Metaplastic?
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Topic: Metaplastic?
Posted By: Loricarol
Subject: Metaplastic?
Date Posted: May 28 2009 at 11:05am
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Hi ladies
After reading my path report myself i was alalmed to see the words metaplastic features and squamous cell differentation. Does anyone know what metaplastic means?
Thanks !  ------------- DX 4/30/2009 IDC, stage 1 ,grade 3,2 tumors,node negative,clear margins ,BRCA negative left breast mastetcomy, 4 cycles of Adramycin and Cytoxan 12 weekly treatments of Taxol start 8/12. No rads. |
Replies:
Posted By: trip2
Date Posted: May 28 2009 at 12:52pm
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http://www.cancer.net/patient/Cancer+Types/Breast+Cancer+-+Metaplastic - http://www.cancer.net/patient/Cancer+Types/Breast+Cancer+-+Metaplastic
http://en.wikipedia.org/wiki/Squamous_cell_carcinoma - http://en.wikipedia.org/wiki/Squamous_cell_carcinoma
Hope this help Loricarol.
------------- Stage 2 2003 Stage 1 2007 BRCA 1+ |
Posted By: Loricarol
Date Posted: May 28 2009 at 1:50pm
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Pam
Thank you for the information. My ONC stated that having some metaplastic components to my tumor did not mean that i had metaplastic breast cancer. I hope she is right. Then she asked if i wanted a third opinion. Sometimes i feel likethe patient asking questions is a bother to them. But it is our bodies and our lives at stake. ------------- DX 4/30/2009 IDC, stage 1 ,grade 3,2 tumors,node negative,clear margins ,BRCA negative left breast mastetcomy, 4 cycles of Adramycin and Cytoxan 12 weekly treatments of Taxol start 8/12. No rads. |
Posted By: trip2
Date Posted: May 28 2009 at 2:33pm
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Hi Loricarol, you are so right!!
It is our bodies and we are hiring these people to make us well.
That was interesting information about how your tumor may just have some metaplastic components. This really gets confused doesn't it?? ------------- Stage 2 2003 Stage 1 2007 BRCA 1+ |
Posted By: glenine
Date Posted: May 28 2009 at 3:02pm
Hi!,
I was dx back in 2001 with metaplastic carcinoma with met to the lung.
This type has components of both a sarcoma and a carcinoma...It is rather rare also..I sought out a third opinion at St Vincents in NY with Peter Paul Rosen MD a leading sarcoma expert.His advice is to have the actual slides looked at by a few pathologists in a leading cancer center. Interesting also that this type usally spreads via the bloodstream not the lymph nodes/My nodes were neg but the cancer went to the lung via trhe blood.
take care,
glenine
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Loricarol wrote:Posted By: Loricarol
Date Posted: May 28 2009 at 3:15pm
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Glenine
I cant even seem to get a straight answer from Huntsman on the path report. They say that the fact that the pathologist states it has metaplastic components means "nothing". I'm not comfortable with that answer but when i ask questions its as if i have insulted theri intelligence or something. How did you get a third opinion while you were in Chemo werent you too tired? I want a third opinion too but now wander with chemo looming if i will have the strength to do it. And if i get the opinion and it is metaplastic will it change my course of treatment?
Glenine how are you doing since 2001? It looks like you have done well even with lung mets.
I guess i need to get my slides and all my chart together then and seek out that third opinion. ------------- DX 4/30/2009 IDC, stage 1 ,grade 3,2 tumors,node negative,clear margins ,BRCA negative left breast mastetcomy, 4 cycles of Adramycin and Cytoxan 12 weekly treatments of Taxol start 8/12. No rads. |
Posted By: trip2
Date Posted: May 28 2009 at 4:51pm
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Loricarol, so you have already had a second opinion?
There is certainly nothing wrong with a third opinion. This is your body and you want to do the best they have to offer to you.
Maybe you could get in to see someone before chemo begins?
Good luck to you and let us know if we can help. ------------- Stage 2 2003 Stage 1 2007 BRCA 1+ |
Posted By: Loricarol
Date Posted: May 28 2009 at 5:32pm
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Pam
I have had 2 opinions but neither commented on what i read in my own pathology report about having metaplastic components in part of one of my two tumors. when i questioned my current MD at Huntsman here in Utah she brushed it off and said its just a different type of cell they see on the pathology. It was as if she knew nothing of metaplastic breast CA or didnt care to discuss it with me. She indicated that it made "no difference"in my care at all. No one had ever told me that the patholgy said one tumor had "metaplastic components characterized by squamous differentiation with enlarged ,bizarre nuclei and numerous highly atypical mitotic features. This is scary stuff yet none of them ever even told me it was in my report. What do you think? Im a nurse so im pretty aware of what most of those medical terms mean.
I hope to get that third opinion but also realize i must not delay chemo either.  ------------- DX 4/30/2009 IDC, stage 1 ,grade 3,2 tumors,node negative,clear margins ,BRCA negative left breast mastetcomy, 4 cycles of Adramycin and Cytoxan 12 weekly treatments of Taxol start 8/12. No rads. |
Posted By: ChrissieD
Date Posted: May 28 2009 at 5:32pm
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Loricarol,
You asked a good question about whether or not it would be treated differently if it was metaplastic. I would get a 3rd (or 4th or 5th...) opinon if you don't feel you have all the answers you need. If you don't feel up to physically to get all the slides/etc. and go to see anyone else perhaps you could email with your third opinion doc to ask the question. I emailed with my 2nd opinion doctor a couple times before I made an appointment to see him (he is a famous onc too).
Keep at it until you get the answeres you need. ------------- 39 from MA, Mom(8.5 and 6), Lumpectomy IDC 1.5cm Stage I, Grade 3 ACx4 Taxolx4 dose dense started 11/17; Bi-lateral Mastectomy with expanders scheduled for 3/24/09 God is carrying me through ! |
Posted By: Loricarol
Date Posted: May 28 2009 at 5:41pm
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Chrissie
wow thanks for replying. Is there any way you would share with me who your ONC is? maybe he would do the same with me? All i would need to do is get my slides and file to him. I would love to get connected with him now. Do you think he would consult with me? Im just feeling pushed for time and like the 2 ONC's here are acting as if it isnt anything to even consider not even worth discussing it. grrrr Its my life and i want to fight this cancer with the best advice and medical help out there. If you take your slides from your original hospital can they be replicated or what?
God is carrying me through too!
Thanks and God Bless
please write me back. ------------- DX 4/30/2009 IDC, stage 1 ,grade 3,2 tumors,node negative,clear margins ,BRCA negative left breast mastetcomy, 4 cycles of Adramycin and Cytoxan 12 weekly treatments of Taxol start 8/12. No rads. |
Posted By: trip2
Date Posted: May 28 2009 at 6:18pm
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Loricarol,
In this ACS article, scroll down to Metaplastic and it says it is treated like an invasive ductal breast cancer.
http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_is_breast_cancer_5.asp?sitearea=CRI - http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_is_breast_cancer_5.asp?sitearea=CRI ------------- Stage 2 2003 Stage 1 2007 BRCA 1+ |
Posted By: Loricarol
Date Posted: May 28 2009 at 7:01pm
 Pam
THANK YOU!! I have been looking for information all evening and trying to decifer how it would change anything if in fact my tumors were metaplastic. As it stands now with the help of your very reputable article i can rest knowing that the treatment would essentially be the same.
Thank God my path says just a "portion" of one tumor has componets so at least not the entire tumor shows these cells.
God Bless you!
Lori ------------- DX 4/30/2009 IDC, stage 1 ,grade 3,2 tumors,node negative,clear margins ,BRCA negative left breast mastetcomy, 4 cycles of Adramycin and Cytoxan 12 weekly treatments of Taxol start 8/12. No rads. |
Posted By: mefowler
Date Posted: May 28 2009 at 7:23pm
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Dear Lori and others, I PM'd Suzie with this study, and she thought that I should put the link on the board. This is a study with tyrosine kinase inhibitors for metaplastic breast cancer. It is available on-line at no charge at the following web address: http://mct.aacrjournals.org/content/7/4/944.full.pdf+html - http://mct.aacrjournals.org/content/7/4/944.full.pdf+html Hope this is helpful to some of you.
Maire
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Posted By: glenine
Date Posted: May 29 2009 at 1:45am
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Good Morning,
Your best bet is to contact MD Anderson in Texas ....Inquire about a pathology read"..........and how you would go about getting your slides to the correct department........But they will need the tumor slides.
Because of the sarcoma component in the tumor My onc went with just a high dose of Adria followed by Taxatere..
I have been disease free for 8 years at stage 4..My met was removed via a VATS proceedure at Sloan in NY...after that we went with the chemo.then I had a double mast with recon..Whew!...Third opinion I believe are the smart thing to do.In my case Two onc just wanted no tx The third said we have to treat systemically just in case..Hope this helps.
Here is the name of the Onc I used
Peter Paul RosenMD,St Vincents Hospital
New York,NY
Google him.He is brilliant...
glenine
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Posted By: glenine
Date Posted: May 29 2009 at 2:00am
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Although the paragraph states it is treated like a ductal carcinoma.I would definately explore this further and rely on the experts that see this type..Remember its rare...........The study my onc followed was from an onc at MD Anderson.I relied on both their experience in treating this type.Not on a blurb from the ACS site.Just my opinion.
Cheers,glenine
p.s. I am also an RN
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Posted By: Loricarol
Date Posted: May 29 2009 at 3:34am
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Glenine
I agree with you i will be seeking the thrird opinion. I will call MD Anderson about a Pathology read. Wil they return your slides? can you get copies of your slides or are they the only ones? That is awesome that you have been disease free at 8 years! Praise God! I have a neice that lives 6 blocks from Kettering. I guess i can get a path read from MD Anderson and still start my chemo here right? Im on dose dense AC folloed bt T for 12 weeks weekly. I will also look into Peter Paul Rosen. I realy appreciate your help. By the way i had found 1 year prior to me BC a 4mm nodule in my lung. It hasnt changed in a year they are saying it is a beign pulmonary nodule and its in a location where i would require open surgey to get it removed and of course facing chemo cannot attempt that. But i have been wandering about that nodule but with 2 CT's over 8 months it has not changed at all in size just 4 mm. What do you think? If it were cancer it should have changed in size in 8 moths right? My breat tumors grew in 5 months! Great to talk to another RN! Your an inspiration.
------------- DX 4/30/2009 IDC, stage 1 ,grade 3,2 tumors,node negative,clear margins ,BRCA negative left breast mastetcomy, 4 cycles of Adramycin and Cytoxan 12 weekly treatments of Taxol start 8/12. No rads. |
Posted By: glenine
Date Posted: May 29 2009 at 4:06am
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Your slides could also be done at Sloan.Call them too.Asfar as the nodule.Did you have a pet scan?........this will be a good diagnostic tool to see if that lung bugger is a met.But I highlt doubt it.No change in size is good!......Cytoxin was not for me due to its lack of effectivenss on my type of tumor...I did have taxatere though..Good Luck and never stop asking questions..Don't settle for anything.........
glenine
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Posted By: glenine
Date Posted: May 29 2009 at 8:07am
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Hey sweetie,
If you would like call Michael Spirtos MD.Duke Medical Center in North Carolina
Ask to speak to him personally.Tell him you were referred to him by
glenine gregory.
Maybe he can give you the how and where of what you need to do
P.s. He is an old beau from High School!
Very Wonderful Man
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Posted By: trip2
Date Posted: May 29 2009 at 9:37am
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Loricarol,
Here is another link http://www.dslrf.org/breastcancer/content.asp?CATID=68&L2=3&L3=7&L4=0&PID=&sid=132&cid=1316 - http://www.dslrf.org/breastcancer/content.asp?CATID=68&L2=3&L3=7&L4=0&PID=&sid=132&cid=1316
This link also says metaplastic is treated like any invasive ductal breast cancer.
I consider my "blurbs" to be coming from very reliable sources. ------------- Stage 2 2003 Stage 1 2007 BRCA 1+ |
Posted By: glenine
Date Posted: May 29 2009 at 12:20pm
With limited research done Metaplasti carcinoma, they had to tuck it somewhere............
I never called your google reference a blurb either.
glenine gregory-Ryan RN MSN
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Posted By: Loricarol
Date Posted: May 29 2009 at 4:12pm
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Hi Glenine
I am getting my slides over to Huntsman as soon as i get home from a brief trip to see my 84 year olf grandma. The aftet they read them i may consider Mayo or another research hospital out of Utah to give me a read as well. I would like to know exactly what im dealing with.
Thanks Lori
 ------------- DX 4/30/2009 IDC, stage 1 ,grade 3,2 tumors,node negative,clear margins ,BRCA negative left breast mastetcomy, 4 cycles of Adramycin and Cytoxan 12 weekly treatments of Taxol start 8/12. No rads. |
Posted By: Loricarol
Date Posted: May 29 2009 at 4:15pm
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Glenine
I cant thank you enough for that referral to the MD from Duke. I will certainly try and contact him by phone ASAP while im in Tennessee this next week. God Bless you!
Lori ------------- DX 4/30/2009 IDC, stage 1 ,grade 3,2 tumors,node negative,clear margins ,BRCA negative left breast mastetcomy, 4 cycles of Adramycin and Cytoxan 12 weekly treatments of Taxol start 8/12. No rads. |
Posted By: Loricarol
Date Posted: May 29 2009 at 4:22pm
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Glenine
have had two chest CT's but no PET. they say i dont need a PET because Im a stage 1. Is this true? My Pulmonologist will order anything i want though so i could ask him. He has been followng me for the pulm nodule for 8 months. It is only 4mm in size so he said doubtful it would be caught on PET. He even offered me to have it removed last year by a cardio thoracic surgeon but i backed out thinking i was being overly aggressive about a apparent "benign pulm nodule" which i guess are quite common. So thus we opted to watch it and no change in 8 months. I plan to see him again by July thats (4mo) since my last visit for another either CT or PET. If the ONC wont order what i want HE WILL.
THANK YOU SO MUCH ------------- DX 4/30/2009 IDC, stage 1 ,grade 3,2 tumors,node negative,clear margins ,BRCA negative left breast mastetcomy, 4 cycles of Adramycin and Cytoxan 12 weekly treatments of Taxol start 8/12. No rads. |
Posted By: Loricarol
Date Posted: May 29 2009 at 4:24pm
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Glenine
How did you know the cytoxan wasnt working for you? I will be getting dose dense AC X4 followed by Taxol for 12 weeks every week and a clinical trial of Avastin. ------------- DX 4/30/2009 IDC, stage 1 ,grade 3,2 tumors,node negative,clear margins ,BRCA negative left breast mastetcomy, 4 cycles of Adramycin and Cytoxan 12 weekly treatments of Taxol start 8/12. No rads. |
Posted By: Loricarol
Date Posted: May 29 2009 at 4:26pm
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Pam
I appreciate the reliable sources that you have posted for me. Im reading everything i can get my hands on. thank you so very much! You are always on here helping out us new ladies. God Bless ------------- DX 4/30/2009 IDC, stage 1 ,grade 3,2 tumors,node negative,clear margins ,BRCA negative left breast mastetcomy, 4 cycles of Adramycin and Cytoxan 12 weekly treatments of Taxol start 8/12. No rads. |
Posted By: glenine
Date Posted: May 30 2009 at 3:49pm
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Hi Loricarol,
Cytoxin was never on the table for me .They felt it usually has minal benefit in my type of TN cancer
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Posted By: glenine
Date Posted: May 30 2009 at 3:50pm
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Hi Lori......
Sounds like a PLAN!!!.........Keep us posted.
glenine
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Posted By: Loricarol
Date Posted: May 30 2009 at 3:59pm
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Glenine
Is your type of TN BC different than mine? I would like to ask my ONc why they are using Cytoxan on me. Is that because of stage?
I appreciate all your help and answers it really helps alleviate more anxiety.
Thanks Glenine! ------------- DX 4/30/2009 IDC, stage 1 ,grade 3,2 tumors,node negative,clear margins ,BRCA negative left breast mastetcomy, 4 cycles of Adramycin and Cytoxan 12 weekly treatments of Taxol start 8/12. No rads. |
Posted By: cg---
Date Posted: May 30 2009 at 6:40pm
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Dear Loricarol,
Below you will find a few options - Dr. Rosen literally wrote the book on breast cancer pathology and two doctors who have a specialist interest in metaplastic.
I found other women on the breastcancer.org site who have metaplastic breast cancer.
Dr. Rosen is available to consult with patients, oncologists, and pathologists concerning the diagnosis and management of breast disease.
To contact Dr. Rosen directly (212) 746-6482 Here are two doctors also you may contact. First Dr. Christopher Pezzi, Abington Memorial Hospital, Pennsylvania, Surgical Oncology. Here is a link to a study he was principle author of recently on metaplastic BC
http://www.annalssurgicaloncology.org/cgi/content/abstract/14/1/166 - http://www.annalssurgicaloncology.org/cgi/content/abstract/14/1/166 There is also at MD Anderson in Texas, Dr. Bryan Hennesey...who by his web page as you will see has an avid interest in metapastic BC...Might be worth a consult... http://utm-ext01a.mdacc.tmc.edu/dept/pub/resrepv2.nsf/all+departments/41E218AD0706A8538625734E0077230E - http://utm-ext01a.mdacc.tmc.edu/dept/pub/resrepv2.nsf/all+departments/41E218AD0706A8538625734E0077230E I haven't dated them but I went through many blurbs and found these 3 little blurbettes. I hope you will find them helpful.
Cytoxan (cyclophosphamide) is the drug that others have taken for metaplastic and Taxotere (docetaxel) - this is how you will find them spelled.
Connie
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Posted By: Loricarol
Date Posted: Jun 05 2009 at 5:18am
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Connie
I want to thank you for the information and contacts you sent me. I have spoken with Dr Rosen's office staff and am in the process of having my pathology sent to him for a overread (another expert opinion).
THANKS AGAIN
God Bless You!
------------- DX 4/30/2009 IDC, stage 1 ,grade 3,2 tumors,node negative,clear margins ,BRCA negative left breast mastetcomy, 4 cycles of Adramycin and Cytoxan 12 weekly treatments of Taxol start 8/12. No rads. |
Posted By: KatieMarie
Date Posted: Jun 05 2009 at 10:55am
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To Loricarol and Chrissie D,
This is off topic, but I am new to this and I see you both look like you may have similar diagnosis as mine in April.
Would you mind commenting on the choice of mastectomy over lumpectomy? I think it was ChrissieD, why did you have chemo before mastectomy?
They found two more lumps near my original 1.4cm IDC while at my 2nd opinion appt. I'm starting to get more uptight, I still don't know my lymph status, and now with more possible cancer tumors found, I'm starting to want a PET.
So I guess I am looking for two answers: the mastectomy decision and who out there demanded a PET and when.
If you need to divert me elsewhere for being off-topic, SORRY.
Thanks!!
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Posted By: Nancy
Date Posted: Jun 05 2009 at 11:27am
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Dear KatieMarie,
I hesitated replying to your post as I want Lori and Chrissie to see it and reply, but I just wanted to welcome you to the site, and give you a link for the neoadjuvant chemo. Many are having the neoadjuvant chemo, as then they can determine if the chemo is actually shrinking your tumor(s). If it is not, then they can switch chemo regimens.
http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Chemotherapy_5.asp - http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Chemotherapy_5.asp
You can ask your doctor to order a PET scan.
I will now send you a private message so that I can give you directions for all the resources here on the site.
Many hugs,
Nancy ------------- Nancy DD Lori dx TNBC June 13,2007 Lumpectomy due to incorrect dx of a cyst mastectomy July 6 2007 chemo ACT all 3 every 3 weeks 6 tx Aug-Nov 28 rads ended Jan 2008 |
Posted By: Loricarol
Date Posted: Jun 05 2009 at 1:43pm
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Katie
GET A MASTECTOMY if you have multiple tumors (as i did) i had an immediate mastecomy to remove the breast and with it the cancer. Sometimes if the cancers are larger the ONC's will do chemo first for a few weeks to shrink the tumors. Mine were 1cm and 2cm and the first thing that they did was a mastectomy. This will tell you your node status too. The opinion of my surgeon was that multifocal tumors meant lumpectomy was not an option any longer. Hope that this information helps.
Pets are used for staging metastatic disease ( i think). I wasnt offered a PET as of yet either. Because Im a stage 1. But you need your surgery to probably determine your stage.
God Bless Katie
Lori ------------- DX 4/30/2009 IDC, stage 1 ,grade 3,2 tumors,node negative,clear margins ,BRCA negative left breast mastetcomy, 4 cycles of Adramycin and Cytoxan 12 weekly treatments of Taxol start 8/12. No rads. |
Posted By: KatieMarie
Date Posted: Jun 05 2009 at 2:27pm
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Thanks Lori!
My surgeon says that these two new lumps are like peas in pod next to the original lump, so he thinks it's still okay for the lumpectomy. Interesting that your lumps weren't that much bigger than mine though. Were they far enough apart that it would leave your breast too damaged, or was it the fact that you had multifocal put it directly to mastectomy?
I think I have a good surgeon, and apparently my case went before a tumor board to verify a lumpectomy was still okay....
I guess I can't get my head around how to determine if we are dealing with mets without a PET. Waiting for symptoms will make it too late. I'm getting worked up about that one month of surgery recuperation before chemo. If there is anything else brewing, it will have a whole month to party in there until chemo.
Thanks so much for your reply, Katie.
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Posted By: Loricarol
Date Posted: Jun 05 2009 at 3:00pm
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Katie
I had the smae worries as you about METS. I spoke with everal ONC's including one at Duke university who was a personal friend of one of the ladies on this site (Glenine). The standard of care (they say) is to only order PET if a patient has stage 2 or 3 and nodal involvement. Dont quote me because this is just my understanding. Even after chemo they just watch you and do blood work and physical exams. They say that studies show that doing PET etc to detect METS earlier made no difference in overall survival. Although Im with you and i dont like their approach. waiting for symptoms sees ridiculous to me too.
My tumors were 2cm apart. The surgeon did a breast MRI and after that he made the determination to do mastectomy. Ask your surgeon about breast MRI.
I have had to wait 6 weeks post op to get my chemo surgery was 5/5 chemo is starting 6/17.
More later hope this helps! ------------- DX 4/30/2009 IDC, stage 1 ,grade 3,2 tumors,node negative,clear margins ,BRCA negative left breast mastetcomy, 4 cycles of Adramycin and Cytoxan 12 weekly treatments of Taxol start 8/12. No rads. |
Posted By: trip2
Date Posted: Jun 06 2009 at 1:17pm
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Hello KatieMarie and welcome.
I can see you are in the middle of many thoughts of confusion over what or what not to do. For some odd reason this is the way this seems to work.
You are diagnosed and then faced with so many things to think about it is a whirl.
I would suggest you slow down a bit, take a few deep breaths and over the week-end do some research. Look around our forum, ask questions, google, get a bit of a grip on what is going on and try to focus on now and not worry about later down the road.
We are all different and no one knows what is ahead for us.
Also remember as you take a deep breath that we all have different situations, different bodies, pathology. This will all calm down and become more settled as a bit more time has passed and you understand a bit more what will be happening.
I would also suggest getting a mild sedative and many of us have used anti-depressants during this dificult time.
Do you have a good support system around you? Friends? Family?
Another thing you must think about is do you have a history of cancer in your family? You may want to do some research in this area on
http://www.facingourrisk.org - http://www.facingourrisk.org which is a very informative website/forum full of information on familial cancer.
When do you go back to the doctor and whom will you be seeing?
Near the top right side of the page look for the word Resources, click on that then there will be a drop down, then click on Taking Charge of your care, this you will very helpful in getting you started.
Feel free to ask us any questions and we will do our best to help. ------------- Stage 2 2003 Stage 1 2007 BRCA 1+ |
Posted By: glenine
Date Posted: Jun 12 2009 at 4:19pm
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Hi There,
Cytoxin they thought would not be as effective on the sarcoma=like cells
So they went with just highdose Adriamycin..Keep me posted
glenine
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Posted By: glenine
Date Posted: Jun 12 2009 at 4:30pm
I never recieved Cytoxin.just high dose Adriamycin followed by Taxatere
hugs,g
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Posted By: glenine
Date Posted: Jun 12 2009 at 4:44pm
Wonderful..Please let us know what Dr.Rosen said.
hugs,g
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