pathology

a quite fascinating if brief “surgical pathology report” arrived in the mail today. it is just over one page long, and i quote:

CLINICAL HISTORY:
     Calcifications left breast
     Postop Diagnosis:  Same
     Operative Procedure:  Left Lu Bx with NL

TISSUES:
     1.  Breast Biopsy after Needle Localization Mass - medial
     2.  Breast Biopsy after Needle Localization - lateral mass
___________________________________________________ 

FINAL MICROSCOPIC DIAGNOSIS:

     Breast, left medial, needle localization biopsy
       -- benign breast tissue.
       -- calcifications identified within benign ducts 
          (slides G and H).

     Breast, left lateral, needle localization biopsy
       -- fibrocystic changes with focal ductal proliferation.
       -- calcifications identified within benign ducts 
          (slides K through N).

     Comment:  There is no atypia or carcinoma in either 
          biopsy sample.

___________________________________________________ 

ORC:  2 specimins received #1 -- medial area.  #2 -- lateral.  X-rayed.  
Clusters of calcifications identified in each fragment.  Surgeon notified.  
H. Kamal, MD

GROSS DESCRIPTION
     The specimen is received in two parts.

     Part 1 is received fresh from the Operating Room, is labeled "medial" 
     and consists of a 4 x 3 x 1-1/2 cm portion of fibrofatty tissue weighing 
     12.5 gm.  The specimen is unoriented.  It is inked entirely in black ink.  
     The specimen is serially sectioned and submitted entirely in 
     cassettes A through J.

     Part 2 labeled "lateral breast mass" is received fresh from the 
     Operating Room and it consists of a portion of fibrofatty breast tissue 
     measuring 7 x 5 x 2-1/2 cm and weighing 47.6 gm.  The specimen is 
     unoriented and it is entirely inked in black ink.  The specimen is 
     serially sectioned and laid out on paper.  The cut surfaces do not reveal 
     a distinct mass.  The slices are x-rayed.  The x-ray shows calcifications 
     in slices 1 through 4.  Representative sections are submitted in 
     cassettes K through W as diagrammed on the x-ray.  Cassettes K through 
     O contain areas of calcification.  Approximately 60 to 70% of the specimen 
     is submitted for microscopic evaluation.

and that’s it!

my initial thought on reading this was how well susan love describes this report, what it should contain, and what questions you should ask about it, in her breast book pp. 161-164.

my immediate thought thereafter (besides once again the relief at the “no atypia”) was: holy cow! 7 x 5 x 2.5 cm?? why that’s as big as … and then we went off to hunt for a centimeter ruler and could not locate one; in fact, we can’t find any ruler. but that sounds like a huge hunk-o-change to me.

leanne seemed more impressed that i collectively lost 60.1 grams (and no dieting!). we were just beforehand looking at my breasts and noticing the left breast seeming much higher. typically one of my breasts was slightly higher than the other, but i wonder.

there’s the part about definitely seeing the calcifications themselves on the slides they biopsied – which is good.

then, there’s the somewhat thrilling “gross description”.

and finally, there’s the matter of “fibrocystic changes”. as the report points out, neither sample showed any ‘atypia’, which is what susan love says is a good thing. but “fibrocystic changes” still — extra cells lining the ducts… how does it get there? what’s this all really about?

though i am curious about what it means to be “unoriented”, and i wonder why the difference between the lateral and medial pathology, i think i’ve asked all i know to ask and am at rest with the procedure and the results. but i’ll be on the lookout for more information as time goes on, that’s for certain.