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Seeing a 40 y/o F tomorrow coming from out of state, with a Hx of B mastectomies, presenting with a large R breast mass. Her core Bx showed G3 DCIS. Her mastectomy pathology showed ADH on the L side; however, R sided path of multiple foci of G3 IDC (measuring between 0.1 to 0.3 cm) and an 8.5 cm G3 DCIS (no mention of microinvasion on report). A SLN Bx was performed with 2 nodes being negative. No LVI. Negative margins. Final stage is pT1aN0(sn). She is triple-positive, receiving TCH currently.
My question is, that big of a mass being just DCIS sounds incredibly fishy to me. How can there be no evidence of invasive carcinoma in that big of a mass?? Should I send the path for a 2nd opinion? I am inclined to do so. What is the role for PMRT in a patient like this? If the DCIS component shows evidence of microinvasion in the 8.5 cm mass, I feel like I should offer her PMRT given her age, grade of the tumor and the size of this lesion. She has had BRCA testing which is negative.
I found a few interesting studies on the matter.
http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=111&abstractID=86469
http://www.ncbi.nlm.nih.gov/pubmed/16918134
My question is, that big of a mass being just DCIS sounds incredibly fishy to me. How can there be no evidence of invasive carcinoma in that big of a mass?? Should I send the path for a 2nd opinion? I am inclined to do so. What is the role for PMRT in a patient like this? If the DCIS component shows evidence of microinvasion in the 8.5 cm mass, I feel like I should offer her PMRT given her age, grade of the tumor and the size of this lesion. She has had BRCA testing which is negative.
I found a few interesting studies on the matter.
http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=111&abstractID=86469
http://www.ncbi.nlm.nih.gov/pubmed/16918134
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