pathology report

[emmasaba]

i had a surgical biopsy and the results were benign, but i am trying to figure out what they saw.  the nurse who "explained" it said everything is fine, was abrupt and then rushed me off the phone.  I want to know WHAT was showing up on 5 sonos as a "lesion". I got the report - can you explain what this means: "Fibrocystic changes including inerstitial fibrosis, cyst formation, adenosis and sclerosing adenosis. focal organizing hemorrage and cholestoral granuloma. Focal hyperplasia without atypia."  the only part i understand is the "hemorrage"  which i think was a blood clot from the first radiologist who stuck a needle in my breast to try to asperate what he thought was a cycst and ended up causing me lots of pain then and for months after (though he claimed he had no idea why i felt pain.)  but can someone explain the rest of the report?

thanks

[river view]

I too noticed soreness on my chest under my breast a couple weeks after my excisional biopsy.  I thought perhaps it was from leaning on the machine where they had my breast compressed when they put the wire in as I had to sit that way for quite some time and it was uncomfortible.  It went away after a week or so.  My biopsy was 6/20 and I still have a hard sore spot near my incision.  It is gradually getting smaller.  I believe it is scar tissue and hope it goes away soon as I need to have a mammo soon as they don't think they biopsied the right site.

[emmasaba]

thanks for your comments Janet.

[SnowWoman]

Glad to hear that the findings from your biopsy were good.

They also removed what seemed to be a fairly large portion of tissue from my breast when doing the biopsy.  My understanding is that often the "problem" area is not readily visible when they do the biopsy (that's why they often depend upon a wire placement to know what to remove based on what they can see on the mammo or ultrasound) so they remove what seems to be a large section to be assured they've got the appropriate tissue and have clear margins if it's something serious. It's not until the tissue is examined under a microscope that they really know what they got.  As several here can tell you, the worst case is that they miss the target and have to go back for another try.

At 4 mos. post op, I still have some pain and lumpiness. Initially it was in different areas of my breast but has now pretty well concentrated around the scar and biopsy area and has diminished a bit and become more noticable cyclically.  My GP said this could last for 6 mos.

I also had a lot of trouble with pain at my breastbone.  This seemed to be caused by wearing a bra (I've gone braless for about 12 years).  It was so bad that I quit wearing a bra probably sooner than I should have after surgery -- the pain from the pressure of the bra on my breastbone was worse than the pain from the surgery.  The only explanation I've seen of this is that it is possibly due to some arthritis at the joint where the ribs meet the breastbone.

Don't be afraid to ask your doctor questions until you feel comfortable with what's happening.  All the best on your continued recovery -- Janet

[emmasaba]

thanks for your reply CCN.  can you tell me why a surgeon would take out 3.5 cm of tissue if he saw there was no lesion?  on the pathology report listed 1- specimen received...labeled "1 breast cyst" and consist of 40 ml clear pale tan fluid...  2- left br wide resection locationzation site consist of one piece of fibrofatty breast tissue measuring 3.5 cm ,,, the specimen is inked and sectioned and is noted consists of appr 60 percent yellow adipose tissue and 40 percent white breast tissue.

also: is it normal in healing after more than 2 weeks to develop lumpy tissue areas at site of incision and former "lump" and tenderness at the incision site (nipple) and occasional mild shooting pain as well as soreness on my breast bone below the br.  This is a recent development.

[CCF-RN,MSN-rf]

Dear emmasaba: Hope this will help you. Sclerosing adenosis is seen in association with fibrocystic change. It is a descriptive diagnosis. Sclerosing means too much stroma. Adenosis means too much glandular tissue.  Cholesterol granuloma is a very infrequent entity in the breast and because of its appearance, on mammogram and ultrasound, can be mistaken for cancer.  Under microscope, this problem is easily resolved (it is a benign entity).  Focal hyperplasia means cellular proliferation (or overgrowth).  This too is benign.  In other words, your biopsy is completely benign.

[emmasaba]

thanks for your reply.  but then what was the "lesion" that was seen in 5 sonos and led me to go through a surgical biopsy?  I was hearing "possible fibroadenoma, papilloma, etc., if not c".  I went through all this just for cysts in my breasts?  there was no "lump", "lesion"?  also why did he take out 3.5cm of tissue with nothing there?

[surgeon]

The second part, the intraoperative diagnosis, means they looked at it during surgery and didn't see any obvious mass or abnormality. Gross means looking with the eyeball rather than the microscope. "Fibrocystic changes including inerstitial fibrosis, cyst formation, adenosis and sclerosing adenosis. focal organizing hemorrage and cholestoral granuloma. Focal hyperplasia without atypia."  Fibrocystic changes are a very common reason for lumps; they are present to some degree in most women. It means scar tissue and cysts -- cysts are fluid collections, ducts that are filled with fluid. Fibrosis means scar tissue; interstitial means between the glandular areas. Adenosis is extra glandularity; sclerosing means the extra glands also have scar tissue around them. It all is part and parcel of what's seen in fibrocystic changes. Sounds like a mouthful, but it really adds nothing to the basic diagnosis: fibrocystic changes -- part of the aging of breast tissue. Granuloma is a form of inflammatory reaction. Not a significant finding in and of itself.

[emmasaba]

also:  one radiologist said (before biopsy) they needed to know more because the original pathology report after an attempted fine needle aspiration (that did not asperate becasue it was not a cyst) said "proliferative changes (more than is usually seen in age group)"  and "cellular crowding" and "papillary tissue".  also I looked at the screen for each sono and saw the "lesion" myself, so i know something was there.

[emmasaba]

one other question - it says in the "Intraoperative Diagnosis" section "Gross: : No Discrete Mass Identified."  what does that mean?