Nottingham score of '2' on Tubule formation--is this possible?

suepenn, sometimes pathologists have a difficult time distinguishing between IDC and ILC. The E-cadherin stain helps them tell the difference. Almost all IDC and special ductal type breast cancers will stain positive for E-cadherin and almost all lobular cancers will stain NEGATIVE.  It really has nothing at all to do with cellular pleomorphism because if it's a ductal cancer, it will stain positive regardless of whether it's low grade or high grade and lobular will be negative. Yours was negative because your tumor was ILC.

Stella,

If I were in you, I would have a completely independent set of eyes examine the tissue - take or have the slides sent to a different pathology lab. If for no other reason than peace of mind. If necessary, get a third opinion.

Don't let the current oncologist or pathologist blow off your concerns because they are clearly not unwarranted.  I do agree with you, about the concerns regarding a lobular diagnosis and a score of 2 on tubular formation (a big red flag in my opinion) and I think you're correct in noting that "true"/classic ILC, the most common type of ILC) doesn't have any significant tubular formation at all and would therefore be expected to recieve a tubular score of 3 using the Nottingham grading system.  Since pleomorphic ILC supposedly has the same type of linear cell patterns and absence of tubule formation as classic ILC and differs only in it's mitotic and pleomprhic scores, I would think that the pleomorphic lobular variant should also be expected to get a tubular score of 3.    I'm certainly not a pathologist though, so maybe I'm way off base in interpreting what I've read.

Again, if it were me, I would ALSO be especially concerned that there had to be a direct request asking a pathologist to do a E-cadherin stain.  It was done on my invasive ductal automatically and I suspect that most path labs automatically do it in as a kind of double check that their diagnosis of either ductal or lobular was correct.

AND, I would also have some deep reservations about using the same surgeon again if you have to have node dissection.  Sounds like you had a failed SNB and then a hematoma so large it required surgical evacuation and a blood transfusion. How much experience did this surgeon have???