pathology - elevated risk?

[s40]

I finally got back my pathology report.  How elevated is my risk?  Do you think Tamoxifen is something I should consider?

Diagnosis:  Extensive Pseudoangiomatous stromal hyperplasia (PASH). Fibroadenoma involved by PASH.
Columman cell change and columnar cell hyperplasia with focal atypia
Single focus of atypical lobular hyperplasia (ALH)
Benigh fibrocystic change includeing extensive fibroadenomatoid change, ductal hyperplasia without atypia, apocrine metaplasia, sclerosing adenosis and stromal fibrosis Duct ectasia

Comment: Sections show benign breast parenchyma with extensive fibroadenomatoid change and pseudoagniomatous stromal hyperplasis.  There is a 2 cm fibroadenoma with stroma that contains PASH. There is no carcinoma or residual phyllodes tumor identified.

Would it be helpful to get a second pathology diagnosis?

[bluebutterfly2222]

I wonder if it might be a hematoma?

I agree with Katarina, that you should check back with your surgeon, since it has apparently only been 3 or 4 wks since your latest surgery.

Best wishes...

[s40]

Its kind of a large area that now feels different, like a big lump.  The area is not generally painful, but near the incision area when pressed it is somewhat painful, which would be expected.  I see oncologist tomorrow and will ask about it.

[katarina777]

It could be scar tissue, s40. You have had a lot of cutting on your breast and maybe this hardness is a result. On the other hand I do not know this for sure. It may be still part of the healing. I would surely ask the surgeon sooner than later. That is frustrating, to say the least. Is the hardness painful?

[s40]

I thought I was healing ok.  When I had this lumpectomy they were able to cut through a previous lumpectomy incision, which is on the outer portion of my left breast.  Two years ago I had another removed but was cut around lower part of nipple, so three lumpectomies so far, and about 5 biopsies all in left breast.  I am still sore, which hasn't happened before...its been over three weeks, and I never have any problems after this at all.  One thing I really notice is that my left breast is firmer now, and not soft like the right one and still somewhat sore. What could cause this?

[s40]

Katrin, thanks.  I appreciate the tip on vitamin D.  I don't really know what tests they will run before meds, but I will definitely ask about that one.  

[katarina777]

Dear s40, I am sorry that I have not written back sooner. That's not like me and it usually works the opposite, as in us putting much care into answering and the the person who asked the question never comes back, or acknowledges what was said.

Again, I am really sorry, and I think part of the reason is that I was hoping sommeone else would respond who knows more about your situation than I do.

I did some research and came across a comment from a foreign doctor who used to answer questions in our forum, and he was great. most experts, like on the 'expert breast forum' are limited in their helpfulness as they feel saying just about anything is too much inless it is not about you.

I also offered  this older comment by Dr. Paul to someone else but she was the type of person who never 'returns phone calls'?

The comment is not specific to you and the person who asked was very ill, I believe, but I think the doctor offers a good overview?

I hope it helps a little and otherwise I just have little to add.

Please let us know if you find out more as I may be able to help more along the way.

Oh, and then one other thing. I took Tamoxifen for a good while and I, as many women who take it, had very uncomfotable side effects; serious hot flashes, many women gain weight, (although I didn't), bone  and joint pain, depression, etc.

The side effects got easier, or better after a while, and tamoxifen for me was not nearly as bad as the Aromatase inhibitors, that are similar but part of a different family of drugs, and only used/prescribed post- menopause.

But then again, not all women have the same problems and/or equally severely. I just do not know what to advise?

You should also have your vit D tested. It's a blood test and unless I am repeating what you already know, please have it tested. I dor severe bone problems while on Tamoxifen and it turned out my Vit D was so low, almost like Ricketts. (the name of vit D deficiency disorder in children)

After being on the supplement for a couple of weeks, my bones started healing and I really believe it was the vitamin D that helped most.

Take care,

KATRIN


by PaulMD, Jul 31, 2008 10:49PM

Hi there.

Tumors grow along a spectrum of development, from benign lesions such as adenomas, or atypical hyperplasias, to frankly malignant ones such as invasive cancers.  Adenomas are a group or lump of cells that escaped the natural control of the body to form the tumor.  Cancers are also lump of cells that are beyond the control of the body, but has a tendency to invade nearby tissues and even spread or metastasize.  Having adenomas may indeed increase your risk of developing invasive cancer especially given your family history.

It is best to discuss with your oncologist about these risk reduction strategies: Hormonal drug treatment, or prophylactic mastectomies, to ultimately lessen or almost eliminate the chance of developing an invasive cancer in the future.

[katarina777]

Dear s40, I am sorry that I have not written back sooner. That's not like me and it usually works the opposite, as in us putting much care into answering and the the person who asked the question never comes back, or acknowledges what was said.

Again, I am really sorry, and I think part of the reason is that I was hoping sommeone else would respond who knows more about your situation than I do.

I did some research and came across a comment from a foreign doctor who used to answer questions in our forum, and he was great. most experts, like on the 'expert breast forum' are limited in their helpfulness as they feel saying just about anything is too much inless it is not about you.

I also offered  this older comment by Dr. Paul to someone else but she was the type of person who never 'returns phone calls'?

The comment is not specific to you and the person who asked was very ill, I believe, but I think the doctor offers a good overview?

I hope it helps a little and otherwise I just have little to add.

Please let us know if you find out more as I may be able to help more along the way.

Oh, and then one other thing. I took Tamoxifen for a good while and I, as many women who take it, had very uncomfotable side effects; serious hot flashes, many women gain weight, (although I didn't), bone  and joint pain, depression, etc.

The side effects got easier, or better after a while, and tamoxifen for me was not nearly as bad as the Aromatase inhibitors, that are similar but part of a different family of drugs, and only used/prescribed post- menopause.

But then again, not all women have the same problems and/or equally severely. I just do not know what to advise?

You should also have your vit D tested. It's a blood test and unless I am repeating what you already know, please have it tested. I dor severe bone problems while on Tamoxifen and it turned out my Vit D was so low, almost like Ricketts. (the name of vit D deficiency disorder in children)

After being on the supplement for a couple of weeks, my bones started healing and I really believe it was the vitamin D that helped most.

Take care,

KATRIN


by PaulMD, Jul 31, 2008 10:49PM

Hi there.

Tumors grow along a spectrum of development, from benign lesions such as adenomas, or atypical hyperplasias, to frankly malignant ones such as invasive cancers.  Adenomas are a group or lump of cells that escaped the natural control of the body to form the tumor.  Cancers are also lump of cells that are beyond the control of the body, but has a tendency to invade nearby tissues and even spread or metastasize.  Having adenomas may indeed increase your risk of developing invasive cancer especially given your family history.

It is best to discuss with your oncologist about these risk reduction strategies: Hormonal drug treatment, or prophylactic mastectomies, to ultimately lessen or almost eliminate the chance of developing an invasive cancer in the future.

[s40]

what do you think about how how risk I am for breast cancer?  Is the risk high enough that I should take the tamoxifen as suggested? I guess I am just trying to figure out if the benefits of tamoxifen outweigh the side affects.  I certainly don't want to take it if my odds are still low of actually getting breast cancer.  Thanks.

[s40]

He said the tamoxifen could help lower my chances of cancer.  I have been reading about the medicine and its side affects and benefits. I would like to make the best decision for my situation.

I have no family history of breast cancer.  I have had previous fibroadenoma and benign phyllodes, and am pre-menoposal.  thanks

[s40]

sorry, yes the breast surgeon has referred me to an oncologist, suggesting I take tamoxifen as preventive.

[katarina777]

Hi,

  Have you discussed this report with your doctor who ordered the tests? Did he/she recommend Tamoxifen?

  You are asking us if you should get a second opinion but without saying anything about a 'first opinion?  It is difficult for us to comment without any background information, and not even knowing what you know and/or where told?

Katrin