For an Appointment Call: 443-287-2778 Search  We hope you find this information helpful. This is a free service done during volunteer hours. If interested in supporting this service so it can be sustained, consider making a donation at: http://jhweb.dev.jhu.edu/eforms/form/surgery. Select JH Breast Center Education, Outreach and Survivorship Fund under the option: Please designate my gift.

Category:

Understanding Pathology Results

Pages: [ << 63, 64, 65, 66, 67 68, 69, 70 >> ]

Question:  #2011 02/28/2003		Q:	Hello- I am a 38 yr. old woman that was diagnosed in Dec. 2002 with High Nuclear Grade Comedo Carcinoma in-situ w/focal microinvasion and associated microcalsifications. The path report also reads; mutifocal lobular cancerization by in-situ carcinoma. The in-situ tumor extends to within less than 1mm of anterior and posterior of surgical margins. The approximate greatest dimension of tumor involvement extrapolated from slides is 2cm- Possible perivascular lymphatic invasion. I am a strong ER + & PR +/ h2neu - I had a simple mastectomy on January 9th, 2003- the mastectomy and all 11 nodes were clean. My oncologist has perscribed 20mg of tomoxifen per day for 5 years. I had the initial biopsy sent to Dr. Peter Paul Rosen in NY- His Path came back a bit different Slides A show intruductal and invasive duct carcinoma. Invasive carcinoma is poorly differentiated, measuring 6mm on slide A3. However this measurement underestimates the distribution of the invasive componant because there are multiple dispersed lymphatic tumor emboli not only ajacent to the invasive tumor but also more widley present in A1 and A2. My question and concern is this going from micro to invasive and the fact that the 2nd pathologist saw multiple dispersed lymphatic tumor emboli. My Oncologist says the tamoxifen for 5 years is still all I would need- I am concerned that this is not enough- Would a short 3-4 month protocal of Chemo give me more insurance in case one of the cells traveled through my blood or lymph node system? Also- FYI- My Mom had breast cancer 23 years ago, and I have had 5 breast biopsys...all neg until this last Dec. 2002- Any info or guidance would be greatly appreciated
		A:	something you didn't mention was lymph nodes. you wrote that you had a simple mastectomy implying no nodes removed. it this is the case then you may want to talk with a surgical oncologist about axillary node dissection. ideally nodes are evaluated with the sentinel node procedure at time of mastectomy but wth the breast gone there is no way to do this. you need to know if you have nodal involvement though-- this is part of the staging information to determine if chemo is needed or advised or not. Consider a second opinion to explore this further.
Question:  #2012 02/28/2003		Q:	I had a wire localization w/ excisional biopsy in my right breast due to microcalcifications 2 weeks ago. Surgeon removed an area 5x 4.5 x 1 cm and another 7 x 3 x 1.5 after xraying first sample. My report reads: densly fibrotic and hyalinized breast stroma. Large and small cysts present. Apocrine metaplasia noted. The second sample reads:hyalinized dense fibrous stroma with many small and large cysts together with foci of apocrine metaplasia. Can you tell me what all this means? I know that there is nothing malignant going on here but I am concerned about breast cancer in the future. I have a strong history in my family. I'm 39. The surgeon is scheduling another mammo in 2 months. Thanks so much for your site and your help.
		A:	you are right-- these are benign findings. there is information on our website in the pathology icon that may help you www.hopkinsmedicine.org/breastcenter as well as on the www.breastcancer.org site. what is described is merely structures of the breast tissue but nothing malignant.
Question:  #2013 02/28/2003		Q:	I had a lumpectomy on my right breast 1-15-03. the pathology report said i had a 1.0 residual focus of infiltrating ductal carcinoma, intermediate nuclear grade, with focal mucinous differentiation. tumor extends to within one low power microscopic field of a lateral resection margin[i'm having a re-incision]. there is lymphatic and adipose tissue invasion. Extensive post biopsy changes. Previous Biopsy was negative for Her-2-Neu and positive for Estrogen Receptor. My right Axilla Levels 1 &2 -18 lymph nodes all negative for tumor. my first biopsy was a right breast mass infiltrating and insitu ductal carcinoma, low nuclear grade 2.0 CM. My question is would Tamoxifin amd radiation therapy be enough treatment for me? Do you think Chemotherapy would benefit me?
		A:	tumors greater than 1.0 cms sometimes are the ticket for chemo. in other cases it may be slightly bigger-- 1.5cms. you describe a tumor bigger than this though which oftentimes does results in a healthy discussion about chemo unless the patient is very elderly or has other medical conditions that are so worrisome that chemo can't be considered. remember that radiation is local treatment-- chemo is systemic treatment. ask the doctor how much higher on the survival curve you can climb by doing chemo. this will help you to make your decision.
Question:  #2014 02/28/2003		Q:	I was diagnosis with breast cancer, but i don't understand my pathology report my surgeon recommend mastectomy and i am in stage 1 it reads like this right breast, core needle biopsy: right breast at 1:00: infiltratin duct carcinoma, grade 2/3 , present in the cores. right breast at 10:00: infiltrating duct carcinoma. right breast at 9:00: cuctal carcinoma in -situ, solid type with marked chronic inflammatory infiltrate ( infiltration cannoth be ruled out.) i really don't understand why i need a mastectomy if it early stage.
		A:	this biopsy report doesn't tell the whole picture to be able to determine what type of surgery is needed. so let's address when mastectomy is advised-- mastectomy is recommended wth extensive DCIS that occupies more than one quadrant of the breast; mastectomy is advised when tumors are large and breast tissue volume is small; mastectomy is advised with the presents of multifocal disease-- disease in several spots of the breast taking up too much volume again to make lumpectomy cosmetically feasible. it is always wise and helpful to get a second opinion before embarking on mastectomy so consider that. if still advised to do it than consider plastic surgery for rebuilding the breast at the same time-- skin sparing, possibly nipple sparing and some time of flap surgery perhaps.
Question:  #2015 02/28/2003		Q:	I had a mass removed and I do not understand the pathology report. The surgeon is away but the office called to tell me everything is ok. The word benign is not used in the report. Can you please explain this report in laymens terms.....breast tissue showing radial sclerosing lesion and duct hyperplasia with cautery effect. Additional study pending. The surrounding breast tissue shows fibroadenomatoid change and stromal fibrosis. Healing core biopsy site changes are also noted. ADDENDUM: Immunohistochemical study of the section with the radial sclerosing lesion for actin (SMA) shows positive staining at the periphery of the epithelial units, indicating the presence of myoepithelial investment of these structures. The findings are supportive of the diagnosis of radial sclerosing lesion. PLEASE EXPLAIN WHAT THIS MEANS. Thanks for you help.
		A:	radial scars is possibly what is being referred to here. a benign mass that on mammogram is often times looked at as being suspcious for possible cancer. there weren't any mention of cancer or precancer in this report. when your doctor returns meet with him and have him walk you through each sentence of the pathology results. the good news is that no cancer was found. that is worth celebrating this weekend.
Question:  #2016 02/28/2003		Q:	You have been so helpful to me in the past, I need you once again. I had a needle loc and lumpectomy done last week for DCIS calcifications. The diagnosis on the pathology report reads: Needle localization biopsy left breast. Status post recent mammotone vacuum-assisted stereotactic biopsy for DCIS, cribform pattern, intermediate nuclear grade. Residual DCIS, cribform architecture, intermediate nuclear grade and atypical ductal epithelial hyperplasia at or near biopsy site. Largest focus measured on glass slide 2.8 x 0.5 cm. Microcalcifications present. The in sutu and atypical changes extend focally to or in close approximation (less than 1.0 mm) to the inked surgical margin. No invasive carcinoma found. Fibrosystic changes with focal ductal ectasia, ductal epithelial hyperplasia, ductal microcalcifications and extralobular fibrosis. I got this report from my surgeon's nurse who implied that I may need more surgery because a spot is very close to the margin area. I cannot speak to my surgeon until Monday and I was wondering what your opinion is. I have a stong family history of breast cancer including the death of my mother. Thank you for everything.
		A:	sorry for the delay in getting back to you. i've been away for speaking engagements. The report states that there is residual disease there which makes sense since this was a biopsy and not definitive surgery. so next the mission is to get clear margins!! hopefully your surgeon reviewed that with you and how to proceed with achieving that end. DCIS is the earliest form of breast cancer and is noninvasive which is the good news. you are the poster child for mammography!
Question:  #2017 02/21/2003		Q:	I received my pathology report from my excisional biopsy. It was benign, and it says Fibrocystic change, sclerosing adenosis, and focal intraductal hyperplasia. I've read conflicting info. on this, so I'd like your opinion: does this indicate I have an increased risk of developing breast cancer? Is a return to annual mammograms all that I need at this point? Thank you.
		A:	this doesn't imply that there is increased risk for breast cancer. there wasn't mention of "atypical" ductal hyperplasia, which does contribute to some increased risk. So your information is good news...
Question:  #2018 02/21/2003		Q:	First off, thank you for your service of helping women with breast cancer.I would like to ask your help. I was diagnosed with mutifical high grade ductal carcinoma insito(comedo type) with associated cancerizition of lobules. Infiltrating tumor is not identified.(this is copied from path report) I had a bilateral mastectomy in late Sept. with reconstruction at the same time. The surgeon took a sampling of my axillary node bearing areas but no axillary nodes were found. Somehow i was not aware of this until I visited the oncologist in December.I would like to know your opinion on this matter. The surgeon said he could go back and get one node using ultasound to locate the nodes. Is this the best course of action? Does the fact that i had multifocal make the chances of node involvement greater. What would you do in this case. Do you think I should come to John Hopkins for another evaluation. I don't want to do any unnecessary surgery as this is my left arm and I'm an artist (left handed) but I do want to do everything in my power to be cancer free. Again thank you for taking time to help me.
		A:	it would be unusual to need to check lymph nodes when the type of breast cancer is confined to DCIS-- noninvasive breast cancer. If there is considered to be extensive DCIS then there may be concern that there is hidden somewhere a tiny invasive tumor. if that is the case then sentinel node biopsy usually is done at time of mastectomy since once the breast is removed it is not possible to identify the sentinel node later. hope this makes sense.... so if no invasive disease was ever found then nodal involvement is not usually a worry.
Question:  #2019 02/20/2003		Q:	I was diagnosed with multi focal DCIS in 1999. I had the breast removed and immediate free TRAM flap reconstuction. The margin was close (1 40X field width). The lymph nodes were negative. I started on Tamoxifen. I had a recurrence in 2000 that invaded the pectoral muscle. I then started Chemo - Adriamycin. After one treatment a new cancersous lump was discovered. The chemo was switched to Taxotere followed by twice a day radiation. Now in 2003 another chest wall recurrence was removed. The path report said that it was metastatic ductal carcinoma cribriform type with a Ki67 of 34%. It was also ER+ and PR +. The PET scan did not show any evidence of disease and all my other tests have been negative. What sort of questions should I ask my oncologist. All the tumors were over 2 Cm. Thanks. It is just very frustrating after such a "near 100% cure" of the original DCIS.
		A:	wow. you've had a tough road to hoe for sure... ask what are all the options for tackling this problem now including chemo, hormonal therapy, other options? even resection? you have a disease that is hell bent about surviving in your chest. see what clinicl trials you might be elegible for as well and ask the doctor how many cases like yours he has seen and how have these patients faired. if he says this is something new for him then consider getting another opinion from a medical oncologist who sees a lot of women with locally advanced recurrence. the same goes for radiation oncology.
Question:  #2020 02/19/2003		Q:	I am a 39 and recently had my first mammogram and ultrasound. I was found to have some calcification in my breasts plus cysts, with some cysts being complex. I am going back for another mammogram in 6 months. I have been reassured that what has been found so far is not a precursor to breast cancer. Is this true? In the meantime I have had a real wakeup call with my health. There is no history of breast cancer in my family, I do not smoke, am a very light drinker, get moderate exercise and am in my BMI zone for my weight(Although I have been modestly overweight for about 3 years). What I am concerned about is my estrogen levels which I believe are high. I have severe endometriosis, and have eratic periods. I recently had a very heavy 4 week period due to not ovulating. I have had a recent progesterone test which came back a 7, which is fairly low. I understand breast cancer risk is also related to life time estrogen load. I started my periods early, around 12 years old, and have a relatively short cycle - approximately 25 days, sometimes shorter. To make a long story short I am thinking of going on natural progesterone, to better balance my estrogen levels. My doctor thinks I am quacky, and since I live in Canada I must get a preion from my GP. Can you give me your thoughts on this. Thank you
		A:	you don;t describe any risk factors for breast cancer which is good. your mammogram findings are not related to predictors of cancer in the future either. so rest easier. Women do store estrogen in their body fat so hop on the treadmill and stop worrying!
Question:  #2021 02/19/2003		Q:	what would be proper treatment for intraductal pappilloma, there is no nipple discharge,or pain.
		A:	it varies. sometimes they are left alone if not causing symptoms and other times they are surgically excised. they usually do cause blood nipple discharge which is how they are most commonly diagnosed.
Question:  #2022 02/19/2003		Q:	I asked a question yesterday and wasn't to specific. I had breast cancer w/MRM 0/14 nodes, ER+PR+, Grade II. It was infiltrating Ductal Carcinoma. One of the remarks on the path report was perineural invasion is noted. What does that mean?
		A:	this means the cancer was noted to be around a nerve or nerve group.
Question:  #2023 02/19/2003		Q:	What does a pathology report that shows hyalinized fibroademona mean?
		A:	here's information and an actual photo of it: http://www.imaginis.com/breasthealth/biopsy/
Question:  #2024 02/19/2003		Q:	My Mother was just diagnosed with infiltrating ductal carcinoma with extensive high grade ductal carcinoma insitu component. the insitu type is comedo carcinoma. The size is 2.5by 1.5 It is rated a stage 3 by Bloom and Richardson. Give it to me straight please. She has diabetes and 4 heart stents. What do you think the prognosis is?
		A:	the tumor measurement may be deceiving because it is including the infiltrating along with the nonvasive disease. the critical part is the infiltrating measurement. sounds like she may fall into a stage 1 if it measures less than 2cms for infiltrating cancer. even if stage 2 though her risk for dying of breast cancer is low. her care will be carefully planned based on her other comorbid conditions though as to not stir up problems with her heart or diabetes.
Question:  #2025 02/19/2003		Q:	I am a 64 year old woman. In 1997 I was diagnosed with stage 1 node negative breast cancer. The original tumor was 2cm with extensive angiolympatic invasion. The intial biopsy/lumpectomy pathology said that I had mixed intraductal and infiltrating tumor. Less than 25% intraductal within the infiltrating component and and intraductal present outside the infiltrating component. Comedo necrosis was present and the predominant pattern of the intraductal was comeda. The predominant nuclear grade was high and tumor was within 1mm of the inked margin. I had an additional lumpectomy and removal of lymph nodes (all negative) that revealed lymphatic and vascular invasion and tumor need the additionally excised margins. I then needed a mastecoomy. I was ER/PR negative and had an elevated DNA index of 1.74 and S phase of 7.6%. I also had an overexpression of c-erb-2.ALthough no residual tumor was found in the breast tissue, there was invasive intraductal carcinoma involving one major nipple duct and invasive ductal canrcinoma in the dermis and dermis lyphatics. I had 4 cycles of Adriamycin=cytoxan and then radiation of the chest wall, axilla and the sub and supraclavical area. Due to severe neutropenia with an ANC of 96 from the chemotherapy after the first cycle my dosage was reduced. My oncologist has given me the information and copies of all reports per my request. However, when I speak to my oncologist about my prognosis and try to get a better understanding of my particular, he generally says I will be fine and not to worry although he has been open about the possibility of reoccurrence in the next five years. My radiation oncologist had always acted as if he considered my case more serious than my oncologist.As I read about Her2neu and ER/Pr negative I have concerns. I am having genetic counseling since my mother and grandmother had breast cancer and I have 3 grown daughters.In addition my father died of prostate cancer. Can I still be tested for the Her2neu oncogene when I have genetic testing? What can you tell me about the odds for metastisis and/or reoccurence? Thank you.
		A:	I understand your concerns. One of the issues with breast cancer is that we never feel like we are quite "done with it." You have had systemic treatment,chemo, for the purpose of addressing any cancer cells that may have traveled elsewhere based on the angiolymphatic invasion. Doctors hesitate to give prognosis information because each person is different and no one can really predict the future of another... You mentioned that you were a stage 1 with the tumor being 2 cms but mixed with invasive and DCIS thus the actual invasive disease must have been smaller than 2cms keeping you at a stage 1 which is good. the lower the number the better the news... Her 2 neu test can be done on the tissue block and path slides that still would be available from the hospital where your surgery was done. it wouldn't be done as part of genetic testing but instead on the actual tumor cells themselves. Genetic testing sounds like a worthy thing to do given your family history too.Local recurrence following mastectomy is less than 1% over your life time. Risk of disease in the other breast is between 10-12% over your life time. Mets risk should be low given that you did chemo, but no one can predict this--- being optimistic though is key. Not dwelling on the negative is important. You are a model for your daughters to watch too. So value each day but don't consider it your last! you have lots of mileage on you to go--- this is a great time though to reassess what you want to do with your life-- how do you want to leave your mark in this world when you die of old age... we each have the opportunity to make a difference. sometimes we don't know it until faced with a critical illness like breast cancer.
Question:  #2026 02/14/2003		Q:	My wife has been diagnosed with Breast Cancer for the second time. First when she was 25 (Non-Invasive Stage 0) and now again at age 31. She had both breasts removed the first time because she did not want to deal with this again. The recurrence was in the scar tissue in the same breast. The tumor was only 3mm which good, but the pathologists can not tell if it is invasive or non-invasive? Is this common? We have had 2 different Pathologists look at the tumor including one at Mayo Clinic. Should we continue to look for a pathogolist who can determine it before we start a treatment plan?
		A:	Yes, continue to have this tissue reviewed as the difference between invasive and DCIS is significant to her treatment. Consider Hopkins and Vanderbilt for a second path read. To have tissue reviewed here you might want to email Dr. Argani, our pathologist expert on breast cancer at: pargani@jhmi.edu
Question:  #2027 02/14/2003		Q:	Is it difficult for a Pathologist to determine the difference between a cancer (ductal) and Angiomyofibroblastoma . I recently had a radical mastectomy and then it was later discovered that I didn't have cancer after all. The ductal cancer was confirmed on both the needle biopsy and the biopsy done in the OR. Thanks
		A:	The accuracy of pathology is very much dependent on the skill and experience of the pathologist reading those slides. this is one of the reasons we chose to have a pathologist who specializes in breast cancer here-- the more specialized you are at something the better you are at it usually. If there is still a question about the type of cancer it is, as these are quite different, consider having it re-read at a place like Hopkins or another large comprehensive cancer center where there are pathology specialists for breast.
Question:  #2028 02/11/2003		Q:	I am 33, and just had my first mammogram. 5 years ago, I had a chest x-ray for tuberculosis screening and was diagnosed with a cyst that was most likely to be from Valley fever. (I lived in Arizona). I recently had another chest x-ray that showed negative, but my mammogram result was fibroadenoma cyst (2 cm lesion with perilesional halo). Is this the same thing? Was it perhaps misdiagnosed in the early x-ray? Should I be worried??
		A:	hard to say--- a chest xray should be looking at your lungs-- not breast tissue. you now have been diagnosed with a benign tumor in the breast-- the operative word here is BENIGN. you may want to have your original chest xray films pulled and re-reviewed by a radiologist.
Question:  #2029 02/06/2003		Q:	After 6 years I came off HRT in May 2002. Having found a lump under my left arm in mid-june 2002 I was diagnosed after a needle biopsy, as having Hodgkin's disease and was told there was noevidence of a carcinoma of the breast. After a biopsy of 2 lymph nodes on 7th August, I was told that my condition was not now looking like Hodgkin's but breast cancer. I have had mammograms, ultra-sound scans, an MRI of the breast and a Pet scan. None of these have shown anything on the breast. The biopsy teasted positive with CK7 and GCDFP-15 and Ca125. A CT scan showed areas needing investigation on my left ovary -but later a laporoscopy didn't find anything suspicious on the ovaries or womb. I should add that after coming off HRT I suffered dreadful hot sweats. Also a very itchy rash appeared on my breast in May. This cleared up with an application of hydrocortisone cream. As you will appreciate it is now over 7 months since I first found the lump. I have had 6 chemotherapies and am now undergoing radiotherapy to the axilla, left breast and clavicle area. I find the whole situation very worrying as nothing has shown up on these scans and as far as I can see all staining was negative, except for those mentioned above. Any comments on my situation would be so very welcome. Thank you.
		A:	consider having your pathology slides re-reviewed by pathologists who specialize in breast cancer. If you wish, that could be done here. your presentation is unusual and having experts who see unusual pathology may help in ensuring that what you are being treated for is in keeping with what what is found on path slides. For more information to get them reviewed send an email to Dr. Argani at : pargani@jhmi.edu
Question:  #2030 02/05/2003		Q:	i had wide excision and lymph node. the lymph node was negative.negative margins.the pathology report said focal residual ductal carcinoma in-situ frbrocystic changes with intraductal hyperplasia. intermediate grade nuclei and central necrosis.whatdoes that mean?
		A:	it means stage 0 breast cancer if only DCIS, insitu disease, were found. that's good news! no invasive disease found. grade was a 2-- growing at an average rate-- not fast and not slow. necrosis means there were some dead cells found among the tissue-- not unusual. Next step will probably be a discussion with a radiation oncologist.
Question:  #2031 02/03/2003		Q:	My path report said the following: right breast and axillary lymph nodes, modified radical mastectomy, moderately differentiated invasive duct carcinoma, grade 2/3, 2.5 cm in greatest dimension (t2), duct carcinoma in situ, intermediate nuclear grade 2 with focal comedo necrosis; metastatic breast carcinoma in one of eleven axillary lymph nodes with focal extracapsular extension (pN1bi). Breast carcinoma is stage IIB(T2,N1,MX). Estrogen receptor-0%, progesterone receptor-81%, Ki-67-2%, Her2/neu-1.6. I have had 4 treatments of Adriamycin, 4 treatments of Taxol and 33 radiation treatements. I have been told my tumor marker count is 24. I am taking Tamoxifen now. Please explain what all this means as I don't completely understand all of it.
		A:	Visit www.breastcancer.org for information about translating your actual pathology report. you have completed your surgery, chemo and radiaton and now are on the down slide taking hormonal therapy with the goal to prevent recurrence in the other health breast.
Question:  #2032 02/06/2003		Q:	I am a woman of 60 yrs. I have been diagnosed with Malignant cystosarcoma phyllodes on 27-Jan-03. Please let me know what this means and what is the recommended tratment. Many Thanks, Meenakshi.
		A:	Phyllodes tumors (also known as cystosarcoma phyllodes) are the more aggressive counterparts of the common fibroadenoma of the breast. Both fibroadenoma and cystosarcoma are fibroepithelial neoplasms; the neoplastic cells are stromal (connective tissue) cells which induce non-neoplastic epithelium to proliferate with it. This is in contrast to usual breast tumors which are derived from the epithelium of the breast. In fibroadenoma, the stromal cells are completely benign. In phyllodes tumors, the stromal cells are more active. Phyllodes tumors are subdivided into three categories based upon the stroma’s pathologic features; the three categories are benign, low-grade malignant, and high grade malignant. The features used to make this distinction include cellularity, mitotic activity, cellular pleomorphism, and overgrowth of epithelium by the stroma. In general, more cellular, mitotically-active, pleomorphic tumors that show stromal overgrowth are more likely to recur and metastasize. Benign phyllodes tumors have an increased risk of local recurrence compared to fibroadenoma (approximately 20%), but almost never metastasize. Borderline or low-grade malignant phyllodes tumors more likely recur (over 25%) and rarely (<5%) metastasize. High-grade malignant phyllodes tumors often recur and a significant proportion (approximately 25%) metastasize.
Question:  #2033 02/03/2003		Q:	What does this mean. This is from the pathology report after a needle core biop.: Microscopic Descritption: "Levels through the specimen show needle cores of breast. The architecture is effaced by a disorderly infiltrating neoplasm. The neoplastic cells are medium sized and polygonal. They are arranged in nests and thin columns with essentially no tubule formation. The nuclei are enlarged and anaplastic tih stippled darkly staining chromatin and nucleoli. One or two mitotic figures are found in some high power fields in more active areas. Similar neoplastic cells are expanding ducts in solid proliferations and there is focal central necrosis. The stroma is desmoplastic and tumor associated microcalcifications are present." Thanks for you answer, Dori
		A:	the key words here are "disorderly infiltrating neoplasm" which implies an invasive breast cancer. Ask your doctor for more information about the specific type, grade, and what is recommendations are for treatment.
Question:  #2034 01/29/2003		Q:	Does prior surgery (5)(bengin tumors) create density in the breasts and if so is there a need for concern regarding cancer factor?
		A:	Prior surgeries of the breast creates scar tissue in the breast which can appear as abnormalities on a mammogram. Stereotactic biopsies produce less scarring than an open excision biopsy does. Anytime that it is hard to read a mammogram we worry a little if we are missing something that might be there. This is why comparing previous films to new mammograms is so critical so that we can see change. Also using other forms of imaging like ultrasound.
Question:  #2035 01/29/2003		Q:	I had a breast biospy in '97. a 4x3x2 cm piece of tissue was taken out. I have recently had 2 friends diagnosed again with breast cancer, one is terminal. So this report came to mind again and I would like another opinion on the biospy results. the report says: fibrocystic change with apocrine metaplasia, ductal ectasia and cyst formation. There are patchy areas of dense fibrosis present as well. Microcalcification is present. There is focal lobular hyperplasia present.(proliferative fobrocystic change).
		A:	these are normal and not worrisome findings. It is understandable to be worried right now because you have two people you are close to ill with breast cancer. Your pathology results from 1997 are okay though. If you want the actual slides re-reviewed here for accuracy email Dr. Argani at : pargani@jhmi.edu
Question:  #2036 01/24/2003		Q:	I had a sentinal node biopsy done. However, I had 0/11 nodes removed. Can this still be classified as a sentinal node biopsy. Thanks.
		A:	hhmm. Sounds like your might have been done as part of a clinical trial perhaps where the doctors are still studying (or learning) about sentinel node and its accuracy. A true sentinel node biopsy procedure would be removal of just the sentinel node--- this node would be evaluated for evidence of cancer and it none is found then the other nodes remain untouched. If the sentinel node does contain cancer cells then a lymph node dissection would be done (usually level 1 and sometimes level 2). Hope that makes sense.
Question:  #2037 01/21/2003		Q:	I've been diagnosed with invasive ductal breast cancer---level 3. How bad is this?
		A:	hhmm. "level 3"-- if you mean grade 3 then this means that the tumor cells are growing faster than average, but keep in mind that most breast cancer cells ARE a grade 3. If you have stage 3, then the tumor is fairly large and involves lymph nodes and you will need quite a bit of treatment to get well again.
Question:  #2038 01/21/2003		Q:	I received the following diagnosis: Biopsy of Right Breast, Anterior (Sterotactic): Fibrocystic changes, with extensive ductal epithelial hyperplasia, sclerosing adenosis, cysts, and miccrocalfications. NOTE: Intraductal papillomatosis extends to the biopsy margins; complete removal of the lesion is suggested if clinically warranted. What would be your recommendations? and How bad is this?
		A:	we aren't able to give you a clinical recommendation without seeing you, examining you and looking at your mammograms and pathology slides. What you described sounds in general pretty standard though. These are benign findings which is the most important news. So talk with your surgeon about what the next steps are and consider another formal opinion to ease your mind.
Question:  #2039 01/21/2003		Q:	What is an invasive carcinoma on a pathological report regarding a core biopsy.
		A:	This means that the cancer, if in the breast, has spread into the fatty tissue of the breast and is therefore capable of spreading to other parts of the body by traveling to blood vessels or lymphatics. The most common type of ductal with the second most common type being lobular. Invasive carcinoma requires treatment, usually surgery at a minimum and depending on size and other factors, also possible chemo and/o radiation.
Question:  #2040 01/14/2003		Q:	On 8/07 was diagnosed with invasive breast cancer. 8/23 lumpectomy, 9/9 re-exicision, 6 weeks of radiation. Pathology is = HER2neu 3+, hormone receptor negative. infiltrating component, elsten grade III of III; vascular invasion is not definitively identified; .9mm mass; negative nodes; dcis extensive represents 90% of mass shows pagetoid extension into larger ducts. dcis is nuclear grade 3 of 3, comedonecrosis is present; comedo present. pathologic stage after first operation: pT1NoMx. Final pathology report: right breast re-excision: breast tissue with biopsy site changes, fibrocystic changes, and usual type duct hyperplasia. Focal atypical lobular hyperplasia is present involving a large duct. Overlying skin with scar. No residual in situ or infiltrating carcinoma identified. My question: What does all of this mean? The final pathology report states "focal atypical lobular hyperplasia is present involving a large duct". Does that mean it is still in there? Also, I'm not a candidate for tamoixfen because of my hormone receptors. I would like a straight answer as to my likelihood of reoccurrence in the same breast and an occurrence in the other breast. Perhaps it will help me to not be so worried about it. It is driving me crazy. I am 46 with no family history of breast cancer. My grandfather had lymph node cancer and died from it. My grandmother had colon cancer and is a 30 year survivor of that. Any info would be appreciated. Thank you.
		A:	Sounds like you may have some residual atypical duct hyperplasia there but remember this isn't cancer... it is a marker that your breast was at higher risk than others for developing cancer and sure enough it proved that it could and did. Based on what you emailed, you have clear margins, a tumor under 1cm. Though it is preferred to have hormone receptor positive and her2 neu negative results, you have negative nodes and sounds like are doing well. Stats would say that risk of recurrence in the same breast is around 10-15% over your life time. (if you hadn't done radiation it would have been more than 40% within 2 years so glad you did the radiation therapy.) Risk for the other breast is also about the same. Lobular cancers have a higher incidence of mirror imaging in the other side over time. It is understandable to feel worried.. a lot has happened and you are still dealing with the shock of the diagnosis and treatment. Don't let this disease comsume you though or breast cancer has won-- you've taken the right steps to get rid of it. Now focus on eating healthy, exercising regularly, and enjoying each day as it is a gift...