ILC reccurrence now IDC is this possible?

sian

ILC reccurrence now IDC is this possible?

sian

Hi

I was originally diagnosed in 03 with a 3.5 cm N0 M0 lobular breast cancer in my left breast.  I had a lumpectomy and rads followed by Zoladex and tamoxifen.  at my 5 year chech up I was diagnised with an advanced local reccurrence in my axilla with no distant mets but with local chest wall extension.  I requested my clinical records from the hospital to send for cyberknife evaluation, and to my surprise found that I have metastatic ductal carcinoma in my axilla not lobular according to the path report.,  Is that possible?  Can lobular cancer reccurr as a ductal mets, or do I have a second primary in my breast tail, an occult primary ductal in the breast????

Any Ideas comments or similar stories much appreciated.

Thank you all 

MarieKelly

It's certainly possible that you could have a brand new primary somewhere that's different from the original one.

It's also possible that your original pathology report in 2003 incorrectly identified your tumor as being lobular when it was really ductal. Ductal and lobular can sometimes be difficult to distinguish from each other and a test for loss of E-cadherin is now used specifically for the purpose of  distinguishing bewtween ductal and lobular. Perhaps this test wasn't done on your tumor sample in 2003 since it had just started being used for this purpose in the early 2000's. When certain tests or procedure first come into use, it's not necessarily being used in every facility or path lab immediately. Change is slow sometimes.

The following is taken from a newsflash dated 2006 on this very topic -

E-Cadherin Staining Can Distinguish Ductal From Lobular Carcinoma: Presented at IAP

http://www.docguide.com/news/content.nsf/news/852571020057CCF6852571EE000E314A

"...Loss of the E-cadherin gene from chromosome 16q is a frequent finding in lobular carcinoma of the breast but is not typically found in low grade ductal carcinomas. A recently developed E-cadherin stain, therefore, is believed to help distinguish the 2 and has become an important tool in pathology. The usefulness of this stain, however, has received little investigative attention, Dr. Kurian said.

To test the ability of the E-cadherin stain to differentiate between lobular and ductal carcinomas, Dr. Kurian and colleagues reviewed more than 1,000 pathology slides taken from 92 patients who had been diagnosed with lobular carcinoma in the previous 10 years.

Using the stain, they reclassified 21% of these patients as having ductal carcinoma. Overall, 9 patients had LCIS, 3 had LCIS with infiltrating ductal cancer, 27 had invasive lobular carcinoma, 25 had signs of both LCIS and invasive lobular carcinoma, and 9 had invasive ductal and invasive lobular carcinoma. The investigators also found evidence of pagetoid spread in 54 patients, 9 of which were associated with LCIS. Two patients had signs of ductal carcinoma in situ (DCIS) and LCIS in the same ducts.

In her poster presentation here on September 17^th at the 26^th International Congress of the International Academy of Pathology (IAP), Dr. Kurian said that the researchers found that 19 of the patients whose pathology slides were reviewed were wrongly classified as being lobular when they were actually ductal carcinoma. "And we could prove that by doing the E-cadherin study," she explained. "Some of the cases had coexisting lobular and ductal [carcinoma], which were missed because the E-cadherin stain wasn't done [until] the early 2000's."


 

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Member_of_the_Club

Also, some women have a combo of both.  Its possible this happened in your case but that the pathologist didn't see the IDC, and it was that component that came back.