My Pathology Report and Frustrations

Testicular Cancer Pathology

Waiting For Pathology

After my surgery I was now waiting on my pathology. I remember laying on the couch one day during the week after surgery and I saw a phone call come in and I knew who it was. I answered the phone and my mind was scattered into a million places as my DR told me the pathology report came back.

He calmly said Joe, we have the pathology report back. You have testicular cancer and it’s 100% seminoma Pt1. He said there was no invasion and the tumor was confined to the testis. Dr R then told me he’d refer me over to a radiologist to start radiation treatment. The phone call lasted only a couple of minutes but felt off to me. I hung up the phone with Dr R then thought about what my options were if any at all.

Joining A Community

I wanted to get a second opinion. Shortly after my diagnoses I signed up for a testicular cancer forum. This ended up being a blessing. After I signed up and posted my story to the forum I was almost instantly contacted by Mike who owns and runs that forum. He sent me an email and said to contact him if there was anything he could do.

I did send Mike an email and it was the best thing I could have ever done. Mike promptly got back to me with referrals and a lot of information to get me on the correct path after diagnoses. He sent me the names of two specialists out of Cleveland. There was one who he met in person out of Cleveland Clinic. The other Dr recommendation Mike sent over to me was a Urologist/Oncologist out of University Health system.

Since everything thus far was under University Health’s roof I decided I’d stick with UH. Before I jump way ahead of myself I want to go back to my pathology report. But before I even do that, I want to stress how important it is for anybody going through a cancer diagnoses to get all copies of their information.

This is smart for you to do so you have all of your information for any second opinions. I had Dr R’s office fax my information over to my new Dr K but I was able to give Dr K all of my imaging as well as the reporting. I can’t stress how important that is. Time is of the essence.

After my surgery I hobbled around the main hospital campus getting all of my imaging on CD as well as my pathology report printed. When I got my pathology I was kind of taken back out simplified it was but had many questions that to this day aren’t still completely answered.

Here are the details of that report.

My Pathology Report

Specimen:

A. LEFT – TESTICLE AND SPERMATIC CORD

Gross Description:

Received in formalin labeled “left testis and spermatic cord” is a testis and spermatic cord. The testis measures 5.5 x 4.0 x 2.0 cm and the spermatic cord measures 10 cm in length x 1.2 cm in diameter. The specimen had a weight of 70 grams. The outer margins are inked with black ink. The spermatic cord margin is inked with blue ink. The spermatic cord and the next section are obtained. On sectioning along the length of the spermatic cord no lesions are noted. Multiple representative sections are submitted as follows: 1) spermatic cord margin and neck section; 2) mid-spermatic cordl 3) distal spermatic cord;4-8) representative sections of testis; 9.10) representative sections of fibroadipose tissue adjacent to the testis.

FINAL DIAGNOSIS

Left testis, left orchiectomy:

– Seminoma.

Specimen laterality: Left.
Tumor focality: Multifocal.
Tumor size: 0.6 cm.
Macroscopic extent of tumor: confined to testis.
Histological type: Seminoma, classic type and intratubular germ no neoplasia – seminomatous.
Spermatic cord mardin: Uninvolved by tumor.
Microscopic tumor extension: Not identified.
Primary tumor (pT) : pT1.
Regional lymph nodes (pN) : pNX.
Distant metastasis (pM) : Not applicable.

Pathology Questions

After seeing this pathology report it raised a couple of flags for me. I picked up the phone and called Dr R and asked him about the multi focal tumor and why on the pathology it only listed one tumor at 0.6 cm. The largest tumor on the ultrasound measured 1.3 cm but these other two lesions were not listed for some reason.

Dr R seemed kind of irritated when I asked him about this and pretty much said “It doesn’t matter because it’s not going to change your diagnoses”. I was kind of rattled by what he had said. I understood it wasn’t going to change my diagnoses but I know that having the correct pathology is crucial to what my treatment options are.

Dr R went ahead and ordered a CT Scan with and without contrast. This was the first time I had a CT scan but it wasn’t too bad. I had to drink some sour stuff and got injected with some stuff that felt all warm running through my body. After my scan I asked them if they could put the imaging on CD for me which they did.

CT Scan Results

A few days after I got my CT scan my DR R called me with the results. For the most part everything sounded good. There were a couple of enlarged areas but may have been due to the surgery which was outlined in the report. The other thing that was concerning to me but didn’t seem concerning at all with the doctors is two small 3mm nodules found in each of my lungs. On the report it listed them as of probably no clinical significance and most likely a “granuloma”. Below are the results of this scan.

STUDY: CT ABDOMEN/PELVIS WITH CONTRAST; CT THORAX WITH CONTRAST

INDICATION: Testicular Cancer. Recent diagnoses of testicular cancer, status post left orchectomy. Complains of muscle tightness in the abdomen on and off for several months.

TECHNIQUE: Helical data acquisition of the chest, abdomen, and pelvis was obtained following the intravenous administration of 100 cc of Isovue-300. Images were reformatted in axial, coronal, and sagittal planes.

I’ll post things that have extra comments on things other than “normal”.

MEDIASTINUM HILA, LOWER NECK AND AXILLA:

The visualized thyroid glan is within normal limits. No evidence of thoracic lymphadenopathy by ct criteria. Minimal soft tissue attenuation in the anterior mediastinal fat without mass effect, most likely representing residual thymus.

LUNGS AND AIRWAYS:

The trachea and central airways are patent. No endobronchial lesion.There are mild areas of atelectasis, most conspicuous in the lung bases. No consolodation is seen. There is no effusion or pneumothorax. Tiny 2 mm high-density nodule noted in the periphery of the right upper lobe, image 84 of 289, most likely a tiny calcified granuloma. The 2 mm tiny nodule also noted in the left lower lobe, image 216 of 289. This is of doubtful clinical significance and can be re-evaluated on follow-up studies.

CONCLUSION: IMPRESSION:

Postsurgical changes relating to left orchectomy. Borderline prominent but non specific mesenteric nodes within the right lower quadrant. Tiny 2mm nodules in the right upper lobe and left lower lobe which are of doubtful clinical significance and most likely represent granulomas but can be re-evaluated on follow up studies. No retroperitoneal lymphadenopathy.

Final Thoughts

I have since brought all of my information and imaging to Dr K who will be handling my case from here on out. It was the best decision I could have done to get a second opinion. Dr K took my imaging the day I went in and looked it over.

He said he saw something suspect the radiologist may have overlooked. He set me up for a CT scan two weeks out from that day. This scan I have next week and which I’m hoping will be all clear. These new results will depend on what my options on going forward.

Dr K also ordered some more blood labs for tumor markers. I have had a lot of these labs lately which have all come up negative so far. I have my fingers crossed and lots of prayers said for a clean reading here in the next couple of weeks! I will keep my blog updated on what my next steps are in this journey.

While I was there I asked Dr K a lot of questions which he took the time to answer. He didn’t really seem too concerned about the pathology report but insisted I get the pathology slides to bring to him on our next visit.

I went to the hospital this week to get my pathology slides and things got kind of weird. They released the slides to me and sealed it in an envelope. My wife opened the envelope to take a look and we discovered something crazy. She found 10 slides that belonged to somebody else! We quickly turned around and gave this person’s slides back to the pathology department.

Dr K is well versed in testicular cancer and I’m pretty confident he’ll be able to identify if there was something different on the slides. I want to make sure the diagnoses is 100% so we can confidently select the right treatment options if it will go beyond surveillance.