title: Fine-needle aspiration cytology in locally advanced breast adenocarcinoma: a case with complete response to preoperative chemotherapy in association with granulomatous inflammatory reaction.
abstract: Preoperative chemotherapy for locally advanced breast carcinoma (stage IIIA,B) is increasingly utilized demonstrating a 70 to 95% objective response and 15 to 35% complete response. A 70-yr-old woman presented with a 9 cm left upper outer quadrant breast mass associated with overlying skin redness and a 2.5 cm left axillary mass. Fine-needle aspiration cytology (FNA) showed a pleomorphic adenocarcinoma in both the breast and axilla. Following three courses of chemotherapy with cyclophosphamide, methotrexate, and 5-fluorouracil (CMF), the patient had a dramatic clinical reduction of tumor, reduction of serum CA 15-3 from 161 to 64 U/ml, and underwent a modified radical mastectomy and axillary dissection. The specimen showed no viable tumor in association with an extensive granulomatous response in both the breast and axillary lymph nodes. This case illustrates two points concerning preoperative chemotherapy for locally advanced breast cancer: (1) The role of FNA v. tissue biopsy is examined. Positive cytology must be conclusive since, as in this case, no viable carcinoma may be present after therapy. (2) Chemotherapy induced host tissue reaction has not been extensively studied. This case showed a remarkable granulomatous reaction in association with tumor elimination. Since this reaction was not present on the original aspiration cytology slides, the chemotherapy treatment must have induced this reaction. Mechanisms for creating this effective host response need further investigation.
authors.affiliation: Department of Medical Pathology, University of California Davis, Sacramento 95817.
authors.forename: M J
authors.initials: MJ
authors.lastname: Costa
authors.forename: G
authors.initials: G
authors.lastname: Stewart
authors.forename: E A
authors.initials: EA
authors.lastname: Perez
authors.forename: J E
authors.initials: JE
authors.lastname: Goodnight
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D003520:Cyclophosphamide / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006099:Granuloma / Q000139:chemically induced / Q000473:pathology*; D006801:Humans; D007249:Inflammation / Q000139:chemically induced / Q000473:pathology; D008727:Methotrexate / Q000008:administration & dosage; D011300:Preoperative Care; D016896:Treatment Outcome
chemical_list: D003520:Cyclophosphamide; D005472:Fluorouracil; D008727:Methotrexate