Pursue second opinion after three lab results (one of which differs)?

**Summary at the bottom in case you don't want to read the whole
thing.

When my father was diagnosed with prostate cancer a few months back,
we asked his PCP about getting a referral for a second opinion. His
reaction was (translated) "That's not a very good thing to do... like
you don't trust your doctor." That infuriated me. With the risk of
infection, bleeding, etc. that comes with biopsies, the fear that
another biopsy would eat away at valuable treatment time and the
doctor's reluctance to provide another referral, my father went ahead
with treatment. Luckily, his surgeon/doctor (not the PCP) was very
experienced and when asked about a second opinion, he indicated that
he would be providing that second opinion. My father is doing fine
now, done with all treatments except for occasional check-ups.

A few days ago, I was devastated again. A small, pea-sized lump under
the skin of my girlfriend's forearm was biopsied. Previous doctors
indicated it was likely a benign cyst, a jelly excreted by strained
muscles, etc. Perhaps because of her age (she's has years before she
turns 30), no one seemed to believe it was anything but a nuisance.
The surgeon sent the sample to the lab. The result came back positive
for malignancy. Surprised by the results, the doctor asked the lab to
test it again. The results now came back negative. Unable to provide
clear-cut answers, he asked the lab to test it a third time. It came
back positive again. He believes it's a sweat gland cancer.

I'm not sure what to do. The doctor indicated that, regardless of its
malignancy, another surgery would need to take place to remove any
remnants of the tumor. My question is, should we be going to another
doctor to remove the remaining tumor and have it sent to the lab as a
second opinion? Could the multiple lab results already be considered
"second opinions"? The current doctor already scheduled a surgery for
the end of next week. That seems somewhat fast since my father went
through a series of MRIs, bone scans, etc. before he was treated. Is
this unusual? There doesn't seem to be much data on sweat gland cancer
and I don't think the doctor is familiar with it. I'd like her to see
an expert in the field, but I don't know if one exists.

**Summary:
1. Girlfriend's biopsy were analyzed by the lab 3 times. It came back
as: malignant, not malignant, malignant
2. Surgery to remove remaining tumor scheduled for next week.
3. No MRIs, bone scans, etc. have been done yet.
4. Should we get a second opinion from another doctor?

Any advice would be helpful. Thanks.

Tom <k9boy@hotmail.com> fell face-first on the keyboard. This was the
result: news:52c85443-3771-46a2-8ccd-
c813a2d026ea@d1g2000hsg.googlegroups.com:

> **Summary at the bottom in case you don't want to read the whole
> thing.
>
> When my father was diagnosed with prostate cancer a few months back,
> we asked his PCP about getting a referral for a second opinion. His
> reaction was (translated) "That's not a very good thing to do... like
> you don't trust your doctor." That infuriated me. With the risk of
> infection, bleeding, etc. that comes with biopsies, the fear that
> another biopsy would eat away at valuable treatment time and the
> doctor's reluctance to provide another referral, my father went ahead
> with treatment. Luckily, his surgeon/doctor (not the PCP) was very
> experienced and when asked about a second opinion, he indicated that
> he would be providing that second opinion. My father is doing fine
> now, done with all treatments except for occasional check-ups.
>
> A few days ago, I was devastated again. A small, pea-sized lump under
> the skin of my girlfriend's forearm was biopsied. Previous doctors
> indicated it was likely a benign cyst, a jelly excreted by strained
> muscles, etc. Perhaps because of her age (she's has years before she
> turns 30), no one seemed to believe it was anything but a nuisance.
> The surgeon sent the sample to the lab. The result came back positive
> for malignancy. Surprised by the results, the doctor asked the lab to
> test it again. The results now came back negative. Unable to provide
> clear-cut answers, he asked the lab to test it a third time. It came
> back positive again. He believes it's a sweat gland cancer.
>
> I'm not sure what to do. The doctor indicated that, regardless of its
> malignancy, another surgery would need to take place to remove any
> remnants of the tumor. My question is, should we be going to another
> doctor to remove the remaining tumor and have it sent to the lab as a
> second opinion? Could the multiple lab results already be considered
> "second opinions"? The current doctor already scheduled a surgery for
> the end of next week. That seems somewhat fast since my father went
> through a series of MRIs, bone scans, etc. before he was treated. Is
> this unusual? There doesn't seem to be much data on sweat gland cancer
> and I don't think the doctor is familiar with it. I'd like her to see
> an expert in the field, but I don't know if one exists.
>
> **Summary:
> 1. Girlfriend's biopsy were analyzed by the lab 3 times. It came back
> as: malignant, not malignant, malignant
> 2. Surgery to remove remaining tumor scheduled for next week.
> 3. No MRIs, bone scans, etc. have been done yet.
> 4. Should we get a second opinion from another doctor?
>
> Any advice would be helpful. Thanks.
>

Personally, if it were me, I'd go with the surgery to remove the tumour:
Benign or not, I wouldn't want it in me. Let them test the removed tissue
as your second/third opinion.


--
Marc Bissonnette
Looking for a new ISP? http://www.canadianisp.com
Largest ISP comparison site across Canada.

Tom wrote:

>
> A few days ago, I was devastated again. A small, pea-sized lump under
> the skin of my girlfriend's forearm was biopsied. Previous doctors
> indicated it was likely a benign cyst, a jelly excreted by strained
> muscles, etc. Perhaps because of her age (she's has years before she
> turns 30), no one seemed to believe it was anything but a nuisance.
> The surgeon sent the sample to the lab. The result came back positive
> for malignancy. Surprised by the results, the doctor asked the lab to
> test it again. The results now came back negative. Unable to provide
> clear-cut answers, he asked the lab to test it a third time. It came
> back positive again. He believes it's a sweat gland cancer.
>
> I'm not sure what to do. The doctor indicated that, regardless of its
> malignancy, another surgery would need to take place to remove any
> remnants of the tumor. My question is, should we be going to another
> doctor to remove the remaining tumor and have it sent to the lab as a
> second opinion? Could the multiple lab results already be considered
> "second opinions"? The current doctor already scheduled a surgery for
> the end of next week. That seems somewhat fast since my father went
> through a series of MRIs, bone scans, etc. before he was treated. Is
> this unusual? There doesn't seem to be much data on sweat gland cancer
> and I don't think the doctor is familiar with it. I'd like her to see
> an expert in the field, but I don't know if one exists.
>
> **Summary:
> 1. Girlfriend's biopsy were analyzed by the lab 3 times. It came back
> as: malignant, not malignant, malignant
> 2. Surgery to remove remaining tumor scheduled for next week.
> 3. No MRIs, bone scans, etc. have been done yet.
> 4. Should we get a second opinion from another doctor?
>
> Any advice would be helpful. Thanks.

Few people need to rush into treatment decisions.
Can you get her to one of the places mentioned here?
http://www.emedicine.com/derm/topic630.htm
If you can get (copies of) the lab reports to take with you, all the
better.
J

"Tom" <k9boy@hotmail.com> wrote in message
news:52c85443-3771-46a2-8ccd-c813a2d026ea@d1g2000hsg.googlegroups.com...
> **Summary at the bottom in case you don't want to read the whole
> thing.
>
> When my father was diagnosed with prostate cancer a few months back,
> we asked his PCP about getting a referral for a second opinion. His
> reaction was (translated) "That's not a very good thing to do... like
> you don't trust your doctor." That infuriated me. With the risk of
> infection, bleeding, etc. that comes with biopsies, the fear that
> another biopsy would eat away at valuable treatment time and the
> doctor's reluctance to provide another referral, my father went ahead
> with treatment. Luckily, his surgeon/doctor (not the PCP) was very
> experienced and when asked about a second opinion, he indicated that
> he would be providing that second opinion. My father is doing fine
> now, done with all treatments except for occasional check-ups.
>
> A few days ago, I was devastated again. A small, pea-sized lump under
> the skin of my girlfriend's forearm was biopsied. Previous doctors
> indicated it was likely a benign cyst, a jelly excreted by strained
> muscles, etc. Perhaps because of her age (she's has years before she
> turns 30), no one seemed to believe it was anything but a nuisance.
> The surgeon sent the sample to the lab. The result came back positive
> for malignancy. Surprised by the results, the doctor asked the lab to
> test it again. The results now came back negative. Unable to provide
> clear-cut answers, he asked the lab to test it a third time. It came
> back positive again. He believes it's a sweat gland cancer.
>
> I'm not sure what to do. The doctor indicated that, regardless of its
> malignancy, another surgery would need to take place to remove any
> remnants of the tumor. My question is, should we be going to another
> doctor to remove the remaining tumor and have it sent to the lab as a
> second opinion? Could the multiple lab results already be considered
> "second opinions"? The current doctor already scheduled a surgery for
> the end of next week. That seems somewhat fast since my father went
> through a series of MRIs, bone scans, etc. before he was treated. Is
> this unusual? There doesn't seem to be much data on sweat gland cancer
> and I don't think the doctor is familiar with it. I'd like her to see
> an expert in the field, but I don't know if one exists.
>
> **Summary:
> 1. Girlfriend's biopsy were analyzed by the lab 3 times. It came back
> as: malignant, not malignant, malignant
> 2. Surgery to remove remaining tumor scheduled for next week.
> 3. No MRIs, bone scans, etc. have been done yet.
> 4. Should we get a second opinion from another doctor?
>
> Any advice would be helpful. Thanks.

Malignant with what?

The pathology report should have said exactly what type malignancy they
identified.
The risk difference between a basal cell carcinoma and a melanoma are
enormous.

On May 23, 12:25 am, "august" <august_west...@nospam.com> wrote:
> "Tom" <k9...@hotmail.com> wrote in message
>
> news:52c85443-3771-46a2-8ccd-c813a2d026ea@d1g2000hsg.googlegroups.com...
>
>
>
> > **Summary at the bottom in case you don't want to read the whole
> > thing.
>
> > When my father was diagnosed with prostate cancer a few months back,
> > we asked his PCP about getting a referral for a second opinion. His
> > reaction was (translated) "That's not a very good thing to do... like
> > you don't trust your doctor." That infuriated me. With the risk of
> > infection, bleeding, etc. that comes with biopsies, the fear that
> > another biopsy would eat away at valuable treatment time and the
> > doctor's reluctance to provide another referral, my father went ahead
> > with treatment. Luckily, his surgeon/doctor (not the PCP) was very
> > experienced and when asked about a second opinion, he indicated that
> > he would be providing that second opinion. My father is doing fine
> > now, done with all treatments except for occasional check-ups.
>
> > A few days ago, I was devastated again. A small, pea-sized lump under
> > the skin of my girlfriend's forearm was biopsied. Previous doctors
> > indicated it was likely a benign cyst, a jelly excreted by strained
> > muscles, etc. Perhaps because of her age (she's has years before she
> > turns 30), no one seemed to believe it was anything but a nuisance.
> > The surgeon sent the sample to the lab. The result came back positive
> > for malignancy. Surprised by the results, the doctor asked the lab to
> > test it again. The results now came back negative. Unable to provide
> > clear-cut answers, he asked the lab to test it a third time. It came
> > back positive again. He believes it's a sweat gland cancer.
>
> > I'm not sure what to do. The doctor indicated that, regardless of its
> > malignancy, another surgery would need to take place to remove any
> > remnants of the tumor. My question is, should we be going to another
> > doctor to remove the remaining tumor and have it sent to the lab as a
> > second opinion? Could the multiple lab results already be considered
> > "second opinions"? The current doctor already scheduled a surgery for
> > the end of next week. That seems somewhat fast since my father went
> > through a series of MRIs, bone scans, etc. before he was treated. Is
> > this unusual? There doesn't seem to be much data on sweat gland cancer
> > and I don't think the doctor is familiar with it. I'd like her to see
> > an expert in the field, but I don't know if one exists.
>
> > **Summary:
> > 1. Girlfriend's biopsy were analyzed by the lab 3 times. It came back
> > as: malignant, not malignant, malignant
> > 2. Surgery to remove remaining tumor scheduled for next week.
> > 3. No MRIs, bone scans, etc. have been done yet.
> > 4. Should we get a second opinion from another doctor?
>
> > Any advice would be helpful. Thanks.
>
> Malignant with what?
>
> The pathology report should have said exactly what type malignancy they
> identified.
> The risk difference between a basal cell carcinoma and a melanoma are
> enormous.

I'm with you on this, but we haven't received a copy of the labs yet.
We'll be visiting the doctor tomorrow. I'm hearing everything through
my girlfriend, so I'm anxious to speak directly with the doctor. From
what my girlfriend has indicated, the doctor doesn't seem all that
familiar with the cancer. I'm not sure what this is based on and it
makes me uneasy. The doctor is a surgeon that specializes in cancer,
but I don't know if he's an oncologist.

On May 22, 5:50 pm, J <xnswex@nalid;"no> wrote:
> Tom wrote:
>
> > A few days ago, I was devastated again. A small, pea-sized lump under
> > the skin of my girlfriend's forearm was biopsied. Previous doctors
> > indicated it was likely a benign cyst, a jelly excreted by strained
> > muscles, etc. Perhaps because of her age (she's has years before she
> > turns 30), no one seemed to believe it was anything but a nuisance.
> > The surgeon sent the sample to the lab. The result came back positive
> > for malignancy. Surprised by the results, the doctor asked the lab to
> > test it again. The results now came back negative. Unable to provide
> > clear-cut answers, he asked the lab to test it a third time. It came
> > back positive again. He believes it's a sweat gland cancer.
>
> > I'm not sure what to do. The doctor indicated that, regardless of its
> > malignancy, another surgery would need to take place to remove any
> > remnants of the tumor. My question is, should we be going to another
> > doctor to remove the remaining tumor and have it sent to the lab as a
> > second opinion? Could the multiple lab results already be considered
> > "second opinions"? The current doctor already scheduled a surgery for
> > the end of next week. That seems somewhat fast since my father went
> > through a series of MRIs, bone scans, etc. before he was treated. Is
> > this unusual? There doesn't seem to be much data on sweat gland cancer
> > and I don't think the doctor is familiar with it. I'd like her to see
> > an expert in the field, but I don't know if one exists.
>
> > **Summary:
> > 1. Girlfriend's biopsy were analyzed by the lab 3 times. It came back
> > as: malignant, not malignant, malignant
> > 2. Surgery to remove remaining tumor scheduled for next week.
> > 3. No MRIs, bone scans, etc. have been done yet.
> > 4. Should we get a second opinion from another doctor?
>
> > Any advice would be helpful. Thanks.
>
> Few people need to rush into treatment decisions.
> Can you get her to one of the places mentioned here?http://www.emedicine.com/derm/topic630.htm
> If you can get (copies of) the lab reports to take with you, all the
> better.
> J

Thank you for the article. Somewhat coincidental that you should ask
if I can get her to one of the places mentioned, since those locations
are in NYC. I live in NYC. I'm not sure how appropriate it is, but
I'll try to contact a few of those authors.

Tom wrote:

> [snipped]
> >
> > > **Summary:
> > > 1. Girlfriend's biopsy were analyzed by the lab 3 times. It came back
> > > as: malignant, not malignant, malignant
> > > 2. Surgery to remove remaining tumor scheduled for next week.
> > > 3. No MRIs, bone scans, etc. have been done yet.
> > > 4. Should we get a second opinion from another doctor?
> >
> > > Any advice would be helpful. Thanks.
> >
> > Malignant with what?
> >
> > The pathology report should have said exactly what type malignancy they
> > identified.
> > The risk difference between a basal cell carcinoma and a melanoma are
> > enormous.
>
> I'm with you on this, but we haven't received a copy of the labs yet.
> We'll be visiting the doctor tomorrow. I'm hearing everything through
> my girlfriend, so I'm anxious to speak directly with the doctor. From
> what my girlfriend has indicated, the doctor doesn't seem all that
> familiar with the cancer. I'm not sure what this is based on and it
> makes me uneasy. The doctor is a surgeon that specializes in cancer,
> but I don't know if he's an oncologist.

I wonder if they need more tissue in order to be definitive?
How did things go yeserday, Tom?
J

On May 24, 4:57 am, J <xnswex@nalid;"no> wrote:
> Tom wrote:
> > [snipped]
>
> > > > **Summary:
> > > > 1. Girlfriend's biopsy were analyzed by the lab 3 times. It came back
> > > > as: malignant, not malignant, malignant
> > > > 2. Surgery to remove remaining tumor scheduled for next week.
> > > > 3. No MRIs, bone scans, etc. have been done yet.
> > > > 4. Should we get a second opinion from another doctor?
>
> > > > Any advice would be helpful. Thanks.
>
> > > Malignant with what?
>
> > > The pathology report should have said exactly what type malignancy they
> > > identified.
> > > The risk difference between a basal cell carcinoma and a melanoma are
> > > enormous.
>
> > I'm with you on this, but we haven't received a copy of the labs yet.
> > We'll be visiting the doctor tomorrow. I'm hearing everything through
> > my girlfriend, so I'm anxious to speak directly with the doctor. From
> > what my girlfriend has indicated, the doctor doesn't seem all that
> > familiar with the cancer. I'm not sure what this is based on and it
> > makes me uneasy. The doctor is a surgeon that specializes in cancer,
> > but I don't know if he's an oncologist.
>
> I wonder if they need more tissue in order to be definitive?
> How did things go yeserday, Tom?
> J

Thanks for asking. I have the reports, which identified the tumor as
"adnexal carcinoma, not further classified". The "not further
classified" part seems to stem from the uniqueness of the sample. I've
included the pathologist's diagnosis and comments below. I was unable
to respond sooner because we've been searching in vain for a doctor
who specializes in this field. After visiting the surgeon who took the
biopsy, he indicated that we should go back to my girlfriend's primary
care physician to receive a referral to an oncologist. Back at the
PCP's office, we were hoping to speak with the doctor for 2 minutes to
see if she had any oncologists to refer us to. The assistants there,
however, made us wait several hours before we spoke to the PCP. Then
the PCP basically said, "I have no clue, so I can't provide any
referrals. My brother is an oncologist, he'll find someone for you."
Today, we went to the brother/oncologist, who spent 10 minutes with us
reciting the lab report (incorrectly, at that) and said "I have no
clue and can't do anything. Here's a photocopy of a doctor's
directory. Please pay the co-pay." So, after 3 doctors, we still
haven't found a doctor who can start ordering (or not order) MRIs,
lymphatic tests, etc. and we're basically left to "looking through the
yellow pages". If anyone can recommend a skin/sarcoma oncologist in
the NYC area, I would greatly appreciate it. Due to the size of the
tumor, the first surgeon did not recommend Moh's Micrographic Surgery,
which is what's recommended in the link provided earlier in the
"Eccrine Carcinoma" article.

Report:

Summary of Immunohistochemical Results
Marker - Interpretation
Epithelial differentiation:
Pankeratin AE1/AE3 - Scattered positive cells
Keratin CAM5.2 - Strong positive
Keratin 34BE12 - Negative
EMA - Positive
CK7 - Positive
CK20 - Few weak positive
Clear cell sarcoma/melanoma of soft parts:
S-100 - Positive, nuclear and cytoplasmic
HMB-45 - Negative
Epithelioid sarcoma:
E-Cadherin - Rare clusters of positive cells
CD34 - Negative
Vimentin - Positive
p63 - Negative
TTF-1 - Negative

"Thank you for referring slides of this subcutaneous mass in this
young woman. This is a very challenging case and I have considered
various possibilities including a metastatic lesion. However, based on
the location and young age, I suspect we are dealing with an unusual
adnexal lesion. It does not, in my opinion, fit the criteria for soft
tissue myoepithelioma. Although it is cytokeratin and S-100 protein
positive, it lacks SMA, calponin, p63 and GFAP. Hence, I would
consider it an adnexal carcinoma of uncertain type..."

Tom wrote:

> On May 24, 4:57 am, J <xnswex@nalid;"no> wrote:
> > Tom wrote:
> > > [snipped]
> >
> > > > > **Summary:
> > > > > 1. Girlfriend's biopsy were analyzed by the lab 3 times. It came back
> > > > > as: malignant, not malignant, malignant
> > > > > 2. Surgery to remove remaining tumor scheduled for next week.
> > > > > 3. No MRIs, bone scans, etc. have been done yet.
> > > > > 4. Should we get a second opinion from another doctor?
> >
> > > > > Any advice would be helpful. Thanks.
> >
> > > > Malignant with what?
> >
> > > > The pathology report should have said exactly what type malignancy they
> > > > identified.
> > > > The risk difference between a basal cell carcinoma and a melanoma are
> > > > enormous.
> >
> > > I'm with you on this, but we haven't received a copy of the labs yet.
> > > We'll be visiting the doctor tomorrow. I'm hearing everything through
> > > my girlfriend, so I'm anxious to speak directly with the doctor. From
> > > what my girlfriend has indicated, the doctor doesn't seem all that
> > > familiar with the cancer. I'm not sure what this is based on and it
> > > makes me uneasy. The doctor is a surgeon that specializes in cancer,
> > > but I don't know if he's an oncologist.
> >
> > I wonder if they need more tissue in order to be definitive?
> > How did things go yeserday, Tom?
> > J
>
> Thanks for asking. I have the reports, which identified the tumor as
> "adnexal carcinoma, not further classified". The "not further
> classified" part seems to stem from the uniqueness of the sample. I've
> included the pathologist's diagnosis and comments below. I was unable
> to respond sooner because we've been searching in vain for a doctor
> who specializes in this field. After visiting the surgeon who took the
> biopsy, he indicated that we should go back to my girlfriend's primary
> care physician to receive a referral to an oncologist. Back at the
> PCP's office, we were hoping to speak with the doctor for 2 minutes to
> see if she had any oncologists to refer us to. The assistants there,
> however, made us wait several hours before we spoke to the PCP. Then
> the PCP basically said, "I have no clue, so I can't provide any
> referrals. My brother is an oncologist, he'll find someone for you."
> Today, we went to the brother/oncologist, who spent 10 minutes with us
> reciting the lab report (incorrectly, at that) and said "I have no
> clue and can't do anything. Here's a photocopy of a doctor's
> directory. Please pay the co-pay." So, after 3 doctors, we still
> haven't found a doctor who can start ordering (or not order) MRIs,
> lymphatic tests, etc. and we're basically left to "looking through the
> yellow pages". If anyone can recommend a skin/sarcoma oncologist in
> the NYC area, I would greatly appreciate it. Due to the size of the
> tumor, the first surgeon did not recommend Moh's Micrographic Surgery,
> which is what's recommended in the link provided earlier in the
> "Eccrine Carcinoma" article.

Hello,
Well, I'm confused as well, but glad you ignored the Moh's idea.
We don't usually mention names of doctors here.
This website has one centre in NY ofr sarcoma
http://www.sarcomacancer.org/
Memorial Sloan-Kettering

Here's another
http://www.med.nyu.edu/surgery/oncol...ients/sarcoma/
Sounds good to me.

If you're really stuck at decisions, you might want to try contacting this doctor

He's also a surgical oncologist
Howard Kaufman, MD
Vice Chairman of Surgical Oncology and
Associate Director,
Herbert Irving Comprehensive Cancer Center
NewYork-Presbyterian/Columbia
Associate Professor of Surgery,
Columbia University College of Physicians
hlk2003@columbia.edu (or call) - unsure if that email is still valid.

I have no experience with any of them.
My impression is that Sloan Memorial is expensive and "cadillac" care; but may
not necessarily be better than the other one.

I hope this helps and/or does not cost you a bunch more wasted co-pays.
Keep in touch.
J

"Tom" <k9boy@hotmail.com> wrote in message
news:71eb3280-3ae0-4861-bf00-dd820b623c5e@m45g2000hsb.googlegroups.com...
> On May 24, 4:57 am, J <xnswex@nalid;"no> wrote:
>> Tom wrote:
>> > [snipped]
>>
>> > > > **Summary:
>> > > > 1. Girlfriend's biopsy were analyzed by the lab 3 times. It came
>> > > > back
>> > > > as: malignant, not malignant, malignant
>> > > > 2. Surgery to remove remaining tumor scheduled for next week.
>> > > > 3. No MRIs, bone scans, etc. have been done yet.
>> > > > 4. Should we get a second opinion from another doctor?
>>
>> > > > Any advice would be helpful. Thanks.
>>
>> > > Malignant with what?
>>
>> > > The pathology report should have said exactly what type malignancy
>> > > they
>> > > identified.
>> > > The risk difference between a basal cell carcinoma and a melanoma are
>> > > enormous.
>>
>> > I'm with you on this, but we haven't received a copy of the labs yet.
>> > We'll be visiting the doctor tomorrow. I'm hearing everything through
>> > my girlfriend, so I'm anxious to speak directly with the doctor. From
>> > what my girlfriend has indicated, the doctor doesn't seem all that
>> > familiar with the cancer. I'm not sure what this is based on and it
>> > makes me uneasy. The doctor is a surgeon that specializes in cancer,
>> > but I don't know if he's an oncologist.
>>
>> I wonder if they need more tissue in order to be definitive?
>> How did things go yeserday, Tom?
>> J
>
> Thanks for asking. I have the reports, which identified the tumor as
> "adnexal carcinoma, not further classified". The "not further
> classified" part seems to stem from the uniqueness of the sample. I've
> included the pathologist's diagnosis and comments below. I was unable
> to respond sooner because we've been searching in vain for a doctor
> who specializes in this field. After visiting the surgeon who took the
> biopsy, he indicated that we should go back to my girlfriend's primary
> care physician to receive a referral to an oncologist. Back at the
> PCP's office, we were hoping to speak with the doctor for 2 minutes to
> see if she had any oncologists to refer us to. The assistants there,
> however, made us wait several hours before we spoke to the PCP. Then
> the PCP basically said, "I have no clue, so I can't provide any
> referrals. My brother is an oncologist, he'll find someone for you."
> Today, we went to the brother/oncologist, who spent 10 minutes with us
> reciting the lab report (incorrectly, at that) and said "I have no
> clue and can't do anything. Here's a photocopy of a doctor's
> directory. Please pay the co-pay." So, after 3 doctors, we still
> haven't found a doctor who can start ordering (or not order) MRIs,
> lymphatic tests, etc. and we're basically left to "looking through the
> yellow pages". If anyone can recommend a skin/sarcoma oncologist in
> the NYC area, I would greatly appreciate it. Due to the size of the
> tumor, the first surgeon did not recommend Moh's Micrographic Surgery,
> which is what's recommended in the link provided earlier in the
> "Eccrine Carcinoma" article.
>
> Report:
>
> Summary of Immunohistochemical Results
> Marker - Interpretation
> Epithelial differentiation:
> Pankeratin AE1/AE3 - Scattered positive cells
> Keratin CAM5.2 - Strong positive
> Keratin 34BE12 - Negative
> EMA - Positive
> CK7 - Positive
> CK20 - Few weak positive
> Clear cell sarcoma/melanoma of soft parts:
> S-100 - Positive, nuclear and cytoplasmic
> HMB-45 - Negative
> Epithelioid sarcoma:
> E-Cadherin - Rare clusters of positive cells
> CD34 - Negative
> Vimentin - Positive
> p63 - Negative
> TTF-1 - Negative
>
> "Thank you for referring slides of this subcutaneous mass in this
> young woman. This is a very challenging case and I have considered
> various possibilities including a metastatic lesion. However, based on
> the location and young age, I suspect we are dealing with an unusual
> adnexal lesion. It does not, in my opinion, fit the criteria for soft
> tissue myoepithelioma. Although it is cytokeratin and S-100 protein
> positive, it lacks SMA, calponin, p63 and GFAP. Hence, I would
> consider it an adnexal carcinoma of uncertain type..."
>

It just needs to be removed with an adequate margin. No need for MRIs and
other tests

Steph wrote:

>
> It just needs to be removed with an adequate margin. No need for MRIs and
> other tests

Figures you'd post something that makes sense!

When I had lump on my arm, I was referred to a general surgeon.
As he started to excise, we were both surprived at its appearance (honeycomb
spongy texture) and depth.
He just kept excising until he got the whole thing out.
I wonder why her surgeon didn't do that to begin with. [rhetorical]
da,da,dum,dee....I don't know.
J

On May 25, 7:44 pm, Tom <k9...@hotmail.com> wrote:
> On May 24, 4:57 am, J <xnswex@nalid;"no> wrote:
>
>
>
> > Tom wrote:
> > > [snipped]
>
> > > > > **Summary:
> > > > > 1. Girlfriend's biopsy were analyzed by the lab 3 times. It came back
> > > > > as: malignant, not malignant, malignant
> > > > > 2. Surgery to remove remaining tumor scheduled for next week.
> > > > > 3. No MRIs, bone scans, etc. have been done yet.
> > > > > 4. Should we get a second opinion from another doctor?
>
> > > > > Any advice would be helpful. Thanks.
>
> > > > Malignant with what?
>
> > > > The pathology report should have said exactly what type malignancy they
> > > > identified.
> > > > The risk difference between a basal cell carcinoma and a melanoma are
> > > > enormous.
>
> > > I'm with you on this, but we haven't received a copy of the labs yet.
> > > We'll be visiting the doctor tomorrow. I'm hearing everything through
> > > my girlfriend, so I'm anxious to speak directly with the doctor. From
> > > what my girlfriend has indicated, the doctor doesn't seem all that
> > > familiar with the cancer. I'm not sure what this is based on and it
> > > makes me uneasy. The doctor is a surgeon that specializes in cancer,
> > > but I don't know if he's an oncologist.
>
> > I wonder if they need more tissue in order to be definitive?
> > How did things go yeserday, Tom?
> > J
>
> Thanks for asking. I have the reports, which identified the tumor as
> "adnexal carcinoma, not further classified". The "not further
> classified" part seems to stem from the uniqueness of the sample. I've
> included the pathologist's diagnosis and comments below. I was unable
> to respond sooner because we've been searching in vain for a doctor
> who specializes in this field. After visiting the surgeon who took the
> biopsy, he indicated that we should go back to my girlfriend's primary
> care physician to receive a referral to an oncologist. Back at the
> PCP's office, we were hoping to speak with the doctor for 2 minutes to
> see if she had any oncologists to refer us to. The assistants there,
> however, made us wait several hours before we spoke to the PCP. Then
> the PCP basically said, "I have no clue, so I can't provide any
> referrals. My brother is an oncologist, he'll find someone for you."
> Today, we went to the brother/oncologist, who spent 10 minutes with us
> reciting the lab report (incorrectly, at that) and said "I have no
> clue and can't do anything. Here's a photocopy of a doctor's
> directory. Please pay the co-pay." So, after 3 doctors, we still
> haven't found a doctor who can start ordering (or not order) MRIs,
> lymphatic tests, etc. and we're basically left to "looking through the
> yellow pages". If anyone can recommend a skin/sarcoma oncologist in
> the NYC area, I would greatly appreciate it. Due to the size of the
> tumor, the first surgeon did not recommend Moh's Micrographic Surgery,
> which is what's recommended in the link provided earlier in the
> "Eccrine Carcinoma" article.
>
> Report:
>
> Summary of Immunohistochemical Results
> Marker - Interpretation
> Epithelial differentiation:
> Pankeratin AE1/AE3 - Scattered positive cells
> Keratin CAM5.2 - Strong positive
> Keratin 34BE12 - Negative
> EMA - Positive
> CK7 - Positive
> CK20 - Few weak positive
> Clear cell sarcoma/melanoma of soft parts:
> S-100 - Positive, nuclear and cytoplasmic
> HMB-45 - Negative
> Epithelioid sarcoma:
> E-Cadherin - Rare clusters of positive cells
> CD34 - Negative
> Vimentin - Positive
> p63 - Negative
> TTF-1 - Negative
>
> "Thank you for referring slides of this subcutaneous mass in this
> young woman. This is a very challenging case and I have considered
> various possibilities including a metastatic lesion. However, based on
> the location and young age, I suspect we are dealing with an unusual
> adnexal lesion. It does not, in my opinion, fit the criteria for soft
> tissue myoepithelioma. Although it is cytokeratin and S-100 protein
> positive, it lacks SMA, calponin, p63 and GFAP. Hence, I would
> consider it an adnexal carcinoma of uncertain type..."

I finally got around to typing up (almost) the entire lab, in case
anyone is interested. It shows that the pathologists don't fully agree
on what this is. The first pathologist seems to believe it's "soft
tissue myoepithelioma" while the second pathologist believes it's
"adnexal carcinoma". In any case, lot's of medical terms in there
which I'm not done looking up yet. Sigh... I wish I had followed the
pre-med path in college now :-/

Lab report: http://homepages.nyu.edu/~tn282/labreport.html

BTW, thanks for everyone's responses so far.

Tom wrote:

> I finally got around to typing up (almost) the entire lab, in case
> anyone is interested. It shows that the pathologists don't fully agree
> on what this is. The first pathologist seems to believe it's "soft
> tissue myoepithelioma" while the second pathologist believes it's
> "adnexal carcinoma". In any case, lot's of medical terms in there
> which I'm not done looking up yet. Sigh... I wish I had followed the
> pre-med path in college now :-/
>
> Lab report: http://homepages.nyu.edu/~tn282/labreport.html
>
> BTW, thanks for everyone's responses so far.

Hello Tom,
I looked through it.
Several are suggesting full excision with wide margins which is what Steph
suggested.
he's Asst Prof (surgery) at a well known University in BC Canada and a rad-onc and
oncologst, for many years.
Get it done. Ascertain what it was (note: past tense) later.
J
..