Help with Pathology report

cs1522
cs1522 Member Posts: 13
edited August 2018 in Not Diagnosed But Worried

Hello,

I need help reading this pathology report:

"Moderately differentiatated invasive ductal carcinoma with solid papillary features."

Any information you can provide would be helpful.

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  • beach2beach
    beach2beach Member Posts: 996
    edited August 2018

    Hi,

    You should post your topic under the

    Interpreting your report thread by Djmammo in the Not Diagnosed but Concerned Don't worry that it says not diagnosed. The thread is in there. He will respond as well as I'm sure many others. Also if you havent done so, you could post it in the IDC. Hope the link I posted works.

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




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  • Rondeezee
    Rondeezee Member Posts: 92
    edited August 2018

    Sounds like your diagnosis is similar to mine..Grade 2 carcinoma with papillary features. Does it say anything about hormone status, HER2 status, ki67 values, LVI

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  • cs1522
    cs1522 Member Posts: 13
    edited August 2018

    It says ER and PR positive, negative for HER2 score... That's all it says. What did they do for you????

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  • cs1522
    cs1522 Member Posts: 13
    edited August 2018

    Did anyone tell you it is Papillary carcinoma?

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  • obsolete
    obsolete Member Posts: 466
    edited September 2018

    Hello, so very sorry you have reasons to be amongst us, but you're not alone, ok? I've found that Pathologists trained in Breast Cancer seem to vary in their terminology used to diagnose BC, based on their individual training. Papillary Carcinoma is a very confusing, controversial & complicated subtype of BC.

    I also had a dx of Solid Papillary Carcinoma (invasive) which had been described by one of 4 Pathologists to read exactly as you had described, but also within the wall of the Solid Papillary tumor were multiple foci of conventional IDC malignant cells, which is why it was classified as IDC with Solid Papillary features.

    The other 3 Pathologists classified it as Solid Papillary Carcinoma, 1 other Pathologist reported concurrent Invasive Ductal Carcinoma and DCIS Grade-III. Was either DCIS or IDC mentioned?

    Moderately differentiated is "middle of the road" Grade-II usually.

    Please be sure to ask your Pathologist for the Molecular Phenotype (for example, Luminal A or Luminal B) because Solid Papillary Carcinoma can sometimes tend to be Luminal B and also seek 2nd opinion(s). Also be sure to ask your Pathologist what % of your Solid Papillary Carcinoma tumor had any conventional IDC cells, if any.

    Papillary Carcinoma thread:

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

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  • cs1522
    cs1522 Member Posts: 13
    edited August 2018

    Hi,

    I'm confused because my breast surgeon says it's not papillary carcinoma... She said it's just ductal carcinoma and forget about that part. From what I read it has a better prognosis. Mine is Pr and Er >90%

    Am I wrong to pursue the question or to find another doctor.

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  • obsolete
    obsolete Member Posts: 466
    edited September 2018

    Hi CS,

    You're very fortunate that your ER/PR 90+% because these higher percentages tend to be mainly Luminal A molecular phenotype, but to be safe, I would suggest that you call your Pathologist on the phone to verify Luminal A and to rule out Luminal B. ( Luminal B tends to require more aggressive treatment). Also please verify your diagnosis directly with your Pathologist. You are entitled to a 100% clear understanding of your diagnosis, so I would ask your Pathologist what % of the tumor exhibited a Solid Papillary pattern. Were they not referring to conventional DCIS with a solid or papillary architecture?

    A 2nd opinion would be helpful in your case from a dedicated Breast Pathologist, to determine what's really going on in your case. I find your breast surgeon's statement confusing in view of your pathology statement, which possibly leaves the door open to more questions. I don't know why Breast Pathologists training cannot standardize their terminology. The doctors conflicting statements and different dx's had my head spinning also, so please don't feel alone in a sea of confusion.

    Integrative genomic and transcriptomic characterization of papillary carcinomas of the breast

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC50372...

    Spectrum of Papillary Lesions

    http://bdiap.org/wp-content/uploads/2017/12/Marchi...





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  • obsolete
    obsolete Member Posts: 466
    edited September 2018

    Other possibility might be ( ref page 43) http://bdiap.org/wp-content/uploads/2017/12/Marchi...

    When frankly invasive carcinoma is present .....

    it is most prudent to report only the size of the frankly invasive component as the tumor size for staging purposes in order to avoid over-treatment.

    We do not take the size of the papillary carcinoma itself into consideration in determination of the T stage.

    Histopathology 2008, 52, 20 - 29; Histopathology 2015; 66, 671 - 770

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  • cs1522
    cs1522 Member Posts: 13
    edited August 2018

    Hello,

    Thank you for all your help. I'm not quite sure how to get a second opinion. Do I call the radiology center? I'm due for surgery probably in two weeks. Do I wait for their pathology report? I asked a pathologist online and he told me to get a second opinion as well. I'm assuming it would be important in the treatment plan. I also understand that papillary has a better prognosis. Is that true? Less recurrences.... It's funny the radiologist who did the biopsy said it was papillary on the phone (it's the only thing I remember on the phone)

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  • obsolete
    obsolete Member Posts: 466
    edited September 2018

    Hi CS,

    No problem... nobody is alone. We are all here to help you thru this. Your current Pathology Report is from an excision, core needle biopsy or fine needle aspiration?

    The best Pathology evaluation is performed on the entire specimen following your surgery. You are having what type of surgery in 2 weeks, if you don't mind my asking? Lumpectomy? Mastectomy? Reconstruction?

    Are you located in the USA, Canada or elsewhere? If you contact me privately (Private Messenger) I can direct you to some dedicated Breast Pathologists in America who will perform 2nd opinion pathology consultations. However, we need to first learn who (labs, pathologists) your insurance plan covers.

    During the interim, please contact your health insurance provider to inquire what procedures you must follow to obtain medical coverage for a 2nd opinion pathology review.

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  • cs1522
    cs1522 Member Posts: 13
    edited August 2018

    Hi,

    It is from a core needle biopsy. They plan on a lumpectomy to take the one 1.3 cm and the .5 DCIS which is next to it. She said radiation for sure but not sure if it is 3 or 6 weeks. I have blue shield blue cross which allows for second opinions. She said the final decision on chemo will be after surgery. It's >90 positive for ER/Pr and HER negative. I am in new jersey. You seem to know so much about this and it helps to be able to talk to someone. My husband doesn't want to talk about it. He thinks it's stage 1 and done.. But i will live in constant fear of recurrence or stage 4. Papillary has such a better diagnosis, it would help me mentally I think.

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  • Georgia1
    Georgia1 Member Posts: 1,321
    edited August 2018

    Hi CS. I don't know a thing about papilary, but your treatment plan sounds right. I had a .8 cm and a .3 cm tumor close together, had a lumpectomy, then three weeks of radiation, and have been on a daily Tamoxifen pill since January. Not a bunch of fun, but very doable. Mine was invasive and a mix of IDC and ILC.

    As best you can, please focus on one day at a time and try not to take the "what ifs" and fear of recurrence to heart. Treatment these days is very advanced and your recurrence risk won't be known anyway until after surgery.

    And please let us know how we can help! Husbands are terrible (generally) about admitting illness or fear, so we are here for you.

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