Hello- trying to understand pathology report

Natalie30

Hello,

I am a young 31 women who diagnosed last year with breast cancer.

I undergone chemo, mastectomy and radiation. I want to understand better my Pathology report. My oncologist said I have a good prognosis but Doesn't answer all my questions unfortunately. I had stage 2a with 2 lymph nodes. Can I understand better if I had a pure or mixed mucinous carcinoma? Is it slow growing ? And if recurrence can happen but many years later?

This is what is said on my pathology:

2/8 metastatic Lymph nodes, the bigger 0.8 cm. No extra capsular invasion.

Left mastectomy: mucinous carcinoma grade 2. Intralesional DCIS, Cribriform and solid Patterns,

tumor size 2.5. grade 2. Mitotic rate 1, histology grade 6 on Nottingham.

Her2 negative, 100% estrogen positive, 40% progesterone positive and ki67 less then 5%.

This is what the pathology says after my mastectomy and after chemo.

I would very appreciate your help:) just trying to understand better.

Thank you so much:)

obsolete

Hi Natalie,

It breaks my heart to see very young ladies being diagnosed with BC. I cannot imagine it happening to my mid 20ish daughters, as I often wonder & worry, so in certain ways I can relate and empathize with you Glad you found us here!

You are wise to question your pathology report. It is the foundation of your diagnosis and is critical. First, I would recommend that you phone and/or visit your Pathologist to obtain more information on your slides. I do not blame you for your frustrations in trying to better understand your diagnosis.

2nd, I would recommend reading thru the Mucinous Carcinoma thread. Here's the link. https://community.breastcancer.org/forum/137/topic... Please obtain a MRI scan, if you haven't already. But please read the M.C.Anderson study mentioned in link.

3rd, please consider obtaining a 2nd opinion on your pathology for further clarification.. Because my slides revealed both mucinous and papillary carcinoma mixed with both conventional IDC and DCIS, I got (3) 2nd opinion consults, all from dedicated "breast pathologists", and none agreed with one another. Descriptions and terminologies vary based on training among breast pathologists. Your insurance provides should cover the costs. Quiz your pathologist on your tumor's molecular subtype (Luminal A or Luminal .

You described a tumor with "low mitosis" which is an excellent prognostic indicator. Low KI67 is great!! 100% Estrogen is also positive for hormonal therapy. Were you offered Oncotype DX assay or other genomic testing?.

You can obtain further information on your (2) positive lymph nodes from your pathologist. Were the cells mucinous or conventional IDC (implying you maybe had a mixed mucinous tumor? What was your % of mucin vs IDC, if IDC was present. These are answers you may wish to know.

Hugs to you, my dear, and please check back in with us. We are here to help you navigate thru this disease process. Best wishes

Natalie30

Heloo Obselete and thank you for replying:)

I am really want to understand better my pathology and prognosis. My doctor is not very attentive to my questions and doesn’t want to answer them.

I wasn’t offered the oncotype, I did chemo first, then surgery and then radiation. It doesn’t said on the pathology about mixed or pure mucinous, just Mucinous carcinoma and DCIS, the tumor is 2.5 ( with the DCIS).

No percentage or more info is said. Just this information...so it is probably pure?

Thank you again on all the support and warm words:)

obsolete

Hey Natalie, there are really no easy straight answers. Most BC doctors do NOT see enough Mucinous Carcinoma cases to become intimately familiar with the mucinous subtype thru their professional experience. But that's why we're here to help guide one another! It's an enormous learning curve for every new BC patient, so it's important that we all keep advocating for ourselves, as you are.

I might suggest that you consider looking for a new breast cancer treatment team. If you have any teaching hospitals or cancer centers nearby, that might be a good place to start. I don't blame you for being uncomfortable with your doctors. I agree with you, my dear, that its VERY important to get every specific detail answered on your pathology.

Especially because you had 2 positive nodes, you really need to get a 2nd opinion from a dedicated "breast pathologist" on your pathology slides. Pathologists need to give you much more info than you were already given, as you had suggested..

Your mucinous could be either pure or mixed.... it's hard to say without professional examination of your slidesl. Your pathologist "SHOULD" know that answer. If not, please shop for another one. It's best to get 2nd opinions on pathology on mucinous. Because you mentioned that your progesterone was PR <50%, the molecular subtype might possibly be a little more aggressive than average with other hormone sensitivities. In your case, I would suggest you get either Oncotype or Mammaprint genomic testing done, if your insurance would pay for it. Because you already had been given chemo & had a mastectomy already, your insurance may or may not approve the cost?? Those genome tests would help ONLY YOU to understand your future risks. Did you have genetic testing?

Because of your 2 positive nodes, you might also want to lear from your pathologist if your mucinous cells showed any other different types of patterns or not (such as lobular patterns or micropapillary) also, if any? You also want your pathologist to tell you how many positive cells were found in your nodes? Especially the molecular subtype of those cells? Were there any conventional IDC cells in your 2 positive nodes? Also, the % mucin vs any conventional cells in your 2.5cm tumor?

You can also phone your pathologist, make an appointment to review your slides with them, tour their pathology lab, maybe speak with the Pathology Director directly. Please do not allow them to treat you like a box moving down the assembly line. Because you're so young, it's critical to understand your pathology details 100%.Your medical team works for YOU. You pay them via insurance, in my cases, hence YOU call all the shots regarding your medical decisions! And don't allow them to tell you otherwise.

There are also wonderful ladies on the Mucinous Carcinoma thread with more experience and knowledge than I have gained. We are all here to help you along, my dear. Link follows:

https://community.breastcancer.org/forum/137/topic...

Hugs to you and let us know how you're doing.