Expert: Claes-Gustaf Nordquist, M.D. - 12/7/2011

Question
could you plese explain, What exactly does all this mean?

Three levels are examined and show core biopsy fragments of breast tissue with a complex sclerosing lesion composed of dense fibroelastotics stroma with entrapped and distorted ducts demonstrating moderate to florid usual ductal hyperplasia with focal cribriform growth pattern, luminal secretions and apocrine metaplasia. Focal atypical ductal hyperplasia, cribriform pattern is also seen. More importantly, a few crowded atypical gland and tubules are seen at the periphery of the lesion inflitrating the fat. On immunohistochemical analysis with the smooth muscle myosin heavy chain immunostain and p63, these athypical glands luck an intact myoepithelial layer , finding cosnistent with low grade invasive ductal carcinoma.

COMMENT

As per the imaging reports, this patient presents with a hypoechoic mass with angulated margins, measuring 1.8 x 1.4x1.1 cm, in her left at 3 o'clock position, 1.5 cm from nipple. Core biopsies from this mass confirm the presence of a low grade invasive ductal carcinoma arising in the background of a complex sclerosing lesion.


FINAL DIAGNOSIS

LOW GRADE INVASIVE DUCTAL CARCINOMA ARISING IN THE BACKGROUND OF A COMPLEX SCLEROSING LESION WITH FOCAL ATYPICAL DUCTAL HYPERPLASIA.

Answer
Unfortunately it means that it has been found that you do have a breast cancer - not a very malignant one - but still a cancer and an invasive one in your left breast. The tumor arises within a sclerosing adenosis lesion which itself is not a tumor but within it are several sites developing towards cancer apart from the mentioned invasive cancer. You have to discuss this frankly with your surgeon. The choice is between a lumpectomy with radiation therapy of the whole left breast after surgery and a mastectomy (removal of the breast). The size of your lesion and its condition make a lumpectomy somewhat uncertain. So you should follow the advice of your doctor! I also recommend - in view of how the condition of your lesion is - that your breasts (both) are also checked by MRI breast scans combined with MRI guided needle biopsies of any unclear lesions seen! What is to be done also depends on what is found there.



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