Pathology dilemma

InStitches · February 2016

Last year I had a core needle biopsy that indicated sclerosing adenosis. That was followed by an excisional biopsy that resulted in a diagnosis of DCIS and LCIS. My BS was able to get it all in the excisional biopsy. I had seven weeks of radiation and am now on Tamoxifen.

I had MRI if both breasts in July of last year and there were no findings. When I saw my BS for follow up in October I showed him skin changes in the opposite breast, my right breast, that had me concerned. He scheduled me for follow up mammogram and ultrasound on January 20th of this year. The ultrasound of the right breast showed five small masses. The RO described them as looking like sausage like links. I had two core needle biopsies performed on January 20th.

On January 22cnd, at around 8:00am my BS calls to say the pathology showed a lot of scar tissue but that the radiologist and pathologist would meet to compare the results. I was very surprised to get the news that they agreed the pathology and radiology findings were concordant.

I then asked for a second opinion on the pathology from MD Anderson. I picked up a copy of the pathology report from MD Anderson today. The first pathology said stromal fibrosis, ductal ectasia, ductal epithelial hyperplasia, usual type and sclerosing adenosis. The only new information on the MD Anderson pathology report is the addition of columnar cell changes.

But here is what has me most concerned. I asked that all slides and samples from the two core needle biopsies from January 20th be sent to MD Anderson. They sent 3 slides from my core needle biopsy from May of 2015, 19 slides from my excisional biopsy of May 20th of last year but only 2 slides from the two core needle biopsies performed on January 20th. Does this seem right to anyone?

I am now wondering if they looked at enough of the sample to identify anything more concerning that would explain the changes in this right breast.

The changes in my right breast are continuing to evolve. Now in addition to the skin puckering in the upper right central portion of the breast starting at the nipple, I now have a dimple on the lower part of the nipple.

My BS wants have a MRI in April and go from there.

I want to have these five small masses removed. The largest of the five is 1.2 centimeters and what they call "taller than wide"

I have a call in the head of pathology at my local hospital to confirm they only have two slides from my two core needle biopsies from January 20th.

I would appreciate any other opinions on how many slides should be prepared and evaluated for a core needle biopsy

Jelson · February 2016

InStitches - is part of the reason that there are more slides from the excisional biopsy because they had more material to work with? I may be mucking up the waters here but when second opinions are requested to be sent to other hospitals - I assumed that new slices of the tissue sample are sent, not the same exact slides which were reviewed initially. In any event, I hope you get answers about the areas of concern in your right breast ASAP

InStitches · February 2016

Thanks Jelson. I have made an appointment with my breast surgeon for next week. I am ready to move forward with an excisional biopsy to get these areas removed. And yes, I think the reason they had 19 slides on the excisional biopsy was because of the volume. I did speak with the head of pathology at the hospital and she told me it is there practice to cut each core into two pieces and create two slides from each half producing four slides for each core. For some reason though they only prepared two slides for each core for my biopsies on January 20th. And they won't send every slide in case the material gets lost in transport. So they only sent two of four slides on the January 20th biopsies. I personally don't think they looked at enough of the cores.

With my previous diagnosis of LCIS I am very concerned about the possibility of a lobular carcinoma which is very hard to find.

Pathology dilemma

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