IDC & IDCIS/Enlarged s - 4TC+Neulasta

BJBQ

Hello All and thank you for sharing your experiences, knowledge and compassion. I have had 3 TC 20 days apart and will have my last on Nov 12. Surgery will tentatively take place on Dec. 2.

I need to choose lumpectomy or mastectomy and would liketo know if anybody has had a similar presentation as mine

Mamogram 6/24/ 2020 : FINDINGS: There is a small mass in the upper outer quadrant of the left breast, 4 cm from the nipple. There are few scattered benign-appearing calcifications.

Ultrasound 7/2/20 revealed an ovoid hypoechoic structure with an echogenic fatty hilum suggesting intramammary lymph node 6 x 3 x 7 mm. This appears to correlate with the mammographic abnormality.Mildly prominent ducts are identified within the retroareolar region.Abnormal appearing lymph nodes within the left axilla with the largest measuring 3.1 x 1.0 x 2.4 cm and 2.3 x 1.0 x 1.8 cm

CT w/contrast 7/13/2 revealed enlarged asymmetric left-sided axillary lymph nodes. There are no areas of
significant mediastinal lymphadenopathy.

Left axillary lymph node biopsy 7/22/20:Immunohistochemical stains were performed with adequate controls on block A1 for ER, PR, HER-2, and Ki-67. The tumor cells are strongly and diffusely positive for ER and focally positive for PR. The tumor cells are negative for HER-2. Ki-67 exhibits approximately 60% proliferation activity in the tumor cells.

Breast Biopsies 8/13/20:

Addendum

ESTROGEN/PROGESTERONE RESULTS: Estrogen Receptor: Positive. 99.08 %. Intensity: Strong. Progesterone Receptor: Positive. 57.83 %. Intensity: Moderate. KI67 RESULTS: 22.51 % HER2 RESULTS: (1+) Negative.

Surgical Pathology Final Diagnosis

A: Breast, Left, mass. excised and formalin 1240, fixation ends 1930. In situ and invasive ductal carcinoma. Nuclear pleomorphism score is 2/3. Tubule formation score is 3/3. Mitotic activity score is 2/3. Histologic grade is moderately differentiated, 2/3 (7/9). Microcalcifications are identified. Negative for tumor necrosis. Negative for vascular invasion. Negative for perineural invasion. In situ ductal carcinoma shows intermediate nuclear grade, solid and cribriform growth patterns and focal comedonecrosis (see comment) B: Breast, Right, excised and formalin 1315, fixation ends 1930. Breast tissue with fibrocystic change including focally dense fibrous stroma, duct ectasia, periductal chronic inflammation, sclerosing adenosis and apocrine metaplasia. Microcalcifications are identified. Negative for evidence of invasive neoplasm by immunohistochemical staining for myosin and p63 with cytokeratin AE1/AE3.

Comment

Regarding specimen A, immunohistochemical staining for myosin and p63 with cytokeratin AE1/AE3 has been performed. There are areas lacking myoepithelial cells with infiltrating nests of epithelial cells consistent with invasive ductal carcinoma. In addition, there are areas with expanded ductal structures lined by myoepithelial cells. These areas are consistent with in situ ductal carcinoma. These areas of ductal carcinoma in situ show solid and cribriform patterns with intermediate nuclear grade and focal comedonecrosis. Diagnosis of malignancy is confirmed by a second pathologist.

MountainMia

Hi BJBQ. If I get it, you're asking for benefits of lumpectomy vs mastectomy. Is that right? From the standpoint of treatment effectiveness, lumpectomy with appropriate radiation has the same outcome stats as mastectomy. With your lymph nodes potentially involved, you might be lined up for radiation, anyway. There are, of course, other considerations.

Are you able to express your concerns? Is it purely treatment effectiveness, or are there other issues you want to know about? Things like recovery period, aesthetics, reconstruction needs, etc? If you can put some of this into words, you'll get a lot better responses from people.

Good luck.

BJBQ

Thanks MountainMia! Effectiveness against recurrance is my main concern. I am 61 and don't want to go through this again if I can avoid it! Lymph nodes will be removed so radiation is part of the plan. I was leaning towards bilateral mastectomy (to remove as much worry as possible) with reconstruction. Now I'm asking myself why go through several surgeries if lumpectomy is truly as effective?

I am wondering about recovery from lumpectomy/lymphectomy. I don't know how many nodes will be removed yet. I will have an MRI mid Novembe to see how effective the chemo was. Would like to hear others' experience re:lymphecma.

Stay well!