Second Opinion on Path

[Physast]

As I have made aware in other threads I sent my Slides to Indianapolis for a second opinion. My case was given to Dr. Chang. Side Note: the people at Indianapolis are really nice. They not only get things done fast, but they seem to genuinely care about the case and how the patient is feeling.

Anyway I received a call today stating that Dr. Chang needed to order a block for a immunostain. I have no idea what this means but I hope it's not bad (does anyone know). He said he needed this before he could make a diagnosis.

Note: my AFP at surgery (9/5/07) was AFP 120 ng/ml and HCG 6.8 UL/L and on (9/13/07) AFP 41.1 ng/ml and HCG 0.5 UL/L.

I also had my local doctor take blood work on 9/25/07 to check my markers. The results came back AFP 12ng/ml and HCG < 2 mUL/mL.

I realize that they used different methods to measure the markers then they do at Duke so you can't directly correlate them, but it still shows they are going down.

Anyway I will keep you updated on the second opinion results.

[Fish]

It sounds like he wants the actual block of embedded testicular tissue to have a new slide cut and stained with special antibodies. Certain antibody stains are performed to confirm the cell types in the tumor. I would not be overly concerned.

It's good to see your markers continue to drop.

[Fed]

Anyway I received a call today stating that Dr. Chang needed to order a block for a immunostain. I have no idea what this means but I hope it's not bad (does anyone know). He said he needed this before he could make a diagnosis.

A block is basically the paraffin-fixed pathology sample. When they did the I/O, they fixed the testicle and partitioned it into blocks. In order to make slides, you take slices from the block, mount them on a slide, and usually they just stain the slice with H&E (hematoxylin and eosin -they stain cell nuclei, among other things- so you can see the cells under the scope). When they want to verify the presence of other proteins, then they do an immunostain. Instead of treating the slide with H&E, they treat it with an antibody specific to the protein of interest. If such protein is present in the sample, the antibody will stick to it, and this is either detected by an enzymatic reaction or a dye.

Hope this helps clear things up.

[Physast]

Thanks for the replies! I get so worried about everything these days. I tend to look for anything abnormal and automatically assume the worse.

I still have not had a good chance to deal with what is going on. I have been busy trying to get my insurance to pay for the treatment and with my new job and loosing my recent job. I have been thinking about looking into a group that I could join for awhile to try and work out my feelings. And of course I am seeing If I will be able to make the Dec. 15th get together, but that does not look good right now.

I have already started to change my diet (more raw veggies, organic, less fats, more turkey, chicken and fish) and I am trying to get in the habit of doing things I enjoy and splurging more on things that I want, but don't need (Maybe a Flat Screen TV!!)

Anyway, I will keep everyone posted on the good news to come from my second opinion.

[Physast]

I just received my second opinion on my pathology report from Indianapolis.

History (my first path report from Duke):
50% Teratoma, 50% yolk sac Path stage: pT1 pNX pMX

Tunica vaginalis: Negative
Spermatic cord: Negative
Scrotal Invasion: Negative
Vascular invasion: Negative
Closest Margin: 0.4cm

New Path from Indianapolis:
65% Mature and immature Teratoma, 10% embryonal carcinoma, 25% yolk sac
Tumor size: 3.0 x 2.5 x 1.0 cm
Invasion: not identified

Tunica albuginea: Free of tumor
Proximal spermatic cord: Free of tumor
Capillary-lymphatic space: Free of tumor
Intratubular germ cell neoplasia: Present (IGNC, unclassified type)
Spermatic cord margin: Free of Tumor

Stage: pT1

Does anyone know what Intratubular germ cell neoplasia is?? So now I await my doctors appointment at Sloan. Do you guys think the plan of action from (surveillance) might change because of the 10% embryonal carcinoma???

[Scott]

Do you guys think the plan of action from (surveillance) might change because of the 10% embryonal carcinoma???

No, I don't believe that will affect the plan.

[Scott]

Does anyone know what Intratubular germ cell neoplasia is??

A synonym for carcinoma in situ, malignant germ cells within the seminiferous tubules.

[dadmo]

From that report I would think that surveillance is a reasonable choice. In my opinion if they recommended chemo it would be as a preventive and not a necessity. I would wait on the chemo until I know it's needed but don't dare miss a follow up appointment.