Expert: Claes-Gustaf Nordquist, M.D. - 5/8/2005

Question
 
Hi I enclosed a portion of my pathology report:

on my path report , it states
Pre ope diagnosis - Bilalteral breast cancer
Post op: same

My docter states thats not the case. COMMENT on report states: atypical apocrine epithelium - moderate, specimen received in multiple sections, no clear margins it cannot be clearly ascertained whether this focus of atypical apocrine is completely excised. 2 samples stained by immunoperoxidase in order to attempt to identify residual malignancy.

supp disci - 1 - immunoperoxidase stains are evaluated in parralell with satisfactort positive/negative controls
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slide A4 (LB) NEGATIVE FOR IMMUNOREACTIVITY IN AREA UNDER STUDY, THERFPRE NEGATIVE FOR RESIDUAL INVASIVE OR INTRADUCTAL CARCINOMA.
Slide B5 (RB) POSITIVE IMMUNOREACTIVITY FOR BRST-2 INDICATING RESIDUAL BREAST EPITHELIUM WITH APOCRINE ATYPIA.

POSITIVE IMMUNOREATIVITY FOR p63 INDICATING ABSENCE OF RESIDUAL INFILTRATING DUCT CARNINOMA

Does this indicate, there is NO cancer of any kind including DCIS?

It also states atypia apocrine ductal hyperplasia of both breasts. moderate category

If no cancer why is he looking for residual malignancy? Is he saying there was before removal of 2 lumps?

Do I need to be concerned that there is residual epithelium with apocrine atypia in ducts? Should I consider having addl surgery to have this removed? I have 2 blood family members who have breast cancer now.
I have 2nd opinion on 5/17...  If you have any email addres, I can email you the complete report if it will allow you to better answer.

Pls left me know thank you
hokuw@cox.net  

Answer
It would have helped if I had had the FULL report, BUT from what you have sent to me the following can be concluded (please do correct me if I make any obvious mistakes):
These are reports from a follow up surgery. The first surgery you had to undergo in this case was the removal of "lumps" from both breasts. According to the report you have sent me these lumps were deemed as being cancerous so that you had cancer in both breasts. From the material of your folloow up surgery it is obvious that no certain remaining cancer could be found in either breast. BUT there are signs of atypical epithelium in all the material and that can be regarded as a precursor to cancer. Since you have breast cancer in your family that is an important finding especially as you already have been found with cancer in BOTH breasts!
What course then to follow? You have not stated your age which is of some importance. But you can have both your breasts surgically removed in order to minimize the risk of new breast cancers - or if that method is too abnoxious to you at least have extensive radiation therapy to both breasts and if past menopaus anti-estrogen therapy. If you are premenopausal you have to have your ovaries removed or otherwise neutralized first. Chemo therapy may also be considered.
If necessary please send me the full report! Please do keep me posted!