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samdah

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I went to my doctor and she said that it doesn't look like thyroid cancer under the microscope, however, they cannot make a definitive diagnosis of breast cancer either. Basically, they said that some of the stains say thyroid and some say breast. The one they did of my neck a couple of weeks ago was weak for mammaglobin which pointed them towards breast.  They have sent these recent samples in for the FSH test for HER-2. If they cannot figure it out with these samples, then they are saying I should have surgery to remove a larger chunk of the one chest node that is at least 1 cm and then hope that they could 100% diagnose it!

I told her that saying "unlikely" to me just doesn't work because I was told that my original breast cancer didn't feel the way that it looked. I was told that my thyroid cancer did not look like cancer on the ultrasound.

I really do not understand why they cannot figure it out!!!





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Reply with quote  #2 
Dear Sam,
This is a terrible state of emotional limbo you are in.... the lung bx was inconclusive on either cancer???
I DO know someone who had her gallbladder burst. She was a BC survivor. When they tested it, they said her BC was back in her gall bladder and probably throughout her body. They did some other bx on a node in another area and it turned out she didn't have cancer back at all....
I am just praying you get this straightened out with the result that NO cancer is found.
Love to you
g


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samdah

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Reply with quote  #3 
They can't seem to confirm anything right now so I hope that the extra stuff they are doing are going to tell us something.

I am on the schedule for Friday for Taxol and Herceptin assuming it is breast cancer, but of course, we need to make sure of it all first.

These spots have to be something, but they can't seem to figure out what.

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Well, Sam, they may be something, but I also believe in miracles.... and you sure have a lot of people praying very hard for you. (((Sam)))

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samdah

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I am very lucky to have many people who are there for us. I just want to know what is up so I can get going on getting rid of it!


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samdah

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Reply with quote  #6 
Starting to think that I need Dr. House and he will say one of two things:

It is never lupus.

Sarcoidosis!

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Reply with quote  #7 

Samdah:


It is difficult to account for the indeterminacy.  But however it arose, I am more interested in solutions.  There are two fairly straightforward solutions:

 

One is to run the samples through a genomic assay like Oncotype DX or Mammaprint, and at the very first pass they will be able to rule in or rule out breast cancer, since malignant breast and thyroid tumors have radically different genomic profiles.  Bu this is costly, and requires insurance coverage.

 

The second solution - which I very strongly recommend - is to send the sample to Dr. David Page at Vanderbilt University Medical Center/VUMC (Tennessee), one of the world's foremost pathologists (he wrote  the book, quite literally).  He offers a consultative second opinion service known as Breast Consultants, considered the most sophisticated in the world, solely devoted to interpretation and diagnosis of breast tissue biopsies and surgical excisions; they render pathology diagnoses, often with advice concerning therapeutic and prognostic implications.  The turnaround time (I have directed dozens and dozens of patients to him over the years) is uncommonly fast, generally within 24 hours of receipt of specimen (sometimes even same day if received very early).

 

The procedure is that your pathologist would send the sample(s) for diagnoses, typically by express delivery service, which should include the glass tissue slides along with any available duplicate slides, and with any already completed or pending surgical pathology reports (including gross description). For this service, a paraffin tissue block is not necessary for most cases, unless it is a particularly difficult differential diagnoses, in which case the paraffin block should be included (call before sending to clarify this requirement: 615-343-0072).

 

Requests for consultations with David Page's VUMC Breast Consultation Service should be sent to:

 

Attn. Dr. David L. Page,

Breast Consultation Service

Vanderbilt University Medical Center

Department of Pathology

C-3321 Medical Center North

Nashville, TN 37232-2561

Phone: 615-343-0072

 

I  would advise that the service first be called (615-343-0072) and alerted to the unique dilemma and indeterminacy involved, but it strikes me that this is likely to be the best and most effective reasonable resolution possible, and depending on when the sample is sent (preferably earlier in morning), you will have the most authoritative answer possible, and if there are other things that may be needed to help resolution, David Page will make those clear  (telephone consults are common as part of the service, along with detailed reports).  I have always found the service dead on target (100% track record to date) and surprisingly affordable ($375), although if ancillary diagnostic studies are necessary, there may be an additional modest charge.

 

I strongly advise going this route so that the type of malignancy issue is resolved and you can get on to the proper treatment, and the frustration and anxiety end. It is imprudent that this indeterminacy continue given that it is vital to the  selection of the optimal treatment plan for you (minus guesswork).



Constantine Kaniklidis

Breast Cancer Watch

edge@evidencewatch.com

samdah

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Reply with quote  #8 
Thanks Edge, I may do that.

My surgeon says that thyroid cells and breast cancer cells can look the same at the basal cell level. Can you expand on that?

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Reply with quote  #9 
Samdah:

Without all of the facts and pathological minutiae, I am not clear where the source of the indeterminacy resides, but I suspect s/he may be referring to biomarkers like TTF-1 (thyroid transcription factor-1), a tissue-specific transcription factor expressed in epithelial cells of the lung and the thyroid (in particular, in pulmonary and thyroid adenocarcinomas).  However although it can occur in breast cells, TTF-1 positivity happens only in 2.6% of cases of primary breast cancer (Yunn-Yi Che at UCSF), and I would have thought that other distinguished markers such as cytokeratins CK5/6 might differentiate, since these are common in basal/TNBC but not in pulmonary and thyroid adenocarcinomas.  In addition, although as to thyroid cancer IHC markers, few have critical potential in accurate diagnosis and prognosis of thyroid carcinoma as opposed to other epithelial cancers, nonetheless HBME-1 and Galectin-3 (GAL-3) shows highest specificity and sensitivity in the diagnosis of thyroid cancer (respectively), and these in general do not appear in breast cells (but perhaps they were not tested for in your case).

Therefore it strikes me once again that only an expert differential pathological analysis can resolve the indeterminacy.  Calling Dr. Page . . .


Constantine Kaniklidis
Breast Cancer Watch
edge@evidencewatch.com

samdah

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Reply with quote  #10 
My surgeon says that my specimens are:

testing positive for TTF1, but negative for Tg
testing positive for CK-7 and ER

So, they are going to pull my previous breast cancer and thyroid cancer slides and compare them to see if anything matches up.

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samdah

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Reply with quote  #11 

My surgeon called back and said that my previous breast cancer and previous thyroid cancers were put through the classic panels for each. This one does not match up to either one completely. So, they are thinking more tissue.


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Reply with quote  #12 
Samdah:

It's far more consonant with thyroid and even more so, pulmonary, than breast (breast rarely has TTF-1 expression, while TTF-1+, CK7+ and ER+ is a fairly common pattern in pulmonary adenocarcinomas or small and non-small cell carcinomas, and the absence of Tg makes thryroid less likely).  As to excising more tissue, that's one option, as is however running more marker tests (like CK20, among others) on the available sample.


Constantine Kaniklidis
Breast Cancer Watch
edge@evidencewatch.com

samdah

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Reply with quote  #13 
Just got word from my surgeon that the ER is actually negative. FISH is not back yet.

So, what can TTF1 positive, Tg negative, ER negative, CK7 positive mean?

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Reply with quote  #14 
Dear Sam, I am trying to remember way back. Maybe I am wrong, but remember the first time you were dx'd - wasn't there some confusion as to the ER status in the very, very beginning? I seem to remember you saying it was er- and then a week or so later you found out it was weakly er+?
I wish we could go back and check- maybe we can.... Let me go explore the old 'hood and see if our posts are still there.


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samdah

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Reply with quote  #15 
It was a low ER+.

They compared my old slides to these. It is just so frustrating because the lung biopsy showed:

thyroglobulin negative
TTF1 positive
mammaglobulin negative
GCDFP-15 positive
CK7 positive
CK20 negative

UGH!

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Reply with quote  #16 
This must be driving you crazy... I am SO sorry you are going through this rollercoaster, Sam.
((((hugs to you)))


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samdah

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Reply with quote  #17 
Thanks. It is just so weird!!

The guy at Froedtert says he feels it is more breast than anything and would treat as such. what a colossal pain!!

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