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Breast malignant, males, children


Treatment effect - chemotherapy

Reviewer: Monika Roychowdhury, M.D. (see Reviewers page)
Revised: 24 April 2014, last major update August 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

Clinical features

● With post-chemotherapy specimens, sample extensively before concluding “no invasive carcinoma” (Hum Pathol 2004;35:781)
● May have disseminated apoptotic or non-apoptotic tumor cells in bone marrow (Breast Cancer Res 2006;8:R60)
● Histologic changes do not correlate with clinical or pathologic response to chemotherapy (J Surg Oncol 2002;80:4), although tumor cell necrosis may have some predictive value (Am J Surg Pathol 2005;29:354)

Case reports

● 46 year old woman with xanthomatous pseudotumor after preoperative chemotherapy for invasive ductal carcinoma (Arch Pathol Lab Med 2003;127:739)

Micro description

● Smaller tumor size, reduced cellularity, generally same morphology and tumor markers (may change rarely)
● Extensive cytoplasmic vacuolization causing tumor cells to resemble histiocytes
● Also tumor necrosis, atrophy and marked nuclear atypia (enlarged, bizarre shapes) in a background of chronic inflammation with hemosiderin laden macrophages and fibrosis; similar changes in lymph nodes (Histopathology 1996;29:63, Pathol Res Pract 1997;193:187)
● May show distortion of glandular architecture, eosinophilic change, decreased mitotic activity (Arch Pathol Lab Med 2009;133:633)

Micro images

Residual tumor cells have bizarre shapes with enlarged hyperchromatic nuclei and cytoplasmic vacuoles

Various images

Post-chemotherapy specimen has only scattered tumor cells in collagenous stroma (AFIP)

Post-chemotherapy fibrosis   scar and foamy histiocytes   foamy histiocytes and lymphocytes

Chemoresistant tumor cells with widespread lymphovascular invasion in both breast and axillary - no apparent treatment effect, Contributed by Dr. Semir Vranic, University of Sarajevo (Bosnia)

Additional references

Ann Surg Oncol 2003;10:734, Breast 2001;10:492, Arch Pathol Lab Med 2009;133:633

End of Breast malignant, males, children > Miscellaneous > Treatment effect - chemotherapy

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