Second Opinion on Pathology

Today I received the second opinion report in the mail. Here's what it says:

"After speaking with the patient who called my office about her case, I realized that the reason I received only ten blocks and no slides is because the slides had been lost during the process of closing of the initial hospital where the surgery was done and the only thing that remained were the blocks. I therefore had the blocks re-cut here in out laboratory and will indicate to you my opinion on those re-cut slides since the originals are no longer available.

She has what appears to be in the isthmus a cystic papillary carcinoma of usual type which measured 1 cm according to the original pathology report. She has in the right lobe, specimens "three" and "four," multiple foci of papillary microcarcinoma with associated positive lymph nodes with metastatic papillary carcinoma. I do not see extranodal extension. It is difficult for me to assess whether or not there is extraglandular extension by the papilllary carcinoma although in some sections, tumor nodules come very close to an inked cauterized surgical margin. What I do note in several of the blocks from the right lobe are numerous intraglandular psammoma bodies in lymphatics. This correlates well with the fact that she has lymph node metastases.

Since she was under forty-five years old at the time of the diagnosis of this case, she would be a Stage I lesion (that would be T1N1Mx) by the AJCC staging system.

In summary, then, my diagnoses are:

Thyroid gland and lymph nodes:

1) Papillary carcinoma, classic type, multifocal, largest lesion and isthmus, approximately 1 cm; no definitive extraglandular extension identified; numerous intraglandular lymphatic psammoma bodies seen. ICD9 193.0

2) Metastatic papillary carcinoma, classic type, to several perithyroidal lymph nodes; no extranodal extension identified. ICD9 193.0"


So that's it. Not a lot that's more revealing than the original path report, but the original never said anything about extraglandular extension and extranodal extension, so I like that she included some thoughts on that (although not definitive on the extraglandular extension). Oh well. The main thing for me was putting to rest my obsessive fears that I might have been misdiagnoses initially and really had a way more aggressive variant. So it was good to get the opinion to rule that out.

The first time I spoke with Dr. LiVolsi, she didn't ask me anything other than why she only got blocks and not slides, and I explained it to her; the second time I spoke with her, she called me back to let me know that her secretary, Cindy, had faxed the report to my doc's office days earlier. My doc's office hadn't received it. Anyway, it was in that second, very brief, conversation that I started babbling at her (I got all nervous that the doc herself called--even though I'd talked to her once before, I was all star-struck)...and that's when the "queen of thyca path" thing shot out of my mouth. Since it was a compliment, she warmed up more and told me the little story about her colleague having an artist daughter who made her a beautiful piece of very colorful art featuring the thyroid gland, and this person had dubbed her "the high priestess of the butterfly gland."

I've got 6 more days til my RAI and 8 more days of the LID. Yea! You know how pregnant ladies "nest" before they have their babies (I sure did!)...that's how I've been lately. I've been baking LID bread and muffins and trying to get some meals cooked ahead of time for my hubby and sons and just trying to get stocked up on things at the grocery store for when I'm isolated in the master bedroom (which is small and can't really be called a "master bedroom" without air quotes).