Pathology report
Hi.. I was wondering if someone could help me understand my pathology report. It says invasive ductal carcinoma with mucinous differentiation. What does mucinous differentiation mean? I also read that the oncotype isn't validated for pure mucinous carcinoma. Would an oncotype score be valid with "mucinous differentiation?" Thank you so much!
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Hi Jenna, I have never dealt with mucinous carcinoma so hopefully someone who had it will chime in. Your tumor is IDC with mucinous characteristics. Some tumor cells have mucin/mucus in them which can be excreted outside the cell mixed with the more common IDC cells. In general pure mucinous carcinoma (>90% of cells mucinous) is not aggresssive so an Oncotype is often not done. Because it's a rare breast cancer there is no data on how well the Oncotype predicts the need for chemo in that case. You will need to ask your MO about your specific situation but it sounds like there may be enough IDC there to make the Oncotype relevant if it fits the other criteria for doing the test (size, receptors, node status.) Hopefully you have an appointment coming up so you can discuss this with your doctor.
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@maggie15 Thank you so much for replying and for your explanation. I appreciate it so much!
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Hello Jenna1220x, a warm welcome to the mucinous carcinoma club!
MC is actually on a spectrum whereby patients' malignancies will present with varying percentages of mucin. Your pathologist will be your best resource for this information.
Typically a patient with a mucinous differential would present with "Mixed Mucinous Carcinoma" as opposed to "Pure Mucinous Carcinoma".
All MC patients are encouraged to seek a 2nd opinion from a dedicated breast pathologist typically resident at a cancer center. This website has a thread on Mucinous Carcinoma which may be a good resource for you. Best wishes to you.
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Jenna, for further info
https://www.pathologyoutlines.com/topic/breastmalignantmucinous.htmlGenerally you would have either...or.
• Epithelial clusters that lie within secreted mucin (type A)
• Large sheets of tumor cells with neuroendocrine features and mucin production (type B)• Breast neoplasm with "pure" mucinous component that comprises > 90% of tumor
• Breast neoplasm with "mixed" mucinous component that comprises < 90% of tumor• < 5% of breast carcinomas have a mucinous component;
• Of these, only 2% are "pure" mucinous carcinoma
• Implies the remaining 3% are "mixed" mucinous carcinomaSeasons Greetings & good luck.
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@obsolete thank you so much for the information and explanation! The pathologist said it was between 40 and 50 percent mucinous. I have a high risk oncotype score. I have grade 2. Tubule 3, nuclear pleomorphism 3, and mitotic rate 1. They are saying I have an aggressive but slow growing breast cancer. I chose to do lupron and anastrazole instead of chemotherapy despite the high oncotype score.
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Jenna, mucinous carcinoma thread:
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Jenna, it's been my experience that more breast pathologists have a deeper understanding of Mucinous Carcinoma than oncologists. It's not textbook science, and neither is traditional IDC because each case is unique. Medicine is imperfect, but here's the best info to answer your 21-gene assay question.
IS THERE A ROLE FOR 21-GENE RECURRENCE SCORE IN MUCINOUS CARCINOMA OF BREAST?
https://ascopubs.org/doi/10.1200/JCO.2018.36.15_suppl.e12538
"likely that this histologic subtype was under-represented in the validation cohorts given its overall low incidence."
"There was no survival difference across the RS (21 gene recurrence score) groups, suggesting RS may NOT be prognostic in IMC (Invasive Mucinous Carcinoma)."----------------
ONCOTYPE DX 21-GENE TEST HAS A LOW RECURRENCE SCORE IN BOTH PURE AND MIXED MUCINOUS BREAST CARCINOMA
https://pubmed.ncbi.nlm.nih.gov/34589150/
"The Oncotype DX 21-gene test can be used to predict chemotherapy efficacy in patients with estrogen receptor (ER)-positive and HER2-negative breast cancer; however, the data on the 21-gene recurrence score (RS) for mucinous breast carcinoma (MBC) are LIMITED."
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P.S. Don't know why the font size defaulted to large size on snips
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@obsolete thank you so much for this information!! Is this saying that the oncotype dx is unreliable in people with mixed and pure mucinous breast cancer? I have an oncotype score of 37 with mixed mucinous breast cancer, and I don't understand it because it seems like it's saying the recurrence scores are usually low?
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Why are Mucinous Carcinoma patients misled to put so much weight on 21-gene test scores for recurrence scores?? Not only that, Jenna, more importantly
"Invasive mucinous carcinoma is a HETEROGENEOUS breast tumor subtype..."SPECTRUM OF MUCIN-CONTAINING LESIONS OF THE BREAST: MULTIMODALITY IMAGING REVIEW WITH PATHOLOGIC CORRELATION
https://pubs.rsna.org/doi/10.1148/rg.230015Please be aware that Mucinous Carcinoma cells can be highly diverse & dynamic within one given MC tumor. This dauntingly mixed heterogeneity further can mean that only a fraction of the tumor cells are typically captured for a biopsy or for a 21-gene test. And were these particular cells actually representative of the entire tumor???? Your guess is as good as mine!
You can read online about the heterogeneity of tumors & how the many differences between cells molecular variations within a given tumor can result in different diagnoses & different treatments. Everyone's biology & genetics are different. Please look up "inter-tumor heterogeneity".
This could also mean important Mucinous Carcinoma features might be missed, such as specific gene mutations. And nobody really knows which cells will grow onward & multiply in numbers, further seeding unfavorable or favorable growth. It's like a crap shoot.
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HETEROGENEITY IN BREAST CANCER0
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Thank you so much for all this information @obsolete !! I appreciate it so much. I'm very confused. My oncologist is putting all the weight on my high oncotype score as the determining factor in whether or not I needed chemotherapy and whether not i survive. I understand my tubule of 3 and nuclear pleomorphism of 3 is high and my mitotic score is 1. I had a 2.4cm tumor and 0.3 micrometasis in the sentinal lymph node. I called oncotype and they said the test is accurate in mucinous carcinoma. I have no idea what to make of my situation and my oncologist isn't thr greatest at the explaining things other than making me extremely scared
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Good morning Jenna, regarding chemo treatment, there's value in the 21-gene testing. But relative to Mucinous (RS) recurrence score, it's subject to interpretation as per the 2 following published articles. There's no denying it's also controversial, so this is a conversation that would best take place between the patient and oncologist. You might best seek out 2nd opinions from more informed & more open-minded oncologists.
https://ascopubs.org/doi/10.1200/JCO.2018.36.15_suppl.e12538
https://pubmed.ncbi.nlm.nih.gov/34589150/
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Jenna, you can also speak to your pathology lab who pulled your tumor sample to send for Oncotype testing. What sample size was taken from your 2.4cm tumor? Was the submitted sample a fair representation of your entire HETEROGENEOUS MMC tumor's biology? You'll need input from your pathologist.
Then you'll likely need to revisit your ER & PR scores. For example, if the ER scores high, but the PR scores low for Mixed Mucinous, then this could typically contribute to a higher RS in the intermediate to high range. One of those 2 articles made reference to this also.
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@obsolete thank you so much for your explanation and articles . I appreciate it so much. I'm 39 years old with 7/8 for estrogen and 4/8 for progesterone . I have 3 tubule, 3 nuclear pleomorphism, and mitotic rate 1 on pathology report. They are saying it's strange i have a low mitotic rate with aggressive features. I was diagnosed 8 months. I received lumpectomy and radiation. And instead of tamoxifen I am on lupron and anastrazole. I declined chemo even though it was recommended based on oncotype score. I thought I made the right decision at the time.
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You're quite welcome, Jenna. I'm sorry that you were hit with BC at a younger age, but you obviously have the skill set to endure & advocate. There are no right or wrong decisions because every case is different. We follow our instincts.
Have you had any genetic testing done to look for mutations, especially if you possibly have any family history?
Your tiny bit of micro-mets had a favorable mitotic rate. Your radiation would have mopped up any stray cells. Eat clean & get extra rest during flu season while enjoying the holidays. Take care
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@obsolete thank you so much for your support. Yes I had genetic testing, and I didn't have any mutations and I have no family history of breast cancer. I am the first one to get it in my family. I hope you enjoy the holidays too! :)
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