Expert: Claes-Gustaf Nordquist, M.D. - 7/23/2008

Question
My mother aged 67 years is having bloody nipple discharge from right breast( that too on squeezing) from two years. Two years ago, I showed her to doctor and he gave some medicine. Discharge was stopped for six month. it is now again  a blood stained discharge. doctor suggests mammography, sonography  and cytology of nipple discharge.
Mammography report says, mammography appearances are suggestive of a large, irregular increased density lesion with microcalcification. The appearance favor a malignant pathology with differential diagnosis of fat necrosis.
Sonography report says, a well defined oval shaped solid hyoechoic lesion(1.15X0.9cms) seen in the upper inner quadrant of right breast at 2 O clock position. lesion morphology is slight suspicious for malignant lesion with few subcentimeter size lymphnode in the right axilla.
Cytology report says. I have cytology test from three labs simultaneously
1st report says- contents of a breast cyst with papillomatous lesion having having nuclear atypia.
2nd report says-features favour duct ectasia with ? papilloma.
3rd  report saya- features are suggestive of fibro-cystic diseases.
Doctor did the wide excision breast surgery and he told me that he has removed both the lumps and sent it for biopsy.
Biopsy report says, Modified Bloom Richardson score 3+2+2=7
                                  Tumor size: 2X1.2X1cm (AJCC: pT1)
Stroma shows desmoplasia. Multiple areas of ductal carcinoma insitu seen in and out side the tumor showing cribriform pattern,comedo carcinoma and intraductal papillary proliferation. The extent of DCIS is significant(EIC positive). Stroma shows lymphoplasmacytic infilteration. The tumor at places is reaching very close to the surgical margin. Surrounding soft tissue is showing fibrocystic changes.
Infilterating duct carcinoma breast grade II with extensive intraductal component.
Doctor is now pressing for whole breast removal.
Request: please examine these reports . how accurate these reports are? Why cytology and histopathology reports are differing? How much confirm is the biopsy report? Please examine these and suggest a suitable treatment.

I will be obliged for your comments / suggestions.

Thanks a lot in advance.


Answer
These reports are most probably quite accurate. Well since the cytology reports and the histopathology reports are examining different things differences are to be expected. In this situation actions should be guided by the histopathology reports! If you put all the reports together the pathology reports are most probably confirmed! I do agree with her dr. with regards to treatment! Good luck! When we have a full pathology report of her whole breast & of lymph nodes we can discuss if an more treatment is necessary.