Flat Epithelial Atypia and Mucocele-Like Lesion
Hi all,
In my last mammogram, there appeared to be a 1cm of clustered grouped microcalcifications.
I received a stereotactic biopsy last week, and the pathology report is as follows -
Left Breast with microcalcifications:
Flat epithelial atypia
Focal mucocele-like lesion
Microcalcifications associated with in flat epithelial atypia and columnar cell changes
Left Breast without microcalcifications:
Mucocele-like lesion
I have spoken to a pathologist, radiologist, and surgeon, and the responses range from wait and see to surgical excision.
I was wondering if anyone has any experience with both flat epithelial atypia and mucocele-like lesions? If so, what was your course of action? And what questions should I ask the surgeon? Any perspective would be much appreciated!
Thank you.
Comments
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Lil, hoping the following links will bring more light. It's good you are pushing for answers and advocating for yourself.
Mucocele lesions are uncommon, which is why nobody has responded until now.
I had a mixed bag of various subtypes of invasive cancers, also uncommon, so I cannot comment on your specific presentation.
There's a wealth of information on this website if you search "microcalcifications".
Best wishes!
"Mucocele-like lesion (MLL) is a rare mucinous lesion of the breast with highly variable upgrade rates to atypia or malignancy on excision"
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obsolete,
Thank you so much for your response! Very helpful. I figured as much, given my search on mucocele-like lesions comes up with little information. I will probably find out more after surgical excision. Best of luck to you!
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lilsoo, I am sorry, but I don't have information on your pathology report. I was glad to read that you spoke with a breast surgeon. You didn't say if you spoke to him/her on the phone or in person. If you only spoke to a surgeon on the phone, I would highly advise seeing one in person. The reason I say this is because I just had a stereotactic biopsy and it was positive for cancer. This is my third time with breast cancer! I had it twice before, in my opposite breast, in 2003/2019. In Jan 2019 I had a single mastectomy with reconstruction. The surgeon I saw, at a well-known cancer hospital in Philadelphia, refused to also remove my other breast! He said it was hospital policy not to remove a healthy breast from a woman unless she was BRCA positive, which I am NOT! (note that my mother and two of my three sisters also had breast cancer)
He also said I was free to go for a second opinion elsewhere. I did not because I was in shock at having cancer a second time!
Fast forward to July 2022 and the point I want to make for you. I decided I wanted to change my records from the cancer hospital to the local hospital. Of course, at the time, I was thinking all I would need were yearly exams and mammograms. I met with the breast surgeon, who I researched online and felt would be a good fit for me. After my appointment with him, I left his office feeling great: I liked him AND I knew I was in good hands with his care! Less than a week later, I had a mammogram, which his office scheduled for me, and discovered I needed a biopsy. A week after that, I had the biopsy and three days later he called to tell me I had cancer.
I CAN NOT tell you what a difference it made going to my appointment yesterday! This was the first of my three times with breast cancer that I picked my breast surgeon! The other two times, I found out I had cancer I was assigned a surgeon! It makes a difference when you feel confident in your surgeon, and it is so much easier going for a second or third opinion when you aren't facing cancer! If you weren't satisfied with the surgeon's opinion, now is the time to look for another opinion. I told my surgeon how much less stressful it was knowing I trusted him before I was diagnosed, and he said that is why he likes seeing high risk patients!
Perhaps you already knew the surgeon, but if you need surgery or treatment now or in the future, seeing someone you already trust is HUGE!
Sorry to rant, but I want you to know I wish you well, and hope this advice helps you or somebody else.
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Lil, you might be interested in this article. Best of luck with your excision.
Maverick makes some excellent points.
"Benign Mucocele-like Lesion Of The Breast: How To Differentiate From Mucinous Carcinoma Before Surgery"
L Cheng et al. Cytopathology. 2004 Apr.
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Just wanted to post a follow up in case anyone else is searching on this topic. One surgeon told me that if anything, there’s a 5-10% chance of upgrade to DCIS or cancer (possibly mucinous) upon excision. She recommended surgery because the MLL present with atypia was enough cause for concern. Another surgeon told me their institution takes a “wait and see” approach where they no longer excise FEA and/or MLL.
I went forward with the surgery, and there was fortunately no upgrade. Thank you to all who chimed in, and wishing everyone the best of outcomes in this nerve-wracking journey.
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