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Topic: Pathology report - help please

Forum: Triple-Negative Breast Cancer —

Share with others who have ER-/PR-/HER2- breast cancer.

Posted on: May 27, 2009 12:41AM

pdaw wrote:

 Dr. says I have IDC, probably stage 2, but can't be sure until surgery and path report from nodes. I'm also triple negative, which apparently carries it's own set of issues.  For example, from what I understand chemo is the only treatment for TN and apparently the likelihood of the C returning is greater for TN.   Lumpectomy Surgery is June 1.  Have already been told that I'll be having chemotherapy followed by radiation.  I was diagnosed with DCIS in 06 - lumpectomy followed by 36 radiation treatments.

 I got my path report today.  I've heard a lot of terms but there are some items that I have not seen listed in any of the forums.  Can anyone help with these?

Nottingham histological score 8

Tubule formation:  3 points

Nuclear pleomorphism: 3 points

Mitotic race:  2 points

total 8 points (poorly differentiated)

No definite angiolymphatic invasion by tumor is identified.  (I'm assuming this means it appears the lymph nodes are not affected; however, dr. has indicated she will be very surprised if not - MRI showed nodes were clear)

 Any assistance is greatly appreciated!!


Dx 5/20/2009, IDC, 2cm, Stage IIA, Grade 3, 0/2 nodes, ER-/PR-, HER2-
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May 27, 2009 01:34AM - edited May 27, 2009 01:39AM by TenderIsOurMight

Hi Pam,

I'm so sorry your going through this twice. Breast cancer doesn't play fair. I'm happy your plan is being worked out with your input.

As to your path report: Nottingham was the pathologist who came up with the scoring index years ago (there was a colleague too I believe who was involved).  It rests on three microscopic findings per field when studying a breast cancer tumor which has been fixed onto a slide. The lower the Nottingham score, the better the finding (prognosis or suggested outcome). This is still done, but increasingly, Oncotype or Mammoprint genetic tumor studies reveal more specific personal tumor information.

Tubule formation: breast cancer cells often form tubules- concentric cells in a ring. A lot of tubules suggests higher cell similarity, organization to the tumor. Some of the cells in the ring have a "snout" like a pig- go figure. Anyway, a low Nottingham score is 1 and suggest much of the cancer has formed tubules. A 2 is medium and three is few.

Nuclear pleomorphism: How many cell nuclei resemble each in an organized manner vs how many are different in their findings from one another. Again, 1 is good and means basically well differentiated nuclei vs 2 which is medium differentiated (I had that) vs 3 which is poorly differentiated- lots of nuclear variation.

Mitotic count: How many cells have been captured in the cell fixing process to reveal gene chromosome bands in mitosis (lining up in replication). This would suggest the number of cells in active division. A count of 1 is low, 2 is medium, and 3 is most in active division.

Angiolymphatic invasion: this is invasion of the cancer by microscopic eye into a blood vessel(s) or lymph channel(s). It does not characterize the lymph node, rather just what is seen in the slice of tumor being viewed. It is felt better not to have this present.

While your Nottingham Index (NI) was on the higher end, newer types of tests done on our breast cancers lend different, perhaps more tumor specific (less subjective) information. Your oncologist will direct their order. Some order ki67 (this is part of OncotypeDX), p53, and cadherin. Increasingly many order the Oncotype Dx or Mammoprint (both genetic analysis). This is all leading to greater specific knowledge, all the way down to one's tumor molecules.  In triple negative there has been recent discussion of improved cisplatin response in tumors which are p63 positive (p63 is a sister gene to p53 ((shares function and homology with p53)), I believe. If confirmed, this offers a "better fit" between one's genetic tumor findings and one's chosen chemotherapy.

I hope this helps and I wish you all the best,


Reference example of where molecular biology in breast cancer is heading potentially:

Pathologic complete remission rate after cisplatin-based primary chemotherapy in breast cancer: correlation with p63 expression


It cannot be emphasized too strongly that treatment of each patient is a highly individualized matter. (FDA-approved labeling for warfarin (Coumadin) NDA 9-218/5-105)

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