Age 52 at diagnosis.
Normal mammogram July 1998. Noticed nipple inverting on Saturday, called GYN on Monday, appointment on Tuesday. Needle biopsy performed; non-conclusive. Referral to surgeon on October 9th, wait two weeks while surgeon is gone to the states. Excision biopsy on October 21st. Surgeon tells me she is 100% sure that it is cancer and only 75% sure she got it all since it was under the nipple. Wait ten days for results.
Final Diagnosis:
1. Invasive ductal carcinoma, moderately differentiated (Histologic Grade II).
2. Maximum invasive tumor dimension 2.5 cm
3. Ductal carcinoma in-situ, Grade III, involving less that 25% of the total tumor mass.
4. The surgical margins are negative but the tumor approaches to within 0.1 mm of the surgical margin in slide number A19.
5. Lymphovascular invasion is not identified.
6. Estrogen and Progesterone receptors pending. (They were positive)
7. Microcalcificatons: identified within the intraductal carcinoma component.
8. Fibrocystic changes.
According to the orientation provided the tumor is present within the superior, superficial, and medial region of the biopsy. The tumor approaches the surgical margin very closely in the slide number 19, which represents a superficial and medial portion of the biopsy. In this area a large duct with high grade DCIS approaches within 0.5 mm of the surgical margin. The invasive tumor also approaches to within 1 mm of the surgical margin in slide 13 and 20. Using the Nottingham modification of the Bloom Richardson system for microscopic grading, the invasive tumor is scored 3+3+1 (Grade II) for tubule formation, nuclear pleomorphism, and mitotic count respectively. A portion of the tumor has been forwarded for ER/R testing. An addendum report will be issued upon receipt of the results.
Second opinion on same slides:
Breast, left lumpectomy: invasive adenocarcinoma with features of both infiltrating ductal and infiltrating lobular carcinoma.
Oncology stage data:
Maximum tumor diameter: 2.5 cm
In-situ component: approximately 2% of the tumor volume is in-situ
Type: Intermediate grade intraductual carcinoma
Extent: In-situ carcinoma does not extend beyond the perimeter of the invasive carcinoma.
Grade: Bloom and Richardson (Elston modification):, Not strictly applicable because of tumor type but grade 1 (if the tumor be graded.)
Multifocality: Unifocal
Multicentricity: Unicentric
Necrosis: approximately 0% of invasive disease is necrotic.
AJCC STAGE: T2pNXMX
Other findings:Usual ductal hyperplasia, atypical ductal hyperlasia, sclerosing adenosis, apocrine metaplasia, blunt duct adenosis and microscopic intraductual papillomas.
Left Japan with the understanding that I would only need chemo and radiation, but when I was evaluated in the states they did not feel that the close margins were good enough. I could not have more tissue removed because of nipple involvement so opted for modified radical mastectomy December 9th in Statesville, NC, with mastoplexy of right breast and reconstruction of left breast with saline implant. There was no further cancer detected and thirteen lymph nodes were negative. I had a port-a-cath implanted and started 4XAC December 21st. The axillary drain was removed within a couple of days, but the implant drain was not removed because of continuous drainage until January 1st. I spent December 31st in the ER with 103.5 temperature. White counts were normal, so I was sent home with Cipro. A nurse suggested testing the drainage since it had increased rather than decreased. New Year's Day I called the surgeon to tell him about increased drainage and that there was green discharge around drain and he agreed to meet me in his office and removed the drain. The next day the left breast was so filled with fluid that is was larger than the right one! The surgeon called the Plastic Surgeon and he arranged for me to have the implant removed on the January 4th. There was a staff infection, but not from the implant. He said that the implant was clear, but the infection was in front of the muscle, but he removed the implant anyway. He told me that in the future he would put drains in front and in back of the muscle. When I called him about replacing implant while I am in the states, he did not think it would be a good idea since I had developed lymphedema!
I had to delay chemo for one week because of the additional surgery, but finished March 2, 1999. Started Tamoxifen on March 21st. Returned to Japan and had checkup on April 1st in which the surgeon found a lump in my right breast! Had to wait two weeks again because she had to return to the states, but the biopsy was benign - fibrocyscytic disease. I had to wait until May 6th for the diagnoses!
Two weeks prior to leaving the states, I developed lymphedema in my left arm! The surgeons had told me this doesn't happen anymore.
February 20, 2002 - Still NED but decided for a prophylactic mastectomy of right breast to prevent lymphedema if there was a recurrence. My mother had a recurrence after ten years so I felt like a time bomb waiting to go off. The pathology was BENIGN.