can someone please help me understand??

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girlygirl13
girlygirl13 Member Posts: 9
edited June 2014 in LCIS (Lobular Carcinoma In Situ)

I am trying to figure out my latest pathology report. Post op path results after bilateral prophlactic skin and nipple sparing mx for needle biopsy result showing Pleomorphic lcis.

left breast e cadherin stains  confirm the dx of pleomorphic lobular carcinoma insitu with focal extension to the antrior superior margin and with lcis located close to the nipple margin. no invasove carcinoma is identified all controls stain appropriately.

specimen size 16.2x 12.7x 2.7 cm, tumor site left upper outer quadrant, mid to posterior third, size of tumor approx 7cm, histologic type lobular carcinoma insitu, intermediate grade, margins focally positive anterior superior in coil clip area

comment section states scattered multifocal areas of pleomorphic lobular carcinoma insitu eztend over an area of approx 6 cm in the upper outer quad with approx 1 cm of involvement in the nipple region but no invasive carcinoma is identified. The pleomorphic  lcis focally extends to the anterior suoerior margin aprox 8 cm lateral and superior to the nipple in the area containing coil clip. Pleomorphic lCIS is  located 0.18mm from the anterior nipple matgin and 0.50mm from lateral margin. 

after this came back it was suggested that may have to do radiation but after a small battle we decided to go back clear margins and remove nipples.

second pathology report showed a. right nipple clear, b. left nipple suture superior: 6mm area of pleomorphic lobular neoplasia identified, 3 mm from deep aspect of nipple( see microscopic description) c. additional left breast tissue margin short suture superior=superior, long lateral,and double deep: breast parenchyma and fibrofatty tisdue identified showing no evidence of residual tumor, abundant prior biopsy site changes identified with foreign body granulomas and o,d suture  aterial, some of the fragments display striated muscle.

comment: we note that patient had a previous nipple sparing, bilateral mastectomy specimen in which the left breast reveal the presence of pleomorphic lobular carcinoma in situ which extends to the anterior/superior margin and was close to the nipple margin and lateral margin. Only a single focal are of p,eomorphic lobular neopladia is identified withinthe ducts underlying the nipple on slide. This area of lobular neoplasia either represent pleomorphic ALH or pleomorphicLCIS extending witjin the ducts in this region. This area is not present at the deep or lateral resection margin of the nipple.

Md said it was good news but i read it different. Does not seam like right area was biopsied. sorry for long thread please help/


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  • Dianarose
    Dianarose Member Posts: 2,407
    edited May 2014

    I think they only comment on thet ares that there is something to report. My report was 12 pages long. 

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  • Anonymous
    Anonymous Member Posts: 1,376
    edited May 2014

    PLCIS is controversial, but I think it is often treated more like DCIS than LCIS.  But even with DCIS, radiation is usually only given after lumpectomy, not after mastectomy (unless area is very close to the chest wall perhaps).  So I would think if you've had bilat masts (and it sounds like you had a 2nd surgery to remove nipples and even more breast tissue), your risk is significantly reduced about 90% and it wouldn't warrant need for radiation.  Hopefully, others who know more about PLCIS will chime in (I only have classic LCIS and do high risk surveillance and meds)

    anne

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  • girlygirl13
    girlygirl13 Member Posts: 9
    edited May 2014

    thanks for you post awb. Interestingly enough before my second surgery my oncologist reccomened radiation based on size of mass removed 7cm and the fact that my margins were not clear. Radiation md suggested trying for clear margins and removal of nipples instead.  So that was what i did. 

    my concern now is that if from the first report there was still positive margins of plcis then the second surgery pathology report should have showed some was removed. instead it shows only single focal area in duct under nipple was removed. Sorry I am just so frustrated cause I want to understand this report !!! Wish i new a pathologist ; l

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  • SpecialK
    SpecialK Member Posts: 16,486
    edited May 2014

    girlygirl - you can ask to have a meeting with the pathologist who prepared and examined your slides.  They usually have to sign off, so if you call the hospital, or med/cancer center, pathology department you can actually speak to the doc whose name you see on the report..  Pathologists often work behind the scenes and many enjoy the opportunity to explain what they do, and what your report means. It is worth a try if you cannot get a satisfactory explanation from your surgeon.

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  • girlygirl13
    girlygirl13 Member Posts: 9
    edited May 2014

    specialK , you just made my day!!!! thank you I had no idea this was even an option. I will definately be calling to find out if I can do just that. Do you know if I have to go thru my MD or can I just call pathologist??? Either way thank you again. I have been loosing sleep over this. All I want is to understand it cause I am pretty sure that I am done with more surgery, besides of course finishing reconstruction. God bless


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  • SpecialK
    SpecialK Member Posts: 16,486
    edited May 2014

    girlygirl - try going directly to the pathology dept first.  I hope they sit down with you - I honestly think they appreciate your interest and having the opportunity to elaborate on the report - they don't get to see that many patients in person!  Always remember that this doctor works for you - you (or your insurance company) paid a fee to have that pathologist look at your samples/slides - they are performing a service for a fee just like your surgeons or oncologists.

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  • QueenKong
    QueenKong Member Posts: 154
    edited May 2014

    Look up all the terms in the report that you don't understand and rewrite the report in language that makes sense to you. If you are uncertain, ask about the pathologist about it. You can read back your rewrite to them to see if you got it right. Do a search on this site for radiation after surgery. I looked at that before I made a decision.

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  • girlygirl13
    girlygirl13 Member Posts: 9
    edited May 2014

    Queenkong, thanks will do that tonight.

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  • girlygirl13
    girlygirl13 Member Posts: 9
    edited May 2014

    SpecialK , update so i put a call into the pathology dept and asked to speak with the MD who did my pathology. I told receptionist I was a surgery patient and asked if it was possible to make appt or talk wth pathologist who did my report. She asked me if i talked with my surgeon already. I told her that i had but would like to ask additional questions. She said it was very unusual but would leave message for pathologist and see if he would do it???? fingers crossed : )

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  • SpecialK
    SpecialK Member Posts: 16,486
    edited May 2014

    I hope it works out - and please come back and tell us if you were successful, and what kinds of questions were addressed.

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