Second opinion pathology- now it\'s high grade

15 years 7 months ago #20383 by ale53
When I went in for my cystoscopy 8/1, I asked my new uro about the second turb. She said that this type of tumor doesn't "skip layers" and since there was nothing found in the lamina propria she doesn't think re-turb is necessary. Also, the area of my orginal tumor site (now scar tissue) and its borders look clear.

With thanks,
Lynn

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15 years 7 months ago #20068 by ale53
Thanks for your responses! I'm going in for my cysto today and will bring this up with my new urologist.

Best wishes,
Lynn

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15 years 8 months ago - 15 years 8 months ago #19853 by Rosemary
Replied by Rosemary on topic Second opinion pathology- now it\'s high grade
Lynn,

Your second opinion path report is very familiar...here is mine...(this was a second biopsy dated 3/20/06 first biopsy was dated 1/31/06 and was determined to be of lowest stage and grade)

Surgical Pathology Consult Report 3/27/06

The biopsy of bladder mass from March 20, 2006 shows nests of urotheluim proliferation in the lamina propria. The nests of urothelium in the lmanina propria are variable in size, some of them with irregular contour and with focal desmoplastic response. There is moderate cytolgic atypia. This case is interpreted as invasive urothelial carcinoma with inverted growth pattern. Much of the tumor is low grade, but a few areas show more cytologic atypia and more mitoses, and are interpreted as high grade.

Also included in the material sent for outside review as a previous case from the patient in which the reviewing pathologist Dr. M concurred with the original diagnosis of a non-invasive papillary urothelial carcinoma.

With respect to the case, while the preliminary report considered a papillary carcinoma with inverted features to be in the differential, this was not the favored interpretation. Drs. M and V, however, interpreted this case as an invasive carcinoma with inverted growth pattern and staged the tumor as pT1, pMX.


The muscle issues of my pathology are always confusing. They all seem to say "No Muscular Proparis present." But, when I asked TOP DOC at UNC if he had gotten enough muscle for testing he said that he had gotten plenty....

:unsure:

Lynn, my advise to you is to ask for a second biopsy. I am with Pat on this.
You should have had a second TURB for residual tumor.


I had 2 TURB's (one for residual tumor) and 4 biopsies within my first 8 months of diagnosis.

Ro

Rosemary
Age - 55
T1 G3 - Tumor free 2 yrs 3 months
Dx January 2006

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15 years 8 months ago #19850 by Patricia
Replied by Patricia on topic Second opinion pathology- now it\'s high grade
What i don't understand is why they have not scheduled you for a second TURB to make sure no residual margins are left behind and especially since there was no muscle involved in the initial TURB? This is pretty standard procedure now. And i know for a fact it saved my life.
Continue to probe............Pat

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15 years 8 months ago #19847 by ale53
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

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