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And yet another pathology report

Editgrl
Editgrl Member Posts: 903

So... some of you may remember than when I was trying to make a decision regarding radiation, I got a third opinion from a panel who also did a second opinion on my pathology.  That pathologist was not totally onboard with the original carcinosarcoma diagnosis and categorized it as serous carcinoma.  Well, after my recurrence was verified at the end of January, I started to get things in order to get yet another opinion on the pathology, this time from MD Anderson.  Due to a number of things, not the least my five weeks in Germany, I just got the results back today.

"High-grade endometrial adenocarcinoma with different components including endometrioid grade 2, papillary serous carcinoma and foci of solid tumor consistent with undifferentiated carcinoma."

In addition, they did some tumor profiling...  

"The solid component is positive for pankeratin, p53 (diffuse,strong) and PAX-8 (weak), and negative for p16, ER, synatophysin and chromogranin. The immunoprofile is not conclusive and while an undifferentiated carcinoma component is considered, solid component of serous carcinoma cannot be entirely excluded."

However, everything in the lymph nodes is categorized as "undifferentiated carcinoma."

Well then.  No carcinosarcoma anywhere in this pathology.  However, as I read it, still aggressive.  Not sure what all of this means yet, going forward, but I do believe that the positive marker for pankeratin means that there was no sarcoma in the original tumor.

 

 

 

Comments

  • Charissa
    Charissa Member Posts: 124
    I Sent You an E-Mail

    Hello Chris, I'm a little confused, since I haven't been on here for a while. I'm hoping, I'm reading this incorrectly. I sent you an e-mail.  If you do not see it in your Inbox, please check your Spam.

    Love and hugs!

  • TeddyandBears_Mom
    TeddyandBears_Mom Member Posts: 1,801 **
    edited April 2017 #3
    Wow.... No wonder we get

    Wow.... No wonder we get confused... As well as having differing opinions from our doctors. I think your treatments would have stayed the same even with this third report, right?

    How are you feeling? I'm sure you are glad to be home. I bet your horse missed you terribly.

    Thanks for posting and looking forward to hearing about your next steps. Enjoy your home time.

    Love and Hugs,

    Cindi

  • Editgrl
    Editgrl Member Posts: 903
    edited April 2017 #4
    Well, I've just started

    Well, I've just started researching this latest diagnosis, but my gut feeling is the initial treatment would probably have been the same.  Anyway, I'm going with that because it doesn't do any good to second guess at this point.  I did find out that the profiling they did does rule out any neuroendocrine elements.  I think Der Maus went through an initial diagnosis of undifferentiated carcinoma, too, but that was later changed.  Apparently, undifferentiated carcinoma is often mis-diagnosed and it often presents with other elements, as mine did above.  

    Anyway, the disturbing thing about this is that the NCI describes undifferentiated carcinoma as Grade 4.  Yikes.  However, I am optimistic that since the cancer so far has stayed within the lymph nodes and is very small, the treatment I am currently undergoing will prevail.

    As far as my horse...  unfortunately, I had to put him down at the end of January.  He was 28, and his feet were not dealing with the very wet ground.  He was in a lot of discomfort, and unfortunately, he would not allow us to keep him in a stall where we could have done something to help him.  It was a dark and rainy Sunday when I had to say good-bye, but in the grand scheme of things, the timing was a blessing.  With everything that has happened since then, it would have been very difficult to keep caring for him.  Now he's grazing on eternally green pastures and snoozing in the sun... 

  • TeddyandBears_Mom
    TeddyandBears_Mom Member Posts: 1,801 **
    Oh Chris, so sorry to hear

    Oh Chris, so sorry to hear about your loss. Just knowing you from your posts, I know he had a great life with you.

    I had no idea there was such a thing as a grade 4 cancer! I thought grade 3 was the highest. Obviously, I have a lot to learn....

    I'm with you - your current treatments are going to get rid of any threats to your well being!

    Take care my friend.

    Love and Hugs,

    Cindi

  • Lou Ann M
    Lou Ann M Member Posts: 996
    edited April 2017 #6
    Editgrl said:

    Well, I've just started

    Well, I've just started researching this latest diagnosis, but my gut feeling is the initial treatment would probably have been the same.  Anyway, I'm going with that because it doesn't do any good to second guess at this point.  I did find out that the profiling they did does rule out any neuroendocrine elements.  I think Der Maus went through an initial diagnosis of undifferentiated carcinoma, too, but that was later changed.  Apparently, undifferentiated carcinoma is often mis-diagnosed and it often presents with other elements, as mine did above.  

    Anyway, the disturbing thing about this is that the NCI describes undifferentiated carcinoma as Grade 4.  Yikes.  However, I am optimistic that since the cancer so far has stayed within the lymph nodes and is very small, the treatment I am currently undergoing will prevail.

    As far as my horse...  unfortunately, I had to put him down at the end of January.  He was 28, and his feet were not dealing with the very wet ground.  He was in a lot of discomfort, and unfortunately, he would not allow us to keep him in a stall where we could have done something to help him.  It was a dark and rainy Sunday when I had to say good-bye, but in the grand scheme of things, the timing was a blessing.  With everything that has happened since then, it would have been very difficult to keep caring for him.  Now he's grazing on eternally green pastures and snoozing in the sun... 

    So sorry

    i don't think,there are many things that are harder to do that lose a beloved animal family member.  It must be a little comforting though to  that your beloved friend is not suffering.

    You are right about not dwelling on the past.  It is just that, the past, and you are on a very promising journey.

    Hugs and prayers, Lou Ann

  • janaes
    janaes Member Posts: 799
    Sounds like a lot of

    Sounds like a lot of information to process to me.  I think its good you got the opinion from MD anderson though.   Pathology reports are so confusing and I hope you find peace with your situation as you go forward. 

    Janae

  • Lou Ann M
    Lou Ann M Member Posts: 996

    Oh Chris, so sorry to hear

    Oh Chris, so sorry to hear about your loss. Just knowing you from your posts, I know he had a great life with you.

    I had no idea there was such a thing as a grade 4 cancer! I thought grade 3 was the highest. Obviously, I have a lot to learn....

    I'm with you - your current treatments are going to get rid of any threats to your well being!

    Take care my friend.

    Love and Hugs,

    Cindi

    Cindi,

    I just noticed the new picture,  really cute hair you have going there. I love your fur babies.

    Lou Ann

  • TeddyandBears_Mom
    TeddyandBears_Mom Member Posts: 1,801 **
    Lou Ann M said:

    Cindi,

    I just noticed the new picture,  really cute hair you have going there. I love your fur babies.

    Lou Ann

    Well thank you my friend! 

    Well thank you my friend!  You are the first one to notice the picture. And, it has been out there for a good 3 months. LOL.... I lost all of my chemo curls at about 6 months. I was hoping to keep them. But, I'm back to my old normal now. And, grateful to have it regardless of the texture. :-)

    My little guys are glued to me. They are like little 4 legged people. And, spoiled as can be. Love them to pieces.

    So glad to see you posting Lou Ann. I hope you are weathering the radiation with limited side effects. Looking forward to hearing a very good report from you soon.

    Love and Hugs,

    Cindi

  • SandyD
    SandyD Member Posts: 130
    Undifferentiated

    Wow Chris, that's a load of information. My understanding is that the less differentiated a tumor is, the higher the grade, however I've not heard about grade 4. Carcinosarcoma is pretty complex to start with in that it's always comprised of more than one type of tumor so I would imagine that the diagnostic process is complicated and maybe even prone to misdiagnosis. Glad to hear that your treatment is going in the right direction. That can make a huge difference in the sense of well being going forward. 

    So sorry about your horse. It's really tough to lose the animals in our life who we're so bonded to.

  • Kvdyson
    Kvdyson Member Posts: 789
    Oh, wow, that does seem like

    Oh, wow, that does seem like a very surprising pathology result! But, now that I think about it, as diagnostic tools become more sophisticated we may all be seeing more nuanced results than in the past. Hopefully this clarification helps your medical team customize your treatments for the best possible outcome. Keep us posted on how you are doing and if you find out any additional information. Good luck and stay hopeful! Kim

     

  • derMaus
    derMaus Member Posts: 558
    Undifferentiated

    First, thank you for keeping us posted on your German treatment. It's fascinating, much as I wish it weren't something you had to pursue. Second, I do have a diagnosis of undfferentiated carcinoma. The post-op pathology report indicated it was mixed with neuroendocrine, which is even more rare than undifferentiated. Because of that, I got two second opinions: one from Cedars Siani and one from Stanford's neuroendocrine tumor institute. Both confirmed that it was not neuroendocrine but rather 'regular' undifferentiated carcinoma that had neuroendocrine features. Worryingly, the Stanford report showed the cancer was much more invasive than originally noted and had made incursions into both ovaries. The oncologist said she'd never seen so many differences of opinion on one sample; regrettably you appear to be having a similar experience. To date I have no real answer what undifferentiated means; best I can surmise is that they want to eliminate the possibility that the cancer came from another site, thus the reports say "undifferentiated, favor endocrine origin" (vs. cervical or ovarian?). From a treatment perspective it doesn't make any difference, since it's all high grade. I think the bigger concern is that undifferentiated could be mistaken for a lower grade cancer and thus under treated, but that doesn't seem to have been true in your case; they're just shifting around the diagnoses w/in the Grade 3/4 category. Of all the literature out there, this article made the most sense to me; I'm attaching the link in case you haven't already seen it. Best wishes and please do keep us posted. B

    http://www.archivesofpathology.org/doi/pdf/10.5858/arpa.2011-0461-RS?code=coap-site

  • Editgrl
    Editgrl Member Posts: 903
    edited April 2017 #13
    derMaus said:

    Undifferentiated

    First, thank you for keeping us posted on your German treatment. It's fascinating, much as I wish it weren't something you had to pursue. Second, I do have a diagnosis of undfferentiated carcinoma. The post-op pathology report indicated it was mixed with neuroendocrine, which is even more rare than undifferentiated. Because of that, I got two second opinions: one from Cedars Siani and one from Stanford's neuroendocrine tumor institute. Both confirmed that it was not neuroendocrine but rather 'regular' undifferentiated carcinoma that had neuroendocrine features. Worryingly, the Stanford report showed the cancer was much more invasive than originally noted and had made incursions into both ovaries. The oncologist said she'd never seen so many differences of opinion on one sample; regrettably you appear to be having a similar experience. To date I have no real answer what undifferentiated means; best I can surmise is that they want to eliminate the possibility that the cancer came from another site, thus the reports say "undifferentiated, favor endocrine origin" (vs. cervical or ovarian?). From a treatment perspective it doesn't make any difference, since it's all high grade. I think the bigger concern is that undifferentiated could be mistaken for a lower grade cancer and thus under treated, but that doesn't seem to have been true in your case; they're just shifting around the diagnoses w/in the Grade 3/4 category. Of all the literature out there, this article made the most sense to me; I'm attaching the link in case you haven't already seen it. Best wishes and please do keep us posted. B

    http://www.archivesofpathology.org/doi/pdf/10.5858/arpa.2011-0461-RS?code=coap-site

    Thanks, Der Maus

    Yes, the articles I've found are concerned about the under-reporting of this particular type.  I had not seen this article but had found an older one.  It'll be interesting to hear what my docs have to say now.