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Help understanding biopsy results

newnana
newnana Member Posts: 3

I have no history of breast cancer but went to the doctor for a rash on my breast. I received antibiotics for 10 days but that made no difference. I then received anti fungal with a steroid and that's still not making a difference. Since I just turned 40 the doctor had me have a mammogram as well. That came back abnormal so I had a diagnostic mammogram and ultrasound and they recommended a cyst aspiration and abiopsy(unrelated to the rash). I had a biopsy on Wednesday and received the results through MyChart but haven't received a call from the doctor and guessing I won't until Monday. I'm hoping someone could help translate what the results mean. I read the rules of posting and think this is ok but if not I apologize.

The summary of the report says “ The pathology has returned as a complex radial sclerosing lesion, concordant with the imaging findings. Surgical consultation is recommended with consideration given to excision.“

I can paste the full report if that's helpful.

Comments

  • newnana
    newnana Member Posts: 3

    thanks, that is helpful

  • newnana
    newnana Member Posts: 3

    just wanted to provide an update. The doctor called and explained that while the complex radial sclerosing lesion is benign they generally recommend surgery to remove it since sometimes it can hide a malignancy. I have a surgery consult on the 20th. They will also reevaluate the rash on my breast at the same time

  • katg
    katg Member Posts: 206

    Good news. No matter what happens, you look to have a caring team looking out for you.

  • cathy67
    cathy67 Member Posts: 411

    newnana,

    Thanks for the info.

    Cathy

  • jw
    jw Member Posts: 13

    MY MOTHER HAS CONFUSING BIOPSY REPORTS:Please help me interpret the report. The oncologist suggests mastectomy. She is an 82 year old diabetic and I am worried about healing from mastectomy.

    First biopsy:
    Microscopic Description:-
    Sections show predominantly sclerosis / hyalinization (~90%) with a small foci of tumor (~10%)
    composed of variably sized glands lined by cuboidal epithelium with mild nuclear pleomorphism
    and no peripheral myoepithelial cell layer. No ductal carcinoma in situ seen.
    -Scant invasive tumor tissue seen, suggestive of invasive breast carcinoma, NST, Grade 1. (NBR
    score: 2+2+1=5)
    The tumor tissue was scant, hormonal studies were not possible so repeat biopsy was performed which showed similar morphology with extensive area of sclera and presence of few glandular profiles with attenuated myoepithelial cells. shows few scattered myoepithelial cells around all glands.shows retained myoepithelial cells around all glands.

    Shows heterogeneous positivity

    External controls show appropriate reactivity

    overall findings suggest complex sclerosing lesion/ neoplasm

    Comment: presence of retroareolar location of lesion with extensive sclerosis is commonly seen in papillary lesions of the breast. Correlation with excision specimen is required for definite diagnosis.

    Advice: Excision biopsy/ frozen section analysis

  • jw
    jw Member Posts: 13

    There is no evidence of spread anywhere as Pet CT verified it. Lymph nodes are clear. Is this lump really cancerous. Why are pathology reports so confusing. Surgeon insists on mastectomy and says she will heal even thought I told him Hb A/ c is 7.5 and her leg wounds don’t heal fast. MRI is alarming and says:Multifocal contiguous nodular and linear enhancement in right breast in central retroareolar anterior and posterior depth parenchyma with contiguous extension into the retroareolar region resulting in nipple retraction and other lesions seen towards axillary tail are suggestive of multifocal-multicentric right breast malignancy (BIRADS 5)- requires histopathological correlation.
    A small non-mass like enhancement in left beast at 5 O’clock position is indeterminate (BIRADS 3).
    Can you all give some advise.

  • jw
    jw Member Posts: 13

    The pathologist called and said the reports are confusing because they don’t know where the needle goes in the tumor. Maybe the first half has cancer cells and second half has none that is why first biopsy suggested invasive carcinoma and second suggested sclerosing lesion. He said it could be very early stage cancer or DCIS but he can’t be sure. Mom wants to remove the lump not the breast as she is not sure she can make it from the surgery with the comorbities she has.
    Any advice on lumpectomy vs mastectomy would help. Thanks

  • maggie15
    maggie15 Member Posts: 844

    Jagdish_wa, A sclerosing lesion is benign but there is sometimes cancer hidden in the area. The radiologist's recommendation was an excisional biopsy which just removes the lump. The mri, however, shows more areas of concern. Only a surgeon would be able to tell whether all the suspicious tissue could be removed in one excisional biopsy. Possibly, depending on the location of things, two excisional biopsies could remove everything. This would not give a good cosmetic result but would probably heal more easily than a mastectomy and address your mother's valid concern.

    It would be worth getting a second opinion from a breast surgeon in a large teaching hospital or cancer center. These places deal with complicated cases and have a broad range of experience. I understand your mother's reluctance to have a mastectomy when no malignancy has been identified by biopsy. I hope you can get the answers you need.

  • jw
    jw Member Posts: 13

    Your opinion really helps. I had a third opinion with an associate professor cum surgeon who said he would remove the lump with mom on operating table and do a frozen section (in 45 minutes) and if came back cancerous he would do mastectomy. I am going back to him to discuss as I don’t know if this really happens during an operation.
    I know the MRI was alarming and Doctors decision to do mastectomy is based on the MRI report. The pathology report has confused the Doctor too.

    Will doing a true cut biopsy get a better sample or would repeating an MRI help.

    My mom is vegetarian has been on Keto since 30 years and is a yoga teacher for same duration.

    Cancer is the last thing I expected..

  • jw
    jw Member Posts: 13

    Your opinion is very insightful. And thanks for pointing out that breast area has good blood supply. I didn’t think of that. Her leg wounds don’t heal and that is because of peripheral vascular disease.
    I did see the Professor cum oncologist again and he advised me to do a Rt Scilla biopsy to check the spread before he does the lumpectomy.

    She will have 3 biopsies in 3 weeks. I hope the poking doesn’t spread the scant tumor cells.

    Thanks for your insight on the matter. It really helps to get a different viewpoint. 🙏

  • maggie15
    maggie15 Member Posts: 844

    jagdish_wa, Connie has made some good points. While hormonal studies couldn't be done, is there a high enough probability that the cells are ER+ so your mom could be treated with an aromatase inhibitor alone with no surgery? Has your third opinion doctor seen the biopsy slides and all the imaging? He could give you his opinion on this. Also, has your mother visited a wound clinic for slow to heal leg wounds? If so it would be worth getting that surgeon's opinion on the prognosis for her post surgical healing.

    Getting all the information possible will help your mom make her decision. We instinctively believe that if there is a medical problem it should be treated. However, sometimes the treatment side effects are worse than the benefit. All the best finding a good resolution.

  • obsolete
    obsolete Member Posts: 333

    "Comment: presence of retroareolar location of lesion with extensive sclerosis is commonly seen in PAPILLARY LESIONS of the breast. Correlation with excision specimen is required for definite diagnosis."

    Hi there, in setting possible expectations, below is a link to add to the excellent advise that's already been shared in response to your Mom's biopsy report which had included above comment. Best wishes to you and your Mom!

    "ATYPICAL PAPILLARY LESIONS AFTER CORE NEEDLE BIOPSY AND SUBSEQUENT BREAST CARCINOMA"

    https://researchexperts.utmb.edu/en/publications/atypical-papillary-lesions-after-core-needle-biopsy-and-subsequen

    "Conclusion: Due to the high upgrade rate of atypical papillary lesions to carcinoma (42%), excision of all atypical papillary lesions with wide excision margin is recommended for cases with pathologic diagnosis of atypical papillary lesion on core-needle biopsy."

  • obsolete
    obsolete Member Posts: 333

    DIAGNOSIS OF PAPILLARY BREAST LESIONS ON CORE NEEDLE BIOPSY: UPGRADE RATES AND INTEROBSERVER VARIABILITY

    https://pubmed.ncbi.nlm.nih.gov/31187678/

    PAPILLARY LESIONS OF THE BREAST: TO EXCISE OR OBSERVE?

    https://pubmed.ncbi.nlm.nih.gov/28845569/

  • jw
    jw Member Posts: 13

    Thanks for the research articles. It will help us make a correct decision for her.
    After reading all your posts I am getting a better idea of the situation.
    Should we do the excision immediately or does the cancer spread fast. I was thinking of doing the surgery by 5/20. Hope ot doesn’t spread so fast.
    In the meanwhile the professor cum Doctor asked me to get a biopsy of the Right axilla before he does the wide margin excision.

  • maggie15
    maggie15 Member Posts: 844

    Jagdish_wa, Even though the third biopsy seems excessive it is a good idea. This is another chance to get a hormone profile which would give your mom another treatment option (AIs) if cells that are ER+ are found. There is no huge rush to do surgery because breast cancer does not spread very quickly. It's reassuring that you now have an expert involved in treatment decisions.

  • jw
    jw Member Posts: 13

    MY MOTHER HAS CONFUSING BIOPSY REPORTS:

    Small Biopsy (Single Container)
    Clinical History: - C/o lump in right breast x 15 days
    Specimen Type: - USG guided biopsy from right breast mass
    Gross Description:-

    Received three grey white linear cores size ranging in size from 0.2 to 0.4x0.1 cm. All tissue
    submitted in cassette A.
    Microscopic Description:-
    Sections show predominantly sclerosis / hyalinization (~90%) with a small foci of tumor (~10%)
    composed of variably sized glands lined by cuboidal epithelium with mild nuclear pleomorphism
    and no peripheral myoepithelial cell layer. No ductal carcinoma in situ seen.
    Final Diagnosis:- USG guided biopsy from right breast mass:
    -Scant invasive tumor tissue seen, suggestive of invasive breast carcinoma, NST, Grade 1. (NBR
    score: 2+2+1=5)
    Note: The tumor tissue is scant, hormonal studies and other ancillary studies is not possible in
    the scant tumor sample
    ..................._-Addendum Report----------.
    01/05/2023 11:09AM
    Addendum DateTime:
    Addendum Comment :
    Repeat biopsy done on 28.04.2023
    Specimen Type: - USG guided biopsy from right breast mass (Repeat)
    Gross Description:-
    Received multiple grey white linear cores size ranging from 0.2 to 0.8x0.1 cm. All tissue
    submitted in cassette B.
    Microscopic Description;-
    In view of scanty tumor tissue, a repeat biopsy was performed.

    Repeat biopsy analysis:


    The repeat biopsy shows similar morphology with extensive area of sclera and presence of few glandular profiles with attenuated myoepithelial cells.

    Immunohistochemistry:

    P63: shows few scattered myoepithelial cells around all glands

    CK5/6: shows retained myoepithelial cells around all glands.

    ER: Shows heterogeneous positivity

    External controls show appropriate reactivity

    Final Diagnosis: overall findings suggest complex sclerosing lesion/ neoplasm

    Comment: presence of retroareolar location of lesion with extensive sclerosis is commonly seen in papillary lesions of the breast. Correlation with excision specimen is required for definite diagnosis.

    Advice: Excision biopsy/ frozen section analysis

  • exbrnxgrl
    exbrnxgrl Member Posts: 4,730

    jagdish,

    Have you been asking your mothers doctor to explain the parts of the report that you find confusing or have questions about? Although many of us are experienced patients, none of us are qualified to give medical opinions on anything. You can easily Google words/terms that you don’t understand but that won’t really give you the full picture of your mom’s situation. I think your mom’s doctor is your best source of information because although there are commonalities between breast cancer patients, there is also a good bit of individuality. Take care

  • jw
    jw Member Posts: 13

    Thanks for the insight everyone. We found a positive lymph node. She is going for surgery soon. Please keep her in your prayers. Thanks

  • jw
    jw Member Posts: 13

    Hi All.

    Many thanks for your insights on my moms scenario. She had the mastectomy and is recovering now. Again I am confused by the histopathology done on the breast tissue. She is 81 and the report came back as triple negative. So 0 receptors of ER PR and HER. Not even one..

    She has DCIS and IDC in one tumour that was malignant. The second one appears to be okay. So if DCIS and IDC both can exist in a tumour. Is that possible.And if DCIS is there why is it triple negative.

    In the lymph biopsy report it positive for spread and that is why mastectomy was done but it turned out to be triple negative so now chemotherapy needs to be done.

    But the lymph nodes on breast tissue sample are all free. The report seems to be contradicting itself.

    Are pathology reports supposed to be so confusing..

    Also in India the healthcare system is commercial so I am thinking maybe the Hospital is giving us worst scenario possible so we take more services.
    my mom says I shouldn’t have touched the tumour. Me getting biopsies done made it cancer. It might have been sitting there silently for years as she never did self exam.
    please give any insight or advise that you have as I am asking the Doctor these questions too and he said he would get back.

    Regards

  • exbrnxgrl
    exbrnxgrl Member Posts: 4,730
    edited May 2023

    Sorry you are going through this. Please remember that not only are we not medical professionals but we are not your mothers medical professionals, so we shouldn’t be offering our unqualified opinions about your mothers situation.

    Yes, pathology reports are not written for patients as you have discovered. They are written for doctors.

    Yes, it is very common for IDC and DCIS to exist together. It is triple negative because IDC is invasive and trumps DCIS which is not. They will be treating her IDC and that treatment will also take care of the DCIS. IDC is the greater concern. Some do not even consider DCIS to be cancer but rather a pre-cancer. TBH, the DCIS is almost a non-issue at this point because of the IDC.
    Getting biopsies done and/or removing the tumor does not create or turn something into cancer. You may be thinking about something called seeding but that exists more in theory than reality. Yes, it probably was sitting there for years as bc is generally slow growing. Most estimates say it takes between 5-10 years for bc to grow large enough to become detectable.
    Again, we are not doctors but I wish your mother the best.

  • maggie15
    maggie15 Member Posts: 844

    Exbrnxgrl has given you good advice. Additionally, the biopsy pathology does not always match the surgical pathology due to the biopsy being just a sample. Your mother will be treated according to the surgical pathology. I hope things go well for her.

  • jw
    jw Member Posts: 13

    Thanks for the advice. The insight and information I am getting is helping me to talk to the Doctors as I didn’t have any knowledge on this before.
    I was doing a lot of research and now that the mastectomy was done as the lymph was positive how would they see the progress in chemotherapy. Are there any markers that they would look at to see if the drugs are working.
    Also the Doctor said my mother could tolerate the chemotherapy but isn’t it tough at 81.

    Is there a choice that I can make. Or if we don’t do chemotherapy the cancer would spread fast.

    These are some crucial questions I want to get informed about.
    By reading on this forum and doing the research I am getting some understanding.
    I don’t need medical advice but when you all give some insight it educates me.

    Again in retrospect the Dr me and mom decided to go ahead with hysterectomy as tumour was scant in 2 biopsies lymph was positive and typing could not be done.
    Now it seems it was triple negative and was behaving like that since the start.

    So I am understanding a lot. Your suggestions and advices and helping me talk to the Doctors.

    Thanks 🙏

  • moderators
    moderators Posts: 7,884

    Hi @Jagdish_wa,

    It is certainly overwhelming, especially in the beginning. It sounds as if you, your mother and her doctor have so far done well in working together to make shared treatment decisions that support your mother's desires. One thing to remember, that hopefully will alleviate some of your stress and worry, is that your mother can always try a treatment, see what the treatment side effects are for her (since it is so individual), and she can always make the decision to stop treatment/try a different one. I hope that is helpful.