928
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
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
E
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.
