Expert: Claes-Gustaf Nordquist, M.D. - 7/11/2010

Question
Will very much appreciate your help with my pathology report.  Based on the information I found, I think this can be a borderline case between papilloma with ADH and papilloma with DCIS.  I understand that in either case, surgical excision is the way to go, but it would give me a little more peace of mind as I'm waiting for my surgery to know that based on this description, there's a chance that it was ADH "upgraded" to DCIS due to inherent challenges in diagnosing this type of cases.  I'm 41, no family history, finished breastfeeding a few months ago, no symptoms, was diagnosed as a result of a routine mammogram which found calcification clusters in one breast, categorized as BIRADS 4A. Thank you very much.
Diagnoses:

DCIS, intermediate to high grade, solid type, largest focus measuring 0.2 cm in greatest diameter, focally involving an intraductal papilloma, with associated microcalcifications.  Focal columnar cell hyperplasia with atypia; papillary apocrine change; pseudolactational change.  See Comment.

Comments:

Immunohistochemical studies are performed. P63, SMA and calponin stains show presence of myoepithelial cells around ducts containing DCIS as well as around the focal fibrovascular cores of the intraductal papillary lesion involved by DCIS.  These findings support the above diagnoses.  

(hormonal receptor status etc. - not available yet)

Answer
Based on your pathology report I do not dare to make that conclusion. Your report clearly states a carcinoma in situ (cancer stage 0) (= DCIS), even a high grade one. So I have no foundation for any belief that this lesion just has been "upgraded" to a carcinoma in situ. So it is BEST to regard it as such too. That means that the treatment should be local excision ("lumpectomy") followed by radiation therapy to that whole breast (to a dose of around 4500-5000 cGy/rad). I regard that radiation therapy as a necessity! Good luck! If the lesion also has hormonal receptors also hormonal therapy should at least be considered (I do not regard such therapy as a substitute for radiation therapy more like a complement).




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