Expert: Claes-Gustaf Nordquist, M.D. - 6/26/2008

Question
QUESTION: hi, i was diagnosed for invasive Ductal carcinoma grade 1 a month back.My biopsy report before surgery said::::

FNA right breast-

Microscopy:  Moderate cellularity consisting of malignant ductal cells, lying singly and in groups.
         The cells nuclei are enlarged, hyperchromatic with prominent nucleoli. Pleomorphism is seen.
         Adipose tissue and stromal element are also seen.

Diagnosis:    Features are consistent with those of ductal carcinoma – right breast

My mastectomy specimen report said: (pathology)

Gross:  cut section shows a white tumour 3cm maximum diameter and 0.7 cm from deep resection margin. No lymph nodes are felt.
         
Microscopy:  sections show breast tissue  involved by an invasive tumour composed of ductal cells that are moderately pleomorphic,
         Show few mitoses and moderate tubule formation. The tumour has provoked an intense desmoplastic reaction.
         The tumour shows intraductal tumour of both comedo and solid styles and shows lymphatic permeation.
         Tumour extends close to the deep resection margin.
         No background breast disease is seen

Diagnosis:       Invasive Ductal carcinoma(NOS) grade I,


The hormone receptor report

Addendum:  Immunoperoxidase staining was performed with adequate controls and the following staining reactions obtained:

         Oestrogen receptor staining  _          Intensity (0)
         Distribution (0)
         Score (0) negative

         Progesterone receptor staining  - negative

         HER2Score -(+3) positive          


SUMMARY :  Immunihistochemistry shows this tumour to be ER (-ve), PR(-ve), her2 (+ve)


these were my reports. olease tell what sort of chemotheraphy i need . will i need herceptin?
thanks
christabel


ANSWER: Since you have this disposition I think Herceptin is indicated as is any complementary chemo therapy. I'm reluctant to give detailed advice on that since I do not have a complete picture of your situation. Only the drs. in charge of your treatment have that. I also think radiation therapy could be of value since your tumor was close to the resection margin. Mormonal therapy is not of much value in your case. Good luck


---------- FOLLOW-UP ----------

QUESTION: hi

these are all the reports i have, there are lung x ray and scan of my liver, abdomen, and other parts, they are fine and there is no metastasis. the surgeon did not remove any lymph nodes, he felt it was not affected. Now do you think i need chemo theraphy? and is herceptin necessary? what are my chances of recovery? please guide me, what all medicines will i need in chemo? i am 38 years old

Answer
Thanks! I meant hormonal therapy at the end. It's a pity your surgeon did not make a sentinel lymph node biopsy. To be on the safe side I think you should (and probably radiation therapy too). Yes Herceptin is probably necessary but apart from that comment I think I should leave the chemo therapy to the dr. in charge of your treatment. Good luck!