Expert: Claes-Gustaf Nordquist, M.D. - 4/11/2010

Question
Just diagnosed w .9 cm tumor in left breast. Age 65.  Mother had DCIS in 1973, mastectomy w no reoccurrence.  I had a complete hysterectomy at age 35, been taking .625 Premarin ever since. Pathology report reads: SBR Histolic Grade: 1 of 3.  Well-differentiated. Nuclear grade 2 of 3, moderately differentiated. 1 mitosis per 10 power fields. The comment at the bottom reads:  The sections show cores of breast tissues extensively infiltrated by tumor. The tumor has both an in situ and invasive component. The invasive component measures .9cm maximally from slide. The DCIS component consists largely of solid type w intermediate nuclear grade. The tumor shows 10% tubule formation, has an intermediate grade overall.  I have an apptmt. w surgeon next week, so have no info on nodules yet.  From this report alone, what can you tell me?  How can the tumor be both invasive and in situ? Does this mean it hasn't spread yet but has the ability to, or has it already invaded surrounding breast tissue? Even if the nodules are clear, would a mastectomy and chemo be a good plan?

Answer
It is in situ (only in its site of origin or stage 0) in one part of the tumor and invasive - invading its surroundings - in another part. That is not rare. It has the ability to spread but if it has is at present unknown. As far as we know now it may be a stage 1 or 2. A sentinel node biopsy should be done to see if it has spread. If not your tumor is small enough for a lumpectomy (surgical removal of your tumor with safety margin only) followed by radiation therapy to  your breast. And that is what I do recommend. As it is now I see no reason for a mastectomy. Chemotherapy only if it indeed has spread to your sentinel node in which case we would need to rethink your whole treatment. Good luck! Please do keep me posted!




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