Significant differences between clinical diagnosis and pathology

dilloa

Dear all

I signed up to this community a couple of months ago to learn more about breast cancer. My 57 yr old wife was diagnosed by biopsy in December 2019. A short context....between normal mammograms (late Oct 2019) she felt a lump. In early December she had a biopsy that revealed a grade 1 tumor of the mucinous type. ER+(100%) PR+ (weak) Her2 Neg (score 0). An ultrasound showed a 2.1 cm spiculated mass, no lymph involvement. Prior to surgery she had an initial consult with an experienced oncologist surgeon who does only breast surgery. He was quite buoyed by the biopsy path and felt very confident of an excellent prognosis. He felt confident that after surgery, she would move to radiation therapy and then hormone therapy

On Jan 13 my wife had her surgery. It went well, 2 sentinel nodes were removed. The surgeon told me that the nodes felt soft and that given the U/S showing no lymph invasion and given that mucinous carcinoma has a 90% chance of no lymph invasion, he felt the results would be good. Today we met with the radiation oncologist. We received the path report. The mass was 4.3 cm vs the 2.1 cm on U/S only barely a month earlier. 1 of 2 nodes was positive with a 3mm macro met. There was a 1mm extranodal extension observed

So....the pathology revealed something significantly more sinister than the clinical and biopsy evaluations. How could a seemingly "safe" mucinous tumor be so invasive so fast?

More importantly we are worried about the positive lymph node and also the extranodal activity. Does anyone have any thoughts on how these two findings can impact disease free survival and overall survival?

with many thanks

fontanalucy296239

Hi dilloa,

Was it a pure mucinous tumor? Even if it was, ER+ PR-tumors tend to grow faster because progesterone somehow slows down its growth.

Did your wife have pre op CT scans?

The prognosis is still very good because the possibility or reocurrence is very low.

dilloa

Hi fontanalucy

thank you for your reply. To answer some of your questions....

I was never able to get a clear answer as to whether the tumor was pure or mixed type. One oncologist told me that this detail falls lower than size, grade, ER, PR and Her2 status and therefore these factors better predict prognosis that pure vs mixed.The surgical path report simply states "Invasive Mucinous Carcinoma"

After reading your reply, i realized i made a typo in my post which i have corrected. The PR status was in fact + and not negative, but it was very weak at 4%. ER was 100%

No pre op scans were done.

thanks

fontanalucy296239

These images show what I mentioned to you about progesterone.

I got this info from the Mucinous breast cancer thread. You should take a look, there's a lot of very good scientific information I'm sure you and your wife will find very helpful.

Did they do an oncotype test on the lump by the way?

fontanalucy296239

fontanalucy296239

I'm in the process of doing pre op tests for lumpectomy. My biopsy pathology report shows my lump as being ER+ 90% PR+ 90% HER -

The information about progesterone helped me understand why my lump took 7 years to get to 3.5 cm

It was really very slow growing.

I'm sure that even if there's positive lymph node on your wife's report, that doesn't mean it got further than the node and it can treated successfully with radiation.