such as staging and how invasive the cancer is? Note that sister had cancer in same breast and is still undergoing treatment. Follow-up will be done in the US. thanks for your time.
		A:	the pathology report is missing the type of breast cancer it is and the grade of the cells. staging cannot yet be determined from a biopsy. it is dependent on the measurement of invasive component (if there is any) and the status of the lymph nodes at time of surgery. given you have a sister also with breast cancer, consider genetic counseling and testing too. if you are able, come to us. 443-287-2778.
Question:  #35 6/20/2009		Q:	Path report reads invasive poorly diff. ductal carcinoma 2.1cm ER+ PR+ HER2+++,Ki-67+ 80%,P53(BP-53-11) Several foci of in-situ carcinoma away from tumor mass Metastatic adenocarcinoma in 1 of 1 lymph node.largest 3.5cm Left axillary same in one of 10 lymph nodes, largest .o6cm I''ve had 8 treatments of A/C, 3 of 12 treatments of taxol, with a year of herceptin. Is this treatment sufficient and what are the prognosis percentages based on this info. Thank you
		A:	this is a common (probably most common) regimen recommendation from a chemo and biological targeted perspective. hormonal therapy should be added after ACT is done, while on your herceptin then continuing the hormonal therapy for several more years thereafter..
Question:  #36 6/20/2009		Q:	2 questions 1.Is treatment right (or enough) 2.What are the survival percentages etc based on the following: Upper inner quandrant, left breast-invasive poorly diff ductal carcinoma.Tumor largest dim. 2.1 cm, extensive vascular lymphatic space invasion present,within mass and away from mass, ER +, PR +,HER2 +++, Ki67 positive 80%,P53(BP53-11) DCIS, invasive tumor extends focally into anterior inked excision margin Lymph node, left axillary, sentinel, excision: metastatic ademocarcinoma in one of one lymph node.largest 3.5cm, tumor replaces lymph node, with focal extranodal ext present Differentiation/anaplasia/proliferation 3/2/3 = 8
		A:	1. no treatment was listed. 2. so first,more surgery is needed. sounds like maybe lumpectomy was done? margins are still dirty and need to be cleared so there is healthy tissue resected around this tumor. worrisome prognostic factors of a very high Ki67. aggressive tumor. positive nodes. it doesn't say how many nodes were removed though. at least 7 are needed for what is termed an adequate dissection. hormone receptor positive is good. looks like you have a lot of chemo and herceptin ahead of you. if you want to come to us for discussion about re-excision vs mastectomy with reconstruction just call 443-287-2778.
Question:  #37 6/14/2009		Q:	I have recently had a wide local excision for a benign Phylloid tumour. The size of the lesion was 33x18x17. My concern is that the the lesion has been completely but narrowly excised.The lateral margin was only 1.5mm microscopically, the anterior 3mm, posterior 5mm and medial 10mm microscopically. What sort of follow-up care should I expect? Is there a risk with these small margins that the tumour could have infiltrated the blood vessels or anywhere else for that matter? Thankyou
		A:	mammo in 6 months. consider re-excision where the margin is close too. you really want wide margins or it will probably grow back.
Question:  #38 6/1/2009		Q:	I just received my pathology report and I am trying to determine if I am triple negative. The conclusion on the interpretation of HER-2neu states: "The sample is interpreted as not amplified." What does this mean? It also concludes "The vast majority of tumor cells are negative for both estrogen and progesterone receptors? Am I assuming correctly that I am triple negative? I was diagnosed with IDC with medullary features grade III 1.8cm total of 6 lymph nodes taken all benign.
		A:	The her2neu is negative--not amplified means negative. THe ER and PR should be read as a percentage, not a vast majority. Giving hormone therapy is based on the positivity of these hormones. Your medical oncologist can request this information. ds
Question:  #39 6/1/2009		Q:	Lillie, you are an angel. Thanks for this great site. Recently had Lumpectomy. Pathology report says "High-Grade Ductal Carcinoma In Situ with a Focus (Approximately 0.05cm) of Microinvasive Ductal Carcinoma." In Situ Tumor size 2.5cm. Invasive Component 0.05cm. Nearest margin: Inferior 0.2cm. TNM: pT1mic pNX MX. Surgeon suggests mastectomy and Sentinel Needle Biopsy. Oncologist said I can preserve breast by having Radiation Therapy. But either case would need Chemo and Hormone Treatment. Very confused. Invasive tumor is very small. Is Chemo too aggressive? Should I have re-excision? Appreciate your comments.
		A:	Very difficult to say given this limited information. But from the sounds of all of this, I would recommend getting a 2nd opinion at your nearest big academic medical cancer center. In particular, having your pathology slides reread would be very helpful to see if you truly have an invasive component since treatment decisions really hinge upon that. Getting a 2nd surgical opinion also could be helpful to determine mastectomy versus breast conservation.
Question:  #40 5/31/2009		Q:	I''m attempting to undestand my path results/risk factor: Results read: Sections demonstrate glandular and fibrofatty breast tissue. There is fibrocystic and columnar cell change with adenosis/sclerosing adenosis, focal florid intraductal hyperplasia of the usual type, stromal fibrosis, apocrine metaplasia, and cysts. There is also focal flat epithelial atypia and atypical hyperplasia. The flat epithelial atypia and atypical ductal hyperplasia does not involve biopsy margins. Intraluminal microcalcifications are noted associated with atypical and non-atypical epithelium. There is no evidence of ductal carcinoma in situ or invasive tumor. What does this mean to me? And are any of these findings concerning? Or put me at an increased risk? I notice the words atypical hyperplasia so do have that or not? This is very confusing to me and as much as I have researched to try and gain a clear understanding I am pretty lost. Clearly, I do not understand this whole margin thing? Sorry, this is pretty new to me and not very clear at all. I just had my hand shook and was told I do not have ductal carcinoma and that was about it. Thank you for any clarity you can bring to this report. I really, really appreciate you taking the time to help me understand. You offer a VALUABLE service!!
		A:	These are benign findings only, no cancer--"There is no evidence of ductal carcinoma in situ or invasive tumor." There is atypical hyperplasia in the second section of report. Atypical hyperplasia are cells that don't look normal and more of them then normal. They are removed so you need not do anything more. The atypical cells are not near the margin, the edge of the specimen. Having atypical hyperplasia diagnosed is important in future follow up as it is a risk factor that increases life time risk of breast cancer 4 or 5 percent. Continue good screening. ds
Question:  #41 5/24/2009		Q:	When I had mastectomy (by choice bilateral) for 2.1 cm er pr pos (3+) breast ca in Feb 09, also had sentinel node biopsy. Was initially told it was negative and two days later after IHC stain,was told there was 2.5 mm cancer finding in that one sentinel node. Since 2.5 mm is over the 2mm definition of micromet, I''ve always wondered why it wasn''t detected upon first stain (H&E)I still get hung up on this finding occasionally, even though 10/10 additional nodes were neg. What is prognostic significance of one pos sentinel node?
		A:	well, you went statistically from a stage IIa to a stage IIb. not a huge difference but enough of one that additional systemic treatment probably happened. invasive lobular (not sure what kind of cancer yours was) has a reputation for showing a false negative sentinel node on first cut then upon additiona staining and evaluation can be a truly positive node. Don't focus on things in the past like this. you can't change them. just move forward.
Question:  #42 5/24/2009		Q:	Hi Lillie, I just read the last message about atypical ductal hyperplasia with papillomatosis. I just had a PEM guided core biopsy and was diagnosed with just ductal hyperplasia and papillomatosis, should this have be surgically removed? I was just told to have a follow up PEM in 6 months. Thanks so much for taking your personal time to help so many.
		A:	the key difference is "atypical". this is what warrants more tissue being removed. sometimes however for papillomatosis additional tissue is obtained. meet with a breast surgeon to discuss. L
Question:  #43 5/23/2009		Q:	Good Afternoon, my pathology report said there was atypical ductal hyperplasia and papillomatosis. What does that mean? Did they find more than one papilloma and is that bad? Thank you.
		A:	if this was found on a core biopsy then it is a sign of abnormal cell growth in a specific concentrated area of the breast. papilloma cells were seen. the next step, if done as a core, is to get an open excisional biopsy and obtain more tissue to ensure that early stage breast cancer isn't already present. 25-30% of the time noninvasive breast cancer will be present. if these were the findings from an open excisional biopsy then no cancer was found and the next step is to see an oncologist about evaluation for being high risk. sometimes tamoxifen is recommended in such situations to reduce risk of getting breast cancer in the future. L
Question:  #44 5/11/2009		Q:	I was diagnosed breast cancer March 2008, 1.9cm, no spread to the lymph nodes. Was put on Taxatere, Carboplatin, Herceptin, and Tamoxifan. My question is about the Herceptin. Why is it given usually for a year, why not 6 months or 8 months and god forbids if cancer returns will my tumor always be Her2+.
		A:	The one year regimen was/is the best studied, though ongoing studies are looking at whether 2 years is better than 1, and whether shorter durations are equivalent to 1 year. If your cancer does come back (let's pray it doesn't!), it may or may not be HER2+. It may be worth retesting if it does, but let's think positively and assume that it won't:)
Question:  #45 5/10/2009		Q:	Do clear surgical margins correlate with the tumor grade? Clear margins possibly meaning a moderate or lower grade tumor?
		A:	no, not at all. clear margins aren't related to tumor grade. grade is 1,2,3. margins measures the distance from the tumor cells to the edge of the specimen containing the cancer. before surgery is considered "completed" margins must be clear. 2mm or larger in all 6 directions. the grade can be 1,2 or 3.
Question:  #46 4/26/2009		Q:	The doctor who did the stereotactic biopsy said that my microcalifications were deep and might not be able to get a sample. Does this mean that it is too close to the chest wall? Fortunately he was able to get some samples. Diagnosis: Invasive tumor shows small nests and cords typically seen in invasive ductal carcinoma, but the negative E-cadherin is suggestive of alveolar pattern lobular carcinoma. The overall tumor grade is I (architectural score 3,nuclear 1,mitotic 1). The diagnosis of LCIS is confirmed by negative staining for E-cadherin and ck 5/6, and the presence of basal cells (p63, heavy chain myosin). The basal cell staining is lost in the foci of invasive tumor. I am mastectomy done for both breasts. What does this all mean and what will the treatments after surgery be? I am scared.
		A:	the spot in question sounds like it is close to the chest wall however that doesn't mean anything in regard to your prognosis or treatment. it simply makes it more challenging to be able to do a stereotactic biopsy. the size wasn't listed anywhere and that's important to determine the stage. if you are doing bilateral masts then you have chosen to be very very aggressive. this isn't required you know and must be your personal choice. grade 1 is very slow growing too.
Question:  #47 4/20/2009		Q:	Hello again, emailed yesterday, but had one more question that I have not really found definitive answer to. 2.1 cm highly er pr positive (3+), clear margins with double mast in Feb 09. Sentinel node biopsy originally negative upon H&E. Was told two days later a 2.5mm cancer was in one sentinel node (IHC). Axillary dis: 10/10 nodes negative. I know that there has been ongoing controversy about the prognostic significance of pos sentinel node found on IHC only. I believe there was a study that had been underway, but failed to accrue enough patients, so was closed. Anyway, what is current thinking on prognistic significance of this finding? Although mine not technically a "micromet", my surgeon referred to it as such.Thanks once again.
		A:	It is not a micromet and I wouldn't consider this as such. Having even one node positive is a sign that the cancer could have spread beyond the local regional area and therefore chemo would be a consideration. The fact that 10/10 additional nodes were negative is however, a very good sign. So it's not really a question of the significance of the one node, which again, tells us that you had a positive node, but really the better sign is that additional nodes were all negative.
Question:  #48 4/20/2009		Q:	report reads left breast 12-1 oclock zone 2. core biopsy invasive ductal carcinoma of breast, histologic grade 2 of 3 (modidied bloom- richardson, 0.7 cm in greatest dimension measured on the histologic slide involving all five biopsy cores. focal ductal carcinoma in situ dcis component solid type high nuclear grade with lobular cancerization. no definitive lymphovascular invasion identified no microcalcifications identified.estrogen receptors negative <1%) progesterone receptors negative (0) % as determined by manual what does this mean and they mentioned cemo and radation is this really bad and they could not find the tumor on mammo only on ultrasound do i need a mri before lumpectmenty
		A:	What we know so far is based on the core biopsy, a piece of the tumor. You have an invasive cancer. The estrogen and progesterone receptors are negative on core biopsy. I am not hearing the size seen on ultrasound. After surgery, you will have all the information about the tumor and a pathology report that will stage the cancer and will guide treatment decisions. Chemotherapy, a systemic treatment is recommended for certain tumors depending on size, certain characteristics and lymph node status. Chemotherapy is used to reduce breast cancer recurrence in other organs than the breast. Radiation is recommended for most all lumpectomy surgeries to lower local in breast recurrence. (It is also recommended after some mastectomies.) Your doctor may be suggesting future treatments on more knowledge than shared here. THink of this cancer as treatable. ds
Question:  #49 4/5/2009		Q:	my mom 48years old is diagnosed with breast cancer.her reports as such:Infiltrating pleomorphic lobular carcinoma grade 3,pleomorphic LCIS(high grade) is noted,desmoplasia and elastosis is noted,dystrophic calcification is seen,modified R.B score=3+3+2=8,ER=positive(score 2),PR=positive(score 6),cerb B2=negative, E.cadherin-negative. i wan to know which stage she is in??can u please explain to me the report
		A:	this report is probably from the biopsy and not from the lumpectomy/mastectomy surgery yet. the diameter of the invasive lobular carcinoma along with the lymph nodes (if any are positive for cancer and how many of them contain it) determine her stage. lobular has a reputation for being bigger than it appears to be on a mammogram report too so we can't go by the mammogram measurement at this point.
Question:  #50 4/4/2009		Q:	On my Core Needle biopsy - receptors factors were not done and had to be resent out - came back in as triple neg - with 0 listed as amounts on each. Had lumpectomy on 3/25/09 showing IDC 1.2cm, Stage 1, Grade III, no nodes but no receptors were checked, so we are all assuming I am triple neg solely from the Core needle biopsy. When I asked why they weren''t done on the final biop. I was told by my BS that the radiologist didn''t feel it was necessary. Can I be comfortable with this and let it go, or do you feel they should be retested. Am also going back in on 4/15 for a re-excision as two margins show remnants of DCIS (which I didn''t know I had). Thank you for any input.
		A:	hormone receptors that are negative on a core ARE to be retested on the surgical specimen due to tumors have an uneven distribution of hormone receptors within it. so you are correct. it worries me that the doctors taking care of you don't know this. be sure margins (all 6) are at least 2 mm in all directions free of abnormal cells.
Question:  #51 3/29/2009		Q:	I have 2 Path reports. 1st report says, ''DCIS, Low grade, solid type'' 2nd report says ''DCIS Grade 2-3 of 4, Solid and Papilliary'' Is low grade the same as Grade 2-3? Did the 1st report miss the Papilliary. Can you explain if this all means the same thing. I am arranging to send the slides to Dr. Argani for a 3rd opinion. Am doing overkill here? Please advise. Thanks.
		A:	i would not be sweating over this one. most important is that both agree it is just DCIS. the grade isn't worrisome either way. grade 1 or grade 2. papillary is a very favorable form of DCIS as well. the key is clear margins-- all six sides of the specimen. you had stage 0 breast cancer. can't beat a number lower than that!
Question:  #52 3/29/2009		Q:	Thank you for this site. I just had the cpyd26 test run and it came back saying I had one functional and one non- functional allele *41, but the report said I had a "normal" phenotype. I''m on tamoxifen now and we ran the test because I''m have a hyster/ooph in May and if I was a good metabolizer of tamoxifen I was going to stay on it for 5 years, then move to an AI. I had IDC (schirrhous), 2.6cm, node neg 0/10, er/pr+, her2-, clear margins, mib-low, no vascular invastion, oncotype dx 15. I am 48. I had a bi-lateral mastectomy, with immediate reconstruction. I was being treated with tamoxifen alone, but decided I wanted an oopherectomy, and decided to take everything out. My oncologist says that even with the non-functioning *41 allele, I''m a good metabolizer and can stay on the tamoxifen, and then move to an AI later. My periods stopped right after I began taking it--I had night sweats for about two months, but they have pretty much ended. I sometimes get a hot flash during the day. Definite fatigue and, "other changes", so something is happening to my body on the tamoxifen, it seems to be working to some degree. Do you use the cyp2d6 test? Is it true that with one non-functional allele that I can still metabolize tamoxifen enough to stay on it with success? Thank you again for your time.
		A:	this test hasn't become mainstream but is being used more frequently now that its value is better understood. sounds like a good plan for you too. this can stretch out your time on hormonal therapy, and help ensure that the treatment you are taking is benefitting you to the fullest.
Question:  #53 3/9/2009		Q:	My pathology report says this: Multiple sections from the right breast show area of fibrosis and cystic change with extensive adenosis. Intraductal hyperplasia is seen as well as apocrine metaplasia and periductal chronic inflamation is also identified. Some areas show sclerosis with the adjacent proliferative changes, but no in-situ or invasive carcinoma is identified. Calcifications are seen within benign ducts in areas of adenosis. The sentinel lymph nodes show no metastasis. Sections from the left breast show an additional lymph node without metastasis. There are similar fibrocystic changes to the right side with proliferative change, adenosis and periductal chronic inflammation. Calcifications are seen within benign ducts. In sections from the biopsy site, a microscopic focus of dcis similar to the orignianl biopsy is seen which surrounding post biopsy reactive changes. Previous pertinent history: Left breast stereotactic biopsies: Intermediate grade DCIS with micropapillary features and cancerization of lobules associated with focal microcalcifications. No invasive carcinoma identified. Estrogen positive. I know this means I had a small area of dcis in the left breast but what does all that indicate that was seen in my right breast? Did it put me at higher risk for cancer there too? Gross Deion shows Specimen #1 right breast is a 318 gram per the operating room scale, 17.0 x 16.0 x3.0cm right simple mastectomy specimen. The specimen is partially surfaced bya 9.5 x 4.0cm tan wrinkled skin ellipse. The everted nipple measures 1.3 cm in diameter. The specimen is serialy sectioned to reveal predominately tan/yellow lobular adipose tissue. There are focal areas of tan/pink fibrocystic breast tissue. No invasive tumor or previous biopsy sites are identified. The fibrous breast tissues show grossly dilated ducts which exude a gray/green material. Specimen #2 labeled left sentinel node biopsy, received fresh for frozen section are three tan/pink lymph nodes averaging 0.6cm in greatest dimension which are submitted entirely for frozen section. Specimen #3 labeled left breast, is 441gram per operating room scale, 20.0x19.0x3.5cm left simple mastectomy. The specimen is partially surfaced bya 9.0cm tan wrinkled skin elipse. The specimen is serially sectioned from the superior toward the inferior aspect to reveal a 0,8x0.8x0.4cm ill defined tan/pin firm area at the 3 oclock margin consistent with a possible biopsy site. No definitive site or invasive tumor can be appreciated. The remaining cut surface shows and abundant amount of fibrocystic breast tissue. The ducts are dilated and multiple tan/pruple cysts are identified. The specimen is submitted to radiology for specimen mammogram aaaand the clip is identified within the specimen. Question 2 Did I have clean margins I just don''t see it specifically stated. Thank you. I''m a respiratory therapist but all this pathology is still hard to understand for me.
		A:	The reason you would be at higher risk for breast cancer is the dcis. Findings in left breast are normal. Since you had mastectomy for a small dcis, the margins are clear. ds
Question:  #54 3/9/2009		Q:	Hi Lillie, my doctor''''s nurse just called me and told me my doctor wants me to see a surgeon. This is base on the biopsy results: Benign fibroglandular breast tissue with fibrous mastopathy including cystic change, apocrine metaplasia, papillomatosis and INTRADUCTAL HYPERPLASIA OF THE USUAL TYPE. I don''''t understand what this mean, the only good thing is that what ever it is, is benign. Can you explain this to me in plain english? I''ll really appreciate it. My doctor didn''t talk to me I got an appointment for the surgeon for 3/18. Thanks.
		A:	A milk duct in the breast is lined with normal cells. With ductal hyperplasia, the duct contains an increased growth in the cell size or the number of cells presnt. The cells can be atypical, abnormal looking. The best way to diagnose and treat this is first mnamogram, then needle biopsy as you had done. The surgeon will remove the abnormal area because there is a slight chance that malignant cells could also be present. If no cancer is identified, careful screening will be suggested. ds
Question:  #55 3/1/2009		Q:	I am a 47 year old mother of 3 with no history of breast cancer in my immediate family. However I recently went in for a mamogram which led to a stereotactic biopsy of left breast due to cluster of microcalcifications. Can you please help me understand what all of this means and tell me if I need to be concerned. I am scheduled to go for a follow up mamo in 6 months. Diagnosis: benign breast tissue showing fibrocystic changes, intraluminal calcifications, focal florid usual type hyperplasia and apocrine metaplasia. Thanks for all your help. This sight is very informative.
		A:	having microcalcifications is a common finding on mammograms for many women at some point in time. the pathology results tell you that it was not breast cancer or even precancerous findings. congrats! these calcifications are calcium, unrelated to diet by the way. there were no atypical cells found either so all findings were completely benign. normal follow up is to get breast imaging again in 6 months. all the words in the pathology report match with normal breast tissue.
Question:  #56 2/28/2009		Q:	Hi Lillie, thanks in advance. Please help me for below mentioned report:- MICROSCOPIC DESCRIPTION A. Sections of breast core show fibrocystic change featuring ductual dilation, fibroadenomatoid hyperplasia, columnar alteration with focal hyperplastic changes and mild cytological atypia, stromal fibrosis and chronic inflammation . Focal intraluminal microcalcification is noted. B. Sections of breast cores show a circumscribed benign fibroepithelial lesion composed of breast ducts and tubules dispersed hapzardly in a fibromyxoid stroma containing plump stromal cells and a few chronic inflammatory cells. There is no stromal overgrowth, increase mitosis or cellular atypia. Features are consistent with fibroadenoma. Adjacent breast parenchyma shows features of fibrocystic change, ductal dilation, mild adenosis, focal apocrine change, stromal fibrosis and chronic inflammation. C. Sections of breast cores show a benign fibroepithelial neoplasm composed of compressed breast ducts and tubules dispered in fibromyxoid stroma.. The lesion is well circumscribed and multilobulated . There is no stromal overgrowth, increase mitosis or cellular atypia. Adjacent breast parenchyma shows fibrocystic change featuring mild ductal dilation, stromal fibrosis, mild chronic inflammation and mild adenosis. A,B & C-There is no evidence of insitu or invasive malignancy. Do I have very high risk as the doctor have schedule me for another close follow up mamo & u/s within 6 months times. Worried
		A:	nope, you don't!! it is routine to schedule for a 6 month follow up when benign findings like these are found. congrats!!!
Question:  #57 2/22/2009		Q:	Lillie, thank you very much for all that you do on this site!! I have two questions. I was diagnosed with infiltrating ductal carninoma with 2 of 3 positive nodes in 2006. Lumpectomy, chemo, bilateral mastectomy, and radiation. Was told it was ER positive, PR positive and Her2 negative. Took tamoxifen for 18 months, and then switched to Fermara. I was recently reading my pathology report. It says in part ER/PR yes, Her 2 Yes Ki-67 yes. Two questions:(1) If mine is Her negative, what does pathology report mean when it says "Her-2 yes". (2) what does "Ki-67 yes" mean? Thank you.
		A:	Good questions. What the typed on the report were not actually the results but i think instead that the tests were performed. For ER and PR it should have a % number. For Her2neu it should be either a negative sign, or 1plus, 2plus, or 3 plus signs. Ki67 should also be a % number. so call the pathology dept and ask about these things, requesting a report with the actual results in them. LS
Question:  #58 2/14/2009		Q:	In 2005 (I was 41) I had three lumps in my right breast surgically excised and was diagnosed with ADH in two of those lumps. February of this month I had a lump surgically excised on the left breast. The pathology is papillomatosis. There is so much of it that they are going to do some additional tests and staining to be sure that is what is being seen. As I understand it, papillomatosis, like ADH, simply raises my risk. Is there additional risk for having both conditions? Are these two conditions just degrees of cell growth along the same continuum?
		A:	correct about last question. and the combo doesn't make risk worse.
Question:  #59 2/14/2009		Q:	My mother had undergone mastectomy of right breast- she was detected with paget''s disease in right nipple. After that her pathology report for ER/PR/HER is as follows: HER-2/NEU-Oncoprotien(IHC) is positive.Intensity is 3+, % HER2/NEU-Positive +98%. I have a couple of question on that basis: 1)What should be line of treatment to prevent this from happening in any other place. 2)Can you please explain the report what does it mean ER- PR- with HER2/NUE 3+ is very rare combination is it? 3) What should be done in such a scenario?
		A:	treatment is dependent on her age, size of the tumor in the breast, number of lymphnodes with cancer, and what scans have shown that might be elsewhere. her prognostic factors are unfortunately not favorable making this a more challenging form of breast cancer to treat. it is not stimulated to grow by estrogen or progesterone. we actually prefer that it were positive. and her HER2neu was positive when it is preferred to be negative. this tells us that it is over-expressing a specific protein that makes it mischievous to treatment. so its possible that herceptin might be one of the drugs given if the invasive tumor was large and nodes were involved. if the disease was limited to dcis of the nipple however then HER2neu wasn't even supposed to be done since it carries no meaning for noninvasive disease. hormone therapy will not be used either. LS
Question:  #60 2/14/2009		Q:	What is the difference between Luminal A and Luminal B breast cancer?
		A:	Luminal A and luminal B types: The luminal types are estrogen receptor (ER)-positive, usually low grade, and tend to grow fairly slowly. The gene expression patterns of these cancers are similar to normal cells that line the breast ducts and glands (the lining of a duct or gland is called its lumen). Luminal A cancers have the best prognosis. Luminal B cancers generally grow somewhat faster than the luminal A cancers and their prognosis is not quite as good.