Rosen's Breast Pathology, 4e

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Chapter 33

had metastatic carcinoma in a pretreatment cytologic speci­ men. The 5-year recurrence-free survival for women with a pathologically documented complete axillary response to combined anthracycline and taxane–based primary che­ motherapy was 78.6%, which was significantly better than that for women who had residual axillary nodal carcinoma (25.4%). Complete pathologic response in the ALNs of women with noninflammatory carcinoma has also been as­ sociated with a significantly higher relapse-free survival rate FIG. 33.38.  Chemotherapy effect in inflammatory car- cinoma. A: Invasive, poorly differentiated carcinoma surrounds mammary ductules. B: Three months after treatment with combination chemotherapy, broad areas of hypocellular, loose stroma with scattered calcifications remain in areas where the carcinoma was destroyed by treatment and resorbed. C: Fibrosis and mild chronic in- flammation beginning to occupy an area of resorbed car- cinoma. D: Microscopic foci of carcinoma remaining in the treated breast. E: Typical appearance of tumor cells in a lymphatic channel after chemotherapy. Note the cyto- plasmic vacuolization in tumor cells.

E

breast after chemotherapy and radiation therapy. Nodal scarring after chemotherapy in the absence of demonstrable neoplastic cells in a patient with IBC can be attributed to tumor regression. The presence of metastatic carcinoma in the ALNs of patients with IBC can be documented by FNA prior to primary chemotherapy. Hennesy et al. 286 reported that no carcinoma was detected in the posttreatment ALNs from 14 (23%) of 61 women with inflammatory carcinoma who