Superficial BC vs. Metastatic BC

Posted by: Rosemary in Tis - Carcinoma in situ: "flat tumor"TCCT1 - Tumor invades subepithelial connective tissuemens issueshigh gradebladder cancerBCG on Print PDF

I got my initial path reports today from 2006, initial diagnosis.

This is what I would have to describe as "pathology whiplash".

That is where you go from Point A to Point Z too quickly for your body and mind to catch up with you.

As an epilogue to these pathologies, when I went for muscle biopsy at UNC in May 2006, my cancer was [i]"POOF[/i]"  [b]GONE[/b].  I began BCG treatments in June 2006.  No recurrances.

When I was at Chapel Hill in May for biopsy, I was told that there were two muscle biopsies performed by my Doctor that day for T1 G3 bladder cancer.  The other guy wasn't as "lucky".  He was going to lose his bladder.

I kind of wonder if they got this right?  

Rosie is right.  ALWAYS ALWAYS OBTAIN A COPY OF YOUR PATH REPORTS!!!!

[b]PATHOLOGIES [/b]


[quote]1/28/06 (first path report - initial TURB)

Histologic type:  Transitional cell carcinoma (papillary)
Hildtologic grade:  Well differentiated (G1)
Invasion of lamina propira;  No invasion of lamina propria is identififed
Muscle present for evaluation:  No
TNM (T) staging information based on available information:  Ta:  In situ carcinoma (papillary): no      
           invasion of subepithelial connective tissue identified[/quote]


[quote]3/20/06 (2nd TURB - residual tumor

Bladder Tumor Biopsy:
   Inverted Urothelial Proliferation within lamina Propria

Comment:   Sections of specimen B demonstrate fragments of focally inflamed and partially denuded urothelial tissue. Within one of the tissue fragments, nests of cytologically bland urothelium with partial biopsy artifact are present in the lamina propria and display somewhat "inverted" growth features.  The nests are solid with smooth regular contours and the stroma is loose without evidence of desmoplasia.  While these are thought to be a proliferation of Brunn's nests, the possiblility of an inverted papilloma is considered.  Additionally, the patient has a recent history of non-invasive papillary carcinoma in this area and a papillary transitional cell carcinoma with inverted features is also in the differential. The case will be forwarded to University of North Carolina for outside consultation.  [/quote]

[quote]3/27/06 (UNC 2nd opinion pathology report)

Addendum comment:  This case was submitted for extradepartmental review at University of North Carolina due to pathologist request for additional opinion.  Also included in the material sent for outside review was a previous case from the patient in which the reviewing pathologist, Dr....concurred with the original diagnosis of a non-invasive papillary urothlieal carcinoma.

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

Histologic type:  Invasive urothlelial carcinoma with inverted growth pattern
Histologic grade:  High grade
Invasion of lamina propria:  Invasion of lamina propria is identified (focal)
Muscle present for evaluation:  No[/quote]


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Rosie
April 04, 2007

Rosemary,  I read your post carefully and am still confused as to your pathology reports.  Particurlary this part where is states - TNM (T) staging information based on available information:  Ta:  In situ carcinoma (papillary): -.  What was it -  In Situ Carcinoma (CIS) or papillary (TCC).  CIS/TIS/In Situ Carcinoma - all the same type stated differently is not a papillary or TCC - transitional cell carcinoma.  In Situ is a flat red growth where papillary is like flowery growth. Were those pathology reports sent to you from your current urologists office?  I remember in another post you stated your current doctor is stating you have/had TA G1 or G2. There is quite a difference in treatment depending on the type - was it In Situ or Papllary?  Is it T1 G3 or TA G1, or TA G2.  It is good to hear all cancer was gone when you had your biopsies. Either the BCG is working or your tumor was low grade and has not recurred. But aren't all bladder cancers "gone" until they recur?  smilies/grin.gifepending on your type and grade the BCG is warrented.  So, yes, if your type was initially papillary TA G1 those BCG treatments  that "crippled you" was overtreatment.  In the letter you posted to and from Dr. Lamm yesterday you stated you are do for 3 more BCG treatments.  Gee, I am confused for you and concerned.  Rosie

Rosemary
April 04, 2007

Rosie,

I agree that this pathology report is most confusing.  Maybe in time, it will all make sense.

The original low-grade path in January 2006 states:

Diagnosis

TUR Bladder tumor:
    Non-invasive papillary transitional cell carcinoma, Grade II/IV


The March 2006 biopsy states:

FINAL DIAGNOSIS:

Bladder Tumor, Biopsy:
    Invasive High Grade Urothelial Carcinoma with inverted growth pattern
    Carcinoma is invasive into lamina propria
   
Comment

The biopsy of bladder mass from March 20, 2006 shows nests of urothelium proliferation in the lamina propria.  The nests of urothelium in the lamina propria are variable in size, some of them with irregular contour and with focal dosmoplastic response.  There is moderate cytologic 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.  Dr. ....has also reviewed this case and agrees with this diagnosis.  This tumor is staged as pT1, pNx, pMx.


I am thinking that when the small "p" is in front of the T, it means papilllary?

This whole thing has never made any sense to me from the get-go.  Why wasn't any "atypia" or "mitosis" seen in the very first biopsy specimen in January?  If it progressed that quickly, then why wasn't it back again when I went for 3rd biopsy 6 weeks later?

Thanks for your interest, Rosie.  It's like an Agatha Christie mystery.... :smilies/smiley.gif

This may be helpful...

Definition of In situ

In situ: In the normal location. An "in situ" tumor is one that is confined to its site of origin and has not invaded neighboring tissue or gone elsewhere in the body.

For example, squamous cell carcinoma in situ is an early stage of skin cancer. It is a tumor that develops from the squamous cells which are flat, scalelike cells in the outer layer of the skin (the epithelium).

The term "in situ" is borrowed from the Romans. It means "in the natural or normal place" and, in the case of cancer, it is good news. It indicates that the tumor cells are still where they originated. They have neither entered neighboring tissues nor have they metastasized afar.


Thanks a bunch,
Rosemary


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