IDC
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I had a lumpectomy, went to doctor yesterday and the path report follows. Does anyone understand this? Also, they told me I have to get surgery again in the same place for a DCIS. I'm thinking it was a unclean border instead? I wanted a mastectomy but was glad to have my breasts after getting a lumpectomy. But . . . it would sure be nice to have no breasts to worry about. The waiting is definitely hard and I've also been told to "Be Positive!"; yeh, I wish I could be.
LEFT BREAST, SEGMENTAL MASTECTOMY:
INVASIVE DUCTAL CARCINOMA, MODIFIED BLACK'S NUCLEAR GRADE 2 (INTERMEDIATE GRADE).
INVASIVE CARCINOMA MEASURES 1.0 CM IN MAXIMUM DIMENSION.
DUCTAL CARCINOMA IN SITU (DCIS), MODIFIED BLACK'S NUCLEAR GRADE 2 (INTERMEDIATE GRADE),
CRIBRIFORM AND MICRO PAPILLARY TYPES WITHOUT NECROSIS, COMPRISING LESS THAN 5% OF
THE TUMOR VOLUME.
INVASIVE CARCINOMA IS 5.0 MM FROM THE CLOSEST DEEP MARGIN, 8.0 MM FROM THE CLOSEST
SUPERIOR MARGIN, 9.0 MM FROM THE CLOSEST INFERIOR MARGIN AND GREATER THAN 1.0 CM
FROM ALL REMAINING MARGINS.
Lymphovascular invasion is not present.
Extensive columnar cell change with hyperplasia and focal flat epithelial atypia.
Fibrocystic changes with apocrine metaplasia, stromal fibrosis and cystically dilated ducts.
(D) LEFT BREAST, SUPERIOR MARGIN:
A SINGLE 2 MM FOCUS OF DUCTAL CARCINOMA IN SITU, MICRO PAPILLARY TYPE PRESENT LESS THAN 0.5
MM FROM THE NEW
SUPERIOR RESECTION MARGIN.
Columnar cell change with hyperplasia
Fibrocystic changes with stromal fibrosis, cystically dilated ducts and duct epithelial micropapillary hyperplasia.
GROSS DESCRIPTION(A) LEFT AXILLARY SENTINEL LYMPH NODE #1 - IN VIVO 85, EX VIVO 128 - Received for frozen section is a 1.5 x 1.0 x 1.0
cm adipose tissue fragment containing a single 0.8 x 0.7 x 0.4 cm lymph node. The lymph node is trisected and submitted
entirely in A. CF/tlc
*FS/DX: ONE LYMPH NODE, NO TUMOR PRESENT. AS/mgd
(B) LEFT AXILLARY SENTINEL LYMPH NODE #2, IN VIVO 303, EX VIVO 387 - Received for frozen section is a 2.5 x 1.5 x 1.0
cm adipose tissue fragment containing a single 1.5 x 1.0 x 0.5 cm lymph node. The lymph node is serially sectioned and
submitted entirely in B1 and B2. CF/tlc
*FS/DX: ONE LYMPH NODE, NO TUMOR PRESENT. AS/mgd
(C) LEFT BREAST, SEGMENTAL MASTECTOMY- A 5.5 x 4.0 x 2.5 cm mastectomy specimen is marked with a short stitch
designating superior and a long stitch designating lateral. The specimen is serially sectioned into six slices, medial - slice #1 and
lateral- slice #6. Sectioning reveals a 1.1 x 0.9 cm firm tan circumscribed mass in slice #3. The mass is 0.7 cm from the superior,
1.0 from the anterior, 2.5 cm from the inferior and 0.9 cm from the deep margins. No additional gross lesions are identified. The
remainder of the breast parenchyma, predominantly consists of adipose tissue admixed with focal fibrous tissue. A portion of the
mass is submitted for research.
INK CODE: Green - inferior, blue - superior, black - deep, yellow - superficial, red - medial and lateral.
SECTION CODE: C1, mass with superior margin; C2, mass with deep margin; C3, inferior margin of slice #3; C4, C5,
remainder of mass with deep margin; C6, superior deep of slice #2 (please note that there is no true deep margin in this section);
C7, area marked by radiologist on slice #2; C8, C9, area marked by radiologist on slice #4; C1 0, superior half of slice #5; C11,
most lateral margin, representatives, perpendicular; C12, most medial margin, representative, perpendicular. CF/tlc
(D) LEFT BREAST, SUPERIOR MARGIN - A 9.0 x 6.5 x 1.5 cm portion of fibrous adipose tissue is marked with clips on one
surface designating the superior margin and a stitch at the lateral aspect. Sectioning reveals a focally fibrotic cut surface admixed
with adipose tissue.
INK CODE: Black - superior margin, red - lateral edge of specimen.
SECTION CODE: 01-08, representative sections, perpendicular. CF/tlc
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ltuenge,
I know it must be frustrating for you, that no one has responded to your post yet. I am usually one of the people who helps to translate path reports. In your situation, though, I'm afraid I can't help. It's just too long and too complicated for me. You really, really, need to have your surgeon explain the report to you. You said you went to your doctor (on Monday?), and got a copy of the report. What did your doctor tell you about the report at that visit? Did you ask any questions then, or ask for an explanation of all the technical terms?
Again, I'm so sorry. Maybe someone else will venture some suggestions. I see you posted part of your report on a different thread. I hope someone else can help you. Please ask your surgeon, though--that is part of his/her job.
otter
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ltuenge,
I agree with Otter that your doctor should give you all the time you need to go over everything in the path report and answer all your questions.
About the need for a second surgery: it sounds to me like both reasons you mention are "correct" -- DCIS and unclean margin.
I think the key point in the path report relating to the recommendation for a second surgery is this:
"A SINGLE 2 MM FOCUS OF DUCTAL CARCINOMA IN SITU, MICRO PAPILLARY TYPE PRESENT LESS THAN 0.5 MM FROM THE NEW
SUPERIOR RESECTION MARGIN."
That sounds to me like the unclean margin is the DCIS margin.
The margins from the IDC tumor sound negative (good!) -- but as far as the DCIS margin ("less than 5 mm") is concerned, this link says that different hospitals have different definitions of clear margins, so you should certainly ask your doctor all about this as well.
It's good that "Lymphovascular invasion is not present" and there is "NO NECROSIS." And Grade 2 is better than Grade 3.
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Re your report:
Based on my reading of researcher's report, all around minimum 5mmdeep, superior, inferior, lateral and anterior margin are good, though higher mm are preferably, but different pathologists may use slightly different criteria. You could go to pubmed website and search for more articles published by the different medical journals concerning this subject.
http://www.ncbi.nlm.nih.gov/pubmed/19072849
I realize this reply is long after, but is also for the benefit of others who've just received their post lumpectomy, post sentinel mode pathology report. All the best.
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