Help with Diagnosis- What to do?
Surgical Pathology Report
A: Breast, left duct excision:- Duct Dilation
- Fibrocystic changes with associated microcalcifications
- Sclerosing adenosis with associated microcalcifications
- Pseudoangiomatous stromal hyperplasia (PASH)
- No in situ or invasive carcinoma identified
B:- Microscopic intraductal papilloma with focal atypical ductal hyperplasia
- Fibrocystic changes with ductal epithelial hyperplasia
- Columnar cell change
- No in situ or invasive carcinoma identified
Size of specimen: 2.5cm med. to lat., 2.4cm ant. to post., 2.7cm sup. to inf.
Fragment of dense fibrofatty tissue with fibrous:adipose tissue ratio of 90:10%
Left breast discharge tested + again and ductal dilation showing raised on skin at 1 wk postop
Breast, right major duct excision:
-Atypical ductal hyperplasia
-Sclerosing adenosis
- Fibrocystic changes
- (PASH)
-Luminal red blood cells present in some larger ducts
- No intraductal papillomas identified
- No in situ or invasive carcinoma identified
Size of specimen: 3.4cm sup.to inf., 2.9cm med.to lat, 1.8cm ant.to post.
Right breast discharge tested + again and ductal dilation showing raised on skin at 1 wk postop
38 years old, Family History: grandmother double masectomy (deceased from cancer) and aunt masectomy when they around my age. 18 yrs of smoking, first abnormal mammo at age 35 ½ (slightly enlarged lymphnode right upper breast axillary area) no biopsy just watched it, also had bilateral discharge, at that time I was also diagnosed with mild cervical dysplasia (once again no treatment was done), and thyroid disease with thyroid nodule. All I know is that my body has lost its mind! I hope you can just give me your thoughts on all this. I am suppose to have scheduled an appt for total duct removal in both breast for Jan. And to do Tamoxifin for 5 yrs & I have put it off until I could research and think more on all this. I am worried that they won't do enough. My husband will deploy soon and I would like to be at my best when I am taking care of our 2 young daughters. Both surgeries they have had to take more than what they thought. I know my body and I really believe that this goes way beyond some precancerous cells. Maybe all the black discharge from both my breast running down the plastic piece when they did my mammo kind of freaked me but, at this point with this crazy body right now I just and waiting to find out what else is wrong. I have very low protein level right now so I have low immune system. I have 2 bacterial infections (bladder and cervix) Yes, a mess! My cat, ultrasound, mammo, all came out normal before any breast duct removals. My breast are so fibrocystic I don't know how they would tell anyway. All I feel is lump after lump and that is pretty much what it looks like on the mammo film I have seen. Do you think asking to get a double masectomy or discussing it with the dr. is ridiculous? I have a very tender spot in the left side of my left breast. I've heard surgery can make it worse and spread more?
Comments
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Sorry you're so stressed about your recent pathology reports, but what jumps out at me on all 3 is "no in situ or invasive carcinoma identified."
If it's weighing heavily on your mind, I don't think discussing a bi-lateral mastectomy with a highly qualified breast surgeon is ever ridiculous. But I'd maybe first explore a high risk program at an NCI-designated cancer center, to see if perhaps being thoroughly screened re. any genetic risk and then monitored more closely than women without that risk if you actually have it, might be an option to explore before going a route from which there is no turning back.
The fact that your grandmother and an aunt had bc could indicate a genetic predisposition. But, remember, diagnostics for early detection and treatment options today are significantly better than they were even a few years ago, and from the information above, it doesn't sound like you are in any immediate danger. So taking time to explore all of your options makes better sense to me than jumping into an irreversible surgery.
Here's a list of some of the top facilities in the US, many of which have high risk programs: http://cancercenters.cancer.gov/cancer_centers/map-cancer-centers.html If you're close enough to one of them for a consultation on your situation and fears, I'd certainly get their take on things.
Good luck, please keep us posted, and try to relax and enjoy the holidays based on the excellent news in your pathology report! Deanna
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Hi. Thanks for your response. I realize that it is not cancer yet but it is pre-cancer and with the other bad things on the report my oncologist says that it is bad. I go to a womens cancer center at a very good univeristy hospital. I love my doctor and she is very knowledgable. I wouldn't be as concern if my body seemed to be taking it slowly and fighting it off. But, I went from having a few ducts removed to having an entire duct removal. And I have a tender spot on the left side of my left breast. I guess some of it is also because of being so sick that I worry my body won't be able to fight it off. At my last visit to the endrocrinologist I hadn't had any pathology results to discuss with him yet. He said that my thyroid was slightly enlarged and he was going to up my meds cause of my levels changing. He said we will discuss removing my thyroid after the breast are taken care of. I have went for genetics testing. We discussed everything. I didn't have an abnormal writing in my genetic writing but that really does not mean anything. Actually, the percent of women who end up with breast cancer who don't have the abnormal writing as she called it is very high. I am going to bring up the question of double masectomy to my doctor. I just didn't know if it would be totally ridiculous. Just wanted to here someone else's thoughts on it. I don't really feel that my pathology report was excellent news. I can see where that would make someone happy who has already had breast concer but going from having an enlarged lymph node for 2 and a half years to having all my ducts removed and having precancer and alot of other high risk factors on my pathology report was not good news. Thank you for your thoughts. It was nice to hear from someone. One other thing I was wondering what your thoughts were on when you having surg if you think that it can cause speading? I did quit smoking as soon as I found out. Thanks again.
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Actually, to my understanding ADH is not considered to be a pre-cancer. It is considered to be a benign condition that increases the risk of the future development of breast cancer.
atypical ductal hyperplasia A benign (not cancer) condition in which there are more cells than normal in the lining of breast ducts and the cells look abnormal under a microscope. Having atypical ductal hyperplasia increases the risk of breast cancer. Also called ADH and atypical ductal breast hyperplasia. http://www.cancer.gov/dictionary/?CdrID=638190
Atypical Ductal Hyperplasia (ADH) This is classified as a benign (noncancerous) proliferative disease of the breast. This is not cancer. This is not precancer. http://www.mmpc.com/breastcare_adh
This isn't to say that you shouldn't be concerned or that you should be asking the questions that you are asking or considering having prophylactic mastectomies. I understand completely, given all that you've been going through, why you are thinking of the options that you are. However I sense that you are in a panic about what's in the pathology report and I think that it's important you have a good understanding of what the report really means in terms of your risk level. In my other post to you (in the High Risk forum), I asked whether your doctor explained your risk level. That's the most important thing that you need to know to make your decisions. Based on your specific situation (which does appear to be somewhat different than the average case of ADH), what does your doctor believe your risk to be to develop breast cancer?
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I can see that your results could be distressing, but from what I know, you do not have cancer now and everything is a benign change. Yes, some of them increase your future risk of cancer (schlerosing adenosis for one) but you have a benign path result. Really, that is excellent and now you are in charge. You can intervene on this through drug therapy or even surgery or just through careful screening. You are so lucky to live in this age of great technology that can find this stuff so early. Hang in there and take some deep breaths. You are ok.
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Hello. Been awhile since I got on. I think I was taking it pretty hard to hear "I should be greatful and I am lucky". Last time I was on I had some ducts removed from both breast that were ADH along with other high risk factors. My main issue that I had was that I knew my body was going crazy because of all the other health issues I am having. I was also confused because I kept reading about core biopsy and lumpectomy. I know what they are but did not think it was the same as what I had. It seemed and (seems) like they are talking about one location or one lump, mass, etc. and in one breast and my diagnosis is in both. I finally got the nerve up to talk to my doctor about the double masectomy since I was schedule to have all my ducts removed (major ductal removal) and it was getting close. I got on the internet and did all this researching because I thought I was going to have to argue with her to get her to do it. Which was my main concern when I started to go onto these forums. So my breast discharge tested positive for blood in Oct. Had the bleeding and dilated ducts removed from right breast in Nov. and left breast Dec. When I talked to her a little less than 2 weeks ago my question for her first was that I did not understand why it was spreading so fast. (I had starting having actual red blood discharge now and pain in my breast starting under my armpit shoting all the way into my nipple and many more ducts dialted (actually raised on my breast) and my nipple was turning dark. She explained to me that I had the ADH in all my ducts and that each one or as a group was presenting it's self at the time of dilation, etc. She explained to me by doing the tot. duct.rem. that they would be able to look at the pathology (if cancer) they would be able to tell type and how agressive it was, etc. Which finally made sense to me. When I asked her about doing the preventive double masectomy she said she that she strongly suggested against it. She said that from everything that I have done (surg's) and the increase in symptoms I was having that she believed there was some sort of cancer there and it was a possiblity that it COULD be invasive. That if I were to proceed with the preventive double masectomy and they found the cancer that I would have to undergo another surgery to scrap the chest walls and remove any lymph nodes (if needed only). I did not know that the two were different. I thought that a mas. was the same no matter what, they removed your breast. Since I talked with her extensively and understood what was REALLY going on I felt very comfortable with going ahead and doing the total ductal removal in both breast which I had done on Friday. I go to my appt. tomorrow to get the results and see which double masectomy I will be getting. The surgeon which I had not spoke to about the double mas. yet asked my husband after surg. if we had talked about doing Dou. Mas. even if the pathology came out the same as before. Which of course my husband said yes. I really hadn't researched the actual details (recovery time, etc) that much because I do not feel that those things should be included in your decision. I think it should be about your health instead. Anyway, I really wanted to know if any of the women had what I did or just masses? I had a papilloma from my left breast surg that was precancerous also. I just couldn't understand what they were talking about. Anyway, now that I have researched it in detail it is pretty scary. Some say not to bad some say they have alot of complications. I just wanted to say that I really should have trusted my instint and talked to her and I would have been more informed however I did become more educated. Tlking to your doctor and asking alot of questions is the way to go. She talked to me always but I really didn'[t ask for details. I just thought well if it needs to be done let's do it. So ask ask ask.
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