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Diagnosed with Sarcoidosis and breast cancer. Can stain test for T-cells be done? Granuloma?

Mar 2013
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I am a diagnosed Sarcoidosis patient(pulmonary) I am in remission. I have now been diagnosed through a needle biopsy as having breast cancer measuring 12mm. I requested the Pathologist to do the stain test for T-cells and he said that they only do this for lung involvement? Due to my querying the T-cells stain test the Pathologist has said that he will now do two additional test being P63 and smooth muscle myosin?? How can I be sure that the lump in the breast is not a granuloma when all they are testing for is cancer cells. My Sarcoid notes that I have say that a Needle biopsy will destroy the structure of the sarc granuloma making it very hard to recognise under a microscope giving a false cancer diagnosis.
Posted Sat, 29 Jun 2013 in Lung and Chest disorders
Answered by Dr. Aarti Abraham 1 hour later
Thanks for your query.
P63 and smooth muscle myosin will help to differentiate actual breast cancer from its histological mimics, one of which is sarcoidosis.
Also, you are right, a needle biopsy will be inconclusive as it would not differentiate breast cancer from sarcoid granuloma.
You should insist on an excisional biopsy which will be conclusive.
Take care.
Above answer was peer-reviewed by
Follow-up: Diagnosed with Sarcoidosis and breast cancer. Can stain test for T-cells be done? Granuloma? 2 hours later
Dear Dr,

Thank you for your reply. I am to be sent to a Surgeon for excision but I am worried as they are talking about taking out a few lymph nodes to test for cancer.(the lymph nodes were clear on the ultrasound) I would like them to leave the lymph nodes alone until the Pathologist have tested the excised lump.

1. What would you suggest?
I cannot see merit in removing lymph nodes with a possible lymphodema
occuring when this could totally unnecessary
2. Once the lump is sent to Pathology how do they then differentiate between
cancer and Sarcoidosis(what will the lump tell them that the needle biopsy
hasn't already )
3. What will be different from testing the lump opposed to the needle biopsy?
(How will having the lump give a conclusive result either way.)

Answered by Dr. Aarti Abraham 11 hours later
1. Sometimes lymph nodes are clear macroscopically ( grossly on appearance ) but come out positive on biopsy ( microscopically). Also lymph node sampling would further differentiate sarcoidosis granuloma from cancer.
2. Only a few lymph nodes are sampled , the possibility of lymphoedema is very low, because lymphoedema is caused only when more lymph nodes are removed, when they are involved in the disease process, unlike sampling or testing, where only few are removed.
3. The needle biopsy is taken at one specific point and is not representative of the entire lump. Excisional biopsy takes into consideration the margins and the WHOLE lump, and yields more information than just needle biopsy. Also, during needling, the tissue is handled more, and chances of error in interpretation increase.

Hope this clarifies things.
Take care.
Above answer was peer-reviewed by
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