Recurrence of Papillary Carcinoma

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arkansasgal
arkansasgal Member Posts: 28
edited August 2018 in Just Diagnosed With a Recurrence or Metastasis

Diagnosed with Papillary Carcinoma In Situ in Nov 2017, lumpectomy in Jan 2018, with one node removed which was negative. Surgeon got clean but close margins. Radiation oncologist felt no further treatment because of the in situ diagnosis, very small size of tumor, no node involvement, and low recurrence rate. Recurrence diagnosed July 28, 2018 of Papillary Carcinoma with invasive characteristics. Very small mass of .9 cm, no node involvement. Radiologist feels it is definitely related to original cancer, and is very close to original surgical site. MRI will be done to determine exact size and the distance from the original tumor. It's hard for me to believe that the recurrence happened this early. I have read that if clean but close margins are obtained, this can open the door for a recurrence.

Anyone with a similar experience?

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  • obsolete
    obsolete Member Posts: 466
    edited September 2018

    Hi ArkansasGal,

    So sorry that you're back with what doctors are alleged to be saying is a "recurrence". I would bet it's not a recurrence, but a missed malignant lesion. (That also had happened to me, so you're not alone.) You also had raised some red flags, but not to worry because not that much time has elapsed since your original dx.

    Please visit the Papillary Carcinoma thread to join your Papillary Sisters. There aren't many of us, but we're all there for you.

    https://community.breastcancer.org/forum/137/topic...

    Please bear in mind that it was not possible for doctors to diagnose you with an "in situ" or "encapsulated" papillary carcinoma last November 2017 BEFORE your surgery last January 2018. I'm truly sorry that it appears that there was either a misunderstanding or that you had been possibly misguided. A Papillary Carcinoma is NEVER "conclusively" determined as either "invasive" or "non-invasive" (in situ) based on a BIOPSY ALONE. The complete surgical specimen following your surgery (LX or MX or BMX) is required by the Pathology Lab to determine the tumor's characteristics and if there was any invasion present.

    Because Papillary Carcinoma is rare and is often very complicated in its presentations, it is STRONGLY recommended that patients obtain 2nd OPINION PATHOLOGY reviews by dedicated Breast Pathologists.

    Please also bear in mind that NOT all Papillary lesions 5mm and under will be visible on MRI, I had been told.

    If your original Papillary lesion was located along the periphery (chest wall, for example) there is a tendency for Papillary lesions to present in multiples.

    The fact that your margin(s) were "close", as you had stated, leaves open the possibility that multi-focal Papillary Carcinoma could have potentially been missed in your original pathology evaluation. Any invasion is usually located either along the periphery of the Papillary tumor or just outside the tumor capsule. Fortunately, extensions into the stroma are usually minimal, but conventional IDC malignant cells are also a not too common possibility.

    Did you have Oncotype Dx or Mammaprint assays run on your original tumor or obtain Ki67 testing? What were your original tumor characteristics (Grade, ER, PR HER2)?

    Best wishes to you and please check in on the Papillary thread to let us know how you are doing.


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  • arkansasgal
    arkansasgal Member Posts: 28
    edited July 2018

    Obsolete - the final diagnosis of papillary carcinoma in situ was made in January 2018 based on the surgical specimen examined by a board-certified pathologist. The diagnosis was not based on the biopsy. It was suspected from the mammogram, ultrasound, MRI and biopsy, but I was advised that the final diagnosis would have to be made after the tumor was removed. The radiologist made clear after the biopsy several days ago, that it "appears" it is a recurrence and invasive, but only a pathologist's examination of the surgical specimen will confirm that. Hopefully the MRI will shed some more light on this.

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  • KBeee
    KBeee Member Posts: 5,109
    edited July 2018

    Sorry you're dealing with a recurrence. Hoping you have a clear plan of action soon.

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  • arkansasgal
    arkansasgal Member Posts: 28
    edited July 2018

    Thank you KBeee.

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  • obsolete
    obsolete Member Posts: 466
    edited September 2018

    KBeee, so sorry about your past recurrences and wishing you a recurrence-free future with improved health.

    ArkansasGal, no problem... minor slips in semantics happen. The following links apply to Papillary Carcinoma ONLY and might be highly worth your consideration before your future surgical decisions are acted upon. Wishing you well ....

    https://community.breastcancer.org/forum/83/topics...

    Papillary lesions of the breast include a broad spectrum of lesions.... It is difficult to determine whether a lesion is benign or malignant based on the fragmented material of a core needle biopsy (CNB).... To avoid overlooking a malignancy, surgical excision [biopsy] is advantageous for papillary lesions, particularly those located far from the nipple......


    Diagnostic difficulty arising from displaced epithelium

    after core biopsy in intracystic papillary lesions of the

    breast https://jcp.bmj.com/content/jclinpath/55/10/780.fu...

    Optimally, in our opinion, localized papillary lesions should be excised completely with a small rim of uninvolved breast tissue without any prior needle instrumentation if and when the papillary nature can be determined by imaging.

    http://www.archivesofpathology.org/doi/full/10.104...

    http://www.archivesofpathology.org/doi/pdf/10.1043...

    Emphasis is placed on the final paragraph in above link.

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