Pathology

When the tissue sample is inspected grossly, the tumor is measured in three dimensions using a ruler and the distance to all the margins of excision are recorded. Other observation such as the presence of satellite nodules, tumor necrosis (death tissue), calcifications, relationship with the skin, nipple or deep fascia etc are recorded. The presence of other possible non-cancerous lesions are described. Ultimately, samples of the tumor, margins, other lesions etc. are taken and submitted for microscopic examination. When the tissue sample is inspected grossly, the tumor is measured in three dimensions using a ruler and the distance to all the margins of excision are recorded. Other observation such as the presence of satellite nodules, tumor necrosis (death tissue), calcifications, relationship with the skin, nipple or deep fascia etc are recorded. The presence of other possible non-cancerous lesions are described. Ultimately, samples of the tumor, margins, other lesions etc. are taken and submitted for microscopic examination.

Lymphoma subtyping is very important as the often predicts the biology and clinical disease course. For example most follicular lymphomas tend to be very slow growing or “indolent”. This means that patients with enlarged nodes who are asymptomatic may not necessarily need urgent treatment. On the other hand Burkitt’s type lymphoma is fast growing, leading rapidly to symptoms and requires urgent chemotherapy to obtain disease control. The subtype also indicates the type of chemotherapy to be used when treatment is initiated. Lymphoma subtyping is very important as the often predicts the biology and clinical disease course. For example most follicular lymphomas tend to be very slow growing or “indolent”. This means that patients with enlarged nodes who are asymptomatic may not necessarily need urgent treatment. On the other hand Burkitt’s type lymphoma is fast growing, leading rapidly to symptoms and requires urgent chemotherapy to obtain disease control. The subtype also indicates the type of chemotherapy to be used when treatment is initiated.

There are multiple parameters used to determine the tumor aggressiveness. Some are histological, some molecular some clinical.

The histologic indicators are: tumor size, tumor histology, tumor differentiation, lymphovascular invasion, multi-focality, and number of mitosis.

Molecular parameters include expression of estrogen and progesterone hormonal receptors; expression of HER2-neu; proliferative activity of the tumor (Ki67, mitosis) and other genetic profiles of the tumor cells as determine by molecular analysis of the cells via RNA or DNA studies such as Oncotype, Mamotomme etc. that provide a “genetic signature” of the tumor cells able to predict the aggressiveness of the tumor and guide to a certain extent the therapeutic approach.

Clinical parameters relate to the clinical and imaging findings such as palpable lymph nodes, positive scans for probable metastasis, etc.

Smaller and single size (<2 cm) tumors with pure mucinous or tubular type of histology or other histology that is well differentiated (grade 1), with no vascular/lymphatic invasion, and ER/PR positive with no overexpression of Her2 neu would be the least aggressive tumors. However, the histologic/molecular parameters are secondary to the stage of the tumor as given by the TNM staging.

Cancer staging system is routinely used to summarize some histologic/clinical characteristics of the tumors. The staging includes three letters: T is for Tumor size; N is for lymph Node metastasis and M is for distant organ Metastasis. Of the four possible stages, Stage 1 will have the best prognosis since the tumors in this group are small and there is no nodal or distant organ metastasis. It is only within the same stage that the histologic and molecular indicator acquire larger relevance. There are multiple parameters used to determine the tumor aggressiveness. Some are histological, some molecular some clinical.

The histologic indicators are: tumor size, tumor histology, tumor differentiation, lymphovascular invasion, multi-focality, and number of mitosis.

Molecular parameters include expression of estrogen and progesterone hormonal receptors; expression of HER2-neu; proliferative activity of the tumor (Ki67, mitosis) and other genetic profiles of the tumor cells as determine by molecular analysis of the cells via RNA or DNA studies such as Oncotype, Mamotomme etc. that provide a “genetic signature” of the tumor cells able to predict the aggressiveness of the tumor and guide to a certain extent the therapeutic approach.

Clinical parameters relate to the clinical and imaging findings such as palpable lymph nodes, positive scans for probable metastasis, etc.

Smaller and single size (<2 cm) tumors with pure mucinous or tubular type of histology or other histology that is well differentiated (grade 1), with no vascular/lymphatic invasion, and ER/PR positive with no overexpression of Her2 neu would be the least aggressive tumors. However, the histologic/molecular parameters are secondary to the stage of the tumor as given by the TNM staging.

Cancer staging system is routinely used to summarize some histologic/clinical characteristics of the tumors. The staging includes three letters: T is for Tumor size; N is for lymph Node metastasis and M is for distant organ Metastasis. Of the four possible stages, Stage 1 will have the best prognosis since the tumors in this group are small and there is no nodal or distant organ metastasis. It is only within the same stage that the histologic and molecular indicator acquire larger relevance.

The margins of the wide excision are examined to make sure there is no melanoma at the edges. Rarely there is melanoma present along part of the margin (usually non-invasive melanoma in situ) and this will need to re-excised to 'negative' margins. The sentinel lymph node is the critical piece of information since it will determine if all surgical therapy is over (lymph node doesn't have any melanoma cells in it) or that more surgery (completion lymph node dissection) and possibly systemic therapy is needed. The margins of the wide excision are examined to make sure there is no melanoma at the edges. Rarely there is melanoma present along part of the margin (usually non-invasive melanoma in situ) and this will need to re-excised to 'negative' margins. The sentinel lymph node is the critical piece of information since it will determine if all surgical therapy is over (lymph node doesn't have any melanoma cells in it) or that more surgery (completion lymph node dissection) and possibly systemic therapy is needed.

Pathology reports usually take 2-5 days to return depending on the complexity of the case with most cases being done in 2-3 days. The sentienl node is thoroughly examined by both routine stains (hematoxylin and eosin) and special melanoma specific stains (HMB45). Pathology reports usually take 2-5 days to return depending on the complexity of the case with most cases being done in 2-3 days. The sentienl node is thoroughly examined by both routine stains (hematoxylin and eosin) and special melanoma specific stains (HMB45).

The type of breast cancer is generally determined by the microscopic appearance of the tumor. When the pathologist examines the tissue, either from a needle core biopsy or surgical excision, they make a determination if the cells are ductal or lobular in origin, and whether or not invasion is present. There are times when it is difficult to tell exactly what type of cancer is present – breast cancers can have a variable appearance and the diagnosis is not always obvious by the initial microscopic appearance. A variety of special stains may be used, and these additional tests can confirm if a tumor is ductal or lobular (some cancers are “mixed” , having features of both cell types), of if invasion is present or not. The type of breast cancer is generally determined by the microscopic appearance of the tumor. When the pathologist examines the tissue, either from a needle core biopsy or surgical excision, they make a determination if the cells are ductal or lobular in origin, and whether or not invasion is present. There are times when it is difficult to tell exactly what type of cancer is present – breast cancers can have a variable appearance and the diagnosis is not always obvious by the initial microscopic appearance. A variety of special stains may be used, and these additional tests can confirm if a tumor is ductal or lobular (some cancers are “mixed” , having features of both cell types), of if invasion is present or not.

Your surgeon or oncologist would be the best resources to explain your pathology report. It is helpful to obtain a copy of the final pathology report and write down the questions you have about the report prior to your appointment. This way you go into your appointment prepared to have a discussion with your healthcare provider.
Your surgeon or oncologist would be the best resources to explain your pathology report. It is helpful to obtain a copy of the final pathology report and write down the questions you have about the report prior to your appointment. This way you go into your appointment prepared to have a discussion with your healthcare provider.

It all depends on the lab...I have worked with one lab who has a 48 hour turn around period. I feel a more realistic time period is 3-5 days and this is what I tell my patients. This time will account for any holidays, non working days, or delay at the lab. This is based on my personal experience with a variety of labs.
Always ask your healthcare provider for their estimated time period based on the lab where they will be sending your specimen.
Thanks,
Heather It all depends on the lab...I have worked with one lab who has a 48 hour turn around period. I feel a more realistic time period is 3-5 days and this is what I tell my patients. This time will account for any holidays, non working days, or delay at the lab. This is based on my personal experience with a variety of labs.
Always ask your healthcare provider for their estimated time period based on the lab where they will be sending your specimen.
Thanks,
Heather