re: cytology report

hull122 · New User Joined: 14 Oct 2007 Posts: 5

A bronchoscope was used , the wash sample showed epithelial lung cells and pulmonary machrophages, a few atypical cells not diagnostic of malignancy. The brush sample showed malignant cells , non small cell , favors adenocarcinoma. Does anyone know why the two samples would not have the same diagnosis?

In · Posted: Mon Oct 15, 2007 12:50 am Post subject: Re: re: cytology report

Hull- you need to give us some background.

what cancer. stage type
what diagnoses
what treatments have been done etc..
you'll get more answers that way.
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hull122 · New User Joined: 14 Oct 2007 Posts: 5

I am not sure I know where to start . The question I posted was in regards to my mother . In march of 2006 after experiancing chest pains , my mom had gone to the Dr. who feared she was possibly having a heart attack. She was transported to a local hospital , tests were ran and she was admitted for 24 hrs observation. The next morning she had a visit from our primary care physician who stated that a chest x-ray done in ER was originally thought to be a small pneumonia however when viewed later by the radiologist they decided further evaluation was needed. A CT pulmonary angiogram w/ contrast and a chest Ct were done. Due to my mother being overweight there was limited contrast opacification of her pulmonary artery. No embolism was detected . There was " marked extrinsic mass " effect on bilateral upper lobe pulmonary arteries and left lower lobe pulmonary artery related to extensive mediastinal or hilar adenopathy as well as a compression on the upper and lower left pulmonary bronchi. The chest CT showed lymphadenopathy in the anterior mediastinum , superior mediastinal , aortapulmonary window , subcarenal region, r. paritracheal region, and a azygoesophageal recess and bilateral hila . Three pulmonary masses in the left upper lobe with the largest being 14mm located anteriorly at the level of the aortic arch, demonstrating spiculation and an adjacent pleural thickening . Some additional lung nodes were seen anterolaterally and peripherally in the upper left lobe . A thin walled cavatary lesion was seen in the superior segment right lower lobe posterioly . A possible thick walled bleb or a cavitary inflammatory or neoplastic process. Upper abdomen showed mild fatty infiltration of the liver and smaller lymph nodes in the gastrohepatic ligament near the celiac axis , size range 7-10 mm. Considerations listed were lymphoma , a metastatic neoplasm w/metastatic medialstinal and hilar adenopathy or thirdly a pulmonary bleb versus a cavitary neoplasm/inflammatory process. A mycardial stress/ rest test was done that showed a defect in the anterior wall near the apex indicationg a myocardial scar. The abdominal and pelvic Ct w/ contrast , showed enlarged periceliac and retroperitoneal lymph nodes and a 2.8 cm left adrenal gland mass.A pulmonary Dr was called in to perform a bronchoscope . The Dr had told us he thought this was a possible case of sarcoidosis . He was unable to get a biopsy tissue sample due to the inflamation but did submit left upper lobe bronchial brushings that showed malignat cells , non -small -cell that favor adenocarcinoma, the bronchial washing, lavage however was epithelial cells and pulmonary machrophages that showed a few atypical cell groups not diagnostic of malignancy. The pulmonary Dr told us after these results it was bronchoalveolar carcinoma due to her being a former smoker ( 9 yrs since she quit ). An oncologist was called in who did a multitude of other tests , mammogram showing multiple round and irregular nodules from 5-8 mm needing further evaluation ( never performed ) , a bone scan was done , mri's of brain etc... The oncologist said thsi was metastatic adenocarcinoma unknown primary . Her guess was a primary breast or gi cancer but no primary tumors found . She had elevation of tumor markers CEA and CA15-3 both very high . Upper GI and lower GI showed no signs of cancer . My mother had several MRI's over a 12 yr period 6 to be exact. It was speculated that she had MS for all that time . In jan of this same yr she was diagnosed with MS , reasons given were changes in MRI over the yrs and a positive epstein barr test . The MRI's the oncologist ran showed extensive bone cancer , but all these yrs she had these same abnormalities and we were always told it was degeneration etc... I want to add that she also had a total hysterectomy done in Aug 2005 7 mos prior to this cancer diagnosis . It was an abdominal hysterectomy. Enlarged uterus , w/florid adenomyosis , uterine fibroids , and hyperplasia . She was also told she had cervical dysplasia . She opted for chemo , gemzar made it through 1st cycle and 2 sessions of a 2nd cycle before Dr said no more . The tumor markers went down and no more lymph nodes were seen on tests however one lymph node in chest was resistant and caused such obstruction that her lungs were being compressed further . Diagnosed in March and she passed away in late june . I am unsure exactly what cancer she had . Multiple records state lung cancer , some say metastatic unknown primary and hospice was told adrenal gland cancer . This is why I posted my question. I just was curious if malignancy was in a brush sample why not in the deadened cells. She was 51 yrs old.

leo · Owner Joined: 23 Sep 2004 Posts: 1574

Hello

Sorry to hear about your mother. Sometimes it is difficult to pinpoint exactly where the cancer started, even after testing the cells. Depending on whom you ask, doctors will give their best estimates of where it may have come from, and treat as such. If she was treated as "unknown primary", there is really no standard treatment, and experience of the treating physician counts a lot. Not sure how much more I can add, but I think there is a good chance you will never know exactly what happened.

best regards
Leo
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hull122 · New User Joined: 14 Oct 2007 Posts: 5

Leo... thank you for your reply. I know that I will never know where or even why my mother's cancer started and that is so hard for me . I have read so many articles , researched numerous websites etc... trying to gain some sort of understanding of this disease . I have lost many family members to cancer. My mother was so untypical of anything I have found . It is funny because she was never "typical" . When she was diagnosed she herself chuckled when the Dr. quoted her statistics, her response was " I will be that 2% in 5 yrs surviving , I have never been typical , so I will defy these odds "
She never even made the full 3 months , so I guess she was not "typical " , not in the way we all had hoped though . I must say though this Dr. did not want to do anything at all , other than some radiation to her lumbar , my mom had a spinal compression . She had been walking with an old cane belonging to my grandfather for almost a year , as she thought this was all related to this MS they said she had . They said the cancer was in her bones.
She told the Dr she was too young to die and she was gonna fight this , beat it . The Dr. always said there was no cure for her disease only treatment,she recommended Gemzar and radiation. The Gemzar was not used with any other drug and was recommended because the Dr said it was fairly easy on the system with the least side effects. The radiation to help my mom be able to walk again. There was some controversy about this radiation... The radiation oncologist believed they needed to do mom's lungs as well as lumbar area. The oncologist said no!... lumbar only lets get this chemo started.My mother never had a cough , no sign of any infection, none of the "typical " things I read on lung cancers. It was all a total fluke any of this was ever found. She went to the Dr for chest pains which turned out to be a panic attack , they said . They had put her on decadron and she had a bad time with it . She would have swelling and suddenly she would develope stridor ... something that was never evident until this medication would get into her system... They attempted use of this medication two seperate times. The second time it was used her Dr was on vacation and another Dr in the office had her taking it . The 5 times a day for so many days etc... that time she also developed mania as well as the stridor .In fact they thought the cancer had mets to the brain . They did mri's and the brain was fine , it was this decadron . They had me pull her off it and within 4 days she was normal again . It was an uneven trade though, because w/out it she had so much weakness and pain and she was back to immobility again . This is when they stopped chemo. Explained to her, how the chemo was working and how it was not, and told her they would need to use it with another drug to get even more results . The DR explained how quality of life is better and suggested she stop chemo. She was admitted to the hospital for a few days , the Dr said it was to give me a break(I was taking care of her ) and give mom a break from home. She was in the hospital about 5 days , came home with a nasty infection... coughing etc.. her vns nurse tried getting her antibiotics but they wouldnt do it . She came home on a thursday was in hospice by the following monday , and passed away thursday . I am sorry this is so long.I suppose I was tying to find someone else who might have had a situation like this . I just wasnt clear as to why two seperate samples of the same area would differ. I was curious if there was any signifigance in this . I didnt even know where to post my question. I can tell you one thing I do know ... my mother's death certificate says lung cancer ... am I silly to be so angry? Is this typical? ughhhhhh . I am done babbling ... Thank you !!!

leo · Owner Joined: 23 Sep 2004 Posts: 1574

Hello,

Sorry to hear what you and your mother have been through. Still, this is fairly common with bronchoscopy bipsies and brushings....one of the techniques may be diagnostic, the other won't. What counts is the positive one, since there was a high suspicion for disease.

Anyway, having been on the other side of things (being the doctor), I can guarantee that this was all done with the best of intentions. What our treatments can certainly do is make things worse, and patients that are too weak and debilitated are the ones who get more toxicity from treatments, therefore the art of oncology is really figuring out who should get what treatment.

What you're going through is absolutely normal. You are mourning the loss of a parent, and it must be tough. I am sure there are many here who would be willing to help you through this forum.

best regards,
Leo
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Disclaimer: this information is for informational purposes only. It is not medical advice.

jenugl · Posted: Fri Oct 19, 2007 7:44 am Post subject: Re: re: cytology report

Hi hull122, I have no answers for you but through your words and having lost both parents I can feel your pain. I hope you can look back at some happy memories of your mother in time without the anger and sadness. It takes time to go through the greiving process and having the unanswered questions that you have must make it even more distressing. Please know that I am thinking of you and send you my thoughts, prayers and support. Love to all. Jen.

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