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Category:

Understanding Pathology Results

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Question:  #1771 09/22/2004		Q:	On 9/17/04 I had my yearly mammography. Afterwards, the tech came back in and asked me if I had a mole on the left breast. I do, but not where she was looking. They asked me to stay for a sonogram, which I did. I informed my doctor about this when I returned home, and he must have called the imaging center right away. I went to see him 9/20/04 and he again performed an examination. He told me not to lose sleep over it, but not to wait until Thanksgiving. I have an appointment with a specialist on 9/24/04 and picked up the report and films from the imaging center yesterday. The report says that a new macrolobular mass of about 15mm x 10 mm was found in the upper outer aspect of the left breast when compared to the previous two exams. No microcalcification was seen. The mass appears relatively well circumscribed in both projections. The ultrasound imaging of the same section shows no discrete solid or cystic mass. They recommend a stereotactic biopsy and at the bottom of the report it says: BI-RADS No. 4: SUSPICIOUS ABNORMALITY-BIOPSY SHOULD BE CONSIDERED. Can you please provide more information? Based on the information I provided, is this common, should I be concerned? Should I be taking a different or additinal course of action? Thank you for your help, and for all you do.
		A:	it falls into the category of being suspicious and therefore a biopsy is recommended to rule out cancer. so pursue it. don't fret over it. there isn't enough information yet to sweat over this.
Question:  #1772 09/22/2004		Q:	I have my final Diagnosis and am so confused now it is being sent to another lab. Fibrocystic Change With Intraductal Epithelial Hyperplasia and Papillomatosis. I would like to know the chance of this being cancer, I have put off for so long I am sick with worry. I went today for the offical copy and they explained it as a wart in my duct. The lesion was removed. Now just waiting.
		A:	based just on what you have typed this is not cancer. having another pathologist re-read this slides is reasonable to help give you peace of mind. there are no comments in what you sent that are even precancer.
Question:  #1773 09/22/2004		Q:	I'm sorry, I sent you a question a little while ago, but now I have more. My Sister was diagnosed with DCIS high grade, ER negative PgR negative, Ner 2 3+. Correct me if I'm wrong, but DCIS means non-invasive, right? Does this therefore mean that it can't be metastatic??? Can it not then spread to the lymph nodes? Surely if it can get to the lymph nodes, it is invasive!!! And if it gets to the lymph nodes it can metastasize, right? I don't understand. Also, my next question is: Why is ER+ and Pgr+ better than ER/PgR - ???? Why is Her2 3+ worrisome?? What is her prognosis?? Should her specialist be recommending radiation or chemo after her mastectomy??? Thanks,
		A:	chemo is not needed for DCIS because by definition is it noninvasive as you mentioned. it is strange to do her2neu on dcis however. that is done on invasive disease. so clarify that it was "only dcis" and no evidence anywhere of invasive ductal also being present. dcis is stage 0. radiation is not needed with mastectomy except in unusual circumstances (such as locally advanced disease-- stage 3b for example.) ER pos is considered better because we have meds to help prevent recurrence of this time. hormonal therapy-- anti-estrogen drugs.
Question:  #1774 09/22/2004		Q:	My sister's pathology report says: "non-invasive carcinoma. Ductal (high grade), growth pattern, comedo. It also says: "Immunostaining for ER is negative. Immunostaining for Her 2 is positive (3+) in DCIS. Immunostaining for PgR is negative. Can you please tell me what this means word for word. Thanks Jaine
		A:	it means stage 0 breast cancer. nonivasive and therefore can't reach the lymph nodes. an aggressive for-- comedo and high grade-- that if left untreated runs a higher risk than other DCIS to become invasive.
Question:  #1775 09/20/2004		Q:	Does it matter what type of cells are in the pathology in relation to the spread of bc? My pathology report said I had a lobular variant. Does that indicate a high risk for recurrance?
		A:	Lobular invasive is the second most common type of breast cancer. ductal invasive is the most common type. the main characteristics of lobular invasive is that it can appear smaller on breast imaging that it actually is. recurrence incidence in the same breast is not different. some say that lobular has a higher incidence of appearing in the other breast over time but there is some controvsery over this point.
Question:  #1776 09/20/2004		Q:	I am a 55 ytear old white female who had DCIS eleven years ago. I had a right breast lumpectomy followed by 25 radiation treatments. Recently I had a sterotatic bx done microcalcifications seen on my yearly mammogram in a different area of the same breast. The pathology report returned DCIS. I don't know what stage it is, but my surgeon is advising I have a mastectomy. Also, my radiation oncologist said she would also reccomend a mastectomy. Should I have another pathologist look at the biopsy just to make sure it is DCIS. And is mastectomy what you would reccomend? I have had a maternal grandmother with breast cancer and a first cousin die from breast cancer at an early age.
		A:	there are several issues here- first, the standard of care for women with local recurrence following lumpectomy with radiation is to do mastectomy (with reconstruction usually). second, you have considerable family and person history. consider genetic evaluation. Also, when looking at reconstruction options, consider diep flap. you are welcome to come here for evaluation and surgical treatment if you like too. just email Lillie Shockney that you want to do so. shockli@jhmi.edu
Question:  #1777 09/20/2004		Q:	I have had an excision and a re-excision in the left breast, one this April and one this August. In April they excised 1.5mm of low grade DCIS and felt they got it all. In August another surgen did a lumpectomy and re-excised 1.5mm low grade DCIS on one side and .9cm intermediate grade DCIS, cribriform and solid with microcalcifications present involving DCIS on the other side. On the .9cm side the pathology report states, "There is evidence of pagetoid spread along the ducts in the specimen represented." At the August surgery, a Plastic Surgen also did an implant reconstructive surgery. My questions are three. 1. Is radiation the best choice? 2. What does pagetoid spread in the ducts mean; is it something to cause concerned? And 3. How might this change my situation and options? Thank you for your time and effort.
		A:	you are describing what sounds like multicentric disease-- several areas of dcis in the breast rather than just one local focus. in such cases, usually mastectomy with reconstruction is done. no radiation then needed either. for women having lumpectomy, and if enough tissue was removed warranting reconstruction, then thoughts go to wondering if lumpectomy was the right choice-- or if mastectomy with recon should be done instead. anytime the breast is conserved radiation is needed. radiation and implants however don't get along. feel free to consider coming to us for a consultation about this. if interested contact Lillie Shockney at shockli@jhmi.edu
Question:  #1778 09/20/2004		Q:	I was diagnosed with DCIS in 2 separate steriotatic biopsy sites left breast and had lt.mastectomy with DIEP reconstuction. Pathology report was negative for ER/PR but positive for P53. How does this pertain to my prognosis and does this increase chance of occurance on my right side?
		A:	doesn't increase chance of new breast cancer on other side or of local recurrence in left either. you have been aggressive in your treatment and should do well. good for you.
Question:  #1779 09/09/2004		Q:	I just received final diagnosis from ultrasound-guided core biopsy "12 o'clock mass w/ calcifications. DCIS w/characteristics as follows: quantity, involves all biopsy cores, greatest extent in any sincle core .6cm (2 foci in one core measures .5 and .45cm ) solid/criboform/van nuys nuclear 3/3, nocrosis present, van nuys path class 3/3, microcalcification associates with DCIS benign changes not identified. estrogen receptor negative no invasive neoplasm identified. I am 56, small build. I am to choose between lump and mast. If lump need radiation? I know from reading your site that DCIS is sort of good news (relatively), but what does the rest of the report mean? MRI was recommended and is scheduled. When is second opinion needed? (I do trust the recommendation of surgeon from primary physician). The more I read, the more confused and concerned I get. What factors should I consider? Thank you very much.
		A:	yes, lumpectomy and radiation go together... MRI will be helpful in seeing what else may be going on. second opinion is always useful. consider a consult with a plastic surgeon too. if you want to come to hopkins email Lillie Shockney at shockli@jhmi.edu
Question:  #1780 09/08/2004		Q:	My first pathology report gave me an inconclusive diagnosys that suggested a mammory lipoma. I sent my specimen to Johns Hopkins for a second oppinion (to ease my mind) and the pathology report came back as such: Breast, Right Mass (Lumpectomy) - Histological findings consistent with hamartoma. Can you tell me if this is a good or bad diagnosys or what it is? Thank you very much for your time. I do appreciate it! :) Sincerely,
		A:	this is also a benign mass.that's the key word. benign!!!
Question:  #1781 09/07/2004		Q:	What is the purpose of using immunostaining for AE!/AE3 and CAM 5.2 in lobular invasive breast cancer, on the lymph node surgical specimens? Also, why weren't there any tests done for hormone receptors on the surgical specimen?
		A:	hhhmm. ask to speak to the surgical oncologist about its meaning. and yes, hormone receptors need to be done on this tissue.
Question:  #1782 09/07/2004		Q:	Hi, I was wondering if I could please get some feedback on my pathology report. It was done on 8/20/04 and I'm scheduled to go back for additional tissue removal and sentinel node biopsy on 9/14/04. I was just given the results on 9/2/04. Here is the final diagnosis: Designated "Right Breast Biopsy" Tumor type: Infiltrating ductal carcinoma of the breast. location: right breast. Tumor size: 2.3cm in maximal dimension. DCIS COMPONENT: High-grade ductal carcinoma in-situ present, compromising less than 25% of the total tumor mass. Tumor Grade (BSR): Poorly-differentiated, grade III (8/9) Tubule formation: 3/3 Nuclear Grade: 2/3 Mitotic Activity: 3/3 Angiolymphatic invasion: Multiple foci of lymphatic invasion identified. Margins: 1. Infiltrating ductal carcinoma approaches to within 0.1mm of the inked surgical margin. 2. as well, foci of lymphatic invasion and ductal carcinoma in-situ are present at the inked surgical margin. ER/PR: Malignant cells positive for estrogen and progesterone recepotors by immunohistochemistry. pathologic staging (TNM): pT2 No Mx Staging form code: (25) Hx: I'm 35 years old, of hispanic origin, never have smoked, do not drink alcohol, have been using OCP'S since 1995 for DUB. Recently dx: NIDDM and HTN. I found the lump on 6/30/04 during a self breast exam and was evaluated on 7/2/04. rt breast u/s came back negative. mammogram was never done. Refered to breast specialist and was told I could have needle guide bx or incisional and I chose incisional bx and these are my results. Should I go ahead w/add'l lumpectomy and sentinel node bx or masectomy? Is there any difference in surival outcome? I was then going to have chemo and radiation. My mammogram is scheduled for 9/8/04 and I have my first meeting with my oncologist then. What are my chances with and without positive lymph nodes? Thank you very much for your review.
		A:	lumpectomy with radiation is equal to mastectomy from a survival perspective. if you have adequate breast volume then lumpectomy is quite feasible. chemo would be needed usually, yes, due to tumor diameter. do press forward with sentinel node biopsy to determine nodal status.
Question:  #1783 09/03/2004		Q:	I'm a breast cancer survivor since 2002 when I was diagnosed with DCIS in my left breast.I had a lumpectomy and radiation done. This report makes me uneasy.There is a relatively large calcified ovoid mass in the left breast which remained stable post bispsy and probably represents a focal area of fat necrosis. Several other areas of rounded calcifications having a benign appearance are seen. Ther is a focal area of microcalcification seen in the left breast in the upper aspect which are thought to project medially. These have developed since the prior. Spot magnifications views were taken. The calcifications are somewhat coarsened and have a rounded appearance. They are 3 in number. IMPRESSION: Small focus of benign appearance calcifications in the left breast since the prior studies. RECOMMENDATIONS: 6 month follow-up with spot magnifications views for these newly developing calcifications. CATEGORY 3: PROBABLY BENIGN. Should I be a little concerned? This is how the last one was diagnosed?
		A:	Whenever there is a history of breast cancer we need to look closely at new findings, even when subtle. so consider getting a second opinion in re-reading these films by a radiologist who specializes in breast imaging so see if they agree and are content with the wait and watch plan.
Question:  #1784 09/03/2004		Q:	My friend was diagnosed with Stage 1 breast cancer in April; she had a lumpectomy; it did not spread to any lymph nodes; she had 6 weeks of radiation. In August she was told that "she has been cured; go out and enjoy life" they will take blood tests and other necessasry tests for the next 2 years. They are not sure how she developed this cancer; she is 44; she was on premarin due to a hysterectomy at 40. She of course is off of that and also will not be able to take any type of hormone. She has a panic disorder and takes serzone and klonapin for control of this. How important is nutrition in her case and what other comments or information could you contribute to her situation in what have I have told you. Thank you.
		A:	No one usually uses the expression "cured " today for breast cancer.... risk of recurrence is a life time risk. not vut off at 2 years. stage 0 is more common to hear someone possibly say that they are cured since it is noninvasive. in any case, there aren't blood tests that are done for monitoring in this case. nutrition is important for everyone and even more so for cancer patients. low fat diet, watching weight gain, exercising regularly are helpful in reducing risk. in most cases we have no idea what caused someone to get breast cancer.
Question:  #1785 09/03/2004		Q:	I was just diagnosed with ductal carcinoma,high grade, grade III. My Docto has advised a lupectomy (partial mastectomy), with lymph node mapping and some kind of mapping of the removed tissue to look and see if there is any cancer outside of the duct and how far out it is. This will be followed by 6 weeks of radiation and 4 to 6 months of chemotherapy, depending on the lymph node test. Does this sound like a good path to follow. I am 41 and my sister had breast cancer followed by a mastectomy 10 years ago.
		A:	the mapping isn't of the duct but of the lymphatic system to identify the correct node that is the first node that if cancer were to travel there it would go. if that node has cancer cells in it then additional axillary nodes are disected. invasive tumors larger than 1.0cm are often times recommended to do chemo, even if the sentinel node was negative. radiation goes in partnership with lumpectomy. the medical oncologist will choose the drug regimen for you and whether hormonal therapy is of benefit or not too. take care.
Question:  #1786 09/02/2004		Q:	My wife is 39 years old. He had a mass in her right breast last more than 15 years. Recently after ultrasound scanning of the breasts under routine checkup revealed that there are multiple noduler and cystic masses in both breasts. Accordingly after discussion with surgeon she undergone a lumpectomy and biopsy. Her biopsy report revealed that"out of 24 slides most shows atypical hyperplasia and scarring but in slide # 3& 5 shows intraductal epithelial neoplasia I. Her surgeon now referred her to an oncologist of LIJ Medical Center NY for further consultation. What best we can do for her? Is Tamoxifen is the best choice for her? Please put some light on her case. I am a medical graduate for Bangladesh, so you can use Technical terms in describing her case. With thanks,
		A:	first, the good news-- no cancer. so technically she didn't have a lumpectomy but instead an open breast biopsy. she had some ADH-- atypical cells and for that reason he is recommending a consultation with an oncologist regarding risk prevention. the oncologist will evaluate her true risk, ie, what other risk factors does she have for breast cancer other than ADH. Tamoxifen is the most common form of hormonal therapy used for that purpose. exercising 3 times a week, avoiding smoke and watching her weight also helps to reduce risk.
Question:  #1787 08/31/2004		Q:	If microscopic cancer is found in the sentinel node and is considered positive node involvement, is that considered a stage 2 breast cancer regardless of tumor size?
		A:	if a micromets involvement then no. If classifying the node as truly being positive for cancer then yes.
Question:  #1788 08/31/2004		Q:	My path report states the section is serially sectioned and on cut surface there is an ill defined area of firmness extending from the centre of the speciment towards to the superior aspect. This measures 5.0 cm. in maximum extent grossly superior to inferior. This area has an area of hemorrhage, possibly representing previous core biopsy. Represnetative sections are A1-A7 - contigous sections thorugh firm area from central A1 to superior A7 - please note that this is still located 9.0 cm from the superior margin. Sections A6, A7 and A1 each show relationship to deep margin. This area of firmness is located 4.0 cm from the lateral margin but is clear of all other margins apart from the deep. Does this mean my deep margin may not be clean. I was diagnosed with DCIS from low grade to high grade comedo type. LCIS & Pagets No definite invasive carcinoma identified - by using the words "no definite", does this indicate that there could be invasive by not definite?
		A:	Ask the doctor for a clearer explanation. the wording is a little confusing. usually if a margin is still involved then the pathology report states clearly that cancer is found "at the margin" or "within 1 mm of the margin".
Question:  #1789 08/20/2004		Q:	I was diagnosed with high grade infiltrating ductal carcinoma, Estrogen and Progesterone Receptor Negative and HER-2 Weak Positive 2+ back in 3/00, Lymph nodes were negative, Tumor size 1 cm.Took Adromycin, 5FU & cytoxin, had bilateral Mastectomy with reconstruction, only to have it recur in 7/01.Had 36 radiation treatments, Taxotere, Xeloda and 6 months of Herceptin. I feel like Im a time bomb. What is my prognosis?
		A:	Prognosis is something that truly is a gray zone and is focused on too much. there is no magic in a number. you had a low risk of recurrence but it came back because somebody ends up in that low recurrence statistic, right? ask your doctor what he thinks... living like a time bomb isn't healthy. ask him what other steps you can take to feel more confident that this is no behind you and will stay that way. power walking, avoid smoke, low fat diet, and laughter are good steps to take to help reduce risk too.
Question:  #1790 08/20/2004		Q:	I am a 39 yr old recently dx with high grade dcis, solid, with comedonecrosis with 3mm margins from the post margin from lumpectomy/partial masectomy pathology. sx was preceeded by a negative core needle bx and then dx with a f/u vacumm mammatone bx. negative estrogen receptors and weakly positive progesterone receptors. there is no mention of how large the margins were other than the posterior; is this usual for this not to be documented and a reasonable request for me to make??? are there any other studies that would be beneficial other than the est/prog receptors that may offer insight into prognosis/tx options??
		A:	each margin is to be listed separately and verified that it is clear of tumor. the grade of the cancer and the hern2neu receptor is important for prognostic reasons and planning her care.
Question:  #1791 08/19/2004		Q:	I recently had an ultra sound guided needle core biopsy after a 2cm lesion was found in my left breast under the nippple. This was found after a baseline mamogram at age 39. According to the surgeon who did the biopsy the results are a benign adnosis with sclerosis. He says having it out is optional. I am concerned that if I don't have it out I will have further suspicious and anxiety producing mamograms in my future. On the other hand if I do have it out I wonder if this could produce scar tissue that could also affect the reading of future mamograms. I am also concerned that it could grow and produce other complications. What should I do?
		A:	this is the deion of a benign finding. you are correct that doing an operation on the breast can result in scarring inside that can look abnormal on future mammograms. it is hard to say what is better. you need to feel confident that all is well though. perhaps having the pathology re-read elsewhere would provide you that confidence.
Question:  #1792 08/17/2004		Q:	I am a 26 year old female with a discover of a lage mass in right breast upper at 1200. I had a lumpectomy, as I have a history of cancer in my family. I am extrememly nervous that my report is missing a confirmed diagnosys by seeing the word "could" in the comments. What do you make of this report... and could I/should I get a second pathologist to look at the specimen for a clearer diagnosis? My pathology report reads as such: Diagnosis: Fibrofatty Breast Parenchyma Showing: Lobulated Adipose Tissue COMMENTS: These findings could represent an intra mammary lipoma. Tissue deion: Irregular pieces of fibrofatty tissue. The smaller of the two is mostly indurated. Size cm/Weight gm: 2.1 x 1.5 x 0.9 cm 2.7 x 2.3 x 1.3 cm Processed: Margins inked In toto Cassettes: 1 smaller piece 2-3 larger piece
		A:	This is a report that reflects totally benign findings. Technically you have had a benign fatty mass removed. We only use the term "lumpectomy" when the surgery was definitively done for breast cancer. glad you got good news.
Question:  #1793 08/13/2004		Q:	My sister just received this news. The sentinal lymph node biopsy, did discover some very minute micro-invasive cancer cells. The surgeon giving me this report said it was the most bizarre case he has seen; certainly not what he was expecting, and is very anxious to hear what the oncologist will now recommend for treatment. He felt that five years ago, these tiny cells would not even have been discovered. The question I have is what she should do now? What are her best options? How serious is this?
		A:	First confirming it truly is micromets and nothing more than that is important. The medical oncologist needs to weigh in here... does he want more lymph nodes sampled or not and what chemo decisions would be made based on this information. it is true that years ago this would have probably gone unnoted.
Question:  #1794 08/12/2004		Q:	How common in a needle localized excison biopsy is it to miss getting the clip on the first try?
		A:	wire localization excisional biopsy i think is what you mean. the tissue is to be xrayed once it has been excised to ensure that the right tissue was taken out, including the clip.
Question:  #1795 08/11/2004		Q:	I have a question concerning my Mother's path report. She has both DCIS and invasive carcinoma. Her report states invasive carcinoma closest distance to margins 4mm and DCIS closest distance to margins 1mm. After having a mastectomy with no node involvment with she still need chemo or radiation? How close to the chest wall is it considered safe to forgo chemo or radiation. What is the safest bet for a good prognosis. Is radiation given as a prophalactic? Thank you for your time.
		A:	the diameter of the invasive component dictates whether chemo is a consideration or not. small invasive tumors usually don't warrant chemo in general-- those less than 10 mm.... depending on how close to the chest wall the DCIS was found to be may influence a doctor to do radiation sometimes. it is worthy of getting 2 opinions from radiation oncologists before proceeding.
Question:  #1796 08/11/2004		Q:	Does invasive carcinoma always start as DCIS are the two related? Is it possible that DCIS can be missed on mammograms? Is this a rapidly growing cancer or can it be present for years and not spread to the nodes? Thank you once agagin for your time.
		A:	We don't know but assume that it may start as DCIS. we do believe that DCIS left untreated as the potential to grow into invasive cancer. the growth rate determines the speed of growth-- a grade 1 is slow, 2 is moderate and 3 is fast. DCIS by its nature can't get to lymph nodes because it is trapped in the duct still. mammography can miss it in a very dense breast.
Question:  #1797 08/11/2004		Q:	My mother is 61 and was justed diagnosed with DCIS and invasive breast cancer. She just underwent a mastectomy & sentinel node procedure. The path report showed no node involvement. I have a couple questions 1.) Her path report showed she is estrogen positive but progesterone negative. What exactly does this mean? Does this make her a canidate for Tamoxifen or Arimidex? I recently heard Tamoxifen can increase your chances of developing other kinds of cancer is this true? 2.)If there is no node involvment will she have to undergo radiation or chemo? For a better outcome is'nt some radiation rcommended? Thank you so much for you input this is a great service.
		A:	1. her cancer was fed by estrogen but not progesterone to stimulate it to grow.2 hormonal therapy would be a consideration. 3. tamoxifen can increase risk of uterine cancer slightly.4. radiation is rarely needed when mastectomy is done. 5. chemo is recommended for positive nodes or larger invasive tumors.
Question:  #1798 08/10/2004		Q:	What is the significance of microscopic sentine node invasion? I can't seem to find alot of information on it.
		A:	Depending on other prognostic factors like hormone receptors and her2neu, it can be significant in planning adjuvant therapy.
Question:  #1799 08/10/2004		Q:	In 2003 I had a cyst that suddenly appeared and the radiologist said it was a cyst. I had it aspirated and it was suggested I go to an oncology surgeon. I had the rest of the "cyst" removed with clear margins and no lymph node involvement according to a Sentinel Node Biopsy and it was diagnosed as Spindle Cell Metaplastic Carcinoma 2cm. I was treated with AC 4 treatments and taxol 4 treatments and 6 weeks of radiation. I am Her2 negative. This seems to be a rare type of breast cancer and I am concerned about how to proceed. Do you have any more information about this particular type of breast cancer?
		A:	this is an unusual form of breast cancer. i believe there is some information on it at www.cancerfacts.com and on www.breastcancer.org If hormonally positive then ask about hormonal therapy options too.
Question:  #1800 08/10/2004		Q:	For the past 8 months my white count has been low 3.0-3.7. I have it checked every 3 months by oncologist. finished A/C & Taxotere 18 months ago and needed neupogena each time. It was normal for a while after that. My oncologist is monitoring it but should I be more aggressive about asking him to test more extensively. Thank you
		A:	sometimes it takes a long time for counts to return to normal. stay clear of little ones with germs and ask the doctor what other steps you need to take to ensure no infection happens until your counts climb back up.