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Category:

Understanding Pathology Results

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Question:  #571 5/3/2006		Q:	Lymph Nodes exisional biopsies#1-3 -Metastatic Carcinoma to one of three lymph nodes, measuring 1.3mm, approx. 100-200 cells in glands and clumps in the subcapsular sinuses of the lymph node and the cortical portions of the lymph node. -Other two nodes, negative for cancer. Mastectomy Residual infiltrating ductal carcinoma, well to moderately differentiated with low nuclear grade measuring 1.3 cm. Focal lymphovascular invasion observed minimal non-comedo DCIS component Tubular component, involving area of sclerosing adenosis. ER/PR Positive >90%, HER2 negative Premenopausal:AC 4x T 4x, tamoxifen. I keep trying to find positive info. in report but I am very concerned about the lymphovascular invasion. Since it is a focal area and the sentinnel node was positive, does this mean that the more than likely the path taken was to the sentinnel node versus the blood stream?
		A:	don't worry about your blood stream... focus on next steps instead. chemo is designed to travel throughout your body no matter where any residual cancer may be.
Question:  #572 5/2/2006		Q:	Do you have an "Ask an Expert" forum by breast pathologists?
		A:	for a re-review of pathology slides, which our breast pathologists do offer, just call chanel at 443-287-2778 and she will instruct you how to do this.
Question:  #573 5/2/2006		Q:	My core biopsy came bak as follows - intraductal carcinoma, solid type, nuclear grade 2-3, with cnetral necrosis and microcalcifications, 1mm focus. One question I have is I have read that central necrosis with microcalcs are ofthe comedo type. Yet, I ask my surgeon (Dr. Klimberg) if I had comedo-type DCIS, she said no, that my record did not indicate that. I am confused. Also, what does the 1mm focus mean? Was that all of the malignant area? She said there was "residual" cells left. The MRI and Pet scan indicates that area "persistent enhancement" of 1.3 x 1.2 x 1.5 cm area. What does this mean? Is the whole area malignant? What does slight increased FDG activity with SUV of.0.50. Is that very bad? Thanks
		A:	doing MRI post biopsy can be misleading because the area biopsied will light up more anyway. that said, since the report didn't specifically say "comedo type" then you assume it wasn't that type of DCIS. 1mm focus implies that in the biopsy they only saw 1mm of DCIS. this is a biopsy though and not the whole specimen. so next step is lumpectomy.
Question:  #574 5/1/2006		Q:	Hi I had a stereotatic bx on 4/5/06 which showed dcis solid typte intermediate nuclear grade 2 of 3 with calcifications and necrosis note; a minute focus suspicious for microinvasion is present. I have undergone a wide excision with lumptectomy this past week I am awaiting final path report on Thurs May 4 I have not met with oncologist. but the surgeon feels the course of treatment would be radiation, tamoxifen nd maybe chemo. what are your thoughts Thank you
		A:	radiation is a given with lumpectomy. hormonal therapy is recommended usually for women with hormone receptor positive breast cancers. microinvasion would be highly unlikely to result in recommendation for chemo. its possible but would be pretty unusual unless the disease was found in the sentinel node. then there may be a discussion about it.
Question:  #575 4/26/2006		Q:	My IDC was dx as grade 1 stage 1. My hormone indicators were strongly postive for estrogen and negative for progesterone. Is there any special meaning for ER+ and PR-? I can't seem to find out info concerning this. Most of the info deals with ER+ and PR+ Does this affect treatment or prognosis? My SNB was negative and there is no node involvement. Plus my Her2 is -. But the whole er,pr thing has me confused and concerned. Any clairifiction would be apprecaited.
		A:	being ER positive is the key... so good news. hormonal therapy works best with both being positive but works also extremely well with ER + and PR -
Question:  #576 4/26/2006		Q:	Looking for some clarification and details on what a well behaved tumor is? Thanks again.
		A:	usually responds well to treatment. lower incidence of recurrence.
Question:  #577 4/26/2006		Q:	thank you for answering so quickly. Sorry a few more questions. From my pathology result could you tell me what stage I am and whether i have a good prognosis and what mitosis means? Also what frozen section. DABS both negative(GW) means ? Q: 1.7mm invasive ductal carcinoma.2 nodes removed in sentinel node biopsy neg .ER+ 75% Pr+ 75% ( no results for hep yet). I was originally told i had well defined grade 1 from the biopsy and would propbably need radiotherapy and hormone drugs but the full pathology results are saying 17mm grade 2 ductal carcinoma (tubules=2,pleomorphism=2, mitosis=1) some dcis is seen within margins of tumour NPI 3.3, no lympho-vascular invasion and they are now recommending chemo (anthra) and tamoifen. Could you tell me the difference in my chances of reacurrence and survival if i do NOT have chemo and just radiation and tamoifen? many thanks. louise
		A:	stage 1. good prognostic factors of hormone receptor positive.
Question:  #578 4/25/2006		Q:	I am a 41 year old in the UK who had a lumpectomy 2 weeks ago to remove a 1.7mm invasive ductal carcinoma.2 nodes removed in sentinel node biopsy neg .ER+ 75% Pr+ 75% ( no results for hep yet). I was originally told i had well defined grade 1 from the biopsy and would propbably need radiotherapy and hormone drugs but the full pathology results are saying 17mm grade 2 ductal carcinoma (tubules=2,pleomorphism=2, mitosis=1) some dcis is seen within margins of tumour NPI 3.3, no lympho-vascular invasion and they are now recommending chemo (anthra) and tamoifen. Could you tell me the difference in my chances of reacurrence and survival if i do NOT have chemo and just radiation and tamoifen? many thanks. louise
		A:	your doctor can using www.adjuvantonline.com
Question:  #579 4/25/2006		Q:	Follow up to my original question which was, " I am a 48 year old who has never had a pregnancy and no history of breast cancer. A few days ago I had a needle biopsy done and this is what it said:" Moderately differentiated lobular carcinoma with an SBR score=6 (tubule formation=3, nuclear pleomorphism=2 and mitotic count per 10 high power field = 1) an intraductal carcinoma is not identified. No lymphatic invasion is identified. Receptor studies will be deferred to a larger biopsy unless specified by one of the clinicians". I am in Los Angeles so will be going to UCLA. What questions should I ask the oncologist with regard to my specific case per the above facts? THANKS IN ADVANCE. (From my internet research I assume I will need a lumpectomy with radiation.)
		A:	first, the surgeon needs to remove it so pathology has a complete specimen and can measure it and stage it. sentinel node biopsy also is needed. the pathologist will do hormone receptors and her2neu also. all this information is needed before seeing the medical oncologist about adjuvant treatment.
Question:  #580 4/25/2006		Q:	My Mother's story so far: 67 years old, dx. on 2/25/06 thru core needle biopsy of breast mass, as intermediate grade Mammary Carcinoma with lobular features. Right Breast, Microscopic on Biopsy: Sections show multiple pieces of needle core of fatty breast tissue. There is focal fibrous condensation. There is a single core which shows invasive carcinoma with lobular features. Lymphovascular invasion not identified. The remaining breast tissue shows nonproliferative fibrocystic change. Next step: Lumpectomy with sentinel node removal. Pathology on this procedure: Diagnosis: A) Excesion, Sentinel Lymph Node #1: Reactive lymph node, no evidence of metastic mammary carcinoma B) Excision, sentinel lymph node #2: Microscopic focus of metastatic lobular carcinoma Broad Spectrum cytokeratin (A13): focal positive C) Segmental Mastectomy, Right Breast: 5.0 mm nodular, lobular carcinoma in situ at anterior (superficial) margin Surrounding invasive lobular carcinoma with several foci of positve anterior margin (Please see comment) Lymphovascular invasion not identified t1c pNO MX Comment: It is difficult to estimate actual size of the invasive component of the tumor because it infiltrates insidiously through tissue and is present on at least four different sections taken serially encompassing the biopsy cavity. Tumor is estimated to be between 1.8 and 2.0 cm. in greatest dimension however. Microscopic: Sentinel node #2 Multiple levels show a small microscopic focus of metatstatic lobular carcinoma (0.3 mm) on a small piece of lymph node. This is identified initially with a broad spectrum cytokeratin immunohistochemistry (AE1/3). Independent review of the ORC SLN smears (ECM) confirms negativity. Microscopic about the tumor, among other things,(I UNDERSTAND), are the report that tumor is not identified in lymphatic spaces. The margins were not clear, so a recission was recommended. My mother opted for a bi-lateral mastectomy with axillary lymph node removal, with immediate reconstruction with expanders. She had this done on 4/18/06. Here is her pathology for that: Diagnosis: A) Right breast, Modified Radical Mastectomy: No residual Tumor around biopsy site All Margins of resection negative Nipple showing no involvement by carcinoma Lymph nodes pending reprocessing B) Left breast, simple mastectomy: Benign nonproliferative fibrocystic change left nipple negative for neoplasia Microscopic: A) Sections through the biopsy site show hyalinized fibrous connective tissue wall with granulation tissue and fat necrosis. Foreign body giant cell reaction is seen but no residual carcinoma. The breast tissue around the previous biopsy site shows exuberant fibrocystic change with sclerosing adenosis, apocrine metaplasia and microcalcifacation. The deep margin of resection is negative. The nipple and areola are negative for tumor. An area of suture is seen in the subareolar tissue near the previous biopsy site. The skin of the nipple shows no involvement by carcinoma. Random breast sections shows no additional areas of carcinoma. Lymph nodes are fatty replaced and sre pending reprocessing. B) Sections from the left breast show benign fibrofatty breast tissue with nonproliferative fibrocystic change. Foci of sclerosing adenosis with microcalcification are seen. No ares of atypia or carcinoma are seen. The nipple shows no significant pathologic change. Sections through the breast parenchyma show predominantly fatty breast tissue without areas of atypia. Addendum Discussion Diagnosis: A) Right Breast, Modified Radical Mastectomy: No residual tumor around biopsy site All margins of resection negative Nipple showing no involvement by carcinoma Eight lymph nodes negative for tumor Comment: A) Re-processed nodes show adequate sections for evaluation. Eight lymph nodes are examined and all are negative for tumor. Now, Would you please explain the microscopic findings on the A) right breast modified radical mastectomy. I do not know what her hormone receptor status, or her her2 status is! I have not found it on any of the copies of pathology that we have been faxed. My mother's oncolgy surgeon said, (after the lumpectomy, snl, procedure), that she would probably have to have chemo, and 5 years of Tamoxifen. We have not met with the medical oncologist yet. Do you think that from her patholgy reports for the bi-lateral mastectomy, and the axillary lymph node removal, that chemo will still be needed? And what do you think her chances for distant metastic spread is, and her prognosis? Should she get bone scans, body scans etc.? Thank you so much!
		A:	sounds like it was difficult to definitively measure the invasive lobular carcinoma but if they feel it was close to 2.0cms then usually a healthy discussion about chemo takes place. one node from the original surgery had microscopic disease in it as well. that would influence this too. hormone receptors and her2neu were listed. hopefully she will be hormone receptor positive and be a candidate for hormonal therapy which some may feel is okay to do instead of chemo. others would say to do both. request that her case be presented to their weekly tumor board. her other breast was benign. no additional findings of cancer in the mastectomy specimen.
Question:  #581 4/25/2006		Q:	Besides the liklihood of hormonal therapies being effective, is there any other significance in the percentage of ER and PR? For example, would a tumor with 90% ER be slower growing than a tumor having 30% ER, is a higher % more detrimental, etc. Any comments would be appreciated. Thanks.
		A:	growth rate isn't determined by hormone receptors. its determined by the grade. (grade 1,2 or 3). the more hormone receptor positive a tumor is though the better behaved it usually is.
Question:  #582 4/25/2006		Q:	I am wondering if you could help me out regarding my cancer. I had a lumpectomy and auxillary node dissection two weeks ago and am now awaiting treatment. My path. report states that it was adenocarcinoma, infiltrating ductal with undifferiantiated edges. It is 1cm. which is small. Bloom Richardson is nuclear grade 2, tubular formation-2, mitotic score-1, overall score-5 grade 1/3. In situ component is moderate, cribiform type. Nodes were clear and we got clean margins. Other abnormalities were fibrocystic changes. Hormone receptors pending. Staging 1b, N0, Mx. I am 46 and have varied health related problems. I also had a benign tumor removed from my other breast and it shows inflamed ducts, enlarged nodes and another cyst surrounded by debris and some microcalcifications. Now, my question is regarding treatment. I know I will have radiation, but it has been put to me that chemo is also an option. I am worried about the changes in the non-cancerous breast and the possiblity of metasis. Do you think chemo is warranted? Is there anything else that I should look at? Thanks so much for your help. You run a valuable service here. God Bless.
		A:	wait and see what your hormone receptors and her2neu receptors are. these weigh in heavily for women in the gray zone for whether chemo is or isn't needed.
Question:  #583 4/24/2006		Q:	I am a 48 year old who has never had a pregnancy and no history of breast cancer. A few days ago I had a needle biopsy done and this is what it said:" Moderately differentiated lobular carcinoma with an SBR score=6 (tubule formation=3, nuclear pleomorphism=2 and mitotic count per 10 high power field = 1) an intraductal carcinoma is not identified. No lymphatic invasion is identified. Receptor studies will be deferred to a larger biopsy unless specified by one of the clinicians". What should I do next?
		A:	time to see a surgical oncologist who specializes in breast cancer. you are welcome to come to us. been seen and treated at a comprehensive breast center that is NCI designated is important. just call 443-287-2778. thanks... hang in there. this is all doable.
Question:  #584 4/17/2006		Q:	I had undergone a lumpectomy/SNB in Mar 06. My path report says: specimen-tumor mass left breast; invasive component-infiltrating lobular ; size 0.9 x 0.6 cm (measured in 2 dimensions on glass slide); histologic grade (MSBR) 2 (6/9 points) nuclear grade 2 (2 points) tubule formation : minimal (3 points) mitotic rate-1 point; no tumor necrosis and no lymphatic invasion: er 80% pos. & PR 60% pos., HER-2 negative.clear margin was not obtained and must undergo another lumpectomy (my decision) and axilary node disection (3 nodes showed positive). I am 44 - pre-menopausal and am told that chemo/radiation/hormone therapy (tamoxifen) will be necessary. I am very scared and am fearful of what is all to come. From this information, can you tell what the outlook may be? TNM classification also shows pT1b, pN1, pMX. Pet scan was clear also.
		A:	take in a deep breath. this is doable. hormone receptor positive is a good prognostic factor. chemo will help to prevent cells that may have traveled from getting to grow further and it will carry you further up the survival curve. stage 2. doable.
Question:  #585 4/17/2006		Q:	Had initial mamo at age 37 - no family history of cancer. "Areas of calcification" showed up. Had stereotactic biopsy. Path results said calcified papilloma and LCIS. I was sent to a surgeon who seemed confused why I was referred to him - said he would consult with the pathologists and radioligist and call me in a few days. With these 2 diagnosis' do I need surgery - or is it a "watch and see" type diagnosis?
		A:	usually surgery is done to remove the papilloma and ensure no early stage breast cancer is present near it or the LCIS
Question:  #586 4/17/2006		Q:	Diagnosed with DCIS after excisional biopsy this month. Pathology report states: Left breast mass at 5oclock: intraductal carcinoma, solid type, with necrosis and calcifications. Proliferative fibrocystic changes with sclerosing papillary lesion and sclerosing adenosis. Carcinoma panel states: Tumor size; President in eight of nine blocks, Nuclear grade; 2, Histologic grade; n/a, Mitotic index; 1, Angiolymphatic involvement; not identified, % of in-situe tumor volume; 100%, Excision margins; not evaluable (multiple fragments); Fibrocycstic background; proliferative fibrocystic changes. Now this followed a core biopsy 7 mos ago that was diagnosed as 'radial sacar w/focal assoc atypical ductal hyperplasia. fibrocystic change, including cyst formation, sclerosis adenosis and apocrine metaplasia. Microcalcifications are present. MY QUESTION: It is hard for me to compare sizes of 3-4 masses from MRI prior to core biopsy and MRI post excisional biopsy. It does seem that (although two different imaging centers used) that the mass of what was removed plus what is left is larger than MRI of 9 mos ago. But am I to assume that since core biopsy showed no carcinoma and excisional biopsy seemed to show 100% presence of carsinoma that my DCIS is destined to progress more rapidly or is more likely to become invasive? Masses are in lower outer and upper central quadrants and mastectomy is recommended. I need to have all info before being comfortable with treatment decision. Thank you for this site!
		A:	can't make that assumption. your case is a good one for presenting at your surgeon's weekly breast cancer tumor board. ask that it be presented to give you some answers to these questions.
Question:  #587 4/16/2006		Q:	Had initial first discussion with breast surgeon who immediately recommended total bilateral mastectomy then chemo after core biopsies in both breasts - pathology found a 3.5cm tumor in left breast diagnosis: infiltrating ductal carinoma, intermediate tubule formation (2), intermediate to high nuclear grade (2-3) low miotic rate (1), Bloom/Richardson score Nottingham modification 5-6 out of 9, ductal carcinoma in-situ identified, cribriform type, intermediate nuclear grade without necrosis, without associated calcifications; ER/PR/Her2 ER: 98% tumor cells positive, PR 80% tumor cells positive, c-erb B-2 indeterminate 2+ for overexpression of c-erb B-2 protein. Right Breast - infiltrating ductual carinoma, intermediate tubal formation 2, intermediate nuclear grade 2, low mitotic rate 1, bloom richardson score - Nottingham modified 5 of 9, ductal carcinoma in-situ identified, crbriform to cicropapillary type, with focal necrosis, with associated calcifications, columnar cell change with atypia, ER -100% tumor positive infiltrating carcinoma, PR 50-60% tumor positive infiltrating carcinoma, c-erb B-2 Negative score of 1+ cor overexpression. I nearly fell off my chair - expecting most likely a recommendation of a lumpectomy on left breast and radiation as treatment. I had no idea about right breast and surgeon said that the right one for certain had to go and size of left tumor would most likely best be served by total mastectomy as well just to be certain. No known issue with lymph nodes - but they would do surgery on centinals at time of mastectomy. Also suggested that I be tested for Cancer gene - in case needed hysterectomy as well. At that point - blackout was nearly certain. We left discussion and made a phone call to another clinic seeking a second opinion. They expressed that first treatment they typically perform is chemo to shrink tumor prior to surgery - I have to wait two weeks before I can see the next doctor to hear a difference of opinion. I'm shocked, confused and don't know how to read this - don't know severity - and feel like something is awry. Definately getting 2nd and 3rd opinions, would love to hear your thoughts about what all of this means and best approach. Please help. I'd like to explain this to my family and friends and be able to keep the faith so - thanks for your guidance.
		A:	neoadjuvant chemo is a worthy suggestion to explore and something we would probably discuss with you if you came our way. shrink the tumor(s) down. do a sentinel node biopsy now to know if there is nodal involvement and to help determine the amount of chemo needed. good possibility in doing chemo first that lumpectomy then is doable. if you want to come to us just call 443-287-2778.
Question:  #588 4/16/2006		Q:	After two negative needle biopsies taken within the last 9 months, my 87-year-old aunt went in for surgery to remove the breast mass under her left arm which had hardened over the period. She is large-breasted and it never showed on her mammograms. The negative biopsies enabled her to put off surgical removal of the lump. She was finally convinced to proceed and two weeks ago a lumpectomy for a benign mass was performed. The biopsy came back as follows: -Invasive mammary carcinoma with lobular features, modified Bloom & Richardson grade II of a possible III (nuclear grade 2 of 3, tubule formation < 10%, mitoses < 1/10 hpf), occupying almost entire specimen (4.4 cm) and present on all resection margins. -Estrogen, progesterone & Her2/neu receptor studies....separate report. Gross deion: ...The specimen consists a portion of fibroadipose issue measuring 4.4 x 3.8 x 3.2 cm. .... The specimen is then sectioned revealing an ill-defined gray white mass measuring 0.8 x 0.8 x 0.7 cm. Grossly this mass extends to within 0.3 cm of the inferior margin, 0.5 cm of the superior margin, 0.6 cm of the anterior margin, 0.6 cm of the lateral margin, and greater than 1.5 cm from the medial margin. QUESTION: How can two biopsies be wrong if the cancer cells occupy “almost entire specimen(4.4 cm) and present on all resection margins?” QUESTION: Since the surgeon wasn't doing "cancer surgery" he didn't remove any lymph nodes---would it be best to get the 'sentinel node biopsy' performed before proceeding to remove all lymph nodes? QUESTION: Any other pre-op tests which would be helpful now? A breast-cancer survivor friend recommended: CAT scan with Contrast; bone scans; CA 27-29 blood test for breast cancer only; CEA bloodwork. QUESTION: What's the stage .... Stage 2 and slow growing? QUESTION: The mass was large (4.4 cm) but there was an "ill-defined gray white mass measuring 0.1 x 0.8 x 0.7 cm. What’s the difference between the small gray white mass and the larger mass of tissue? QUESTION: That 0.8 cm mass does not extend TO the various margins mentioned but in the diagnosis above it says that the carcinoma is "present on all resection margins." Are we to assume that cancer was on the margin of the larger mass and therefore more excision surgery is required? QUESTION: I read elsewhere in the Q&As here that radiation treatments for women over 70 are not as beneficial as previously hoped. What does that mean? Not worth doing after surgery for an 87-year-old? QUESTION: Chemo just seems too harsh but she may be willing to do it if required. Is the efficacy as poor for chemo as it is with radiation? Thanks.
		A:	Find out if at the time the original core biopsies were done that were negative, did the doctor place a clip in the spot where the tissue was sampled? were mammograms done immediately after the biopsies to help ensure that the mass in question was the area biopsied? This is a large tumor... it has taken several years to reach this size. the pathology report though is confusing. it says that the cancer is at the margins but in the deion of the margins every margin is free of cancer. so something is confusing about this report. pathologist needs to clarify this. radiation for elderly sometimes is not felt to be of great benefit when its mission is to prevent local recurrence--- and her age of 87 would imply that she may have other health issues that could cause her death long before a recurrence of the disease would. and radiation is not without side effects. that said, again depending on whether they would treat her differently if her sentinel node was positive needs to be answered. if it were positive they may do an axillary node dissection for example. doubtful that chemo would be offered, again because of side effects and her age. if hormone receptor positive though she may be a candidate for hormonal therapy that would be helpful.
Question:  #589 4/16/2006		Q:	I am 29, diagnosed with invasive ductal carcinoma, had lumpectomy to remove 1.1 cm tumor. One margin came back positive for invasive lobular, 0.2 cm . My surgeon says she thinks the lobular was part of the same cancer as the larger ductal tumor. She is still classifying this as uni-focal. Is this accurate, even though there was no invasive lobular at all found in the larger tumor? My surgeon has recommended re-excision this week. I am not sure whether to proceed with this or to go instead with mastectomy. (I had a breast MRI prior to lumpectomy -- all it showed was a uni-focal mass at the site of the known tumor. Didn't show this additinal 0.2 cm mass, or anything else.) Is it likely that the cancer is really uni-focal even though it's both ductal and lobular? Thank you.
		A:	a tumor can contain both types of cancer. glad you got the MRI done as this helps to confer that this may be one mass and not two. you are young and it would be worthy to consider genetics evaluation too before making decision about type of surgery to do next. also a re-review of the pathology with another facility may help to answer the questions above you listed. you are welcome to come to us. 443-287-2778. there is no reason to feel rushed about getting the next surgery done. better to have all the facts and make an informed decision rather than merely a fast decision. also hope your sentinel node was negative.
Question:  #590 4/16/2006		Q:	Thank you for this wonderful service - My pathology results show a tumor with nuclear grade 3 but mitotic rate 1 - What is the prognostic value of these results? Thanks!
		A:	its more significant to focus on the grade. this would imply this is a more rapidly growing tumor. next look at the size of the invasive component. for women needing chemo, chemo works best on grade 3 cells. if you have additional information from the pathology, like tumor diameter, type of breast cancer, sentinel node results, hormone receptors, her2neu receptors that would be good to know. if all factors in. none of it "stands alone."
Question:  #591 4/15/2006		Q:	This is my story and would like your opion on treatment.In january I had two specimens removed for path.Report reads,extensive high grade comedo-type dcis with cancerazation of lobules.Associated microaclcifications grade 3.DNA index pop.1.25,Dna index pop.2.39,Multiple aneuploid populations detected,Her-2 Fish 3+,Estrogen pos., progesterone neg. In March had lumpectomy,path read high grade focal ductal carcinoma,microscopic foci of infiltrating ductal carcinoma grade 2,with involvement of deep aspect of retoareola,invasive foci present in 3/24 slides,greatest single slide deminsion 6mm.Organizing fat necrosis.Fibrocystic changes. I am 53 and premenopausal with very dense breast.Since margins weren't clear have had mastectomy recommended.What are your thoughts on prognostic indicators and treatment? Thank you for your time and may God Bless You.
		A:	the her2neu and hormone receptors now need to be done on the tiny amount of invasive disease that was found. sentinel node done at time of mast i hope. would be unusual to recommend chemo for someone with only tiny foci of invasive disease. no radiation would be done usually either. hormonal therapy likely. time to meet with a medical oncologist to discuss that.
Question:  #592 4/15/2006		Q:	I am post chemo, post surgery (bilateral), node negative, small, but clean margins. Possibly HER2 negative at biopsy and HER2 positive (IHC test waiting for results of FISH) after surgery. Herceptin is being recommended if in fact HER2 positive. Is it really necessary?
		A:	depends on size of invasive tumor, your age, hormone receptors before that decision is made. get two opinions from 2 different medical oncologist to help you decide.
Question:  #593 4/15/2006		Q:	OK here goes, my wife,s mother and her mother passed at an early age from breast cancer. She had a mastectomy less than 2 years ago and underwent a 4 week accelerated trail program of chemo,Paxo I believe was the drug. She has just undergone mastectomy of the other side and was told initially due to the size of the lumps found chemo would not be required. Upon onocologist visit with pathology report last week she was told his recommendation is Maximum treatment of 2 drugs for 6 treatments or 6 months. We do not have another onocologist in our area and really want to ensure we are doing the right thing as this was the doctors only recommendation and told he would not feel comfortable doing anything less. Here are the pathology reports, and Thank You and God Bless you for your site and all that you have done 2 seperate foci of Grade 3 Invasive and in Situ Ductal Carcinoma. Invasive element measuring 8 x 7 mm, significant comp of ductal carcinoma in situ with comedo necrosis, nuclear grade 3, associated with and along periphery of invasive carcinoma. In situ malignancy free of deeper posterior margin by 1.0 cm. Diagnostic Lymphovascular invasion not identified. 2nd focus of grade 3 ductal carcinoma 7 x 4 mm, invasive component free of deep or posterior margin by 0.3 cm with in situ component free of deep margin by 0.2 cm. Signifigant in situ component admixed with and along periphery of invasive tumor with comedo necrosis, nuclear grade 3. Diagnostic lymphovascular invasion not detected
		A:	am assuming her sentinel node biopsy was negative for tumor. if so, then this is stage 1 disease. 8mm and 7mm tumors. don't know her age. genetic testing should be considered too since there is significant family history and she has experience primaries now in both breasts herself. this would help to determine risk for next generation as well as help to determine if her ovaries should be possibly removed. that said, she really needs a formal consultation with another medical oncologist to determine chemo decisions. her hormone receptors and her her2neu receptors weigh in heavily here too. for example, if she were hormone receptor positive and her2neu negative then hormonal therapy may be what is recommended, again assuming her nodes were negative. the chemo drugs she had before can't be repeated so if she were to have chemo it would be different medicines this time.
Question:  #594 4/14/2006		Q:	I am 40 and went for the 1st mammo. I had no lumps or problems noticed and no family history of bc. Then a 2nd was done indicating calcifications and then a mammotome biopsy. I am trying to read the pathology report. Invasive ductal carcinoma, grade 3, and high grade ductual carcinoma insitu. T otal nottingham score: 9(grade 3). Tubule formation: minimal less than 10%(score 3). Nuclear pleomorphism: marked variation in size, nucleoli, chromation clumping, etc. (score 3). In-situ component: present, high-grade solid type with focal comedonecrosis, approx. 50% of tumor present in biopsy tissue. microcalifications: focal, in area away from tumor. The doctor offered me two options: lumpectomy or masectomy. How serious is my cancer? My surgery is scheduled in two weeks. thank you.
		A:	what a heck of a way to start your annual mammograms! what isn't present, and probably is in the mammo report, is the size of the area. the path report didn't say. you have invasive ductal which is the most common type. grade 3 so rapidly growing (but that is a relative term). no mention of angiolymphatic invasion in the biopsy specimen which is good. also had insitu disease-- very common. lumpectomy with radiation is equal to mastectomy from a survival perspective. if this is a relatively small lesion then usually lumpectomy is doable and still leaves the breast looking cosmetically acceptable. once the entire tumor is out then the precise will be known and decisions about other treatment can be made.
Question:  #595 4/14/2006		Q:	I was 40 years old when I had my first breast exam and was found to have distributed calcification. A fine wire biopsy was performed and tissue measuring 7.5 x 5.5 x 3.5 cm was removed. I was surprised post-surgery at the amount removed; all they said was that they would remove 1cm around the affected area without stating how large the area was. I am petite woman so this biopsy basically gave me a mastectomy. The tissue sample was negative. "The slides show breast tissue with extensive areas of fibrous stroma. There are some beign glands showing intraluminal calcifications. Some benign dilated glands are seen, some of which show apocrine metaplasia. There are some glands showing ductal epithelial hyperplasia (epitheliosis). There are some collections of small benign glands with features consistent with adenosis. A few of these are associated with a spindle cell stroma, assuming the appearance of sclerosing adenosis. A tiny benign lymph node is noted in one area, showing reactive follicular hyperplasia." Does this result indicate any future risk for developing cancer? Isn't a biopsy supposed to take out a sample and not the entire area (in my case, almost my entire breast)? I developed several complications after surgery including hematoma and shingles; is this normal for a healthy, active person?
		A:	you are correct that a biopsy is to take a sample... not the entire breast being the sample. these findings listed are benign and without signals of showing increased risk. so the doctor needs to explain why such an aggressive step surgically was taken. perhaps consider some form of reconstruction at this point.
Question:  #596 4/13/2006		Q:	I had a breast reduction 8/2004 everything when fine. I have had my yearly mammogram my results from the first one after surgery is as follows test done: 5/16/05-There is a scar in both upper outer quadrant. There is a scar in the inferior medial quadrant of the left breast. I see no suspicious cluster of calcification, spiculated densit,mas lesion or skin thickening I had a gyn checkup in Feb-06 and Doctor discovered a lump in my right breast had a mammoram of right breast results: Test done: 2/20/06 stated Their is a scar in the right upper outer quadrant with probably dsytrophic calcifications then an ultrasound of the right the right breast showed in the right breast at 7 o'clock, 3cm from the nipple there is a hypechoic, soild lesion measuring 1.4x0.9x0.8cm. An adjacent small cyst measuring 0.5x0.7x0.5 cm. The solid lesion does not correspond to the scar which is in the upper outer quadrant. IF WARRANTED CLINCICALLY, MRI OF THE RIGHT BREAST WHAT DOES ALL THIS MEAN!!!!!! DO I HAVE BREAST CANCER OR WHAT? AWAITING YOUR REPLY
		A:	they see something very small but were not able to definitively provide a diagnosis of what it is. doesn't sound terribly worrisome but due to your breasts having "changed" they want to be thorough. so follow up with additional testing to ensure piece of mind.
Question:  #597 4/13/2006		Q:	hi, A friend of mine was diagnosed yesterday with "Invasive ductal carcinoma w/adjacent atypical lobular and ductal epithelial hyperplasia". She knows she needs to have surgery right away but that's all she has been told so far. From what she has said it sounds really bad. Can you tell me what that term really means, and maybe refer me some places where I can do some good research? Thanks~
		A:	they probably can't tell her much of anything else until after her surgery is done. they will then know the diameter of the invasive component of the tumor, hormone receptors, her2neu receptors, grade and such to plan if she needs chemo. if doing lumpectomy surgery she definitely will need radiation.
Question:  #598 4/12/2006		Q:	You kindly replied to my post, as copied below. Unfortunately, I did actually have a tumour which was measured to be about 1 cm. So, on that basis, please would you reconsider your response. Thank you. Q: I live in the UK, and am perplexed by my pathology results. Perhaps you could shed some light. In November 2005, I had surgery for a 1 cm, grade 2 ductal tumour. The high grade DCIS from which the cancer escaped expressed microcalcifications over a 6 cm x 4 cm area, hence the need for a quadrantectomy. I had immediate reconstruction and a reduction on the other breast. Absolutely brilliant cosmetic appearance. Initial results were good (clear margins with no nodal involvement or vascular invasion). Chemo was not recommended (thankfully), but I had 13 sessions of radiotherapy. Even better were my ER (8/8) and PR (6/8) scores. I was prescribed tamoxifen, even though I am 52 and four years post menopause. This was my choice and I have had no side effects whatsoever. However, I recently received my path report and found to my dismay that I am HER2+ {scored 2+ (weakly positive) on the IHC test and tested positive on the FISH test.} Actually, ‘FISH yielded amplification 2.71.’ What I need to know is what this score actually means and how serious it is in view of all the other good prognostic indicators. I have read that being HER2+ might lessen the effectiveness of tamoxifen, so should I be changed to arimidex? Do you think herceptin would be appropriate for me? And how likely is the cancer to recur? My oncologist is surprised by my HER status, and is going to consult with his colleagues about my particular case. Thank you for reading this, and I hope you can give me some answers. A: actually, DCIS isn't supposed to be checked for Her2neu.... and DCIS usually is her2neu positive, but it doesn't really mean anything since the disease in NONinvasive disease.
		A:	aromatase inihibitors are designed for post menopausal women only. so that would need to be part of the criteria for considering discussion with your doctor about switching.
Question:  #599 4/12/2006		Q:	I know that there are three major types of breast cancer, ductal, lobular and tubular. 1) What does a well differentiated TUBULAR tumor exactly mean in terms of type of cancer, prognosis, etc? 2) Can you define tubular tumors? 3) And what does it mean when one is diagnosed with ductal cancer with tubular components? Thank you so much!
		A:	there are actually more than 3. tubular is considered a very favorable type of breast cancer that in general is usually less aggressive and carries a good prognosis. for more informaiton on it go to www.breastcancer.org click on "pathology"
Question:  #600 4/12/2006		Q:	I live in the UK, and am perplexed by my pathology results. Perhaps you could shed some light. In November 2005, I had surgery for a 1 cm, grade 2 ductal tumour. The high grade DCIS from which the cancer escaped expressed microcalcifications over a 6 cm x 4 cm area, hence the need for a quadrantectomy. I had immediate reconstruction and a reduction on the other breast. Absolutely brilliant cosmetic appearance. Initial results were good (clear margins with no nodal involvement or vascular invasion). Chemo was not recommended (thankfully), but I had 13 sessions of radiotherapy. Even better were my ER (8/8) and PR (6/8) scores. I was prescribed tamoxifen, even though I am 52 and four years post menopause. This was my choice and I have had no side effects whatsoever. However, I recently received my path report and found to my dismay that I am HER2+ {scored 2+ (weakly positive) on the IHC test and tested positive on the FISH test.} Actually, ‘FISH yielded amplification 2.71.’ What I need to know is what this score actually means and how serious it is in view of all the other good prognostic indicators. I have read that being HER2+ might lessen the effectiveness of tamoxifen, so should I be changed to arimidex? Do you think herceptin would be appropriate for me? And how likely is the cancer to recur? My oncologist is surprised by my HER status, and is going to consult with his colleagues about my particular case. Thank you for reading this, and I hope you can give me some answers.
		A:	actually, DCIS isn't supposed to be checked for Her2neu.... and DCIS usually is her2neu positive, but it doesn't really mean anything since the disease in NONinvasive disease.