pseudo-DCIS possible!

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mginger
mginger Member Posts: 150
edited June 2014 in DCIS (Ductal Carcinoma In Situ)

   I do not want to scare anybody but...  

   I read stories about women beeing diagnosed DCIS and waking up years later with metastasis (ok, few, but still...)  .   I was puzzled by that, since DCIS, by definition, cannot mets.

   An explanation could be that some invasive BC mimick DCIS.  

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2014768 

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  • Beesie
    Beesie Member Posts: 12,240
    edited August 2008

    Really interesting.  Thank you for posting.  

    I wonder how frequently DCIS pathological samples are sent for IHC staining for myoepithelial markers?  I have no idea.  Hopefully if it's not done a lot now, it's will be done more in the future so that this type of misdiagnosis can be avoided.  And this also points out the importance of doing an SNB on women diagnosed with high grade DCIS with comedo necrosis.  Not only could the pathology possibly be missing a tiny microinvasion (which could lead to lymph node involvement) but the diagnosis itself could be incorrect and the cancer might actually be invasive. That probably doesn't happen often, but it sure isn't something that you want to miss, even once.    

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  • mginger
    mginger Member Posts: 150
    edited August 2008

    well, even negative nodes are not safe : read ''case 4'' in the article...

    Can't wait to see my onco at the follow up apt

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  • co1214
    co1214 Member Posts: 11
    edited August 2008

    I went back and reviewed my path report and found that IHC staining was used - Calponin and P63 which are both mentioned in the article. 

    This case study is from Pakistan, so I'm assuming the 4 cases discussed were from that country also.  Possibly the techniques used by various pathology departments throughout the world are not standard. 

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  • mginger
    mginger Member Posts: 150
    edited August 2008

    Well I went back to my path report and did not find anything mentionned about that. (lucky you!)

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  • pip57
    pip57 Member Posts: 12,401
    edited August 2008

    Having had multi focal tumors myself, I think it is more likely that there were microscopic tumors left behind that were IDC or became IDC.  I am all too aware of how easy it is to assume everything is removed if you have small, but clean margins.

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  • dk721
    dk721 Member Posts: 18
    edited August 2008

    I read the article and well really didn't complete understand it.  Maybe someone understands my pathology report...the doctor explained it to me but (as I am sure like a lot of women) I usually don't complete "hear" or "understand" what the doctor is saying until I go home and read up on it myself.  I was originally diagnosed with 3mm of IDC (with DCIS an "in-situ" tumor of 1.6cm).  I went for a second opinion at Sloan Kettering and that doctor told me my cancer is not "invasive" only DCIS.  And he circled this note on my pathology report: 
    "Immunohistochemical stain for p63 and calponin were performed.  An attenuated myoepithelial cell layer is noted on calponin stain on the focus suspicious for invasive carcinoma."

    Is this basically what that article is stating.  I take it as because there is an myoephithelial cell layer it is not invasive.  Does anyone have any idea if I am interpreting this correctly.  I will definitely ask my doctor when I go back to see him.  I am happy that he said it is not invasive but would be happier if I know the reason he has a different diagnoses then the first doctor.

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  • co1214
    co1214 Member Posts: 11
    edited August 2008

    dk721,

    Since the article states this:

    In the ideal world invasive cancers are characterized by lack of both basement membrane and myoepithelial cells. However in the real world while invasive cancer lacks myoepithelial cells, some produce basement membrane components adding further to the confusion. Therefore for the assessment of DCIS and invasive comedo DCIS, assessment of myoepithelial lining is most reliable.

    It sounds to me like invasive cancer will never have myoepithelial cells but could have a basement membrane.  If the area questionable for invasion actually had a myoephithelial cell layer, according to this study, it was DCIS not invasive carcinoma. 

     I would still ask your doctor, but it sounds to me like you are interpreting it correctly.

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  • co1214
    co1214 Member Posts: 11
    edited August 2008

    mginger,

    In re-reading the study I noticed that the possible mis-diagnosis was because high grade comedo DCIS and infiltrative ductal carcinoma closely resemble each other:

    Here we present a series of infiltrative ductal carcinoma breast cases (infiltrative ductal carcinoma with central necrosis) so closely mimicking 'DCIS with central comedo necrosis' that on initial morphological analysis these foci of tumors were labeled as DCIS (high grade, comedo).

    I noticed your diagnosis was DCIS, grade 1, so possibly when it's the low grade variety of DCIS and/or if there is no comedo necrosis, the other stains aren't necessary. 

    If it looks like a duck and quacks like a duck, there's a darn good chance it's only a duck so maybe they didn't have to prove that it wasn't a goose in your case! Wink

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  • traveler56
    traveler56 Member Posts: 164
    edited August 2008

    Ok -- my Dr. told me today that the reason my biopsy took so long is that one path that looked at it thought he saw a microinvasion so they sent it to have it "dyed" is how I remember her saying it.   the local hospital (teaching and highly recommended hospital) tumor board --- 4 members all agreed with the later findings of DCIS -- but boy I am nervous now.   It is of intermediate grade.   I am having lumpectomy on Tuesday with rads to  follow, and then very close follow up.   also ER+

    yikes -- Beesie, do you have any comments -- you have a lot of knowledge of this.  My DCIS area (microcalcs) are less than 1/2 centimeter

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  • mginger
    mginger Member Posts: 150
    edited August 2008

    Co1214,

    My mistake: I hadn't put the right stage.  It is stage 3, with central comedo necrosis. Maybe that is why I stressed when I read that article. Anyway, do you guys think I could ''simply'' call the pathologist and ''simply'' ask him ?

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  • CHRISTY2
    CHRISTY2 Member Posts: 50
    edited November 2010

    I know this is an old post but I just read this article and it scared me. I was diagnosed with High Grade DCIS with comedo necrosis and I took the article to my doctor today and He kind of made me feel stupid. Has anyone else actually showed the article to their doctor and if so what were their thoughs on it. Non of this staining was done on mine hell the pathologist never even gave a size of my DCIS.

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