Results

[Ronnie313]

Hi
I recently had a breast biopsy and don't understand the results. The comment and diagnosis are as follows:
Comment:
The histological features noted are consistent with a complex sclerosing ductal lesion and are highly suggestive of a sclerotic intraduct papilloma with surrounding fibroadenosis.  The degree of epithelial hyperplasia is florid but there sis not evidence of true DCIS or malignancy.

Diagnosis:
Left Breast Features a complex sclerosing ductal lesion consistent with a sclerotic papilloma, with florid epithelial hyperplasia and background fibroadenosis.

I am having the lump removed on Thursday but would like to know what the results are in layman's terms.

Many thanks
Ronnie

[ncmichigan]

Hi, Ronnie,
I'm sorry your biopsy experience was more difficult than anticipated. I agree with zouzi that a second opinion and maybe a third would be helpful. I'm not sure why your surgeon is recommending BPM based on ADH being the worst that was found. I am a retired nurse and from what I'm seeing in your diagnosis you have benign proliferative changes with some small areas of ADH. It is not clear if the margins are clear and that might be something that needs to be asked. Maybe BPM is recommended  because of your young age, but someone should be able to explain it to you and you just need to ask "why" ? I'm not a pathologist, so I'm sure I'm not getting everything from your report but I don't see anything malignant. I also have benign proliferative changes and LCIS with a 30-35% risk of developing invasive breast cancer, but I'm 63. My oncologist said I was a candidate for BPM, but I'm not ready to take that drastic a step, at least not now.
I do hope you'll get another opinion and clear explanation of what's being recommended because BPM is major surgery, especially with reconstruction.
Take care and all the best,
nc

[zouzi]

Hi again Ronnie,
I am glad to know that you are feeling better.
I am not sure also abou"why",but your Surgeon must have a good reason to recommend  a bilateral subcutaneous prophylactic mastectomy.
It's difficult for me to understand the details of your pathology results, as I am not a Medical professional,but the best advice I could give you, is to have your report explained in details by your Doctor,and also seek the opinion of another Surgeon to see if what was recommended by your first Surgeon is in fact what should be done.When uncertain about what to do or why,many women seek second and even third opinions from Breasts specialist to make sure that whatever decision is taken, is for sure the right one.
Sorry Ronnie for not being of much help,but I am sure that everything will be clearer to you when you'll have your report explained by the professionals I mentioned above.
Always wishing you the best and good LUCK!!

[Ronnie313]

Hi Zouzi

3 weeks post surgery and I am eventually feeling better.
My surgeon discussed genetic testing but feels that either way I should consider a bilateral subcutaneous prophylactic mastectomy.  I'm not really sure why though.

The diagnosis was:
Area of extensive fibroadenosis and benign proliferative breast changes with a range of changes including:
1. Sclerosing intraduct papilloma with florid epithelial hyperplasia and occasional foci of atypical herplasia
2. extensive fibroadenosis with sclerosing adenosis present,

There was a supplementary report that says:
In the presence of adequate and positive controls, the following results have been optained:
p63 - positive rim of myoepithelial cells around areas of sclerotic papilloma as well as proliferative areas.  No evidence of DCIS is noted on the sections examined.
S100 protein:  this mimics the p63 and some of these shows a strong population of myoepithelial cells.

Appropriate immunohistochemical stans have been performed on the tissue submitted and in the presence of adequate controls, these stains have proved as follows:-
Marker:  oestrogen receptorsm
Assessment:  proportion of positive cells 10 - 33%, instensitve of staining 2+, allred score 5/8,
Result:  Positive

Marker:  progesterone receptors
Assessment:  proportion of positive cells 10 - 33%, intensity of staining 1-2+, allred score 4/8
Result: moderately positive

Final comment:
the features are those of sclerosing papilloma with focal atypical ductal hyperplasia.

Other than recurrence and a BC risk of 25% why would they recommend mastectomy.

Thanks very much for all your advice and help.

Ronnie

[zouzi]

Hi again Ronnie,
Thanks for the update and I am so sorry to hear that you experienced so much pain after the surgery. :(
The pain could be originating from severed nerves during the surgery, which sometimes,unfortunately, cannot be avoided and is the usual risks for this procedure.However,the pain can be relieved by medications during the acute attacks.Not putting too much stress on that arm may also prevent pain.Another is through gentle exercises(It is very important though, to talk with your doctor before starting any exercises so that you can both decide on a program that is right for you.) that can loosen up the fibrous tissues in your breast that may avert future pain. Also warm compresses,massaging the breast gently with vitamin E lotion and wearing a good supportive bra can help a lot.
I wouldn't think about a mastectomy if I were you...this procedure is too drastic to even consider for a Papilloma that could very well be benign in nature
Waiting with you for the results and hoping that all will be just fine.
Best wishes....  

[Ronnie313]

Hi There
Thanks very much for all your advice.
The op was on Thursday and to be honest I was not expecting as much pain as I have had.  I don't know if it makes a difference how big the incision is but  I can't seem to control the pain.
I am back at work today but I probably shouldn't be.
Obviously very concerned about the results and wondering wether a profilactic mastectomy isn't the way to go.
Anyway, thank you for your encouragement will keep you updated!
R

[ncmichigan]

Hi, Ronnie,
Just thought I'd add my personal experience to zouzi's advice for you.I've had three excisional biopsies ( one that involved two incisions for two lesions in different areas) and I have to say the recovery was really much easier than I had anticipated. After the first one ( the one with two
areas biopsied) I went to a dance class the next evening! I hasn't hospitalized for any of them-all were out-patient procedures. I was retired but I think if I had been working at a desk job, I could have returned after one day off. I needed very little pain medication, but did use ice as directed. The bruising and soreness took about a week to resolve but there really was very little pain. Of course, everyone is different in how they recover and their perception of pain, but compared to other surgeries I've had, these were a piece of cake! Really the hardest part of each of them was the wait for the results and most women end up feeling that way. My scar from the first in '04 is barely visable and the last one from '09 is also very, very faint. I did use an
over-the-counter product called Scarzone that I think really helped.
Most importantly, please try to remain positive that the results will be benign. That's exactly what I'm wishing for you along with an easy biopsy experience. We hope you'll let us know how you're doing if you wish and ask any additional questions you may have.
Sending you a big hug (       ),
nc

[zouzi]

Hi again and you welcome.
Usually the recovery time is not very long..Some women feel better in about 3 days or so and they are able to go to work.When you are home from the hospital,take it easy for a few days to speed up the healing.
Make sure to take your pain medication, (if needed) also apply ice on the breast every so often for about 5 to 10 minutes to minimize bruising and pain.Wearing a good supportive bra can also help.The incision is small that leaves a little scar,but it will eventually fade away and be hardly visible.
Sending you my best wishes! :)

[Ronnie313]

Hi Zouzi

Thanks very much!
The surgery is on Thursday and the results will take a week.
Do you how long the recover is on an excisional biopsy?

Thanks
R

[zouzi]

Hi,
Your biopsy report states that you have an intraductal Papilloma which is usually a benign breast condition particularly if you have only one lump.The results also states that there is no true evidence of malignancy( cancer) especially that also "Atypical"( which means abnormal cells) is not mentioned in the report.
The Ductal Papilloma is often removed so the entire tissue can be studied under the microscope to make absolutely sure that no pre cancerous cells are present.The procedure would be similar to an excisional biopsy or lumpectomy and would be done as an outpatient.This is a relatively minor surgical procedure and the recovery time is fairly short and you'll be able to go home on the same or next day.
I am pretty sure that you'll be just fine.
Please let us know how things are proceeding and in the meantime I wish you all the best and quick recovery.