A Histo-Morphological Study of Changes in Neoadjuvant Chemotherapy in Breast Malignancies

Abstract

Introduction: The administration of systemic chemotherapy in order to shrink the size of the tumour before surgical resection is termed as Neoadjuvant Chemotherapy (NACT) and has been shown to improve the overall disease free survival. It also helps in downstaging the tumour and monitoring treatment efficacy. Aim: To study the histo-morphological features following NACT in breast malignancies. Materials and Methods: The present study was carried out in a tertiary care hospital in Southern India between November 2013 and December 2014. Twenty two cases of breast carcinomas were analysed and the histo-morphological alterations were studied. Results: Twenty two cases of breast carcinomas were studied. The age group ranged from 27 to 70 years. Five cases showed marked response following NACT while 17 cases showed poor response. The nuclear alterations were pyknosis (n=16), karyorrhexis (n=14) and karyolysis (n=14). The cytoplasmic alterations included vacuolation and foamy cell change. The stromal alterations included lymphoplasmacytic infiltrate (n=19), hyalinisation (n=17), collection of foamy macrophages (n=5), fibrosis (n=5), haemosiderin laden macrophages (n=5), giant cell formation (n=5). Conclusion: As NACT is increasingly becoming the standard of care for patients with breast malignancies, Pathologists need to be aware of the myriad of histo-morphological features that may be seen in specimens following radical surgery and be able to predict the probable chemoresponsiveness to NACT. In the present study, the histo-morphological features included nuclear, cytoplasmic and stromal alterations.

Keywords

• breast carcinoma
• response
• systemic chemotherapy