Introduction: Neoadjuvant chemotherapy for breast cancer over the last several years is being utilized with increasing frequency. Neoadjuvant therapy can potentially downstage advanced regional disease, increasing the likelihood of negative surgical margins. This study analyzes the utilization and outcomes of neoadjuvant chemotherapy for breast cancer at a single institution.

Methods: A retrospective chart review was performed at the Jacqueline M Wilentz Breast Center in Long Branch, New Jersey. All patients from 2010 to present that underwent neoadjuvant chemotherapy for breast cancer were analyzed. The initial biopsy pathology, initial staging workup, response to therapy, operation, surgical pathology reports were studied. Chi square analysis was then used to identify factors more likely to yield a pathologic complete response. Finally, outcomes in patients that did and did not have a pathologic complete response were examined.

Results: The most common indications for neoadjuvant therapy for advanced regional disease and Her2 positive status. The tumor was successfully downstaged in 29 of 46 patients (63.0%), with 13 (28.3%) achieving pathologic complete response. The major predictors of pathologic complete response were chemotherapy regimen and Her2 status, as 12 of 21 patients (57.1%) patients with amplified Her2 and 8 of 12 (66.7%) patients receiving TCHP therapy achieving pCR. Predictive factors of residual disease included triple negative status and treatment with ACT chemotherapy. Pathologic complete response was predictive of favorable prognosis, as no patient that achieved a pCR had recurrence, local or distant, within the time frame of this study. Factors predictive of recurrence included residual nodal disease or residual tumor T3 or greater.

Conclusion: In our retrospective study, neoadjuvant chemotherapy successfully downstages patients in the majority of patients. The patients that were able to derive the most benefit from neoadjuvant therapy were those with Her2 amplified tumors, and those that underwent therapy with TCHP. Achievement of pCR incurred a favorable prognosis.

Histiocytoid breast carcinoma (HBC) is a rare type of breast cancer with a controversial histogenesis, generally considered to be a variant of invasive lobular carcinoma. It comprises fewer than 0.3% of breast cancer cases. Published reports on this neoplasm are sparse and there exists a significant diagnostic challenge when differentiating these tumors from other tumors with similar presentations. Paget’s disease of the breast comprises up to 3% of all breast malignancies. The majority of Paget’s disease cases are associated with ductal carcinoma in situ, with bilateral, multifocal, and synchronous pathology rarely reported. While bilateral presentation of invasive lobular carcinoma is well documented, synchronous and metachronous forms are rare. We present a case of a 20-year-old female with bilateral invasive histiocytoid lobular breast carcinoma and concurrent massive bilateral Paget’s disease of the breast. The goal of this manuscript is to explore possible pathologic associations and to clarify diagnostic parameters based on current literature.

Primary angiosarcoma of the breast is uncommon and only diagnosed in roughly 0.04% of all malignant breast tumors. Only 20% of these cases are primary malignancies while the remaining are complications of radiation therapy. Diagnosis is difficult because it tends to mimic benign characteristics on mammogram and histology. Although it can appear benign, breast angiosarcoma is an aggressive, malignant tumor with a poor prognosis. Radiologic imaging along with immunostaining with Factor VIII and CD31 can confirm the presence of angiosarcoma. Currently, surgery is the only treatment option that improves the clinical outcome of the disease, with little help from chemotherapy.