In the background of a borderline tumor

Hi Dr. Goodman,

I very recently had the tumors from my debulking tested for hormone receptors.  I wanted to have this information because I have recurrent low-grade serous carcinoma and the possibility of using a hormonal therapy in the future is very attractive.  The report says "This is a low grade serous carcinoma arising in the background of a borderline tumor.  The section submitted for immunohistochemical stains shows borderline tumor which is positive for ER and PR."  I understand the ER and PR part.

What does "in the background of a borderline tumor" mean?  
What does "section submitted...shows borderline tumor" mean?

Thanks,
Ramsay

[Annekathryn Goodman, M.D.]

Hi Ramsay,
thank you for your question
basically the report says that you have two different types of cells in the tissue . One is a malignant neoplasm called borderline tumor and the other is the low grade serous carcinoma. Now they may be related. It could be that your tumor started out as a borderline and then changed into an invasive cancer. That may be fairly common in advanced (that is stage 3 and 4) borderline tumors.

Ultimately What is important is the most aggressive component of the tumor which for you is the low grade serous carcinoma. Treatment decisions are based on that. So one question to ask your doctor is whether the estrogen and progesterone receptors are in the invasive carcinoma or only in the borderline
best wishes

[Ramsay14]

If the ER and PR are only in the borderline tumors what implications does that have as far as hormonal therapy?  

If the ER and PR are only in the low-grade carcinoma what implications does that have as far as hormonal therapy?

What if the ER and PR are in both?

[Ramsay14]

Never mind about my follow up question.  I totally get it now.  If the low-grade serous carcinoma isn't ER and PR positive the hormonal therapy won't do much for me.  I would still need to treat it with chemo.

[Annekathryn Goodman, M.D.]

exactly right
take care

[Ramsay14]

"So one question to ask your doctor is whether the estrogen and progesterone receptors are in the invasive carcinoma or only in the borderline."  I asked my doctor this question and she said that she doesn't know for sure.  The piece of tumor that was sent from where my surgery was done just happened to have no invasive carcinoma.  It only showed borderline tumor just as the report stated.  

I asked her if the test should be done again and she said she really doesn't think it will help.  She said we can't control what samples are sent and they could keep sending borderline samples. They can't tell what they are sending because they have to be sent unstained.  She's pretty confident that the invasive carcinoma would turn out positive for ER and PR due to the fact that the borderline was positive and because of the low-grade of the invasive carcinoma.  She said the lower the grade the more likely the tumor is to be ER and PR positive.  Do you agree with this?  The not knowing for sure makes me nervous.

Should I ask for my original hospital to re-run the test until they get a sample of the invasive carcinoma? Or do you agree with my doctor's approach of assuming that the invasive carcinoma will most likely be ER and PR positive and giving hormonal therapy a shot when the time comes?

[Annekathryn Goodman, M.D.]

Dear Ramsay,
I do agree with your doctor.
best wishes