My wife, 34 yrs has just been operated in breast for lump excission
and has tested positive for Infiltrating duct carcinoma (SBR grade II/
III). The HPE reports are present to the end of this post. Could
somebody please help me understand -

1) the fallout
2) stage of cancer
3) whether mastectomy is required
4) course of management

Sending the complete patient history -

======================

Name: Mohua Upadhyay
Date of Birth: 17/05/1973
Age: 34 years
Sex: Female
Status: Married
Children: 1 daughter
Last Child Birth: 06/05/1995 Procedure: Normal

Previous medical issues - Thallasemia Minor, operations - DC of cervix
in 2005.

Current Issue: Lump excision in left breast. HPE confirms -
Infiltrating duct carcinoma (SBR grade II/III)

History:
June 2004:    Started complaining of soft noodle in both breast in 2004.
USG and Mammogram done on 11/06/2004.

USG Findings - Fibroadenosis both breast. A small intra-mammary lymph
node is noted in upper inner quadrant of left breast

Bilateral Mammogram Findings - Cranio caudal and medio-lateral views
of both mammary glands reveal course texture of dense glandular
elements with generalized increased nodularity. Increased asymmetric
density is seen in left breast.     Density is seen in left breast.
Multiple nodular opacities without any microcalcification are seen in
both breasts - likely to be benign SOL's - cysts? Fibroadenoma.
Axillary lymph node is visible only on right side.

Medication - Primosa for 4 months

Result - noodles disappeared

6 Dec 2006:    Complained again of soft noodle in right breast. Visited
Surgeon Dr Sumit Chaudhury on 06/12/2006.

    Finding - Nodularity in breast, right breast nodule
    Advise - Usg of both breast
    Medication - Danazol 50 mg BD  x 30 days, Evion - 400 mg OD x 30 days

27 Jan 2007:    Complained of soft noodle now in left breast. Visited
Surgeon Dr Sumit Chaudhury on 27/01/2007.

Finding - Small nodularity in left breast
    Medication - Danazol 50 mg BD  x 30 days, Evion - 400 mg OD x 30
days, Primosa 500 mg BD x 30 days

5 Feb 2007:    Complained of increase in size of noodle left breast.
Visited Surgeon Dr Sumit Chaudhury on 05/02/2007.

Finding - Left Sides breast lump
    Advise - Usg guided FNAC of both breast

6 Feb 2007:    USG guided FNAC of both breast done at Nightingale,
Kolkata by Dr Gunjan Gupta

    Study: A 1.3 x 1 cm sized hypoechoic solid lesion with posterior
acoustic enhancement is noted at the 12 O' clock position of left
breast. No calcification is noted in the lesion.

    A 7 x 3 mm sized cystic lesion is noted in the 6 O' clock position of
right breast.

    The rest of the tissues of both breasts show increased echogenecity.
The retrommary and subareolar regions are normal. No cerivical
lymphadenopathy seen

    Impression - Solid lesion in left breast -? Fibroadenoma
    Cystic lesion in right breast with increased echogenecity of breast
tissue - ?fibrocystic changes

    FNAC Findings - USG Guided FNAC from left breast lump.
    Macrocospic Examination - Size of the lump is 2 cm x 2 cm. Firm mass
    Microscopical Examination shows 1) A high yield of sheets of ductal
epithelial cells of bimodal population and single bare nuclei of
benign type
    2) Mild ductal epithelial cells atypia

    Diagnosis - Cytomorphology is suggestive of benign epithelial
hyperplasia.

10 Feb 2007:    Visited Surgeon Dr Sumit Chaudhury

    Advise - Follow up USG in 3 months
    Medication - stopped

2 April 2007:    Visited Surgeon Dr Sumit Chaudhury

    Advise - Lump in left breast, excision advised

2 April 2007:    Visited Surgeon Dr Sumit Chaudhury

    Advise - Lump in left breast, excision advised. Pre-op pathology.

18 April 2007:    Pre-op pathology

    HB - 11.2
    TC - 6.1
    DC - N :58, L:36, M:02, B:00
    BT - 1m 50 sec
    CT - 5min 10 sec
    RBC - Anisopoikilocytosis, Anisochromic
    Platelet - Adequate
    Glucose (pp) - 130
    Creatinine - 0.8

    Chest PA View - No active parenchymatous lesion is seen, Both apical
region are normal, Both hilar region are normal, Both costophrenic
angles are clear. Contour of both domes of diaphragm are smooth and
regular in outline. Cardia size - normal, Bony thorax - normal.

    ECG - normal

27 April 2007:    Pre-op pathology

    Anti HCV - non-reactive
    HBsAG - non-reactive
    Anti-HIV - non-reactive

27 April 2007:    Lump in breast excision done by surgeon Dr Sumit
Chaudhury in Woodlands hospital. Breast lump sent for HPE

    Findings - Lump in breast, Left Side, Excision of breast
    Incision - Transverse Upper quadrant

3 May 2007:    Histopathology Report 1

    Specimen - Left Breast Lump

    Gross - Specimen consists of a single fibrofatty tissue piece
measuring 5.4 cm in maximum dimension. Cut section shows a relatively
circumscribed gray white lesion of 2 cm (marked by a sil suture),
grossly located almost on one resection of margin. Furthest resection
margins are grossly free of lesion.

    Microscopic - Multiple sections studied. Sections show features of an
infiltrating duct carcinoma (S.B.R Grade II/III). The tumour cells are
arranged mostly in syntical sheets, clusters and trabeculae, lying on
a desmoplastic stroma. Nuclear pleomorphism, snisonucleosis, mitosis
and areas of necrosis are present. Few areas of intraduct carcinoma
are seen and an occasional tumour emboli present. The rest of breast
tissue shows stromal fibrosis and proliferation of the duct lobular
units.

    Diagnosis - Infiltrating duct carcinoma (S.B.R Grade II/III)

Histopathology Report 2

    Specimen - Breast Tissue - left

    Gross - Specimen consists of a single fibrofatty tissue piece
measuring 4 cm in its longest dimension. Cut section yellowish in
colour.

Microscopic - Multiple sections studied. Sections show locules of
mature adipocytes with spindle cells and scattered duct-lobular units
in focally scierosed fibrocollagenous tissue. Ocacssional focus of
sclerosing adenosis is also noted.

There is no evidence of malignancy.