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Category:

Understanding Pathology Results

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Question:  #2071 10/27/2002		Q:	i am in my 30's and just had a core biopsy, on two tumors, one is each breast. i was told one was a fibroademoma. i was also told the other result was inconclusive and was being sent to sloan-kettering. from there, it was sent to cornell to be viewed my dr. rosen. my doctor called me and said there is a radial sclerosing lesion and it is in a fibroadenoma tumor. but she said there is concern because there is necrosis present. i have been told i need a lumpectomy and that there is also a small tumor in the same breast that is suspicious. my doctor told me not to worry, she feels it may be benign. i need to know if a benign tumor like this can have necrosis. i see the work necrosis associated with cancer and fat necrosis only. i will get surgery this week coming. please answer and let me know if necrosis can be present in a complex fibroadenoma with radial sclerosing lesion. i am anxiously waiting for reply.
		A:	yesp, it sure can. it is not uncommon to see necrotic cells in the center of a fibroadenoma.
Question:  #2072 10/27/2002		Q:	Final Diagnosis: Right breast, needle core biopsy-poorly differentiated (grade III, 8 points, infiltrating duct carcinoma with intermediate grade duct carcinoma in situ. 2. Right breast , needle core biopsy-moderately differentiated grade II, 7 points, infiltrating duct carcinoma with intermediate duct carcinoma in situ. 3. Right axilla, lymph node needle core biopsy metastatic duct carcinoma.
		A:	hhhhmm. I received your path report you typed but not the question you have about it? looks like you have been diagnosed with breast cancer in both breasts-- stage 1 in left side and stage 2 in the other (due to lymph node involvement).
Question:  #2073 10/26/2002		Q:	What exactly is "infiltrating ductal carcinoma with focal chondroid metaplasia"? And, at a histologic grade of III, what does this mean for my prognosis after mastectomy, chemo and radiation?
		A:	this is merely describing the structure of the cells and doesn't effect your prognosis. Prognosis is based on size of tumor, involvement of lymph nodes, presence of disease elsewhere in the body, and how aggressively you've been treated as well as some other pathology factors like hormone receptors and her2neu receptors. Infiltrating ductal simply means that the disease spread from the lining of the duct of the breast into the fatty tissue of the breast-- this is the most common form of breast cancer.
Question:  #2074 11/05/2002		Q:	I am 45 and have been getting mammo's since 35 - i had implants 3 years ago - this last mammo showed lesions and i got a breast mri - the report states "two or three lesions anteriorly in the right breast that are most likely proteinaceous cysts". What exactly is that and other than mammos every six months should i do anything else or be concerned with cancer? thank you so much
		A:	Sorry for the delay in getting back to you. I requested one of our pathologists and radiologists to review this question as well. bottom line-- the recommendation is for you to consider a second opinion for reviewing your mammograms/ultrasounds by a facility that has dedicated radiologists (mammographers) who do breast imaging.
Question:  #2075 10/22/2002		Q:	Will you explain a radial scar?Intraductal epithelial hyperplasia and Apocrine Metaplasia? How large is 4.2 cm-4.2cm-3.ocm? Thank you!
		A:	you will find this information in the pathology section on our website (click on the pathology icon from the homepage) as well as visit www.breastcancer.org and see their pathology icon section too. (2.5cms equals 1 inch by the way)
Question:  #2076 10/22/2002		Q:	I had a mastectomy for low grade DCIS in June. Now there is concern about a dense area in my other breast. It was biopsied (core needle)in June and found to be stromal fibrosis. The oncologist had me do a mammogram six months later which showed denseness with some fine calcifications. Now they are concerned and want me to have it taken out and analyzed. Do you agree?
		A:	hhhmm. to render any medical opinion you really need to have a proper consultation and evaluation-- having a breast surgeon examine you, review your mammograms and determine this personally. pursue a second opinion to ease your mind.
Question:  #2077 10/26/2002		Q:	What is the difference between a simple and complex fibroadenoma? Does a fibroadenoma have to be large in order to be classified as simple or complex? Does a pathology report describe fibroadenomas as simple or complex or is other terminology utilized? Thanks.
		A:	Fibroadenoma is the most common tumor of the breast and is usually diagnosed in adolescents and young women. This benign tumor is composed of a mixture of glands and stroma (connective tissue). It is derived from the hormonally responsive stroma of the terminal duct lobular unit, which is thought to induce benign proliferation of the epithelium. Fibroadenomas are overall associated with a very slight (approximately 2X) long-term increase in the risk of breast cancer. A “complex fibroadenoma” has one of the following 4 features: sclerosing adenosis, papillary apocrine hyperplasia, cystic change, or epithelial calcification. These 4 features are basically those of benign fibrocystic change, which is also exceedingly common in the breast. The size of the lesion does not determine if it is or is not complex. A recent study found that, compared with controls, patients with complex fibroadenomas had a slightly increased risk of breast cancer compared to those with non-complex (or simple) fibroadenomas. However, the relative risk (3.1X) was lower than that previously associated with atypical duct or lobular hyperplasia (4-5X) or carcinoma in situ (10X). Moreover, two thirds of the population with fibroadenomas had noncomplex (simple) fibroadenomas and no family history of breast cancer: these patients had no appreciable increased risk of breast carcinoma. Dupont WD, Page DL, Parl FF et. al. Long-term risk of breast cancer in women with fibroadenoma. New England Journal of Medicine 1994;331: 10-15.
Question:  #2078 10/20/2002		Q:	I've had breast symptoms since this past July of areola hardening, enlarged pores-looks similar to an orange, some redness and slight swelling, areas of skin thickening and stiffness. I've been on antibiotics 2x. Neg mammo and ultrasound. Skin biopsy neg for malignancy, showed chronic perivascular inflammation. Breast remains unchanged. What does all this mean?
		A:	get a second opinion on your pathology slides from your skin biopsy and also get another opinion from breast surgeon who specializes in breast cancer. your symptoms certainly sound suspicious for trouble.
Question:  #2079 10/20/2002		Q:	I have just been told that the results of my mammotome biopsy have diagnosed me with DCIS. There is one are of 1mm and another of 2mm. Will I need treatment after an excisional biopsy? Is an excisional biopsy enough-or should I have more extensive surgery? Thank you.
		A:	you have the tiniest amount of DCIS on record and are proof in the value of mammography for early detection. A lumpectomy will remove this quite effectively. there are clinical trials for women like yourself that results in some not needing radiation so pursue getting information about them and see if you qualify. Your doctor might also recommend hormonal therapy to prevent the return of the disease
Question:  #2080 10/20/2002		Q:	I was told after an ultrasound I have many simple cysts, but one is a complicated cyst??? The girl said this over the phone. I am not sure if she meant complex? Anyway, can you tell me what each of those mean exactly? I am to have a follow up in 2 months with another ultrasound. Does this sound resonable to wait? Is this still a cyst, with little chance of it being cancer? Thank you
		A:	she probably meant complex cyst. to read more about these definitions visit www.breastcancer.org and click on pathology.
Question:  #2081 10/20/2002		Q:	After additional magnification views, the radiologist reported, "Calcifications seen on mammogram not seen on previous exam. They are seen as a cluster and most of these appear fairly rounded but there is some heterogeneity, and I believe stereotactic biopsy would be appropriate." Assessment: "Isolated cluster of calcifications slightly suspicious in the slightly superomedial left breast. Stereotactic biopsy is recommended." I am scheduled to see a surgeon in a few days. Do you think there's a chance that she will NOT want to do the biopsy, and if so, shouldn't I insist? I'm familiar with DCIS and LCIS, but what else do you think this could indicate? I just want to be as informed and familiar with terms as possible when I go to the Dr. THANK YOU so much for being here for all of us!
		A:	yes, insist on a biopsy. It could be an early form of breast cancer like DCIS or it could even be a tiny amount of invasive cancer at this spot. a needle localizatin biopsy will probably be recommended for you.
Question:  #2082 10/20/2002		Q:	I had DCIS (high grade) diagnosed from a stereotactic core biopsy. The hormone receptor tests done on that tissue came back negative (zero) for both receptor tests. I have had 2 lumpectomies with a good margin on the second surgery and have started radiation. The oncologist just recommended tamoxifen. But I've read that may not be indicated. Should I request receptor tests be done on the tumor specimen from the surgery? To confirm the receptor status before making the important decision to not take tamoxifen?
		A:	oftentimes receptors tests aren't done on DCIS because the test is terribly accurate on non-invasive cells. From the extensive tamoxifen clinical trial though it was learned that women with DCIS benefit from tamoxifen in having it help prevent the return of this diseae so that is why they would be recommending it for you at this time.
Question:  #2083 10/20/2002		Q:	Can a pathologist make a positive finding of a fibroadenoma, or is it, simply, a negative finding as to cancer? That is, is the absence of cancer in the face of a solid mass categorized as a fibroadenoma?
		A:	fibroadenomas have a certain cell sructure just like cancer cells have a certain structure. When a pathologist states it is a fibroadenoma you should be able to depend on that pathology finding.
Question:  #2084 10/15/2002		Q:	My pathologist says "unfortunately, the entire lesion is distorted with diathermy artefact". ... "Evaluation of this lesion, again, is succeedingly difficult due to poor preservation and diathermy artefact,...". Again it is difficult to be certain or dogmatic about this atypical proliferation but in better preserved areas, the cytology of these atypical tubules and nests of cells appears atypical,..." A wider re-excision of the surgical site should be recommneded as this lesion does not appear fully excised." Can cauthery distort normal tissue to make it look like something cancerous? I am told the failure to get good preservation is because the edge was cauterized and that part does not preserve well. Is that possible, or is it possible the lab did not preserve it properly? With tissue that is distorted as they say, is it ever possible to make a definitive diagnosis? If they re-excise, is it possible the remainder of the lesion will be a "diathermy artefact" and will not be able to be well preserved? The main palpable lump which was the reason for excision was not found to be malignant. The worrisome part is at the edge of cauterized normal tissue cuff excised. The pathology report does not mention calcifications in the worrisome sample, but does so in the lump part. The mammogram said there was microcalcification in the centre of the spiculated mass "just deep of the BB" placed over the lump that I felt. I have read on the internet that the mammograms should be reviewed at the same time. Is this true? If so, do I neeD a separate request form?
		A:	This is the response from our lead pathologist on breast cancer: cautery artifact is not due to laboratory processing errors. there is always some cautery artifact at the edge of the tissue where the surgeon cuts-they need cautery to minimize bleeding. i don't know why some specimens have more artifact than others-it may be due to the amount of time spent cauterizing or the setting on the instrument. cautery makes tissue difficult and sometimes impossible to interpret. it can make benign lesions look worrisome, and obscure malignant ones. it usually is not too much of a problem in the re-excision as long as they use less cautery when doing the surgery.
Question:  #2085 10/15/2002		Q:	i have a report from one of screening xeromammograms. it states "there are fine calcifications scattered in both breasts suggesting developing sclerosing adenosis." What does this mean?
		A:	Three patterns of microcalcification may occur in ductal carcinoma in situ. Granular or lamellar calcifications form by calcium deposition on secreted material. Necrotic nuclear debris calcifies in DCIS with comedonecrosis, often yielding a branched linear pattern on mammography. The latter tend to be high nuclear grade DCIS. In general, lower grade, nonnecrotic DCIS is less likely to have calcifications. It’s important to remember that not all calcifications in the breast indicate carcinoma. Microcalcifications are commonly seen in benign fibrocystic changes (particularly calcium oxalate deposition), in intramammary arteries of older patients (especially in those with diabetes), and in the connective tissue stroma of benign neoplasms like fibroadenoma. A skilled radiologist is needed to determine how worrisome mammographically detected calcifications are.
Question:  #2086 10/10/2002		Q:	I had a mammogram which showed microcalcification of left breast. They were biopsied by needle. The doctor said there was no mass and they were benign. Are microcalcifications usually cancerous or can they be benign.
		A:	they can be benign too and when they are they are calcium.
Question:  #2087 10/08/2002		Q:	I had excisional biopsy ,Dr said the margins were unclear during biopsy so he took out what he thought he could feel. He said some of the mass is probably still there. Diagnosis was fibrous mastopathy with scattered foci of interductal hyperplasia and pseudoangiomatous stromal hyperplasia. Dr said to have reck in 6 months.There is little info on PASH and I am unsure if additional treatment is needed or if it is safe to wait 6 months. Need more info on pash:treatment-prognosis.Sister died from breast cancer age 50. Unsure of type. Thank you.
		A:	According to our pathologist here who specializes in breast cancer and breast disease, PASH is completely benign. the only significance is that is can make a clinical mass (rarely), or be mistaken under the microscope for angiosarcoma ( though he personally has never seen that happen). Hope that information is helpful
Question:  #2088 10/04/2002		Q:	My wife has just been diagnosed with breast cancer in stage 0.The doctor is wanting to do a full mastectomy on her left breast.She is wanting to get a 2nd opinion.What is the procedure for getting a 2nd opinion at your facility and how long it would take to get an appointment.Thank you for your help in this matter.
		A:	It shouldn't be long at all. Call Joan at 410-955-2615 or Judy at 410-955-8964 ext 4071. You are right to explore a second opinion as it is unusual to need a mastectomy for DCIS today unless the disease is classified as "extensive", occupying several quandrants of the breast. If mastectomy is necessary, then breast reconstruction should be offered at the same time.
Question:  #2089 09/30/2002		Q:	I am a 25yr old woman. I just had a small tumor removed from my breast. The surgeon was sure it was a fibroadenoma, but when the pathology reports came back it was diagnosed as a fibroadenoma with phyllodes features. The nurse could only explain it to me as a fib. that could have grown REALLY big, REALLY fast. I have to go back in 6 months to get another ultrasound. Apparently if he would have 'thought' it had phyllodes feature he would have taken more tissue out, but he didn't. Should I be worried? Can you tell me what this phyllodes features mean???
		A:	It relates to a type of cell growth/structure. Glad it was benign but yes, it could have grown considerably. It is smart to continue to be followed by breast imaging to stay on top of your breast health has you have presently done. don't fret. You've taken the right steps in getting it removed and will continue to follow your breast health diligently I'm sure.
Question:  #2090 09/29/2002		Q:	One year ago I had a mammo. which showed calcification. A year later went for another mammo. and the clinic had lost my last years exam. Long story short, I had a sonogram and biopsy which showed dense breasts and a mild nuclear atypia. I am scheduled to have these removed. What exactly does this mean?
		A:	Atypical cells are a sign that the breast tissue wants to mutate into irregular cell structure. It is not cancer. Visit our pathology section for more information: www.hopkinsmedicine.org/breastcenter then click on pathology icon You can also read more about pathology findings like this at: www.breastcancer.org
Question:  #2091 09/27/2002		Q:	I had a green discharge. Pathology report said: material mostly proteinaceous. Cells scant but present. Nuclei appear large and hyperchromatic. What exactly does this mean please?
		A:	sounds like the makeup of the contents of a cyst. Commonly breasts will grow cysts which is a benign pocket of fluid. Army green fluid being the most common color.
Question:  #2092 09/26/2002		Q:	My wife has just been diagnosed with carsinosarcoma of the breast. She has had a radical mastectomy. The tumor measured 5 cm, and the cancer was found in one lymph node. She is 36 years old. The pathology report indicated that the margins were clear. We have been told that the treatment will be both chemo and radiation. As this cancer is very rare, we are having difficulty finding information on it. Can you provide us with some references on this particular cancer? We would like to be as informed as possible so that we can have meaningful input into her treatment.
		A:	You may want to have the pathology re-reviewed here by Dr. Argani to help ensure its accuracy since this is quite rare. He can also speak with you on the phone regarding this type of tumor. Call 410-614-2428 to talk with him about this. He will also advise you how to arrange for her slides to be sent here for his review.
Question:  #2093 09/26/2002		Q:	I was diagnoised with focal lobular carcinoma in situ, background breast tissue includes mild ductal epithelial hyperplasia with associated microcalcifications, no invasive neoplasm identified.what does all that mean? should I have an open biopsy or wait and follow up with a mammogram and let the dr. keep an eye on it
		A:	The biopsy findings presently show LCIS which is a marker for risk of developing breast cancer. Meeting with a medical oncologist who specializes in high risk women would be a good next step. This individual can work with you on a plan of breast cancer prevention.
Question:  #2094 09/13/2002		Q:	I am confused. My biopsy report came back ADH. My surgeon says she must remove a 2 inch area where this is and put me on Tamoxifen. I asked what is the percentage that this will turn into cancer. Her reply was "there is no statistics, it would be cruel not to remove this just to see if it turned into cancer". My confusion: I have read on different sites on the internet where they state that the treatment is monitoring the ADH with 6 month mamograms and physcian exam because ADH has a high percentage of not turning into cancer. If a change occurrs, the cancer would be considered caught early. I would appreciate your thoughts on removing ADH vrs. monitoring. Thanks
		A:	When ADH is seen on a fine needle biopsy usually a surgeon who specializes in breast cancer will do an open excisional biopsy to remove a little more tissue with the goal to ensure that there isn't evidence of precancer or cancer present in the breast now. A second opinion with someone who does a large volume of breast cancer surgery and preferably is a surgical oncologist might be a good next step. the decision to take hormonal therapy in the form of tamoxifen involves many factors. tamoxifen is usually prescribed for women with high risk and it is recommended by a medical oncologist after thorough consultation and evaluation of the patient's present condition, pathology findings, and family history as well as assessment of other risk factors for breast cancer.
Question:  #2095 09/11/2002		Q:	Friends: I need pathology clarification...the report reads: Fragments of solid papillary neoplasm with focal atypical cribiform proliferation with aprocrine change. Excisional biopsy is recommended. I am having that procedure done on Sept. 17. I'm getting conflicting information from 3 different doctor's opinions that I have gone to. Is this DCIS? What is it? Some say DCIS some say no....can you help me out so that I can feel clearer as to what is going on in there before the surgery? I would really appreciated it. All 3 doctors have told me that although there are no guarantees (they all talk like that! So cute!), my chances are good that even if it is DCIS, it is low grade and it is non-invasive. I had another pathologist, a "big shot" in New York also agree with the first report. Thanks ever so much....
		A:	this sounds like a report from a needle core biopsy of the breast, and it sounds like the differential diagnosis is atypical duct hyperplasia versus low grade ductal carcinoma in situ. the proper treatment for either diagnosis is excision. a significant number of lesions diagnosed as ADH on biopsy prove to be DCIS on excision. the pathologist needs to really see the whole lesion to make this distinction, since the distinction really depends upon the extent of the lesion-if there is very little, it might be classified as ADH, if there is a lot, it might be classified as DCIS. It's also important to be sure that the needle biopsy did not miss an area of invasive carcinoma-you can't tell that without seeing the entire lesion, which you do not on a needle biopsy.
Question:  #2096 09/06/2002		Q:	You have said that a sentinel node biopsy can still be done after a lumpectomy. There seems to be some controversy about the feasibility of this. I was told that the path from the lesion to the lymph node could be disrupted or cut in the process of the excision and that it might not work afterward because of that. Is this just lack of experience on the doctor's part or does anyone else there concur? The doctor I talked with said he had done approximately 100 sentinel node biopsys. I am not sure if this is a small number or large?
		A:	There may be differences of opinin regarding this, but from our experience here, we've successfully done them. Sentinel node biopsy has been done here for more than seven years-- so we are talking way over 100. 100 is a decent number to ensure that the surgeon is well beyond the learning curve though which is good.
Question:  #2097 09/05/2002		Q:	If a pathology report says that the cancer is non-invasive, do the surgeons normally act accordingly and take that report as a fact. Or, do they still do the sentinel node biopsy to make certain?
		A:	If the pathologist reading the slides is someone the surgeon works with regularly and has confidence in then there is no real reason to question there results. In such a case, assuming the DCIS is limited to one foci and not diffusely scattered throughout the breast, then the surgeon usually would not perform a sentinel node biopsy. If there is a large amount of DCIS however and the surgery being performed is a mastectomy, then a sentinel node might be obtained-- this is because if invasive disease were to be found buried somewhere in a large amount of DCIS and the breast were now removed, there would be no way to identify which node is the sentinel node, thus forcing the need for an axillary node dissection. If a lumpectomy were being done and, though uncommon, a small foci of invasive disease were newly found after this re-excision were performed, a skilled surgeon with expertise in performing sentinel node biopsies can still do this procedure retrospectively, as long as the breast is still there for injecting the blue dye or radioactive isotope.
Question:  #2098 09/03/2002		Q:	What is the prescribed treatment for LCIS. Do doctors usually opt to remove the lesion or do they watch it carefully?
		A:	LCIS, lobular carcinoma insitu, is a marker for risk of development breast cancer in the future. Though the term contains the word "carcinoma" it in fact is not cancer. cells that are not normal but that stay inside the milk mkaing part of the breast best describes LCIS. Usually patients with LCIS are followed in a breast evaluation program that specializes in women who are high risk. A risk reduction/prevention plan can be developed with the patient, based on evaluating other risk factors that she may have which may further increase her risk of developing breast cancer in the future (ie, family relative with breast cancer; smoker; no children born until after age 30, etc). In some cases, patients are advised, based on the degree of risk they have, to take a drug called tamoxifen as a means to further reduce risk.
Question:  #2099 09/02/2002		Q:	Can you please tell me first what is the prescribed treatment in the field for LCIS (do they normally watch and see or do a lumpectomy?) and if there is a ductal extension with focal zonal necrosis associated with microcalcifications but no invasive carcinoma identified, is this treated as LCIS still or now is it treated as DCIS? What factors are taken into account? The pathologist at a comprehensive cancer center has stated that by immunohistology, the critical cells are negative for E-cadherin (what does that mean?) How can I get someone to help me interpret this pathology report so that I can understand it?
		A:	Verifying the findings of pathology may be the first step. You are welcome to have the slides re-reviewed here at Hopkins by pathologists expert in breast tissue. This is important to then determine a treatment plan. LCIS is a marker for breast cancer and not actually cancer, though it contains that word (carcinoma) that is confusing to many. Being seen in a program that specializes with high risk patients would be a wise move. Determining by a pathologist how much is DCIS vs possibly LCIS is important. It may require also a bigger specimen if the tissue obtained to date is confined to a needle biopsy.
Question:  #2100 02/11/2004		Q:	Can you tell me what my pathology report means when it says that by immunohistology, the critical cells are negative for E-Cadherin?? lynfrost@hotmail.com
		A:	E-cadherin is a type of cell adhesion molecule (CAM) and is considered an "invasion-suppressor" in many cancers (including breast). Its loss of expression (such as by immunohistochemistry in this case) would mean that the cells would be less cohesive. Loss of E-cadherin is characteristic of lobular carcinoma of the breast, both in insitu and invasive.