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Biopsy and Surgical Tissues Completely Different

Alexandria
Posts: 3
Joined: Jan 2012

Hi everyone! I wanted to ask if anyone else found that their original biopsy and later the tissues removed during surgery contained completely different kinds of uterine cancer?

My original biopsy showed endometroid cancer with clear cell features and was classified high-grade. But the surgery revealed no clear cell in the uterus, only Grade 1 Endometroid.

Surgery showed the cancer to be only in the lower uterine segment with a focal cervical stromal invasion, so it was labelled stage 2. But myometrial invasion was only 10-20 %. .

The doctors are nervous about this microscopic bit of tissue containing clear cell features or "clear cell change" and are treating the cancer as if the whole uterus was clear cell -- just to get the "bad guy," as my primary doctor put it.

I am scheduled to have chemotherapy (6 cycles of Carboplatin/taxol as well as brachytherapy).

Still, I am puzzled as to how the original biopsy -- just a small piece of tissue the gynecologist happened to get when he took a sample of the uterine lining. He did not aim for a visible polyp or anything, he told me -- could contain clear cell features when there is not a single cell of this to be found in the whole uterus during the surgery (radical hysterectomy with lymph nodes etc)

If any one has had a similar experience, please share.

Alexandria

Gracegoi's picture
Gracegoi
Posts: 59
Joined: Aug 2011

I remember reading and rereading My Path report trying to understand it all so I can relate to your concern. Mine was straight forward 100% UPSC. I had to ask the doctors for that answer it wasn't on the report that I could see.

I have read where a woman had a biospy done and that was all that was found after the hystorectomy was done. It sounds unbelievable but it happens. Sometimes its just in part of a polyp thats removed during a Biopsy procedure .

Thats all I have to share . Sounds like a talk with your Oncologist about it or a second opinion on the path report as a possibility.

Good luck

lkchapman's picture
lkchapman
Posts: 105
Joined: Jan 2011

It is quite possible they got all of that particular cancer with the biopsy. I have seen it happen at my hospital. On more than one occasion I have seen the oncologist recommend chemo for these high grade cancers even when the hysterectomy specimen comes out clear (no cancer) if either papillary serous or clear cell cancer was found on the original biopsy. They are such aggressive cancers they don't like to mess around.

Laura

longtermsurvivor's picture
longtermsurvivor
Posts: 1806
Joined: Mar 2010

Ikchapman's answer is exactly correct. Every now and then a biopsy will actually get ALL the cancer, and the surgical speciman will show nothing at all. It just happens.

It is fine to get a second opinion on the pathology in cases like this. The slides, or even the blocks can be sent off and looked at by a variety of experts, generally chosen by the pathologists who read your slides locally. This is a very acceptable practice.

You should be treated according to the most aggressive tissue type identified on your biopsy or surgical speciman. Otherwise you could be undertreated, and you don't want that.

You want to be cured!

Best to you.

Susanna23
Posts: 66
Joined: Dec 2010

Dear Alexandria
Yes, this happened to me too though the diagnoses were different to yours. The biopsy showed grade 3 adenocarcinoma, which is the more common kind of uterine cancer, and I was told that surgery would cure it but maybe I would also need radiotherapy (but not chemo).
After the surgery, it turned out it was a carcinosarcoma (also called MMMT on this board) which is always classed as grade 3. The stage was 1a. And I was offered adjuvant chemotherapy (carbo/taxol) which I had,but did not need radiotherapy. So the final pathology determined the follow-up treatment offered.
The good news is that I have been fine (NED) since surgery in November 2010 - third check-up coming on January 17.
I wish you all the best with your treatment - happy to have you get in touch with me whenever you wish if you have more questions.
Susan

snowbird_11's picture
snowbird_11
Posts: 160
Joined: Oct 2011

I had a uterine biopsy following abnormal endometrial cells noted on pap smear. Biopsy result was high grade uterine papillary serous carcinoma. Path results from debulking surgery found no cancer at all within uterus, even tho multiple polyps, but external side of uterus, tubes, ovaries and throughout abdominal cavity samples were UPSC, with some endometroid and clear cell noted (Stage IVb). I was and continue to be treated as UPSC.

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