Hello all-
In another thread someone asked about my tumor which was initially characterized as low grade and then was characterized as high grade by a second pathology reading. I thought it might be useful and/or interesting to others, so here's the story.
I had my tumor removed last January (TURBT). It was biopsied as were other random sites throughout my bladder. The initial pathology report on the tumor was:
"Although the papillary carcinoma shows some degree of pleopmorphism, the architecture and lack of mitoses would argue for a low grade lesion." There was more detail that I won't type here (I'm lazy) but my general impression from the report was that it wasn't definitively low grade.
Also another concern for me, was that the biopsy of the tumor base did not have muscularis propria present.
So I did not immediately seek a second opinion from a urologist or a second opinion on the pathology. I told myself that if my next cystoscopy showed any new tumors, then I'd go get the second opinions. Thankfully, my scope at the end of April was clear. And even though, I'd read it here over and over again to go get a second opinion, I was putting it off.
I had gone in to see my family practice doctor for another matter and updated her on my bladder tumor situation. After recounting the pathology and a couple of things about my urologist that I didn't feel great about, she encouraged me to seek a second opinion from a urologist. She said she would do a little research and point me in the right direction. Great, I thought.
A couple of weeks later, she calls me. My doctor had talked to a urologist at the University of Washington. The urologist was interested in my case. They have a urologic pathologist who can look at my slides and give them a second opinion on the pathology.
So I get my second opinion appointment scheduled. And then I track down my biopsy slides. It only took 4 phone calls to figure out who was holding them. Thankfully, everyone is very helpful and the slides get to the UW in time to be read before my appointment.
My meeting with the new urologist goes well. She agrees with the plan my original urologist had (scopes every three months for two years, etc.) but adds that she would suggest a yearly scan to check my kidneys, ureters and bladder. I wasn't necessarily planning on switching urologists but she's who I'll be going to next week for my cystoscopy.
But the second opinion on the pathology came back high grade. My impression is that my tumor had hallmarks of both high and low grade, but this pathologist's opinion was to call it high.
For your enjoyment here is the Comment:
"Descriptively, the bladder tumor biopsy contains urothelial mucosa arranged in large papillary configurations with fibrovascular/stromal cores. Some fusion of papillary structures and a nesting architecture are present. Although low grade cytology is present, there are definite fragments with high grade cytology, consisting of marked nuclear enlargement and nuclear shape variability, and coarser nuclear chromatin, most consistent with the diagnosis of high grade urothelial carcinoma. No invasive carcinoma is identified."
I'm more likely to put faith in the second opinion path since I know that pathologist specializes in urologic pathology. I don't know anything about the first pathologist.
Just to clarify, the second pathology reading was of my original tumor. So same sample, but two different conclusions.
I'm glad I was encouraged by what I read here to get my slides read by a urologic pathologist. I'd encourage others to get a second opinion.
Best wishes,
Lynn