Diagnosis is DCIS - so why do I see the words "invasive tumor"

alicia63017

Hi, I'm brand new to this site and am hoping someone can answer my question since I won't be seeing a surgeon for a few days. I had an 8 cm area of concern so I had a stereotactic biopsy on each end. The Formal Diagnosis part of my pathology report says:

Biopsy A: 3.5 x 3.1 x .7 cm. Small focus of DCIS, nuclear grade 2, cribriform architecture. Microscopic description: small focus of high grade DCIS with grade 2 nuclei and cribriform architecture.

Biopsy B: 3.4 x 1.7 x .6 cm. DCIS, nuclear grade 2, solid architecture with extensive comedo necrosis, DCIS calcifications. Microscopic description: extensive high grade DCIS with grade 2 nuclei in solid patterns. Comedo necrosis is seen in most areas. There are calcifications associated with DCIS.

Okay, I get the gist of that. But then there's this:

Immunohistochemistry report:

Material: Block B1

Cell Population: Tumor Cells

Test ER protein Result 100% positive

Material: Block B1

Cell Population: Invasive Tumor

Test PR Result 90% positive

Can someone please explain why it says that so I can sleep tonight?

Moderators

Hi Alicia-

It could be that you have a diagnosis of DCIS-MI, or DCIS with microinvasion. It's still considered a form of DCIS, but your treatment plan might differ slightly because of the microinvasion. You can read more about the different types of invasive and non-invasive breast cancers here: http://www.breastcancer.org/symptoms/types/dcis/di....

Please keep us posted on what you learn when you see the surgeon!

The Mods

EDITED TO ADD: Thank you to Beesie for alerting us to the clarification needed in our post: While DCIS-MI is still considered a form of DCIS, it may be diagnosed as Stage I disease, and therefore, as noted, could be treated differently than a Stage 0 DCIS diagnosis.

BarredOwl

The report is not clear based on the information you provided.

Ordinarily, if invasive disease is present, then somewhere in the main report, it should mention it. When both DCIS and invasive disease (of any size) are present, the features of the DCIS and of the invasive disease should be separately specified.

If the below is the only reference anywhere in the reports to invasion (e.g., invasion, invasive, microinvasion, microinvasive, infiltrating, IDC, ILC), that might tend to suggest a typographical error in the below regarding the second cell population.

___________________

Material: Block B1

Cell Population: Tumor Cells

Test ER protein Result 100% positive

Material: Block B1

Cell Population: Invasive Tumor

Test PR Result 90% positive

___________________

Ordinarily, DCIS is tested for ER and PR status only. (HER2 testing of DCIS is not recommended under NCCN guidelines (because it does not affect management of DCIS), although some institutions may conduct HER2 testing of DCIS.)

In contrast, if "invasive" disease is present, then under NCCN guidelines, the invasive component should be tested for ER, PR and HER2 status (as feasible). Yet your report gives only the PR status for the "Invasive Tumor".

Review and clarification by the pathologist is required. The pathologist should review your case and issue a corrected report if the reference to "Invasive Tumor" in the PR testing section is an error (or else supplement the main report to identify the invasive component(s) (if present) and features thereof, supply ER and HER2 status, as well as revise the formal diagnosis to reflect the invasive disease (if present)).

Best,

BarredOwl

alicia63017

Thanks for the inputs. I actually thought it must be a typo when I first saw it but then I thought that would be a pretty horrible thing to accidentally put in a report. I should have an appointment with the surgeon scheduled by tomorrow and hopefully she will be able clear things up.

ksusan

Please let us know!

ShetlandPony

The pathologist needs to clear things up before you meet with the surgeon, as the surgeon will be relying on the pathologist's report when recommending a treatment plan. I would call today so you can have the pathology review done in time for your appointment.

alicia63017

Thanks for the advice. My primary care is at the VA, then my biopsy was done at a nearby teaching hospital and now I have been approved the have all my care transferred to Siteman cancer center. My first suspicious mammogram was on December 6th so the delays are really frustrating but I will meet with the Siteman surgeon February 7th and hopefully everything will roll smoothly from there. The nurse said they would get my records, images and slides from both places and clear up anything unclear with the pathologist.

BarredOwl

I think Siteman is an NCI-designated cancer center ? (see list to confirm), and a good choice for second opinion pathology review, etcetera.

To ensure completion of necessary reviews before your appointment and no additional delays, I recommend that you call the nurse back next week to confirm that: (a) all materials have indeed been received, including the pathology slides; and (b) have been or will be timely forwarded or flagged internally for review by the pathologist, radiologist, and/or surgeon as applicable.

Best,

BarredOwl

alicia63017

Hi,

So after a whirlwind I sit here at home recovering from a bilateral mastectomy with reconstruction and they took 5 nodes, no path results yet. My general surgeon came from Siteman Cancer Center to the VA and my plastic surgeon came from St. Louis University Hospital to the VA to do my surgery. I just feel like I don't know who I'm supposed to talk to about what. As far as I know, I can call my PCP, who only knows what's going on by reading my chart, or I can call the surgery clinic if I'm having complications from the surgery. But as for other questions, I just feel lost. For instance, I am 6 days out of surgery and just had a gush (not a lot, just enough to soak through my clothes) of old (brown) blood from my vagina not urethra from cath or anything. It's pretty much right in the middle of my cycle right now and I have always been very regular. Basically I just feel lost about who to ask what. The two surgeons and their residents are the only ones I have met with at all.

Thanks,

Alicia

BarredOwl

Hi Alicia:

I'm not sure how you can tell the origin of the blood as not being urethral. You may be right, but I would be inclined to check in with the surgery clinic to report this and to obtain their professional view as to potential causes, and whether surgical complications can be excluded. If complications are excluded by the relevant professionals, you can then check in with your PCP or gynecologist to and inquire if you need to be seen or or if this can be attributed to diagnostic/treatment-related stress.

BarredOwl

alicia63017

Hi,

I think it probably was just a scab from the cath being discharged. I haven't had any problems since. And to answer the question I posed while starting this thread - yes, it was just a typo, a copy and paste error made by one of the lab students. There was nothing invasive, and I received a clean pathology report after the surgery, so yay!. Thanks for your responses.

ksusan

Great news!