Can anyone help me with this pathology report?

Well, I'm certainly no tech wizard and the report did not load. Here are what I believe is of importance after a needle biopsy:

1. Multiple foci of ductal carcinoma in-situ with high nuclear grade, solid pattern, with comedonecrosis and associated microcalcifications. There is cancerization of the lobules with associated prominent inflammation and stromal reaction. Ki67 shows 40-50% proliferation index in areas of DCIS.

2. Biomarkers. Estrogen receptor: Low positive, 10% with dim nuclear expression
Progesterone receptor: Negative, 0% with strong nuclear expression

3. Immunochistochemical studies for p63 and calponin demonstrate retained mycepithelial/basal cells around DCIS,

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I googled comedonecrosis (below):

"Comedo-type DCIS completely fills and dilates the ducts and lobules of the terminal duct lobular units (TDLU) with plugs of high grade tumor cells with pleomorphic nuclei and central necrosis ("comedonecrosis").

Infiltrating ductal carcinoma (infiltrative ductal carcinoma with central necrosis) may so closely mimic the pattern of DCIS with central comedonecrosis that on initial morphological analysis these foci of tumors are often labeled as DCIS (high grade, comedo-type). There is a risk of occult infiltration. A comedo that extends for >2.5 cm has an invasive component in 45% of cases."

This goes with the high grade and high Ki67% (proliferation rate) on your report. A risk of hard to detect spread so docs will make sure it is taken care of in surgery.

And this: not invasive unless it breaks out of lobules or ducts so "cancerization" is a misleading term:
"Lobular Cancerization (or cancerization of lobules, COL) is the presence in a lobule of ductal carcinoma in situ (DCIS) tumor cells with preservation of the normal lobular pattern. It appears to represents a variation in the growth pattern of DCIS, not secondary extension of DCIS into a lobule. [from NCI]"

With a low estrogen score (10%) they may still do an Oncotype DCIS test which would determine whether chemo is needed or not, or radiation, or just surgery, and whether anti-estrogen meds would help. You can ask and request this too.

More:
"The high prevalence of p63 expression in specific tumor types makes p63 immunohistochemistry a suitable diagnostic tool. Loss of p63 expression might constitute a feature of aggressive cancers."

Report does not say P63 is lost.

And finally on the "retained mycepithelial/basal cells around DCIS. I am not a doctor or educated on reading this type of report. My uniformed, lay person reading of it is that this last one is a positive. These cells are apparently (I interpreted the info below as....) protective against spread.

Your doctor can explain this to you but to a lay person it looks like your DCIS is fast-growing but still contained and it is great that you got it early!!

"As already mentioned, myoepithelial cells act as natural tumor suppressors by secreting the various molecules that have inhibitory effects on tumor cell growth, invasion and angiogenesis. They also act as a physical barrier to prevent the invasion of tumor cells from the duct to the stroma. It is generally accepted that primary breast carcinomas show a dramatic increase in the ratio of luminal epithelial cells to myoepithelial cells. In the later stages of breast cancer, the ducts completely lack myoepithelial cells (45). Thus, it is mandatory for this layer to be disrupted in order for the tumor to spread and metastasize"

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I googled comedonecrosis (below):

"Comedo-type DCIS completely fills and dilates the ducts and lobules of the terminal duct lobular units (TDLU) with plugs of high grade tumor cells with pleomorphic nuclei and central necrosis ("comedonecrosis").

Infiltrating ductal carcinoma (infiltrative ductal carcinoma with central necrosis) may so closely mimic the pattern of DCIS with central comedonecrosis that on initial morphological analysis these foci of tumors are often labeled as DCIS (high grade, comedo-type). There is a risk of occult infiltration. A comedo that extends for >2.5 cm has an invasive component in 45% of cases."

This goes with the high grade and high Ki67% (proliferation rate) on your report. A risk of hard to detect spread so docs will make sure it is taken care of in surgery.

And this: not invasive unless it breaks out of lobules or ducts so "cancerization" is a misleading term:
"Lobular Cancerization (or cancerization of lobules, COL) is the presence in a lobule of ductal carcinoma in situ (DCIS) tumor cells with preservation of the normal lobular pattern. It appears to represents a variation in the growth pattern of DCIS, not secondary extension of DCIS into a lobule. [from NCI]"

With a low estrogen score (10%) they may still do an Oncotype DCIS test which would determine whether chemo is needed or not, or radiation, or just surgery, and whether anti-estrogen meds would help. You can ask and request this too.

More:
"The high prevalence of p63 expression in specific tumor types makes p63 immunohistochemistry a suitable diagnostic tool. Loss of p63 expression might constitute a feature of aggressive cancers."

Report does not say P63 is lost.

And finally on the "retained mycepithelial/basal cells around DCIS. I am not a doctor or educated on reading this type of report. My uniformed, lay person reading of it is that this last one is a positive. These cells are apparently (I interpreted the info below as....) protective against spread.

Your doctor can explain this to you but to a lay person it looks like your DCIS is fast-growing but still contained and it is great that you got it early!!

"As already mentioned, myoepithelial cells act as natural tumor suppressors by secreting the various molecules that have inhibitory effects on tumor cell growth, invasion and angiogenesis. They also act as a physical barrier to prevent the invasion of tumor cells from the duct to the stroma. It is generally accepted that primary breast carcinomas show a dramatic increase in the ratio of luminal epithelial cells to myoepithelial cells. In the later stages of breast cancer, the ducts completely lack myoepithelial cells (45). Thus, it is mandatory for this layer to be disrupted in order for the tumor to spread and metastasize"

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Windyshores,

You are amazing! This is new territory and we're trying to learn as fast as possible. You've certainly shared some good information. I can't thank you enough for your time and effort!!!

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