Pathology Question

justachapter

I have my surgical consult Thursday so I'm sure she will go over all this with me, but does anyone know what this means:

Periductal Stromal Reaction: Present

From biopsy, my report is as follows:

Histopathologic Type: Ductal with Apocrine and Micropapillary Patterns
Histopathologic Grade: (Modified Lagios) Intermediate
Nuclear Grade: 2

Necrosis: Absent

Periductal Stromal Reaction: Present

Microinvasion: Absent

Extent of Involvment: DCIS involves 3 cores (I'm not sure how many they took) The largest focus is 1cm

And I'm ER+ (92%), PR+ (9%)

Thanks!

april485

"Microinvasion was often associated with periductal stromal reaction (71.5%) and/or a lymphocytic infiltration (78.6%)."  

I took this out of this when I googled the term. http://www.ncbi.nlm.nih.gov/pubmed/12828606

Hope this helps...not sure what it means to be honest with you. It does not look like you had a mic invasion though so obviously this does not apply to you. Hopefully Beesie or someone who knows more can help you.

justachapter

Thank You April485.  I guess I'll have to wait and see as I know they didn't take everything out and there was a lump missed on mammo.  I don't even know what microinvasion means, will have to look that up.  New journey....

Beesie

I found the same article as april485 and was just about to post it, along with this other one:

Histologic and Radiographic Analysis of Ductal Carcinoma In Situ Diagnosed Using Stereotactic Incisional Core Breast Biopsy

"Microscopic invasion or foci suspicious for invasion are a frequently
encountered problem in core biopsies showing DCIS, collectively
accounting for 24% of our cases. We would emphasize that cases of DCIS
may have a periductal stromal reaction that can be difficult to
distinguish from a desmoplastic reaction associated with true invasion."

"Presence of a periductal stromal reaction was not correlated with occult invasion"

So my conclusion from both of these studies is that while most cases of DCIS-Mi include the presence of periductal stromal reaction, having periductal stromal reaction does not mean that one is likely to have a microinvasion.  

In your case, all the other elements of your pathology suggest that you are probably pretty low risk to be found to have a microinvasion when you have your final surgery and all the suspicious breast tissue is examined.  Micropapillary patterned DCIS and apocrine DCIS (if it's lower grade without necrosis) tend to be less aggressive.  Similarly, intermediate grade and the overall lack of necrosis are other good indicators. It is also great that your pathology report specifies "Microinvasion: Absent"; too often on needle biopsy reports we see words like "suspicious for microinvasion".  So the fact that nothing like this is written on your report suggests that there's a good chance that your 'periductal stromal reaction' is not associated with having a microinvasion.  

Let us know what your surgeon says.

Edited to Add:  If you haven't already done so, it might be helpful to read my opening post in this thread.  It explains what a microinvasion is, and much more.  A layperson's guide to DCIS

justachapter

Thanks Beesie!

I just read the layperson's guide, appreciate it.  Am interested to have the Dr explain it all and her thoughts.