Help with post-op pathology report

frommom2two

Mom just got post-op (lumpectomy) pathology report: Diagnosis:Invasive ductal carcinoma, NOS with micropapillary component. 2/2 sentinel lymph nodes negative, but 1/1 axiallary content lymph node is positive. Margins invasive carcinoma: uninvolved. Distance from closest margin 6.0 mm. Where I'm confused is that there is a comment following diagnosis that says:This is an invasive ductal carcinoma, NOS with a micropapillary component. Tumor emboli show micropapillayr features and involve small and large lymphovascular spaces in the peritumoral area and well away from the main mass, they are also seen very close to multiple resection margins and transected at the posterior and the revised inferior margins.... so how if the margins are negative (and the dr. told us this) what does this comment mean and should I freak out about it?

doxie

I wish I could help you with your question, but I can't. Hope someone will show up to help.

It's good you are there for your mom. Mine was for me and that made things easier.

Moderators

Hi Mom2two-

We just wanted to welcome you to our community here at BCO. We're sorry for the circumstances that bring you here, but we hope you find support for yourself and your mom.

We're sure someone from our knowledgeable community will read your post and have some insight or advice to share you with, so we're bumping this post for more people to see. We hope your mom's recovery is swift and easy, and that her treatment goes well.

The Mods

Dancermom1999

Hello: When I was diagnosed I went to the "ask an expert" john hopkins breast cancer website. There you can ask questions and Lillie Shockney is a nurse there who is a breast cancer survivor herself. You can " ask " her what this means and she might be able to give you a layman's understanding of the terms. She did for me and I felt so much better after getting her reply.

BarredOwl

Hi Frommom2two:

I would want to understand that too. It is a pretty technical description, and is probably beyond the ability of most laypeople including me to know with certainty either: (a) what is described in the comment ("Tumor emboli . . .); or (b) whether or not it has any significance for prognosis or treatment of a patient with your mom's particular pathology and node status.

The reference to "lymphovascular spaces" makes me think of local lymphovascular invasion (square-bracketed [text] inserted by me):

"Lymphovascular invasion (LVI) is defined as tumor emboli present within a definite endothelial-lined space [blood or lymph vessels] in the breast surrounding invasive carcinoma."

BC.org has some information and illustration of LVI here:

http://www.breastcancer.org/symptoms/diagnosis/vas...

My pathology report actually set forth two different measurements of margins for the same surgical sample: (1) margins for the IDC present; and (2) margins for the DCIS present.

So, my layperson's guess is that it might be a description of two separate phenomena, and may reflect two different distance assessments:

(1) margins for the invasive ductal carcinoma ("Margins invasive carcinoma: uninvolved. Distance from closest margin 6.0 mm"); and

(2) distance measurements from some other phenomenon (which might be LVI) to the edge of the tissue sample.

Please definitely follow-up with the doctor. You could say/ask: We understand the tumor margins are 6 mm or more, but would like an explanation of the second phonemenon (Is it LVI?); What is the meaning of "close" and "transected" relative to the various tissue margins of the second phenomenon?; and What are the implications (if any) of the second phenomenon (LVI?) and those distances for prognosis and recommended treatments?

Your Mom is lucky to have you help her through this!

BarredOwl

frommom2two

Hi BarredOwl,

Thank you so much for you reply and info. I have e-mailed the surgeon as he replies to e-mails, but it is the long Thanksgiving weekend here in Canada so I don't think I'll get an answer soon. Through my own research I found a site on the internet that had all the common components of a pathology report for breast cancer (it was like an info for pathologists) and in terms of margins they only had two options to check off for positive margins: IDC and/or DCIS which led me to believe that these are the ones that are important? Also I posted a question to the John Hopkins ask an expert site and the answer there said that "This finding based on microscopic pathology exam is fairly common and does not mean cancer has spread. Talk to your surgeon directly for complete explanation as to your individual case"

This is all so overwhelming. I am so afraid of the big "C and this is now the third time it has hit my parents (mom had thyroid cancer years ago, dad had prostate cancer and now this)....

BarredOwl

Hi frommom2two:

Since the surgeon emphasized the IDC margins to you, hopefully you are right (no re-excision needed). But it is best to obtain express confirmation from the managing surgeon for your own understanding and to confirm consideration of the findings as you are doing. He can also explain if it affects risk in any way, although other findings may drive adjuvant treatment decisions.

I understand the worry and concern. I hope you can take a break and find some enjoyment in the holiday.

Best to you and your mom.

BarredOwl