DCIS with no microcalcifications?

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Rosamond
Rosamond Member Posts: 114
edited June 2014 in DCIS (Ductal Carcinoma In Situ)

My 2nd opinion surgeon shared with me an interesting finding from my stereotactic biopsy path report-the samples taken with microcalcifications had no DCIS, yet the section that tested positive for DCIS had no microcalcifications. I will be getting an MRI to help determine extent of disease as she pointed out that this finding might mean much more DCIS is in there...or even much less. It impacts my surgery plan, to be sure...



Anyone else have this on a path report, or have an idea why this might be? I thought DCIS always shows up with microcalcifications.

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  • deb1973
    deb1973 Member Posts: 96
    edited July 2013

    Hi Rosamond,

    What a beautiful story about your cat.  It is nice to be inspired by other survivers, of all species.

    To answer your question, my DCIS was also found w/o calcifications. I have no idea about the frequency of this, but it helps partly explain why it was not detected, in my case, by a mammogram. I guess that is also why an MRI will be especially helpful for you to tell the extent of the disease.

    Wishing you a speedy recovery path,

    Deb

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  • redsox
    redsox Member Posts: 523
    edited July 2013

    My DCIS was found from symptoms with no sign on imaging.  

    Microcalcifications are a sign of DCIS but they may turn out not to be DCIS, while DCIS can be present without microcalcifications showing on mammography or ultrasound or MRI in any combination.  That's why it can be hard for the surgeon to remove all DCIS with good margins in the first try or even the second.  Of course, if they take a very large chunk of tissue, chances of clear margins are better but then the cosmetic result is likely to be poor.  

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  • ballet12
    ballet12 Member Posts: 981
    edited July 2013

    Hi Redsox, how did the surgeon know exactly where to go, in your case, if it didn't show up on imaging (was it found on MRI?).  Mine was not initially obvious on imaging, and the stereotactic core biopsy only found ADH.  When he went for the surgical excision, the surgeon found extensive multifocal dcis (ultimately requiring three lumpectomies to get clean margins).  He was able to do a wire localization based on the calcs in the area.

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  • redsox
    redsox Member Posts: 523
    edited July 2013

    I had discharge from the nipple. The doctors all said it was probably a papilloma but we need to be sure. Something did show up on ultrasound but that biopsy came back as benign without explaining the symptom. Then I had a ductal excision with the surgeon using the discharge to guide her to the location. That showed a papilloma and also DCIS. I then had a lumpectomy again guided by the discharge. With no imaging to guide the surgery I missed out on the wire-guided localization -- does not sound like fun from the descriptions I have read here!

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  • deb1973
    deb1973 Member Posts: 96
    edited July 2013

    Interesting. I also had nipple discharge, but the MRI (not the mammo or ultrasound) subsequently showed a significant area of potential abnormality. Redsox, did you have any previous history of papillomas or nipple discharge? I just spoke to a doctor who is suspicious that some earlier growths identified as papillomas, in my case, may have been accompanied by hidden DCIS. My surgeon also thought (because of the ten centimeters of DCIS that was taken out) that the cancer may have been a long time coming. 

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  • redsox
    redsox Member Posts: 523
    edited July 2013

    I had no prior history of either papillomas or nipple discharge.  The path report that showed DCIS also showed quite a few types of non-cancer abnormal cells around the papilloma, such as papillomatosis and ductal hyperplasia.  It does seem that papillomas can disrupt the normal environment of the breast and be surrounded by abnormal cells including DCIS.  I think the doctor's suspicion about earlier growths is reasonable.  There should still be tissue blocks from biopsies of the earlier growths and you could try to have a pathologist go back to examine them.  

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  • Jelson
    Jelson Member Posts: 1,535
    edited July 2013

     I had no microcalcifications - a month after all clear mammo, I felt "funny", my primary felt "something", an ultrasound showed an enlarged duct, the bs did not feel a lump, said to watch and I had a second ultrasound in 3 months at which point the duct was more enlarged and actually plugged, a subsequent needle biopsy revealed the DCIS which was as the bs explained multiplying and dying and clogging the duct.

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  • deb1973
    deb1973 Member Posts: 96
    edited July 2013

    Thanks, redsox. That is good that they caught it for you w/ the first excisional biopsy. 

    The doctor I am speaking with is a pathologist and he is going to go back and look at the other tissue blocks from my previous biopsies. He says it would be a good sign if, despite being grade 3, the DCIS was there all along (for six or seven years) and never turned invasive.

    p.s. Jelson, isn't it interesting how sometimes our own instincts are so accurate? 

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  • Rosamond
    Rosamond Member Posts: 114
    edited July 2013

    Got a call from the University of Chicago surgeon tonight. After presenting my case, all agreed that MRI should be conducted due to the unusual pathology findings. Surgeon says that there's as much of a chance that DCIS is more extensive as there is that it is less extensive. I feel well prepared for either outcome as I can definitely see the beauty of switching out breast tissue full of tumor activity for an implant and less chance of recurrence. If given a choice, I will do lump plus rads. Now, waiting game until I get my period, which could be any day now, and then 7-10 days later, I will have the MRI in the morning and the results later that day. Glad I won't have too wait long for the info. Looking forward to having a best-guess "final" plan in place and moving on through to the next steps. I truly feel blessed by the gift of time provided to me by this (currently, only) DCIS as I have come to understand the (current) diagnosis and various treatment pathways so much more, been able to wrap my head around them, move relatively quickly through the shock and "why me?" and taken control of my nutrition and physical activity level (as well as stress) in order to prepare my body, mind, and spirit for surgery and treatment. The friends and family support is also being shored up, and I've even made a new survivor friend in my town who is currently finishing up chemo and waiting for BRCA tests results before putting her own surgical plan in place.



    What a summer-you truly never know what learning paths life will suddenly lay in front of you.

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