Wednesday, June 29, 2011

mixed pathology report

We just got back from seeing our doctors at Beth Israel. The pathology report had both good news and bad news in it. The main good news is that the growth was indeed what they had diagnosed: an epithelioid angiomyolipoma, and not a recurrence of either of Deb's two previous cancers. It was also good news that the other (smaller) lesions that turned up on the ultrasound during surgery seem to be epithelioid angiomyolipomas of a less serious kind; there is reason to hope they might sit there doing nothing into the indefinite future.

The bad news was that the surgery did not produce a clean margin; the tumor goes right up to the edge of the removed lobe and presumably somewhat beyond. Dr. Hanto, the surgeon, says that he cauterized the area, which would kill the tumor cells for another few millimeters. Whether that is enough or not, or whether the surviving cells will be able to reconstitute a viable tumor, we don't know. (Something similar happened when Deb's GIST tumor was removed in 2003. That time the cauterization seems to have been enough, and the GIST has not been seen since.)

Dr. Pandya, the oncologist, emphasized the unchartedness of the territory we're in. Malignant epithelioid angiomyolipomas are extremely rare, to the point that we're talking in terms of case reports, not studies or statistics. (For example, we don't know whether the small nonmalignant epithelioid angiomyolipomas are unusual or not. It's possible lots of people have them and never notice them. Deb may have already had these for many years.)

Both doctors recommended watching to see what happens next rather than jumping into more surgery or some other kind of treatment. We have another ultrasound scheduled for late September, when Deb's liver should have healed and regrown.

Everyone seems happy with the way she is recovering from surgery. We'll go back for another follow-up with the surgeon next Wednesday.

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