Help with my pathology report

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Spikar
Spikar Member Posts: 16
edited September 2017 in IDC (Invasive Ductal Carcinoma)

I just had my lumpectomy two days ago.

Can someone please explain the following section of my pathology report? Especially the Margins section?

TUMOR
Presence of Invasive Carcinoma:
Histologic Type: Invasive mammary carcinoma of no special type (ductal, not otherwise specified)
Histologic Grade (Nottingham Histologic Score):
Glandular (Acinar) / Tubular Differentiation: Score 3 (< 10% of tumor area forming glandular / tubular structures)
Nuclear Pleomorphism: Score 2 (Cells larger than normal with open vesicular nuclei, visible nucleoli, and moderate variability in both size and shape)
Mitotic Rate: Score 1 (<=3 mitoses per mm2)
Overall Grade: Grade 2 (scores of 6 or 7)
Ductal Carcinoma In Situ (DCIS): DCIS is present
Ductal Carcinoma In Situ (DCIS): Negative for extensive intraductal component (EIC)
Architectural Patterns: Cribriform
Nuclear Grade: Grade I (low)
Necrosis: Not identified
Lobular Carcinoma In Situ (LCIS): Not identified
Tumor Size / Focality:
Tumor Size: Size of Largest Invasive Carcinoma: Greatest dimension of largest focus of invasion > 1 mm
Greatest Dimension (mm): 7 mm
Lymph-Vascular Invasion: Not identified
Treatment Effect: Response to Presurgical (Neoadjuvant) Therapy: No known presurgical therapy

MARGINS
Invasive Carcinoma: Margins uninvolved by invasive carcinoma
Distance from Closest Margin: Distance (specify in mm): 2
Closest Uninvolved Margin: Superior
Ductal Carcinoma In Situ (DCIS): Margins uninvolved by DCIS (DCIS present in specimen)
Distance of DCIS from Closest Margin (mm): Distance (specify in mm): 4 mm
Closest Uninvolved Margin(s): Posterior

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Comments

  • obsolete
    obsolete Member Posts: 466
    edited September 2018

    Breast Cancer pathology holds a steep learning curve, and we hope you're healing well from your surgery. Here's my take:

    - conventional IDC, grade 2 (intermediate), 1mm > focal infiltration, 7mm largest dimension, no invasion into lymphatic & vascular systems

    - low mitosis of 1 (excellent prognostic)

    - low DCIS (cribriform pattern), grade 1 present (4mm in distance)

    - CLEAN margins: 2mm (smallest margin)

    Best wishes!

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  • larajv
    larajv Member Posts: 12
    edited September 2017

    Breast cancer is representative of the "aggressive potential" of the tumor; in a broad generalization, "low grade" cancers tend to be less aggressive than "high grade" cancers. Determining the grade is thus very important, and the clinicians use this information to help guide the treatment options for patients.

    There are different "scoring systems" available for determining the grade of a breast cancer. One of these systems is the Nottingham Histologic Score system

    1. the amount of gland formation ("differentiation" or how well the tumor cells try to recreate normal glands)h

    2. The nuclear features ("pleomorphism" or how "ugly" the tumor cells look)the mitotic activity (how much the tumor cells are dividing)

    3. The mitotic activity (how much the tumor cells are dividing)

    Each of these features is scored from 1-3, and then each score is added to give a final total score ranging from 3-9. The final total score is used to determine the grade in the following way:

    Grade 1 tumors have a score of 3-5; 2 tumors have a score of 6-7; 3 tumors have a score of 8/9.

    Lymphovasular invasion: where there any cancer seen in the vessels of your lymphatic system. NO

    Also noted was "in situ"along with IDC: this means the pathologist saw both invasive cancer- cancer that has broken free of the ducts and cancer that has remained in the ducts.

    Cribaform: the cancer as a whole looks like Swiss cheese.

    Margins: are clean, meaning your surgeon removed all the cancer of that specific region

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