Nee Help With Pathology Report

[mel43]

My "Breast Biopsy" was a nightmare and continues on...can someone help put this in english so I understand it.

Biopsy of left breast 5x3.5x1.5cm. The submitted breast biopsy demonstrates mammary ducts & lobules embedded in lighly staining fibrous tissue. A degree of ductular dilatation to cystic proportions is also present. One area centrally has a slightly myxoid appearance and represents a area of fibroadenoma or fibroadenomatous change. A focal area of apocrine metaplasia is also present.

My husband & I was disappointed with the surgeon yesterday, he didn't explain any of my report just said that is wasn't cancer. Also a week after surgery my nipple has become so painful that it even hurts when I take a shower. I couldn't believe the surgeon said put a bandaid over it and if it isn't better in 2 months come back. And that was the end of my doctors visit. Any help would greatly be appreciated, any advice on how to deal with this nipple pain that didn't appear until a week AFTER surgery would be nice.

[CCF-RN,MSN-rf]

Dear mel43:  The report that you submitted basically describes benign breast tissue.  The description of ducts and lobules in fibrous tissue is normal anatomy.  Ductal dilitation describes that the ducts are expanded in places.  A fibroadenoma is a benign growth of tissue.  Apocrine metaplasia is a growth of cells believed to be caused by changes in hormones.  We cannot speculate on why your nipple may be painful.  It could be that there is a bruise from the procedure but without examination, it is not possible to speculate.  You may benefit from another discussion with your surgeon or your doctor who can examine this and better advise you on why it is so painful.

[healthcareguerilla]

I would definitely contact the Pathologist directly for an explanation of all this.  You are entitled to meet with him or her.

Breast pain following biopsies is not uncommon, even appearing some time afterwards.  (That helps, doesn't it..yeah, sure).

For this kind of pain, I would place a warmed cabbage leaf over the area if it has healed -- warmed, not hot -- you don't want to add a burn to all this.  Either drop a leaf in boiling water until it heats through, or iron one.  Come to think of it -- why the heck haven't I done this for myself? I even have cabbage growing in the garden.

Yes. Speak with the Pathologist.  His or her name should be on the pathology report.  Also, demand -- or ask nicely, but don't take no for an answer - to have your surgeon examine you, just to make sure all is well at the biopsy site.

Take along a tape recorder in both instances.  This is as much for their benefit as yours.  Then everyone can be certain of what is said.

Also - on what basis did you have the biopsy?  Did you feel something, or was something found on mammogram and/or ultrasound?

I am sorry you not only hurt but have been given 'bandaid' attention.  But you'll change all that today.

[mel43]

Thanks for your advice...my biopsy was for a Microcalcification which also concerns me that it wasn't mentioned on my pathology report. It was a nightmare experience that I don't intend on going through again. The wire they inserted fell out right before surgery but the surgeon went ahead and did the biopsy with out the guide wire. I sure hope he took out the right thing. He is also the one that told me to put a bandaid over my nipple!!! I can understand the soreness around the incision area but I don't understand the pain in my nipple that didn't start until a week after surgery. This is called "Rural America" which has it's benefits with some things but not when it comes to medical issues.
I do have an appointment with a breast specialist at the end of September in St. Louis. I hope this pain in my nipple is gone by then or it's going to be a long from now till then.

[healthcareguerilla]

Glad to hear you have an appointment with a specialist.  I well understand the 'rural' problem.

My question should 'really' help the way you're feeling...I did not think that wire localization would be the choice for a microcalcification.  Was there also a mass?

If you don't want to see that surgeon who you probably 'rightly' would just as soon have pummeled with oranges, maybe at least get the surgeon to order an ultrasound to make certain the wire did not break off in your breast.  Although you may already have a sense of that.  Or you may already know.

Here are some notes on wire localization that I found with a standard search http://www.emedicine.com/radio/topic911.htm  They're not the 'be all and end all' but there's some more information for you.

Ahem.  You did not say you called the Pathologist.  If not, why not?  Don't rest on your laurels.  Let me know if the cabbage leaf works for you.  It is not silly.  You will find great comfort from it.  And call St. Louis and tell them about your pain.  They should be able to move up the appointment.  But you HAVE to speak up.  You have to do what you need to do. Wait -- you do have your original films -- or are they digitized -- you'll need those.  Also the operative report.  I'd sure have that...any other pertinent reports.  All yours.

[mel43]

Thanks for your response...I really appreciate it :-)

I did talk to the Pathologist he basically said the same thing as the health official said here. The surgeon said he had to do this biopsy with the wire because it couldn't be felt, so he needed the wire to find it. There was no mass or lump, just he cluster. I'm worried because the wire fell out before surgery and there is no mention of the cluster, so I wonder if they got that out or not???
I still have the pain in the nipple which is confusing for me. I can understand the pain around the incision but not the nipple. I could get in earlier in St. Louis but it's a 5-6 hour drive one-way, so I scheduled this appointment with my daughters appointment. I take her to St. Louis to the Childrens Hospital and I don't have the days to take off from work twice. I did try the cabbage leaf (we grow a big garden) it felt good but didn't take the pain away. I wonder if the ducts in my breast being dialated may cause this pain?? I guess eventually I will find out I hope it's sooner than later.

[jadesothermimi]

Hi Mel..I just happened to find this website while waiting to do a mammogram on a patient here at work. When I read your post I became particularly interested when you said that the needle fell out before the procedure was done and you were wondering if the surgeon even got the correct area.  Here (and I assume at most other hospitals) after a patient undergoes a needle localization biosy and then goes to the OR to have the area of concern removed from the breast, that breast speciman is sent back over to the mammography department. We then take an x-ray of the speciman with the wire still in it. The radiologist then checks the x-ray to see if the calcifications or mass is in that speciman. He then calls the OR and tells teh surgeaon if they indeed did get the area of  concern.. I hope this helps and I pray that you are doing well. (I also believe that in the path report calcifications are mentioned if that is what is being biopsied)

[mel43]

Thanks for your input. I know I have read on websites that they x-ray the biopsy before it is sent off. But, this is a very rural area and I'm not so sure things are done here like they are at other hospitals. I'm just worried because the microcalcification was not mentioned on the pathology report. I'm not sure when I get my next mammogram done, but I'm going to be very upset if they didn't get that out of there.
Do you all give any numbing meds or pain meds when you do the wire localization???? because these people didn't give me anything and it was very painfull.

[Montana girl 06]

I was numbed up for my wire localization. But one of the wires (I had 2) had to go really deep and I felt a burning sensation. When I complained to the radiologist he just said it was very deep and there was nothing he could do about it. Since then I've been told I shouldn't have felt a thing.

[mel43]

Nice to hear from you Montana Girl...I had read up on this procedure before I had it done & I really thought that they would of numb me. But I was told AFTER they had me in the Mammogram machine that they don't numb the breast to insert the wire. It was one of the most painfull things I ever went through and I have no intentions of going through it again. I will not deal with the local hospital no more. The nearest big facility is 3 hours away but I don't mind traveling, I chose St. Louis which is 5-6 hours away. I hope to get some answers when I go down there. I still have a lot of pain in my nipple and I can't figure that one out.

Thanks Montana for your input...I knew they could have numbed me for that...

[ziggy123]

I am scheduled for a lumpectomy on Thursday and need to have two wires inserted. My surgeon assured me that he will be there when that is done and that I will be numb. I am counting on that because I do not want to feel a thing! Just like you Montana girl, one wire needs to be inserted deep as the second area is behind another.

[Montana girl 06]

After my wires were inserted I went to the surgeon for the biopsy and told him I felt the deep wire as it was inserted. I asked if I would feel anything during the biopsy since it would be as deep as the wire and he said no. If I felt anything he would numb it more. He kept his word and I felt nothing. That's great that your surgeon will be there for the wire insertion. I think they realize the need for numbing more than radiologists do.

[Montana girl 06]

I just reread your post and see you are having 2 areas removed. I thought you just had one area of calcifications. Is there more?

[jadesothermimi]

Hi Mel43..I've done mammograms for 15 yrs now and have done needle localizations with as many radiologists over the years and they all do them differently. Some prefer giving a local anesthetic and some don't. The ones that don't like to use it feel that they don't want the anesthetic to obscure the breast tissue  making it it harder for them to see the area of concern. And some don't want to use it because they don't want to give two needle sticks. They feel that if they are going to put a needle in your breast, why not just put the needle in that's going to do the job. I can see it from both sides. And I am not sure if I wouldn't want to be numb! I hope this info helps. (And I wish I could have been there holding your hand during the procedure)

[ziggy123]

I had two areas of calcifications. I had some funny calcifications in one of the two areas. The second deeper spot was not biopsied with the first. My surgeon wants to go after it and make sure that everything is fine. I would rather he get it now than worry that it might turn into something later. My surgeon is a family friend and I trust that he is not taking any chances with me or my nerves. I would constantly be worrying about what this second spot might/might not turn into later on down the road.
The otc stomach medicine has been doing its job. I will mention what has been going on, but hope that once all of the bc stuff is done, my nerves will return to normal and so will my stomach.

[boninclyde]

Wow I can't believe they did not give you anything for pain. Even a muscle relaxer might would have helped some. Also when I had my biopsy (the 2nd) the breast hurt, stung and burned. Nipple was very sensitive. Dr. said they may have gotten part of a nerve in my sample and that was reason for the pain. Anyways had masectomy Friday the 5th August so now its a slightly different kind of pain. I would find a really good doctor. I know you need to look after your little girl but you need to look after you also, so you can take care of her. Can't husband help somehow? They're has to be someone. Check into local service.

[Montana girl 06]

I can totally understand why you're having both areas taken out. That will be such a relief!

[Montana girl 06]

To you your daughter is top priority, but I certainly hope someone is putting you as their top priority (maybe husband?) because you need attention, too. I'm glad you're taking the time off work to see a specialist who can ease your mind and answer some questions.

[mel43]

So good to hear from you boninclyde, how are you doing since your surgery? I hope you are doing okay. Take care of yourself and let me know how you are doing.

I'm really hoping this doctor I'm going to see in St. Louis is good. My daughters doctor is the one that got me in with this doctor at the Breast Institute. My daughter is top priority. My husband does what he can to help, but we farm and that takes a lot of his time. It's hard for him to deal with our daughter's health problems. He has been very good with me through all of this and that has been a blessing. Like you I thought they could of given me something, but now it's over, I'm still healing and I hope they took out what they were suppose to, I guess I'll find out in time.

[boninclyde]

I did not mean to offend. Just know that you need to stay healthy in order to take care of your daughter. Will the farming season end soon or do you farm yearly? I would still check into local agencies to see if any help could be provided there. Will talk more later. Today is a better day but I'm still extremely tired.

[mel43]

My husband has been very good through all of this,which surprises me.  he has been very worried about me. Having said that, he isn't one that deals well with sickness, he doesn't go with me when I take our daughter to St. Louis. But we are also farmers and unless we have someone to take care of things it's hard for both of us to be gone at the same time. But he perfers to stay home. My sister and I are very close, but she lives 3 hours from me. But she calls often to keep track of me and how I'm doing. I am anxious to see the Specialist in September, just to have everything explained to me and maybe find out why my nipple is to sore & sensitive.

[Montana girl 06]

When in September is your appointment?

[mel43]

My appointment is September 29. So I have a month to wonder about everything. However I have took it upon my self to make an appointment with a family doctor for this coming Tuesday, I'm just a little tired of dealing with the other doctors/nurse practioneners and have decided to change everything to this new doctor if I like her. I'm hoping that this new doctor will listen to what I have to say, that is something that I haven't had in years, so I just don't go to the doctors. But after this ordeal I figured I can't just quit going to the doctors I just have to find one that cares.

[Montana girl 06]

Good for you. Hope you like your new doctor.