Spontaneous Pathological Complete Regression Of High-grade Triple-negative Breast Cancer With Axillary Metastasis
Cserni, G., Serfozo, O., Ambrózay, É., Markó, L., & Krenács, L. (2019). Spontaneous pathological complete regression of high-grade triple-negative breast cancer with axillary metastasis. Polish journal of pathology : official journal of the Polish Society of Pathologists, 70(2), 139–143. https://doi.org/10.5114/pjp.2019.87105
View Original Source →Abstract
We report on a breast carcinoma with medullary features diagnosed by core needle biopsy in a 72-year-old woman. Both the primary tumour and its fine needle aspiration-proven, rapidly growing axillary metastasis regressed completely in less than 2 months, by the time surgery was performed. The biopsy of the primary tumour demonstrated a dense stromal infiltrate of CD8+/granzyme B+ activated cytotoxic T-cells suggestive of a robust antitumour immune response. Paradoxically, both tumour cells and tumour infiltrating immune cells demonstrated a diffuse PD-L1 expression, revealing that antitumour immune response has the ability to spontaneously overcome inhibitory mechanisms induced by cancerous growth.
Case Details
Disease Location
Bilateral breast
Personal Characteristics
72-year-old obese female with type 2 diabetes and hypertension
Clinical Characteristics
Her right breast was perceived, in mammography, as having a 7-mm circumscribed nonpalpable benign lesion with microcalcification in the upper-outer quadrant at the 10 o’clock position, with a physically negative ipsilateral axilla, which on ultrasound (us) showed an enlarged lymph node (13 × 8 mm) with a thickened cortical layer. The upper-outer quadrant of her left breast harbored an ill-defined, spiculated mass with microcalcification this corresponded to a firm mobile palpable mass measuring 16 mm in the greatest dimension on us, located in the two o’clock position, 2 cm from the areola and 6 mm deep from the skin. The left axilla demonstrated a rounded pathological lymph node, which was not present on the screening mammogram, measured 34 × 25 mm on us. Needle core biopsy was obtained from the left-sided primary tumour, and this resulted in a grade 3 (poorly differentiated) carcinoma. The phenotype was triple-negative. Us- guided fine needle aspiration cytology was done on both axillary lymph nodes described, yielding a negative result on the right side and proving metastatic involvement on the left side. The right sided breast lesion was also targeted with us-guided core needle biopsy on day 40; this resulted in an invasive carcinoma diagnosis. Bilateral radio-guided and wire-guided wide local excisions plus right sided sentinel lymph node biopsy and left sided axillary lymph node dissection was performed. A repeated breast imaging was performed on day 131; it showed a postoperative status with clips in the excision area, but no signs of residual disease
Remission Characteristics
The 82-g, dominantly fatty specimen, obtained from excision, included a 14 × 11-mm tumor bed with no residual carcinoma, but wavy loose fibrotic tissue, and focal aggregates of lymphocytes and calcifications. No lymph node metastases were detected, but two lymph nodes also demonstrated signs of regression with a similar wavy loose fibrous tissue. Spontaneous regression of the grade 3 carci- noma and its axillary metastases was established, and the ipsilateral dcis identified was considered an incidentally identified different disease
Treatment & Mechanisms
Proposed Remission Mechanisms
Tumour infiltrating lymphocytes may play in antitumour defence.
Clinical Treatment
Fine needle biopsy, excisional biopsy. Metformin 1g/d (for diabetes)