Making Sense of Post Surgery Pathology

FaithsMama

I have my oncology and radiology initial consults this week and next. I have NOT been given my stage yet. My dr isn't able to give me much concrete info regarding my diagnosis due to the fact that I have TWO tumors with different cancer markers. She says this complicated things because some info is good, some not so good. I am looking for what "not so good" means. You ladies are all so knowledgeable about your own reports. Anyone care to give their insight into what this report means? (I understand you aren't drs.:) 5/24/2018 11:17 AM silhouette Pathology report Interpretation: 1. LYMPH NODE, RIGHT AXILLARY SENTINEL, BIOPSY: - NO EVIDENCE OF MALIGNANCY IN ONE LYMPH NODE (0/1). 2. BREAST, RIGHT, MASTECTOMY: - TWO FOCI OF INVASIVE DUCTAL CARCINOMA, BOTH GRADE 1, WITH ASSOCIATED DUCTAL CARCINOMA IN SITU, CRIBRIFORM TYPE, LOW AND INTERMEDIATE NUCLEAR GRADES. - RECEPTOR STATUS: TUMOR #1 (5:00): ER +, PR +, HER2 - ; TUMOR #2 (8:00): ER +, PR -, HER2 -. - CLOSEST MARGIN LESS THAN 1 MM POSTERIOR. - STAGE: pT2(m), pN0(sn). - SEE SYNOPTIC REPORT. BREAST CANCER CASE SUMMARY: SPECIMEN AND PROCEDURE: Right breast, mastectomy TUMOR SITE: 5:00 (Kaiser 7:00) and 8:00 (Kaiser 10:00) positions TUMOR SIZE: Dimension of largest focus of invasion: 22 mm TUMOR FOCALITY: Multiple foci: 2 Sizes of individual foci: Tumor #1 (5:00): 2.2 x 2.0 x 2.0 cm; tumor #2 (8:00): 1.8 x 1.7 x 1.2 cm HISTOLOGIC TYPE: Invasive ductal carcinoma NOTTINGHAM HISTOLOGIC GRADE: Grade 1 (Total score 4 ) (both tumors) TUBULAR DIFFERENTIATION: Score= 1 (both tumors) NUCLEAR PLEOMORPHISM: Score= 2 (both tumors) MITOTIC RATE: Score= 1 (both tumors) PRIMARY TUMOR STAGE (pT): m (multiple foci of invasive carcinoma) pT2: Tumor >20 mm but d50 mm in greatest dimension REGIONAL LYMPH NODE STAGE (pN): (sn): Only sentinel nodes evaluated pN0: No lymph node metastasis identified histologically SKIN: Not involved SKELETAL MUSCLE: Not present DUCTAL CARCINOMA IN SITU: DCIS present ESTIMATED EXTENT OF DCIS: Greatest dimension: Scattered 1 mm foci associated with both invasive tumors NUCLEAR GRADE OF DCIS Grade I (low) and Grade II (intermediate) ARCHITECTURAL PATTERN OF DCIS: Cribriform NECROSIS IN DCIS: Not identified MARGINS (INVASIVE CARCINOMA): Margins uninvolved by invasive carcinoma Distance from closest margin: Less than 1 mm, posterior MARGINS (DCIS): Margins uninvolved by DCIS Distance from closest margin: 12 mm, posterior LYMPH NODES: Total nodes involved:Total nodes examined (including sentinel nodes): ( 0 / 1 ) Total sentinel nodes involved / Total sentinel nodes examined: ( 0 / 1 ) LYMPH VASCULAR INVASION: Not identified ANCILLARY STUDIES: Tumor #1 (5:00) (Kaiser 7:00) ER: Positive (1%, strong intensity) PgR: Positive (90%, intermediate intensity) HER2: Negative (1+) Tumor #2 (8:00) (Kaiser 10:00) ER: Positive (1%, strong intensity) PgR: Negative (<1%) HER2: Negative (1+) Performed on prior Kaiser case S18-14327 ADDITIONAL PATHOLOGIC FINDINGS: Changes consistent with the previous biopsy sites Electronically Signed Out Daryl G. Vogel, M.D., Ph.D. Gross Description: 1. The specimen is received in formalin labeled with the patient's name and "right axillary sentinel nodes". Received is a 4.5 x 3.4 x 1.0 cm area of yellow fibroadipose tissue and lymph nodes. The specimen is sectioned to reveal a 4.3 x 2.7 x 0.7 cm tan-pink, focally blue dyed lymph node. The lymph node is serially sectioned and submitted in its entirety in cassettes 1A-C. Time to fixation: 3 hours Time of fixation: >72 hours 2. The specimen is received in formalin labeled with the patient's name and "right breast mastectomy". Specimen size and weight: 565.0 g, 22.0 cm from superior to inferior, 17.0 cm from medial to lateral, 4.5 cm from anterior to posterior Orientation: Stitch = superior margin Skin and nipple: There is an overlying tan-pink skin ellipse which is 6.5 x 2.5 cm. The skin surface is tan-pink, wrinkled, and displays a central 1.2 cm flattened nipple. The margins are marked as follows: Anterior superior-blue, anterior-inferior-green, posterior-black Lesion focality: Two lesions Lesion #1, size, description: Identified at approximately 5:00 is a white, indurated, stellate, ill-defined mass which measures approximately 2.2 x 2.0 x 2.0 cm. A silver metallic clip is identified within lesion #1 Lesion #1 distance from surgical margins: This mass appears to abut/possibly involve the posterior margin, and comes to within 1.1 cm of the anterior inferior margin, and 4.5 cm of the anterior superior margin. Lesion #2, size, description: Identified at approximately 8:00 is a 1.8 x 1.7 x 1.2 cm irregular, ill-defined, tan-white, indurated mass. A silver metallic clip is identified within lesion #2. Lesion #2 distance from surgical margins: This mass is approximately 2.8 cm from the posterior margin, 1.5 cm of the anterior superior margin, and 3.2 cm from the anterior inferior margin. This is between lesion #1 and lesion #2: Approximately 2.4 cm Lymph nodes: No lymph nodes are identified. Remaining tissue: The remaining cut surfaces display yellow lobular fibroadipose tissue and white dense fibrous tissue, which comprises approximately 30% of the total tissue. Time to fixation: 4 hours Time of fixation: >72 hours SECTIONS: 2A. Nipple, perpendicularly trisected, in entirety 2B. Rep. sections of tissue beneath nipple 2C. Rep. section of posterior margin nearest lesion #1, perpendicular (site of clip) 2D. Rep. section of anterior inferior margin nearest lesion #1, perpendicular 2E. Rep. section of anterior superior margin nearest lesion #1, perpendicular 2F. Additional representative section of lesion #1 (disregard ink) 2G. Rep. section of posterior margin nearest lesion #2, perpendicular 2H. Rep. section of anterior inferior margin nearest lesion #2, perpendicular 2I. Rep. section of anterior superior margin nearest lesion #2, perpendicular 2J. Additional representative sections of lesion #2 (disregard ink; site of clip) 2K-L. Rep. sections of tissue between lesion #1 and lesion #2 (disregard ink) 2M-N. Rep. sections of upper outer quadrant 2O-P. Rep. sections of lower outer quadrant (>2.0 cm from lesion #2) 2Q-R. Rep. sections of upper inner quadrant 2S-T. Rep. sections of lower inner quadrant (>2.0 cm from lesion #1) Madison H. Hedges, P.A. Microscopic Description: 1. Examination of multiple levels from the right axillary sentinel lymph node biopsy shows one multiply cross-sectioned histologically unremarkable lymph node. There is no evidence of malignancy. 2. Examination of multiple sections from the right breast mastectomy specimen shows two separate foci of invasive ductal carcinoma with associated ductal carcinoma in situ, cribriform type, low and intermediate nuclear grades. Please see synoptic report for complete details.

Georgia1

That looks like a pretty good report to me. Perhaps the "not so good" is that one of the tumors was ER+ but PR-?? If you ask DJMammo on his thread I'm sure you'll get helpful advice. Best of luck.

FaithsMama

Thank you  Georgia. I'm not able to pin any of my drs down and what it means that one tumor is prog pos while the other is prog neg. They all just say, well the one tumor is low grade, both tumors are small, that's good. Lymphnodes are clear, that's good.  But, the neg prog tumor and the fact that you have more than one tumor and the fact that the one tumor was too close to the chest wall to get clear margins during surgery is not good. 

I have my oncology appt tomorrow. Perhaps that will answer some questions. 

All my research tells me that the prog negative cancers are aggressive and do not respond well to treatment. So, there's that.