extensive tumor necrosis – good or bad?
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extensive tumor necrosis – good or bad?

› Forums › General Melanoma Community › extensive tumor necrosis – good or bad?

  • Post
    • August 8, 2011 at 11:23 pm
    triciad
    Participant

    Hi All,

    I just got a copy of my path report from my surgery from 7/20.  It says "the mitotic index is 2-5 mitoses/high powered field (20x).  There is extensive tumor necrosis."

    I would greatly appreciate it if anyone could translate this for me.  Please tell it to me straight.

    Thanks!

    Tricia

    Hi All,

    I just got a copy of my path report from my surgery from 7/20.  It says "the mitotic index is 2-5 mitoses/high powered field (20x).  There is extensive tumor necrosis."

    I would greatly appreciate it if anyone could translate this for me.  Please tell it to me straight.

    Thanks!

    Tricia

Viewing 3 reply threads
  • Replies
      • August 8, 2011 at 11:57 pm
      Teodora
      Guest

      It means literally that large parts of the tumor are  dead tissue.With melanoma nothing is ever good news but I suppose this is rather good.Your immune system probably is really good and fighting it hard.

      Teodora

      • August 8, 2011 at 11:57 pm
      Teodora
      Guest

      It means literally that large parts of the tumor are  dead tissue.With melanoma nothing is ever good news but I suppose this is rather good.Your immune system probably is really good and fighting it hard.

      Teodora

        • August 9, 2011 at 12:30 am
        triciad
        Participant

        Teodora,

        Thanks so much for your immediate response.  I'm sitting here with tears rolling down my face because I'm so tired of everything being explained in a cryptic fashion.

        As my mom would say about your interpretation – "From your mouth (key strokes) to God's ear!"

        Thanks again for your help!

        Tricia

        • August 9, 2011 at 12:30 am
        triciad
        Participant

        Teodora,

        Thanks so much for your immediate response.  I'm sitting here with tears rolling down my face because I'm so tired of everything being explained in a cryptic fashion.

        As my mom would say about your interpretation – "From your mouth (key strokes) to God's ear!"

        Thanks again for your help!

        Tricia

      • August 9, 2011 at 12:19 am
      MichaelFL
      Participant

      Interesting indeed. Your body is trying to kick this tumor to the curb.

      Tumor necrosis means that your immune system (lymphocytes) was aware of and doing something about the melanoma. Many of the tumor cells were dying or dead.

      Mitosis or mitotic rate is the rate of cell division. I believe it is usually read in a HPF (high power field) of 10, so 20 means they looked at a larger area. Since they looked at a size roughly double, you may wish to ask if they feel this 2-5 number is twice of the 10 HPF number. So maybe the 10HPF number is half of that, so the mitotic index or mitotic rate may be 1-2.5, and that would still be considered low,

      Is this part of your pathology report from your intransit on 7/20-Wednesday? You also did the entire year of interferon and nothing else since correct?

      Also, what does the rest of your pathology report say? Anything about tumor regression?

      Michael

      • August 9, 2011 at 12:19 am
      MichaelFL
      Participant

      Interesting indeed. Your body is trying to kick this tumor to the curb.

      Tumor necrosis means that your immune system (lymphocytes) was aware of and doing something about the melanoma. Many of the tumor cells were dying or dead.

      Mitosis or mitotic rate is the rate of cell division. I believe it is usually read in a HPF (high power field) of 10, so 20 means they looked at a larger area. Since they looked at a size roughly double, you may wish to ask if they feel this 2-5 number is twice of the 10 HPF number. So maybe the 10HPF number is half of that, so the mitotic index or mitotic rate may be 1-2.5, and that would still be considered low,

      Is this part of your pathology report from your intransit on 7/20-Wednesday? You also did the entire year of interferon and nothing else since correct?

      Also, what does the rest of your pathology report say? Anything about tumor regression?

      Michael

        • August 9, 2011 at 12:27 am
        MichaelFL
        Participant

        Looking at some of your posts I see you also had radiation to that area. But that was after the removal, so it was not the radiation.

        Please fill out a profile when you are able, (or I will send you a bill) as it is much easier than reading most of someones post.

        Michael

        • August 9, 2011 at 12:27 am
        MichaelFL
        Participant

        Looking at some of your posts I see you also had radiation to that area. But that was after the removal, so it was not the radiation.

        Please fill out a profile when you are able, (or I will send you a bill) as it is much easier than reading most of someones post.

        Michael

        • August 9, 2011 at 12:51 am
        triciad
        Participant

        Michael,

        How do you know all this stuff?  You are simply amazing…thank you!!!!

        Yes, this is from my pathology from my excision on 7/20.  I did a year of Interferon.  I will be starting radiation on 8/17 for this last surgery's site.  I will go 5x/week for 6 weeks for a total of 30 treatments.

        Now, I have second thoughts about the radiation.  My surgeon told me today that the tumor grew from the inside up and it had a strong base.  It was deeper than he thought it would be.  He wasn't his jovial self, so I took it as things aren't going well for me.  He said radiation was a good idea.

        Here's the entire microscopic description of the pathology report –

        Sections show a circumscribed subcutaneous nodule of pleomorphic epithelioid cells with abundant eosinophilic cytoplasm and prominent nucleoli, consistent with metastic melanoma.  The mitotic index is 2-5 motoses/high-power field (20x).  There is extensive tumor necrosis.  the tumor is broadly transected in Part 1 along the superior margin, in concordance with the intraoperative consulation findings.  The epidermis is unremarkable.  Part 2 shows melanoma on once surgace of the unoriented specimen.  Part 3 contains foci of melanoma in serveral tissue fragments.  Part 4 shows fibroadipose tissue with no evidence os tumor.

        The tumor is postive for S-100 protein and Melan-A, and negative for HMB-45.  Additionally, the tumor is negative for CD117.

        Now please remember, I teach first grade, so if it doesn't rhyme…I can't read it!  Do you think they have early elementary pathologists who can make it rhyme?

        Thank you so much for all of your help.  I am going to make another attempt at filling our a profile right now!

        Have a great night!

        Tricia

        • August 9, 2011 at 12:51 am
        triciad
        Participant

        Michael,

        How do you know all this stuff?  You are simply amazing…thank you!!!!

        Yes, this is from my pathology from my excision on 7/20.  I did a year of Interferon.  I will be starting radiation on 8/17 for this last surgery's site.  I will go 5x/week for 6 weeks for a total of 30 treatments.

        Now, I have second thoughts about the radiation.  My surgeon told me today that the tumor grew from the inside up and it had a strong base.  It was deeper than he thought it would be.  He wasn't his jovial self, so I took it as things aren't going well for me.  He said radiation was a good idea.

        Here's the entire microscopic description of the pathology report –

        Sections show a circumscribed subcutaneous nodule of pleomorphic epithelioid cells with abundant eosinophilic cytoplasm and prominent nucleoli, consistent with metastic melanoma.  The mitotic index is 2-5 motoses/high-power field (20x).  There is extensive tumor necrosis.  the tumor is broadly transected in Part 1 along the superior margin, in concordance with the intraoperative consulation findings.  The epidermis is unremarkable.  Part 2 shows melanoma on once surgace of the unoriented specimen.  Part 3 contains foci of melanoma in serveral tissue fragments.  Part 4 shows fibroadipose tissue with no evidence os tumor.

        The tumor is postive for S-100 protein and Melan-A, and negative for HMB-45.  Additionally, the tumor is negative for CD117.

        Now please remember, I teach first grade, so if it doesn't rhyme…I can't read it!  Do you think they have early elementary pathologists who can make it rhyme?

        Thank you so much for all of your help.  I am going to make another attempt at filling our a profile right now!

        Have a great night!

        Tricia

        • August 9, 2011 at 1:20 am
        MichaelFL
        Participant

        Not sure what else to pull out of the rest of the pathology. It's melanoma, and there is extensive cell death. Seems it was cut through (transected). I am not a doctor, but it is my understanding that radation may sometimes be used to assist in cleaning up (hopefully killing) any stray cells after surgery.

        Don't give me any credit for any of this either, as three years ago when I was first diagnosed I was not even sure I could spell melanoma, let alone anything else. When I got the dreaded phone call, I even confused Clarks Level two with stage two, and even wrote down the wrong Breslow depth. I confused .30 mm with 3.0 mm and wrote that down instead. I understand why people do that though, as when one hears the cancer word over the phone, the rest of the converstaion becomes a haze. The people on this forum helped me straighten it all out. Then, I just started researching from that point and never stopped.

        Having a wife and two cousins that are nurses does not hurt either.

        Keep killing that melanoma any way you can.

        Michael

        • August 9, 2011 at 1:34 am
        triciad
        Participant

        Thanks for sharing your learning curve with me.  I had a pretty similar beginning experience, but I find it hard to research.  I google it and come up with a lot of technical articles…again, not rhyming!  Hopefully, someday, I will understand a lot more about this disease.   Honestly, I've learned everthing here on this board from you and the wonderful members…my extended family!

        Thanks again for your help!

        Tricia

        BTW – I did the profile!!!!!!!!!!

        • August 9, 2011 at 1:34 am
        triciad
        Participant

        Thanks for sharing your learning curve with me.  I had a pretty similar beginning experience, but I find it hard to research.  I google it and come up with a lot of technical articles…again, not rhyming!  Hopefully, someday, I will understand a lot more about this disease.   Honestly, I've learned everthing here on this board from you and the wonderful members…my extended family!

        Thanks again for your help!

        Tricia

        BTW – I did the profile!!!!!!!!!!

        • August 10, 2011 at 9:53 pm
        JerryfromFauq
        Participant

        Yeah, Micheal!  What can I say about another dumb Engineer!  At least you didn't wait for 7 months to learn what the word "Oncologist" was.

          Wish my memory was still anywhere near where yours is.  I am very glad you came to  this board.  (Even if my son only had 5 mango's this year.  The freeze wasn't nice!)

        I knew there was some reason you married that Gal!

        • August 10, 2011 at 9:53 pm
        JerryfromFauq
        Participant

        Yeah, Micheal!  What can I say about another dumb Engineer!  At least you didn't wait for 7 months to learn what the word "Oncologist" was.

          Wish my memory was still anywhere near where yours is.  I am very glad you came to  this board.  (Even if my son only had 5 mango's this year.  The freeze wasn't nice!)

        I knew there was some reason you married that Gal!

        • August 9, 2011 at 1:20 am
        MichaelFL
        Participant

        Not sure what else to pull out of the rest of the pathology. It's melanoma, and there is extensive cell death. Seems it was cut through (transected). I am not a doctor, but it is my understanding that radation may sometimes be used to assist in cleaning up (hopefully killing) any stray cells after surgery.

        Don't give me any credit for any of this either, as three years ago when I was first diagnosed I was not even sure I could spell melanoma, let alone anything else. When I got the dreaded phone call, I even confused Clarks Level two with stage two, and even wrote down the wrong Breslow depth. I confused .30 mm with 3.0 mm and wrote that down instead. I understand why people do that though, as when one hears the cancer word over the phone, the rest of the converstaion becomes a haze. The people on this forum helped me straighten it all out. Then, I just started researching from that point and never stopped.

        Having a wife and two cousins that are nurses does not hurt either.

        Keep killing that melanoma any way you can.

        Michael

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