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Suspicious lymphovascular invasion and Triple negative DCIS?

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everythingwillbefine
everythingwillbefine Member Posts: 35

I am so sad that I returned to this board reporting after 3 years of left mastectomy, I just found from MRI that I have developed DCIS in my right breast and "suspicious for focal lymphovascular invasion".

I did not have MRI in the past 3 years. All I had was diagnostic mamo and ultrasound which is all clear. I wonder what if I had MRI last year….

How bad is it? Does it mean metastasis?

I was driving when I got the call. I did not get too much time to think of questions. I will see surgeon on Tuesday. I know I am going to have another Mastectomy. It's Okay. I wish I did BMX 3 years ago!!! But time cannot go back… I will sentinal node biopsy I know. Should I ask for PET scan regardless the result? I am with Univeristy of Chicago. Should I get a second opinion at Cleveland or Anderson? I am going to have chemo and radiation due to the invasion? Why they cannot say for sure. Why they say it's suspicious? Will the answer is confirmed after the mastcetomy?

I have been on Tomaxifen for the past 5 years and still developed DCIS on my right breast. And Lymphovascular invasion!

My kids are still young 11 and 9. I want to live till at least they graduate from college.

As of now I am still waiting on ER PR status. It's been a week since my biopsy. Surgeon said she wants to do sentinal node biopsy first before surgery since there is suspicious lymphovascular invasion they suspec that there could be invasive cancer in there but the biopsy did not get it. Also I am scared that this time could be Triple negative since I develop this new primary while on Tamoxifen…..

Anyone developed contraladeral DCIS while tamoxifen?

By having DCIS twice how does that impact the long term survial rate?

I am thinking to get second opinion from MD Anderson.

Final Diagnosis

A. Right breast 7:00; core needle biopsy: - Ductal carcinoma in situ, intermediate nuclear grade, solid pattern. - Suspicious for focal lymphovascular invasion; see comment.

Comment

While there is no evidence of invasive carcinoma seen in this sample, there is a focus of tumor separate from the area of DCIS that is concerning for lymphovascular invasion. By immunohistochemistry, the periphery of this tumor nest is negative for p63 and positive for CD34. Together, the histological and immunohistochemical findings are suggestive of possible lymphovascular involvement. Immunohistochemistry for ER and PR is pending.

Comments

  • everythingwillbefine
    everythingwillbefine Member Posts: 35
    edited October 2023
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    ER 60% and PR <1%

    So I am hormone negative.

    I don't know if there is any invasion and the surgeon suspected IDC and Possible lymphovascular invasion

    They don't test Her2 although I asked them to

    I am very nervous.

    I have an appt with MD Anderson on 10/24 and I hope to have surgery as soon as possible.

    Am I at risk for metastasis?

  • obsolete
    obsolete Member Posts: 333
    edited October 2023
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    Hi, sorry you've got reason to come back to us. Please take it slow. Just breathe deeply & slowly, and you'll get thru this. If you take little baby steps, only one at a time, it will get easier. Try to relax, walk in nature and enjoy the park with your kids.

    It's bad luck you're possibly presenting with a suspicious LVI differential case, but DCIS is known to have a wide range of appearances. It could also be a misreading. They likely suspect one tiny little lymphatic space adjacent to your blood vessels or similar situation, which is NOT mets. Unfortunately, DCIS has the biologic potential for progression to invasive carcinoma. Please let us know how it goes with your appointments and see below on some helpful info. Hugs to you! 💞

    ------------

    High grade DCIS has similar molecular profile as invasive breast cancer.

    https://www.ncbi.nlm.nih.gov/pubmed/26249178

    Have you had genetic testing? Up to 6% patients with DCIS carry a mutation for BRCA1 or BRCA2. 

    Extensive DCIS / extensive intraductal component" refers to a concurrent small invasive component. 

    https://www.ncbi.nlm.nih.gov/pubmed/2838791

    Some patients do not metabolize Tamoxifin adequately. Were you tested before starting Tamoxifen?

     In the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-24 trial, tamoxifen reduced the likelihood of ipsilateral recurrence at five years from 9 - 6%, and also reduced the risk of a tumor in the contralateral breast.

    https://www.ncbi.nlm.nih.gov/pubmed/24663048

    https://www.ncbi.nlm.nih.gov/pubmed/10376613

  • moderators
    moderators Posts: 7,911
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    @everythingwillbefine, we're sorry to hear that you're facing this difficult news. Please know that you're not alone on this journey. 💗 If you decide to go to MD Anderson, you can read helpful tips on Getting a Second Opinion at the main Breastcancer.org site, including why, where and when to get them, and what to expect.

    Hope this helps. Please, come back and tell us all how you're doing.

    The Mods

  • everythingwillbefine
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    Hi

    I want to give an update.

    i had mastectomy last Monday and today the 2 drains were removed. i healed very well. Final pathology said no DCIS nor IDC is found and lymph nodes are clean. So the biopsy removed all the DCIS! So no lymphovascular invasion!

    I am so relieved! I know I am very lucky! Now I need to call my OB to get D&C. Right after I got this breast cancer diagnosis my OB called saying that my lining was too thick and there is a polyp and she want to do a D&C to get something out for testing! She thinks all related to tomaxifen. Now that I had both breasts removed and I no longer need tonaxifen so hopefully the lining is going to thin out on its own. I also had a period on my surgery day! Crazy!

    Thank you for everyone replied!

    I will update later on the lining part.