Differences in Pathology Reports

[Belleview Teacher]

After a routine mammogram and subsequent ultrasound,a radiologist at the imaging center performed a core biopsy on a suspicious area.  The pathology report indicated:
1.3 cm invasive ductal adenocarcinoma, grade 3, poorly differentiated with necrosis and chronic inflammation within the tumor.

After diagnosis, I secured an appointment with a surgeon at a regional nationally-known cancer center. After viewing my mammograms and the pathology report, he recommended a simple mastectomy with sentinel node biopsy.  I had these procedures on Nov. 20.  On my follow-up visit, the surgeon provided me with a copy of the cancer center's pathology report.  This report indicated:
1.1 cm medullary carcinoma,surgical margins negative,ER/PR negative, HER2/neu negative, stage T1c NO Mx, lymph node shows no evidence of malignancy; comment: immunohistochemistry for low-molecular weight cytokeratin (5D3) to detect the presence of micrometastasis reveals no cytokeratin-positive cells.

My question is, "How could one pathology report show IDAC and the other Medullary cardinoma?"

[cow chaser]

so.. what is next for the both of you???

[~Barb]

Quite curious.
My core biopsy report called my lump IDC-high grade. The path report after surgery said I had medullary features as well as a clear sentinel node and a tissue from left axilla metastatic adenocarcinoma.
My report went off for an automatic 2nd opinion which cals it:
Infiltrating duct carcinoma, poorly differentiated Grade 3/3.
"The diagnostic features of a medullary carcinoma are not fulfilled by this tumour.Specifically there is too much irregularity and infiltration at the tumour margin (which should be smooth and rounded in medullary carcinoma)and there is not enough lymphoplasmacytic infiltrate, This could also be called "Atypical Medullary carcinoma" but is not helpful clinically." I did shorten up the actual comment since it is a page long.
I am glad mine went for an automatic 2nd opinion and treatment of course is being done on the IDC High grade with 2/6 lymphs involved.

[cow chaser]

Oh my Gosh!! I have the same thing
I was got the  results thanksgiving eve night!!!! Scheduled for the cancer doctor, wed.. Please tell me what this means...

[CCF-RN,MSN-JS]

Dear Belleview Teacher, There could be several reasons for the differences.  The initial biopsy report describes poorly differentiated cells, this indicates that the cells are very unlike normal cells, this would indicate a cancer, not necessarily show features that would be indicative of medullary type.  Medullary type of breast cancer is an uncommon type of breast cancer (accounting for about 5% of breast cancers).  With more of a specimen and additional stains can help to distinguish more precisely.