Biopsy report

[Ch_balaji]

My mom had MRM two months back.stage 2a, nodes negative (0/20) with grade3 and her2 positive.i have some doubts regarding report i.e.,

1.tumor shows large areas of necrosis& focal lymphocytic response

2.focal intraductal carcinoma of solid & camedo type of high nuclear grade is seen,content of which is not significant

3.vascular tumor emboli or perineiral invasion are not seen.

I just want to know what is the meaning.

and i could not find the word LYMPHOVASCULAR INVASION in my report

I'm waiting for the reply eagerly.

[kaarenorgaard]

Hi,

It looks good. Comedo and the other text means that it is predominantly "in situ", which normally means it is not infitrating. But your report says it is infiltrating (a.k.a. invasive).

There is no lymphovascular invasion according to the report - and you say that no lymph nodes are involved (which would also have been surprising, given that it is almost in situ).

The only "bad" thing is that it is grade 3 ("high nuclear grade"). But don't worry about that, when it hasn't spread. The following is more important:

You mention it is HER2 positive. So she must have Herceptin or one of its equivalents for a year. She should have chemo therapy for approx. 4 months (the first 4 months of that year).

What about the Estrogen/Progesterone receptor (a.k.a. the ER and PR status).

Kind regards,

Kaare

[Ch_balaji in reply to kaarenorgaard]

thank you sir,I appreciate your quick response to my query.

below is my whole biopsy report

histopathology report:

GROSS:

Received a specimen of Left modified mastectomy measuring 25*15*5cms.skin flap measures 12*9cms.

skin nipple and areola are unremarkable.

on serial slicing,a grey white firm infiltrative tumor measuring 4.5*4*3cms is seen in the outer quadrant.it lies 0.7cms away from base and 1cms away from skin

axillary dissection:twenty lymph nodes,largest measuring 1.5*1*0.5cms are dissected.

MICROSCOPIC EXAMINATION:

infiltrating ductal carcinoma.NOS.

Modified R.B.score 3+3+3=9 grade 3

tumor shows large areas of necrosis& focal lymphocytic response

.

focal intraductal carcinoma of solid & camedo type of high nuclear grade is seen,content of which is not significant

vascular tumor emboli or perineiral invasion are not seen

IMPRESSION:

infiltrating ductal carcinoma,NOS,grade3 with uninvolved regional nodes(0/20),pT2N0Mx

ADDENDUM:

immunochemistry*results:

ER:negative.

PR:negative,

cerbB2:positive,score 3

this is the biopsy report.

could you please tell me the stage.

[kaarenorgaard in reply to Ch_balaji]

OK - so is the treatment after the surgery Herceptin (or Hetraz or Canmab) for a year and chemo therapy for the first 3-4 months?

[Ch_balaji in reply to kaarenorgaard]

Sir could u plz see the above biopsy report .and tell me what is the stage.im waiting for ur replay

[kaarenorgaard in reply to Ch_balaji]

You mention it yourself in the text:

T2N0Mx (I think it is safe to say that x=0, when lymph nodes aren't involved)

[Ch_balaji in reply to kaarenorgaard]

as u said it is situ.why did report mentioned it as invasive.

[kaarenorgaard in reply to Ch_balaji]

I don't know; but the "T2" part of the stage says it is invasive. I suggest you ask back to the hospital what is really the case.

And which treatment does she follow now, if any?

[Ch_balaji in reply to kaarenorgaard]

she is suggested to take 4 cycles of AC then ,12 cycles of paclitaxl+trastuzumab ,then 13 cycles of trastuzumab.

now she has completed 2 cycles.

sir do u think they(pathologists) mentioned it as invasive and given the staging T2N0M0 because of the size of the tumor.

SIR CAN U PLEASE ONCE AGAIN SEE THE REPORT.and tell me what exactly u want me to do

histopathology report:

GROSS:

Received a specimen of Left modified mastectomy measuring 25*15*5cms.skin flap measures 12*9cms.

skin nipple and areola are unremarkable.

on serial slicing,a grey white firm infiltrative tumor measuring 4.5*4*3cms is seen in the outer quadrant.it lies 0.7cms away from base and 1cms away from skin

axillary dissection:twenty lymph nodes,largest measuring 1.5*1*0.5cms are dissected.

MICROSCOPIC EXAMINATION:

infiltrating ductal carcinoma.NOS.

Modified R.B.score 3+3+3=9 grade 3.

tumor shows large areas of necrosis& focal lymphocytic response

.

focal intraductal carcinoma of solid & camedo type of high nuclear grade is seen,content of which is not significant

vascular tumor emboli or perineiral invasion are not seen

IMPRESSION:

infiltrating ductal carcinoma,NOS,grade3 with uninvolved regional nodes(0/20),pT2N0Mx

ADDENDUM:

immunochemistry*results:

ER:negative.

PR:negative,

cerbB2:positive,score 3

*SIR DO U REALLY WANT ME TO ASK THE ONCOLOGIST ABOUT THIS? waiting for ur reply

[kaarenorgaard in reply to Ch_balaji]

It seems like the treatment is right. In any case it is treated like if it was invasive. The report says it is infiltrating (and that means invasive). And I don't think you need to worry further or ask your oncologist...

[Ch_balaji in reply to kaarenorgaard]

thankyou for ur reply

[Rkbuntyg in reply to kaarenorgaard]

Sir ,

Please suggest me too My mom Right Breast Specimen Says Invasive Ductal Carcinoma PT2N0MX with component of ductal Carcinoma in SITU - (AJCC Manual for Cancer Staging - 8th Edition.

2. NH Score ( Modified Richardson-Bloom Score :9[Grade 3]

3: All surgical margins and Lymph node-free of tumor .

Advised For ER, PR +Her2 /Nev Studies

Just Advice me what is pros and cons after getting Chemo Therepy and what is the stage according to the report you analyze and fyi Tumor Size was 4*3*3 .

And Balaji ,

I hope your mother is fit these days .