Central Necrosis

AlohaGirl

My pathology report from my biopsy showed "central necrosis" and intermediate nuclear grade.  No additional necrosis was present in my lumpectomy pathology and the nuclear grade was intermediate to high.  So I have been thinking of myself as having had high nuclear grade (or maybe intermediate, but possibly high at least) and comedo necrosis.  But now I am wondering, is central necrosis the same thing as comedo necrosis?  I'm already done with surgery and rads and am taking tamoxifen, so it doesn't matter from a practical perspective, but I am curious.  Does anyone know whether central necrosis is the same as/different from comedo necrosis?  (I could ask my oncologist but now that I am wondering I don't really want to wait to find out until I see him in February.)

Thanks, all, and happy new year.  Here's to a healthy, happy, peaceful 2010!

TenderIsOurMight

Central necrosis is often seen on core biopsy, and means the tumor growth rate outstripped the local blood supply, resulting in necrosis or death of the tissue. There is usually less oxygen in the center part of tumor as I understand it, which leads to less favorable anaerobic (oxygen lacking) conditions favoring growth. Pathologists don't like to see central necrosis, but it's common on biopsy. I haven't read where it dramatically worsens one's prognosis with breast cancer, and had this finding myself years ago.

Comedo necrosis refers to a specific histologic finding of comedo cells, one of several types in in-situ disease. It is not the same as central necrosis. Comedo findings are associated with higher grade of tumor. Your oncologist should be able to explain it to you, or you could look at bc.org home site under comedo dcis. 

I'm sorry for your diagnosis. Glad you had your surgery and rads already,  and that you're on Tamoxifen. Has you're oncologist mentioned the possibility of testing for how you individually metabolize or breakdown Tamoxifen? If not you may wish to look at the many threads on Tamoxifen and CYP2D6 genotype and read up. Since you're just starting Tamoxifen it's always nice to find out about this available test ahead of time. Tamoxfen also should not be taken with certain antidepressants which also are discussed in the threads. Just some helpful information for those who are interested.

Happy new year to you too and good luck.

Tender

AlohaGirl

Thank you so much for the very helpful information, Tender.

 My oncologist iddn't mention the CYP2D6 test to me but I have read about it quite a bit on this site and plan to ask him for the test when I see him in February.  So far, I haven't had too much trouble with the tamoxifen but of course if it isn't doing anything because I am not metabolizing it there is no point in taking it and risking side effects in the future.