QuestionHi Dr Nordquist
I am scheduled to have an excisional biopsy where I have been given the option to have extra margin taken instead of waiting for definitive results and possibly going for a re-excision. Here are the results from the Core Biopsy
Diagnosis:
1) Fibroepithelial Lesion with Cellular Stroma and Patchy Monomorphous Atypical Intraductal Proliferation
2) Negative for In Situ and Invasive Malignancy
Comment:
The sections show multiple portions of a fibroepithelial lesion. The cellularity of the stromal component is markedly increased. However, there is no stromal atypia, stromal overgrowth or increased mitotic rate. The borders of the lesion cannot be reliably assessed in this small sample. The epithelial component is hyperplastic with a patchy thickened layer of monomorphic cells undermining the ductal epithelium of multiple duct spaces and lobules. The cytology is low grade and the architectural complexity falls short of atypical ductal hyperplasia and low grade ductal carcinoma in situ. The E-cadherin is positive ruling out atypical lobular hyperplasia. These cells seem too monomorphic for usual hyperplasia and further evaluation of the epithelial component is recommended to rule out atypical ductal hyperplasia or low grade ductal carcinoma in situ arising in a fibroepithelial lesion. The main differential diagnosis of this fibroepithelial lesion includes fibroadenoma with cellular stroma and phyllodes tumor. The distinction between these two lesions is difficult to make on a core biopsy and a conservative excision for further evaluation is recommended.
Clinical History
7 o'clock right breast 20mm solid nodule new Birads 4B
I am 49 and pre-menopause
Based on the pathology report would you have any thoughts on whether it would more or less likely to be a phyllodes? I hate the thought of doing the surgery twice (to increase margins) if it turned out to be Phyllodes, but I am small breasted and concerned that taking the extra margin will make a difference in the appearance of the breast and may turn out to be completely unnecessary. What are your thoughts on this?
AnswerJust as the pathologist who has examined your biopsy and written the report remarks, it is possible! I can certainly not add anything more to his evaluation since contrary to him I have not seen your biopsy! So his recommendation must be regarded as still standing! I do understand your concern but in this situation I can only recommend and in fact strongly suggest that you follow his advice. Yes it may turn out that a second biopsy was "unnecessary" but without that second biopsy we will NOT KNOW that and besides it may also turn out that there a phyllodes tumor there and without a new biopsy we will not KNOW that either. So I can NOT regard a second biopsy - in spite of the complications you mention - as "unnecessary". In my opinion it is DEFINITELY NECESSARY! As a matter of fact, if there is no phyllodes tumor there or anything else bad, then you do not need to worry about it any more. That too is worth a lot! Good luck!
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