Ask a Pathologist

Generally, if there is hyperplasia, we will report that it is there and further classify it (e.g. usual, florid, atypical). If there is need for further clarification of a pathology report, I encourage you to speak with your clinician and/or call us with questions.

1) Atypical lobular hyperplasia: This is a distinct diagnostic category that has a scientific literature supporting the clinical implications. Your surgeon, I'm guessing, can tell you more about the clinical implication of this diagnosis.

2) Micropapillary hyperplasia: In contrast to atypical lobular hyperplasia, I think this is a description rather than a diagnosis. This is important because descriptions do not (generally) have a clinical correlation or a scientific literature behind them. Instead, it's simply a verbal description of what the pathologist sees visually. In the absence of other findings, such as cytologic atypia, I do not think that the word "micropapillary" implies carcinoma.

3) Because "micropapillary hyperplasia" is a description, and not a diagnosis, there is no substantial medical literature on this term. One exception comes to mind… this type of hyperplasia is associated with gynecomastia (enlargement of the breast).

4) Finally, you could consider reviewing your pathology with the pathologist who signed it out. I am guessing that they would be pleased to look at your case and discuss your questions with you.

During pregnancy and breast feeding it is not unusual to have "lumpy bumpy" breast tissue due to normal physiologic changes. That being said, radiologic findings could warrant further evaluation. It is possible that after drainage of the abscess a more solid area was noted in the cyst wall that wasn't visualized before because the abscess itself obscured it. In that case, biopsy may be advised which is usually done by a radiologist under image guidance. It is understandably stressful because you are living with uncertainty, so I would advise patience, especially in the presence of other major life stresses like a newborn baby. Your sister may not have answers to your questions until the work up is completed and might not be ready to discuss them. I'd also encourage your sister to ask her health care providers questions when she has them and stay engaged with her care. She can also request copies of the reports to help her understand what was seen.
Answered By: Tracey Harbert, MD

These follow up scans and tests after a cancer are a well known cause of great anxiety and fear. The fact that your mother did not need chemotherapy for the breast cancer likely means that it had not spread to the lymph nodes which is a good finding. The radiation given is to prevent local recurrence at the site of surgery and is standard. Kidney cysts are very common (more than one quarter of all people over 60 have them) and CT scans are now good enough that they can usually tell if it's a cyst or a solid tumor. The vast majority of cysts are benign and require no treatment. The lung nodule is very small, at the limit of detection of the x-rays, and that small-size by itself is reassuring. But more important is the fact that it is stable, meaning that it has not grown over some interval between x-rays, indicating that it is likely an old scar, or granuloma, from a prior infection and not a tumor. These scars are also quite common and her doctor has no doubt seen this innumerable times which makes him/her confident that these are nothing to worry about.
Answered by Dr. Whitten

Mislabeling errors are very uncommon, but do occur. There should NEVER be multiple patients' labels present at a given procedure. When the patient enters the biopsy/procedure suite, there should be verbal correlation of the patient's name with the labels that are present. Each procedure center should develop their own checks and balances that work and are critically evaluated.

Occasionally when a biopsy "pass" is attempted, a piece of tissue does not come out. This can easily cause a discrepancy in the number of attempts versus the number of pieces of tissue. Likewise, it is not unusual for there to be more tissue fragments than biopsy attempts, as tissue can often fragment within the specimen container. A large discrepancy in number though, could be an issue.
Answered By: Barry T. Kahn, M.D.

Bronchoalveolar lavage is a cytological method which is used most to identify what types of inflammatory cells are present and thereby which type of infection or other inflammatory process is suggested. For example if lymphocytes predominate, sarcoidosis, viral infection, hypersensitivity pneumonitis and drug reactions are suggested. If neutrophils or macrophages predominate then bacterial pneumonia, some cytotoxic drug reactions and rare neoplasms such as Langerhans' cell histiocytosis are suggested. If there are abundant eosinophils then eosinophilic pneumonia, interstitial lung disease, and drug induced lung disease and HIV/AIDS are suggested. Some patients with asthma may also show increased eosinophils and mast cells, but not all, and there is significant overlap with other diseases. To my knowledge there are no universally accepted reference ranges for WBC differential counts in bronchoalveolar lavage fluids.
Answered by Dr. Whitten