Lumpectomy additional pathologic findings

Katja23 · February 2016

I was very pleased to hear 2 days after my lumpectomy + SNB that the margins were wide and clean and the the lymph nodes were free of cancer.
Then at my 2-week post-surgery appointment with my BS, she handed me the full pathology report, but we did not go over it. Now I am looking at it.

Additional pathologic findings include:
- Focal atypical lobular hyperlasia
- Columnar cell change
- Pseudoangiomatous stromal hyperplasia
- Previous biopsy site changes

My goodness. I looked these up. It seems as if Pseudoangiomatous stromal hyperplasia is rare but benign. Columnar cell change could possibly be a precurser to DCIS, but it probably not an issue when seen along with atypical lobular hyperlasia. Atypical lobular hyperlasia, however, is of possible concern. According to cancer.org, it is "it is linked to an increased risk of getting breast cancer later on." But I already have breast cancer, so I am wondering if this means an increased risk of getting cancer again. Well, I guess the radiation and Tamoxofin should help take care of that.

Anyone else get any of these in their lumpectomy pathology?

Also, what are typical sizes for the tissue removed with respect to the tumor size? My tumor was only 7 mm, but the pathology report says the "specimen" was 7 cm X 7 cm X 3 cm. That seems awfully large. (I forgot to ask my surgeon.) My breast does not look any smaller (yet), because it still has fluid it in.

snorkeler · February 2016

Congrats on your successful surgery. I can't speak to the additional findings, but I was also surprised at how much tissue was removed during my lumpectomy. On the pre-op MRI the tumor looked to be 1.2cm. The actual tumor was 9mm, and the tissue removed measured 6.5cm x 5cm x 2.5cm. In addition to the IDC, it turned out I had a 2.5cm portion of DCIS, so I was glad that the surgeon was able to get that as well with wide margins all around. I remember reading somewhere that breast ducts are too small to be seen by the naked eye, so maybe that's why surgeons take a generous amount of tissue, to increase the chances of clear margins.

I was also (pleasantly) surprised at how my breasts still look remarkably symmetrical, even after that much tissue was removed from one of my A-cups.

Wen99 · June 2016

Hi Katja23,

May I ask what was the outcome of your findings which were discussed in your post? I am going to a breast specialist on Tuesday regarding PASH and what options he recommends. I am hoping PASH is the only thing in the diagnosis, but I won't know for certain until I get this second opinion on Tuesday.

Thanks, Wendy

Katja23 · June 2016

Wen99 , I might assume that PASH is Pseudoangiomatous stromal hyperplasia? My surgeon did not seem concerned about any of these findings, which perhaps did not seem significant in comparison with the malignant tumor. Nevertheless, she told me to get a follow-up MRI in 6 months, due to these findings (and I don't remember which one in particular). That will be next month now, in July. I could report on that then.

Katja23 · July 2016

I had the follow-up MRI last week with a follow-up appointment to the surgeon yesterday. The surgeon said the MRI showed no change from the MRI 6 months prior (other than the cancerous tumor removal, of course), and I should have yet another follow-up MRI in 6 months. Actually, she did not mention the pathology findings at all, and I forgot to ask. She said there was no change from the previous MRI which showed some "foci" and that's what she wanted to follow up on.

Lumpectomy additional pathologic findings

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