PMC3350088_01
Comparison of mammographic studies before and after neoadjuvant chemotherapy. (a) Right MLO view prior to neoadjuvant chemotherapy. The blue arrow indicates the mass with surrounding microcalcifications. The yellow arrows indicate additional malignant-appearing microcalcifications occupying the upper part of the right breast. (b) Right MLO view after neoadjuvant chemotherapy. The blue arrow shows resolution of the mass but persistence of surrounding microcalcifications. The yellow arrows show persistence of the additional, extensive microcalcifications. (c) Right CC view prior to neoadjuvant chemotherapy. The yellow arrows indicate the areas of microcalcifications. The blue arrow indicates the breast mass. (d) Right CC view after neoadjuvant chemotherapy. The yellow arrows indicate the areas of persistent microcalcifications. The blue arrow shows complete resolution of the breast mass.
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Digital mammography revealed a new 2.5 cm irregular solid mass at the 12 o'clock position of the right breast, which was highly suggestive of malignancy, and a 12 cm area of linear pleomorphic calcifications occupying most of the upper part of the right breast (Figures 1(a) and 1(c)). Prior to surgery, a diagnostic mammogram of the right breast was obtained, showing no significant change in the diffuse pleomorphic calcifications, but complete resolution of the breast and axillary masses (Figures 1(b) and 1(d)).
Pathologic findings from core needle biopsy before neoadjuvant chemotherapy. (a) H & E stain showing high-grade invasive carcinoma. (b) H & E stain demonstrating high-grade ductal carcinoma in situ associated with microcalcification (black arrow).
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The core biopsy demonstrated invasive, moderately to poorly differentiated ductal adenocarcinoma, extensively involving both core biopsy fragments (Figure 2(a)). In addition, grade 3 DCIS, solid and clinging types, with comedonecrosis, and focal associated microcalcifications were seen (Figure 2(b)).
Comparison of bilateral breast MRI studies performed before and after neoadjuvant chemotherapy. (a) Doppler flow MRI before neoadjuvant chemotherapy. Yellow arrow points to the 2.7 cm irregular mass in the right breast. (b) Doppler flow MRI after neoadjuvant chemotherapy shows complete radiologic response. Yellow arrow points to area where the mass was located prior to treatment.
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A bilateral breast MRI revealed a 2.7 cm irregular mass in the right breast (Figure 3(a)). An MRI also showed complete radiologic response to treatment (Figures 3(b) and 4(b)).
Comparison of bilateral MRI of the right axilla performed before and after neoadjuvant chemotherapy. (a) Doppler flow MRI before neoadjuvant chemotherapy. Yellow arrow points to a 2.6 cm pathologically enlarged right axillary lymph node. (b) Doppler flow MRI after neoadjuvant chemotherapy shows complete radiologic response. The yellow arrow points to the normal-appearing right axillary lymph node.
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In the right axilla, there was a 2.6 cm pathologically enlarged lymph node, likely metastatic (Figure 4(a)).
Pathologic findings from the surgical specimen obtained following neoadjuvant chemotherapy. Both pictures show no evidence of residual malignancy indicating a pathologic complete response. Black arrows point to benign appearing ducts with foamy macrophages, fibrous reactive tissue, and residual intraductal microcalcifications without evidence of DCIS.
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The specimen contained numerous residual microcalcifications but no malignancy (Figures 5(a) and 5(b)).