Pathology Report

Hi Button. Even though I'm very sorry you've joined the club that nobody wishes to be a member, I still wish you a very warm welcome and send you HUGS, sister! You are not alone in feeling overwhelmed from a pathology report. Papillary carcinoma is found in less than 1% of all breast cancers.

For my solid papillary carcinoma, I had 4 pathologies done by 4 separate labs in order to reach a final diagnosis. My first advice to you would be to have your pathology slides sent out for a 2nd opinion to evaluate what invasive components or cancer subtypes, if any, are present. There is much controversy and complications as to what constitutes "invasion" associated with papillary carcinoma. Not all pathologists are trained in the same manner.

You should feel real good about your pathology showing your 3-4 lymph nodes clear with no involvement, so CONGRATULATIONS! Also CONGRATS on being ER+ and PR+.....100% is as good as it can get, which means your cancer will respond to tamoxifen or AI medication. Usually this is an indicator of a tumor would would likely score low on Oncotype testing, whereby papillary averages about 9.9 as a score, indicative of not needing chemotherapy. You are also HER2 negative, which translates into it being a less aggressive tumor, according to many camps.

Your tumor is stage 1a, according to this pathology, as low a stage can be for an invasive breast cancer, so you should feel ENCOURAGED about this also. Also it was a low grade 1 tumor, which is good. Low grade papillary tumors are known for being especially "indolent".

It also says your surgical margins are "clean", as opposed to being dirty with cancerous cells. Having 1/2 centimeter margin is good. It says ADH (Atypical ductal hyperplasia) was found, so you may want to ask your doctors where exactly this benign ADH was located in the tissue and how large an area. You can read about ADH on some threads on this site.

Your tumor size was 4.6mm which is tiny and way below average in size, so feel good that it was found early. Don't let this scare you, but papillary carcinoma can be known to grow rapidly and very large. Your tumor was low grade 1, which means your cancer cells were dividing more slowly with a mitotic score of only 1, which is an excellent prognostic factor. My 30mm (3 centimeters) solid papillary tumor grew in just several months according to my doctor, but it had high mitosis with an aggressive grade of DCIS (aka precancer). Your report says that DCIS was not present, which is an excellent prognostic factor. You should feel good about this because 75% of the time, precancerous DCIS accompanies solid papillary....and your pathology said DCIS was not present....good for you!!

OK, within the papillary carcinoma family, solid papillary is reported to be most frequently associated with some invasion, usually along the peripheral edge of the papillary tumor. So please don't panic that your pathology report mentioned some LVI invasion, just be aware of it. Ref: " Lymphovascular invasion: Present (carcinoma is present in the lumen of a small muscular vein)." Please ask your doctor what the architecture of the cancer cells were in this vein...papillary pattern or another pattern, such as a conventional subtype of invasive cancer. You had a slow-growing low-grade favorable tumor, so there is no need to panic, but if I were you, I would most definitely seek a 2nd opinion on your pathology. Sorry for my rambling on here, but I just wanted to arm you with more information since your meeting is tomorrow. It's impossible to research all this stuff in 24 hours in advance of your meeting tomorrow. It's a very steep learning curve for new ladies with these weird rarer cancers because there's so little info on it as so few of us have these weirdo cancers. But papillary is one of the better types to have, so you would maybe wish to meet with the pathologist and your doctors to determine what types of invasive cells, if any, were present in the stroma (besides that vein) if any? Be sure they give you exact subtypes of all invasive cells that might have been present.

Also be aware that papillary carcinoma is more susceptible to mechanical detachment during core needle biopsies, which could have possibly released those cancer cells into your muscular vein, I'm just saying. Not sure, but it's a good question to ask your doctors. There are medical studies on mechanical detachment during biopsies, due to papillary carcinoma being more friable a tumor due to it's cystic content.

There's a papillary carcinoma thread on this website and you can do a search in the left bar also. If you need more info, please PM (private message) me. There are many of us here who wish to support and help you down your path. {{{HUGS}}}

Dear Button:

Good luck at your appointment tomorrow with your breast surgeon.  We Are Connected said it all.  She was extremely informative and helpful.  Please follow her advise.  The only thing that I would add is that Atypical Ductal Hyperplasia is a benign condition.  That being said, ADH raises your chances of a malignancy so it is good that the ADH was excised along with everything else listed above.  I am sorry that you joined this club but your prognosis should be excellent.  You want to be ER+, PR+, and HER2-,  as We Are Connected said, because you will be able to take Aromatase Inhibitors if you are in menopause or you will be able to take Tamoxifen to inhibit any recurrences.  Your breast surgeon should be able to explain the pathology report to you and your Medical Oncologist will lay out a plan for recovery and for the future.

I wish you the best.

Button, hope your doctor visit brought more clarity today!

Vanderbilt

https://www.mc.vanderbilt.edu/root/vumc.php?site=vmcpathology&doc=18031

Johns Hopkins

http://pathology.jhu.edu/department/services/secondopinion.cfm

Search for NCI designated cancer centers :

http://www.cancer.gov/research/nci-role/cancer-centers/find

M D Anderson

http://www.mdanderson.org/education-and-research/resources-for-professionals/clinical-tools-and-resources/pathology-second-opinion-and-consultation-services/outside-consultative-service/index.html

Please let us know how you're doing. Sending positive energy for healing your way!