Neverready's pathology reports and other cancer papers

01/21/2011 MRI ("DRAFT" in large text is superimposed over the top half)

"Procedure Report

Patient History

Patient has history of breast cancer at age 46 and is nulliparous

Family History of ovarian cancer in mother at age 35*

Malignant left breast biopsy, by ultrasound, of the left breast, December 20, 2010**

Reason for Exam: known biopsy proven malignancy. Newly diagnosed left breast cancer. Preoperative assessment.

MRI Breasts, without and with contrast: January 21, 2011 - Exam #[identifiable info?]

Prior study comparison: 

December 13th, 2010 left breast ultrasound.

December  13th, 2010, bilateral digital diagnostic bilat mammogram.

Technique: sagittal and axial T1 VIBRANT weighted and sagittal fat suppressed T2, and fat suppressed T1 VIBRANT gradient echo sequence of both breast without contrast. Sagittal fat suppressed T1 VIBRANT echo sequences of both breasts obtained after administration of contrast. Patient received 16 mL of Multihance intravenously without adverse reaction.

Findings:   Breast parenchyma is of average density with low background enhancement. A few small subcentimeter cysts bilaterally. There is a dominant heterogeneous mass with ill-defined margins in the lateral posterior left breast corresponding with the known biopsied mass and measuring 1.7 x 2.0 x 1.7 cm in maximum dimensions.  Mass shows heterogeneous enhancement with ares of signal wash-out on dynamic imaging typical for malignancy. Localization clip seen as signal void within. No other suspicious enhacing lesion in either breast. There is no axillary or internal  mammary adenopathy.Anterior chest wall is unremarkable. 

Assessment:   Known Biopsy - Proven Malignancy-Appropriate action should be taken-BI-RADS 6  Known  biopsy - proven malignancy-Appropriate action should be taken BI-RADS 6 of the left breast. Solitary mass. Benign BI-RADS 2 finding of the right breast."

*[added note by me - this was a mistake I had told them but later corrected. It turns out what my mother had was actually cervical cancer, not ovarian]

 **that paper (as is anything from 2010 including an important Oncotype paper) is still missing; to be added later once relocated.

2/18/2011 pathology report (different from above, appears was 'amended').

Looking closer this report is exactly the same as above with the exception that 4 of the 14 listed points above were omitted and the whole thing is in a much easier to read font (go figure). 

I don't just have it in me to type this nearly exact same thing all over again.

It does seem pretty clear that they very nearly missed my lymph node involvement (I never noticed or knew that before, it was never mentioned to me).

"Amendment reason" is listed as "typographical error." (hmmm.) 

Leaving this space then for other missing papers, as I find them.

07/02/2013 MRI

"Procedure Report

Patient History:

Patient has history of cancer in the left breast at age 46 and is nulliparous. Family history of prostate cancer in father at age 60,unknown cancer in mother at age 49, and overian cancer at age 35."*

"Malignant pathology specimen, February 18, 2011. Malignant left breast biopsy; by ultrasound of the left breast December 20, 2010. Taking Tamoxifen for 1 year 2 months.

MRI BREAST BIL WITH AND WITHOUT CON: July 2, 2013 - Accession #[omitting to be safe]

Technique: Sagittal and axial T1 VIBRANT weighted and sagittal fat suppressed T2, and fat suppressed T1 VIBRANT gradient echo sequences of both breasts without contrast. Sagittal fast suppressed T1 VIBRANT [..]" 

[okay this part is exactly the same as in the earlier MRI I posted, Moving on] 

"Prior study comparison:  April 1, 2013, left breast US axilla. January 7, 2013, mammo diagnostic bilateral. October 25, 2012, left breast US axilla. July 17, 2012 bilateral MR BREAST BIL WITHOUT AND WITH CON. Breast parenchyma is of average density with low back ground enhancement. Stable postsurgical scarring lateral left breast and postradiation therapy changes left breast. No suspicious enhancing lesion in either breast. Anterior chest wall unremarkable. There is an enlarging soft tissue mass in the left axilla measuring 19 x 22 mm in size. On prior chest CT of 03/15/2013, this measured 16 x 18 mm. Minimal soft tissue density in this region on first postoperative breast MRI of 07/25/2012. Although this mass shows no definite enhancement on MRI, I think this could be artifactual due to technique and inability to obtain adequate fat suppression in this region. Regardless of enhancement characteristics,irregular margins and interval growth are concerning. Recommend patient return for second look ultrasound with needle core biopsy. No right axillary or bilateral internal mammary adenopathy. 

Assessment: Suspicious BI-RADS 4

Suspicious BI-RADS 4 abnormality in the left breast. Right breast is negative BI-RADS 1.

Recommendation:

Needle biopsy of the left breast axilla mass using ultrasound guidance. The results and recommendations were discussed with [my medical oncologist]"

*they really got confused here. I'd earlier incorrectly identified my mother as once having ovarian cancer when it was actually cervical, and my mother's other, the 'unknown cancer" was actually lung cancer (I know I told them this, I never was confused about her lung cancer). My father has had prostate cancer, so that part is completely correct.

-- This is where a very sharp student doctor at the ER had picked it up with his "prior chest CT of 03/15/2013, this measured 16 x 18 mm" -- if it weren't for him, nobody would have noticed, When Student Doc advised me to make sure to alert my oncologist, at first this was blown off as 'scar tissue' to start -- this is where I even went for a plain ultrasound (no needle) and they still said 'just scar tissue' -- until this very report right here -- and as you can see, they only knew here because 'scar tissue' just doesn't keep growing like that. It turns out I wasn't having a heart attack that fateful day of 03/15/2013 -- but that chance ER visit (something I never do).. as far as I am concerned that ER visit and that student doctor most certainly helped saved my life anyway.

7/23/2013  PET/CT scan -- skull base to mid-thigh

08/19/2013 Surgical Pathology Report

and 

08/19/2013 Final Pathology Report

Space holder for 2014 (pending right mastectomy and possibly biopsy of new suspect area)