QuestionHello,
I am 43 yrs. old and had an abnormal mammogram on Nov.18, 2008. On Dec.3rd, I had a Right Breast mass needle localization biopsy. The Diagnosis: ductal carcinoma in situ, comedo type, microcalcification.Minute fibroadenoma.Fibrocystic changes.Tumor is present in inked surgical margin of resection.Tumor is within 1mm from the inked surgical margin of resection.
On Dec.9th I had a Right Breast, re-excision and biopsy.The Diagnosis:invasive ductal carcinoma, Nottingham Grade I. Margins are free of tumor. What does the Nottingham Grade mean? Microscopic examination reveals minute foci of invasive ductal carcinoma and focal area of ductal carcinoma in situ. What does this mean ?
Also in the diagnonsis is: two foci of invasive ductal carcinoma, grade 2.Maximum dimension of each invasive carcinoma focus:4.5mm & 4.1mm (respectively). No vascular invasion identified.
The report also reads:H&E stained sections of block 3 show small nests and clusters of adenocarcinoma which form rounded slightly nodular exspansile masses. Excluding the rare, isolated entrapped duct, the nests are devoid of myoepithelial cells evidenced by the lack of immunoreactivity around the periphery by smooth muscle myosin and p63. The majority of neoplastic cells have luminal differentiation, evidenced by cytokeratin 8 expression, while a minority of neoplastic cells have myoepithelial differentiation, evidenced by cytokeratin 5/6 staining.Prognostic markers were previously performed under AG08-13383. What does all of this mean ?
I am scheduled for a sentinel node biopsy on Dec. 23rd.
AnswerA breast lesion has been found in your right breast. In the first biopsy only a ductal carcinoma in situ was found = a cancer originating and growing in a milk duct ("ductal"). It was filling up the milk duct ("comedo type"). But it did NOT invade surrounding tissues. That is why it was called "in situ" = in place, not growing out of place, a good sign. However the lesion was VERY close to the surgical margin, less than 1 mm of it = less than 1/25 of an inch. Therefore more surgery was done which was good since it brought more facts to light. In fact several foci (= centers of growth) of cancer were found. In some of these the cancer DID invade surrounding tissues ("invasive"). In some it was still in situ. The surgical margins were free of cancer. Some of this invasive cancer was of (Nottingham) grade 1. Grade is an evaluation of how malignant (how "bad") the cancer is based on how it looks in the microscope. The lower the grade the better it is. Grade 0 = cancer in situ. So a grade 1 though invasive is not much worse than a cancer in situ. Grade runs from 0 to 4. However in 2 places invasive carcinoma grade 2 was found. These 2 lesions were 4.5 mm and 4.1 mm in size. 1 inch = 25.4 mm. Nowhere was any invasion of blood or lymph vessels ("vascular invasion") seen which is a good but uncertain sign. Beside these findings were also seen a number of small adenocarcinoma cancers (cancers of milk gland origin - the others above were of milk duct origin). This is not good. It means that you have/had several (though small) cancers in your right breast. In view of that I think a mastectomy of your right breast is what should be done unless it already has been done. There is also a risk that similar conditions may exist in your left breast and that risk must be considered too. A sentinel node biopsy here is VERY important! If cancer is found there too chemotherapy should be given. Radiation therapy should also be considered. I'm astonished that your dr. did not explain these things to you when you were given these reports! How are you to understand them on your own? The rest in your report is just technicalities leading up to these conclusions above. I assume that hormonal and genetic tests have been done though there are no results of that in these reports. Good luck!
