Pathology came back ADH - Need Lumpectomy

Hi Tracy,

Your reply means so much to me. You have made me feel better. I do have a palpable thickening, not a mass persay.

The truth is, I think I have had bad care up to this point. The surgeon's motives are in my mind questionable. He gave me 50/50 odds of malignancy and refused to explain the pathology report to me. I had to bring up the word papilloma to him, he didn't even mention it to me even though the pathology report stated that the aspirate was suspicious of a papillary neoplasm. He told me he had "no idea" why the findings were atypical. From what I have read, the presence of a papilloma would never warrant benign results (even though the majority are benign) because excising them is standard of care regardless of whether atypical cells are present.

He only would say that it could be cancer so we have to have a lumpectomy (which I suppose is true). He also mentioned a plastic surgeon being there at the time of the lumpectomy to do reconstruction (up to me) and that he would essentially be able to give me a "free breast lift" that would be billed as reconstruction. All felt very shady, and I have a contact at Johns Hopkins that confirmed it is highly unusual to a. need or b. suggest reconstruction at the time of a surgical biopsy. The breast surgeon told me the plastic surgeon being there would mean he could "take more tissue" which also gave me pause. Wouldn't you be taking the tissue you need to make a diagnosis and nothing more? At this point, shouldn't his concern be detecting cancer only? I am not worried about aesthetics. He also was rather unkind to me and told me I was frustrating him, so I spent the last week seeking second opinions. I have an appointment at MSKCC on Friday morning, so I hope my fears will be alleviated once I can talk to someone with my best interests at heart. It has been a tough week and I feel like I have had to scrounge the internet for information about what my pathology report meant. He kept things vague and played into my fears and I've been a wreck since.

I am glad to hear you're doing so well and that your diagnosis wasn't aggressive despite your young age. It seems like there is a lot of information out there points to young = aggressive so my mind has been going wild. I really pray I don't get a diagnosis, and if I do, I hope it is early.

Thank you again for your kindness. xo

Thank you to each of you who took the time to reply to me. You're all very, very sweet people.

My appointment yesterday was a total 180 from my prior experience. The BS I saw was kind and clear and alleviated a lot of my fears. First of all, she couldn't find anything suspicious in my breast through clinical breast exam. She is speculating that the thickening is likely cyclical breast change or even postpartum (i'm two years post baby) since she couldn't feel anything concerning and i'm a week and a half past my period. She then ordered all new imaging (reg mammo, 3d mammo and ultrasound) which all came back clear as day with no suspicious findings.

She said we need to take a step back, that we wouldn't be jumping into surgery, and said we would cross that bridge if we come to it. She spoke with me about my pathology report and explained that while the findings were atypical, the specimen was "paucicellular" which means that there weren't many cells, just abundant blood. She seemed to think the biopsy report could mean many things, and based on everything else, it's very unlikely I have cancer. So, the pathologists at MSKCC are going to reanalyze my slides (the other lab sent them over) and she said she was curious if they would agree they were papillary etc. She said that papillomas are very tiny, so they wouldn't usually cause a lump (and she didn't feel a lump anyway - just normal glandular tissue) so we will see. She also didn't seem convinced that my atypical findings were ADH. I imagine they'll call me sometime next week after their pathologists look at my slide.

The FNA with the original surgeon was blind meaning he basically just extracted fluid in the area - not a specific known lesion and the findings don't really correlate to the other findings (no lump, clear imaging). It's worth noting that the original surgeon decided to biopsy my breast based on how they felt 6 days before my period. The actual biopsy took place 3 days before my period. I'm a lot less worried now. She mentioned an MRI if we have to go there, but I'm not sure if she thinks that's necessary. We'll see.

Having good care is incredibly important. I went from a 50/50 chance of breast cancer with a lumpectomy needed as soon as possible to a low likelihood of cancer with surgery not necessarily happening in a week. Last night was the first night in weeks that I slept and didn't wake up feeling like my world was out of control.

God is good!

xo