Post-Surgical Path Report

mary625

I had my BMX this past Monday, 2/6, and some of my path results are in. I am not sure how to interpret them. My BS basically said that they are not the worst or best results and that they point to a high need for radiation, maybe in 3-4 planes(?). 10 of 16 lymph nodes removed in ALND were positive for macromets with areas of extra capsular extension. The tumor was 1.8 cm which was greatly reduced by chemo from its original estimation of at least 7 cm. However, I think this puts me as T1N3 or Stage III b or c. I was obviously hoping for much less node involvement and a better stage.



The part I am very confused about is that they are going to run some further tests on E-Cadherin and Her2neu even though I was previously told Her2neu negative on my biopsy. "The invasive carcinoma shows area characteristic for ILC and area showing signet ring cell changes or much atypical pleomorphic appearance. Some tumor cell nests are quite rounded and may indicate in situ lobular or in situ ductal; however, they are cytologically quite pleomorphic." Then it says that the E-Caherin and Her2neu would be run again and an addendum made. Any ideas about this?

SpecialK

mary625 - here is a definition of E-Cadherin from Dr. Google:

 E-cadherin is also used by pathologists to diagnose different kinds of breast cancer. When compared with invasive duct carcinoma, E-cadherin expression is markedly reduced or absent in the great majority of invasive lobular carcinomas when studied by immunohistochemistry.

Sounds like they want to make sure of the BC types in your complete tumor that was removed instead of relying on the biopsy sample alone.  It is possible to have mixed types - I had both IDC and DCIS in one breast and ADH and ALH in the other breast.  Sounds like they are checking for LCIS, or DCIS and any of those components may be Her2+, so they need to check, based on the differing appearance of parts of the tumor histologically (pleomorphism).

beacon800

I guess the question is, do you have pleomorphic invasive lobular cancer or do you have pleomorphic LCIS along with an invasive component of ILC? I had pleomorphic LCIS, which basically means a more abnormal looking bunch of cells than classical LCIS. But insitu cancers, pleomorphic or otherwise, are not a big deal since you have a bmx. Pleomorphic invasive is thought to be more aggressive than standard invasive, but recent research may have changed this characterization. You'll want to ask your doctor to clarify your dx and what the treatment path will be. It's fairly standard for them to retest for her2 as sometimes the status does change between biopsy sample and larger pathology.