Just blowin' smoke?

Jacsma said:

No longer Garden Variety ... I don't understand

Can any of you more experienced, more knowledgeable folks help me understand?  As I've said before, and as is still the case - I'm don't know enough about all this to even hold an intelligent conversation.  All I know is what I've been told, what the reports have said, etc.... and honestly don't even know whether or not any of it makes sense.  I'll give you all that I know, or have been told, and maybe you all can tell me whether or not it makes sense.  

The pathology from the original biopsy came back on December 2nd, as Grade 1 Endometrial Adenocarcinoma.  I was told it was the 'good kind' of cancer cells - non-aggressive, very slow-growing, etc. and 95% chance that hysterectomy would be the only course of action needed. Had the complete hysterectomy on January 5th.   Was told that my bladder had basically been fused into the uterus due to past cesareans, scar tissue, etc. but they were able to separate it and everything looked good.  Good News!

I got an update on January 9th that stated “Good News!  Your washings are negative.  Your final pathology is still pending.”  In looking at the report, it states “Specimen source A – Pelvic Washing”  “Negative – no evidence of malignancy” “Benign Mesothelial Cells”

I got a voicemail from gyn/onc this morning that my pathology was back and she was posting it (on the patient portal).  She said (in voicemail) that the good news is that the lymph nodes were negative, but that I actually have a more aggressive form of cancer.  My post op is schedule for Tuesday (17th), so she said we would discuss further treatment, scans needed, etc. then. 

In viewing the report, I find the following:

Her note ”Your pathology revealed a tumor called carcinosarcoma, which is a more aggressive tumor.  The good news is that the lymph nodes were negative. 

I hope you don’t mind, but I’m not familiar enough with these reports or the lingo to even know what part of the report is relevant – so …  here’s pretty much the whole thing.  I apologize for my ignorance. 

A. Right external iliac sentinel lymph node, excision:   One benign lymph node (0/1). 

B. Left proximal obturator sentinel lymph node, excision:   One benign lymph node (0/1). 

C. Uterus, bilateral ovaries and fallopian tubes, hysterectomy and bilateral salpingo-oophorectomy:

Malignant mixed mullerian tumor (MMMT, carcinosarcoma), 7.5 cm, with a predominant exophytic component.

The tumor invades 4 mm into a 26 mm thick myometrium

Lymohovascular invasion is not identified.

Remaining uterus:

Myometrium: No pathologic diagnosis. 

Cervix: No pathologic diagnosis. 

Serosa: No pathologic diagnosis.

Right and left ovary: No pathologic diagnosis. 

Right and left fallopian tubes: No pathologic diagnosis. 

See synoptic report for additional details. 

  Synoptic Report

    ENDOMETRIUM: Hysterectomy, With or Without Other Organs or Tissues  (Endometrium - All Specimens) 

SPECIMEN 

   Specimen Integrity:    Intact hysterectomy specimen 

TUMOR 

   Histologic Type:    Carcinosarcoma (malignant mixed Müllerian tumor) 

   Carcinosarcoma Types:    Homologous type 

   Tumor Size:    Greatest dimension (cm): 7.5 cm 

     Myometrial Invasion:    Present 

       Depth of Myometrial Invasion:    Specify depth of invasion (mm): 4 mm 

       Myometrial Thickness:    Specify (mm): 26 mm 

     Tumor Involvement of Cervix:    Not involved 

    Involvement Status of Right Ovary:    Not involved 

    Involvement Status of Left Ovary:    Not involved 

    Involvement Status of Right Fallopian Tube:    Not involved 

    Involvement Status of Left Fallopian Tube:    Not involved 

     Lymph-Vascular Invasion:    Not identified 

MARGINS 

   Margins:    Uninvolved by invasive carcinoma 

LYMPH NODES 

   Regional Lymph Nodes:    Pelvic 

     Number of Pelvic Lymph Nodes Examined:    Specify number: 2 

   Lymph Node Involvement:    None identified 

STAGE (pTNM) 

   Primary Tumor (pT):    pT1a: Tumor limited to endometrium or invades less than one-half of the myometrium 

     Modifier:    (sn) 

     Category (pN):    pN0: No regional lymph node metastasis 

   Distant Metastasis (pM):    Not applicable - pM cannot be determined from the submitted specimen(s) 

FIGO STAGE 

   FIGO Stage:    IA: No or less than half myometrial invasion 

 Clinical Information

 Endometrial cancer.

Per Maestro care: The patient is a 55 year old female with endometrial adenocarcinoma FIGO 1 on EMB on 11/30/16.

  Gross Examination

 A. "Right external iliac sentinel node". Received fresh and placed in formalin on 1/6/17 at 8:35 am is a 3.5 x 2.2 x 0.4 cm portion of adipose tissue with a 2.3 x 1.5 x 0.5 cm tan-pink, and firm, bisected and submitted entirely in blocks A1-A2 following sentinel lymph node sectioning protocol.

B. "Left proximal obturator sentinel lymph node". Received fresh and placed in formalin on 1/6/17 at 08:35 am is a 3.0 x 2.0 x 0.5 cm portion of adipose tissue with a 2.5 x 1.0 x 0.5 cm tan-pink and firm lymph node is bisected and submitted entirely in block B1 following sentinel lymph node sectioning protocol.

C. "Uterus, tubes, ovaries, and cervix", received fresh for frozen section and placed in formalin on 2150 at 1/5/17.

Procedure: Simple hysterectomy with bilateral salpingo-oophorectomy

Specimen integrity: Intact

Weight: 177 grams

Height of uterus: 11.5 cm

Breadth of uterus at fundus: 7..4 cm

Anterior-posterior width: 4.2 cm

Serosa: Pale tan-white, smooth and glistening, grossly unremarkable

Length of endometrial cavity: 6.9 cm

Cornu to cornu width of endometrial cavity: 5.4 cm

Tumor size: 7.5x4.0x1.1 cm with an overlying exophytic tan and firm polypoid mass that is 5.0 x 4.5 x 2.5 cm that is attached to the posterior fundus. 

Tumor description: Raised, tan, firm, with tan-white cut surface. The attached polypoid mass has a tan, firm and hemorrhagic cut surface. 

Tumor site: Diffusely involving the anterior and posterior including the fundus and cornu but does not grossly extend to the lower uterine segment

Myometrial invasion: 0.5 cm

 Myometrial thickness: 2.6 cm

Remaining myometrium: Tan-pink, firm with mild trabeculation.

Leiomyomata absent. 

Adjacent non-neoplastic endometrium thickness: 0.2 cm

Adjacent non-neoplastic endometrium description: Tan, smooth, glistening. 

Diameter of cervix: 2.8x2.0 cm

Diameter of external os: 1.0 cm

Shape of os: Slit-like

Endocervix and Cervix: The ectocervix has mild blue-green dye but is otherwise pale tan, smooth and glistening. The endocervical canal is tan, glistening with grossly unremarkable with herring bone pattern. 

 Bilateral tubo-ovarian complex were received unoriented and detached from the main specimen. One set of the tuboovarian complex is received with the ovary separated from the fallopian tube now designated as tubo-ovarian complex. Tubo-ovarian complex A is 7 gram (post fixation) and tubo ovarian complex B (attached ovary and fallopian tube) is 6 grams, post fixation.

Ovary A is 3.4 x 1.7 x 1.0 cm with an detached 6.0 cm long x 0.5 cm in diameter fimbriated fallopian tube. 

Ovary B is 3.3 x 1.5 x 0.9 cm with an attached 3.5 cm long x 0.6 cm in diameter non-fimbriated fallopian tube. 

The external surfaces of both ovaries tan-yellow with superficial cysts up to 0.3 cm in greatest dimension. The cut surface of both ovaries is tan, firm and grossly unremarkable. The serosa of both tubes is tan-gray, smooth and glistening with a small paratubal cyst up to 0.2 cm in greatest dimension. The lumen on average is patent, pin-point and grossly unremarkable.

Special studies prospectively ordered: No

Photograph: No

Block diagram: No

Representative tissue collected for the Biospecimen Repository and Processing Core under Duke Pro00035974?: No

Tumor submitted entirely: No

Endometrium submitted entirely: No

Sections submitted in blocks C1-C19

 

Can you give me a crash course in what the heck I’m looking at?  What should my questions be for her on Tuesday?  Does all of this make sense?

Thank you for any help that you can offer.

 

Pam 

 

Pam:

Those reports can be confusing at times (most of the time!).   However, the one thing that stands out for me is that you have clear margins. (Thats great).  It appears that the tumor was contained within a certain area (also good).   N = nodes and yours were 0 which means no lymph nodes were involved.   M = metastasis which yours indicates not applicable at this time which means that they did not on THIS particular specimens find any metastasis.  CM = centimeters  For example your ovary was 6 cm so that would be about 2 inches.   mm = millimeters - which are very tiny (as per your invasion of 4 mm) that would be 0.15748 of an inch (so very small).

Most of the report shows sizes of the ovaries, and specimen sizes.  Homologous type tumor means everything is simliar in natur.

Questions for Tuesday:

Will they have to go back in to do a proper staging?  (They did with me)

How are they going to treat you?  (They weren't sure if my endometrial adenocarcinoma was that or MMMT and they were never able to determine where it originated so I was treated as Ovarian Cancer).   The reason for this is that your insurance carrier covers more tests and scans for this type of cancer than endometrial.

Ask what exactly your Grade and Stage is.   (Mine was Stage 3a, Grade 2).

I'm glad you were able to read your report.   I didn't officially read mine until about a year or so later.   It was too scary at the time.   Although when I read it a year later, it didn't seem as scary then.

Just so you know Pam, I was 45 when I was diagnosed.   I turned 56 in June.   

For your information, I had 3 C-Sections so when they did my original hysterectomy, it was very difficult.  They didn't even think I had cancer at the time.  It was only after the pathology came back and they were surprised.  I had it in my uterus, cervix and left ovary.  And then I had to go back a month later and have staging done and they also removed my appendix and omentum at that time.

I'm telling you this because you can get through this.  This site is a good place to vent.  Take a deep breath and don't be afraid to ask questions questions questions.   Every question you have is important.

My best to you on your upcoming appointment.

Kathy

MAbound said:

Homologous

The word homologous itself means similar, but in regards to MMMT tumors, they are divided into two different types: Homologous type is the type in which the sarcomatous component is made of tissues found in the uterus and Heterologus type is the type in which the sarcomatous component is made up of tissues not found in the uterus. It's nit-picky, I know, and not all that important to the bottom line, but I thought I'd just clear that up in case any one was interested in understanding that distinction where type gets mentioned on a report like this. 

Thanks for expanding the definition when it regards MMMT tumors.  Its not at all nit-picky as I didn't elaborate and it is important for any one dealing with MMMT to get as much information as they can. 

MAbound said:

Homologous

The word homologous itself means similar, but in regards to MMMT tumors, they are divided into two different types: Homologous type is the type in which the sarcomatous component is made of tissues found in the uterus and Heterologus type is the type in which the sarcomatous component is made up of tissues not found in the uterus. It's nit-picky, I know, and not all that important to the bottom line, but I thought I'd just clear that up in case any one was interested in understanding that distinction where type gets mentioned on a report like this. 

...that you're willing to do the heavy lifting to research and articulate this in terms I can understand. Thanks!