My name is Aleksey and I’m writing you from Moscow, Russia. My question is about my Mother – now we are trying to find the doctor/clinic which has an adequate experience to make a diagnosis in our case.
I'm writing here because my quest of finding the doctor directly is not yet successful.
I have prepared the description of my mother's case, but our main goal is now to find clinic which have an adequate expertise and specialists to make a differential diagnosis in our case, because as our practise shows many doctors in Russia which we are talking with don't have an expirience of such cases. I will be very gratefull to you if you will pay attention to my message and give us a recomendation of doctors/clinic which can help us with professional differential diagnosis.
My mother (53 years) has discovered some very alarming symptoms more than a year ago. Firstly, it was in February 2010, she developed palpable mass of varying volume under her nipple (left breast) with redness of the skin on areole. This mass was clearly reacting on active palpation in the way the inflammation usually do - increasing in volume and increasing of skin redness. My mother are approaching her menopause and she discovered these symptoms in February in days before her menstruation – she also have a massive hormonal changes during last year. After menstruation the redness went and mass went down. After that was a four-month pause in cycle with no symptoms present. But after that in June 2010 prior to menstruation this symptoms had returned together with skin redness not only on areole, but also in lower part of left breast. After that till august 2010 moment this symptoms were present (together with cycle). In the end of august 2010 mother also discovered that areole and skin not only reddish but also have orange peel appearance. So, summing up, for august 2010 she had two distinct symptoms - palpable mass with changing volume under the nipple and redness of the areole and skin with low orange peel effect. In the August 2010 she went through a massive diagnosis in the Russian State Oncologic clinic with doctor’s suspicion of IBC. She had absolutely normal mammogram and ultrasound research. Mammogram showed no any pathologies. Ultrasonic research showed no lumps and stated only two things, including skin thickness and many small cysts under the nipple were the palpable mass is located. The MRI research also didn’t discovered and alarming signs. So, at that point she was said to continue looking at symptoms and came back in case of any alarming changings.
After that in September 2010 her cycle returned and was stable till January 2011 – during this period the symptoms also subdued, the breast redness went. After that cycle disturbed again and starting from this point her symptoms started gradually to become more alarming – redness returned, step by step the breast was becoming more and more swollen and painfull. In May 2011 she discovered an uncomfortable feeling under the left arm. In June-July 2011 she went through a new cycle of diagnosis in the clinic. This time ultrasound didn’t find any pathological signs again – all regional lymph node are normal (including underarm), it stated only increased swollen region near the areola and besides. Mammogram also didn’t discovered anything, except swollen region. This time she also undergone FNA biopsy which, eventually, discovered alarming signs – the conclusion of cytological analysis states that (translate from Russian) “fragments of stroma are present, proliferating cubic epithelium, complexes of polymorph cells with signs of atypical nucleis”. Summing up the whole picture the doctor insists on the diagnosis of IBC.
I have read many sources about breast diseases in the last year (however, I’m not a specialist in medicine or any biological field). And in different sources including as usual articles like that (http://breastcancer123.org/treatment-of-plasma-cell-mastitis/) or books like that (Rosen's Breast Pathology http://books.google.ru/books?id=_DJvdehOkzgC&printsec=frontcover&dq=rosen%27s+breast+pathology&hl=ru&ei=n0lwTPvRIoeAOJDmxYYL&sa=X&oi=book_result&ct=result&resnum=1&ved=0CC0Q6AEwAA#v=onepage&q=plasma-cell&f=false) I found that exist a disease Plasma-cell mastitis which simulates symptoms of IBC (as I can see from many, but not all sources, even ‘orange peel'), but are common for women approaching menopause and often results from hormone imbalance. Some more articles with speaking for itseld titles for example: http://casereports.bmj.com/content/2010/bcr.03.2010.2844.abstract and http://www.belsurg.org/uploaded_pdfs/106/106_222_224.pdf And as I can see, plasma-cell mastitis is also have a symptom of palpable mass under the nipple and areole, which IBC doesn't have. As I also read from Rosen's book, the difference of IBC and plasma-cell mastitis is hard to catch on FNA biopsy, because in case of plasma-cell mastitis hyperplastic epithelial cells are present which appears as atypical cells. I also found that atypical cells which are present in case of plasma cell mastitis (and some ‘close by’ diseases) can have atypical nucleis and be polymorph which is closely resemble cancer cases and that clear difference may only be based on disease history and analyzing of paraffin sections (FNA and frozen sections can’t view the difference) or making an immunohistochemistry analysis.
The problem is the none of doctors we are talking with don’t know anything and don’t have any experience in diagnosis of plasma cell mastitis or any similar diseases.
So, now we are trying to find the doctor/clinic which has an experience in careful analyzing the cases like I have described.
I'm looking forward for your answer and comments on my letter - I hope that you may now how we can find a clinic/doctor which will be able to help us in diagnosis and treatment (The best choise for us will be the clinic in Germany). Anyway, I will be very gratefull for any comments and thougts!
Thank you very much for your time and attention. We will be very grateful for your response.