Neoadjuvant Chemotherapy for Primary Sarcoma of the Breast

A Case Report

Chieko Miyazaki; Mikio Shiozawa; Rintaro Koike; Kasumi Ogihara; Yumiko Sasaki; Satomi Shiba; Saki Nishida; Masako Sakuragi; Hirofumi Mizunuma; Takashi Fujita; Noriyoshi Fukushima; Alan K. Lefor; Joji Kitayama; Naohiro Sata

Disclosures

J Med Case Reports. 2019;13(289) 

In This Article

Abstract and Introduction

Abstract

Background: Primary sarcoma of the breast is rare. Surgery has been the only curative treatment available. Recently, neoadjuvant chemotherapy including anthracycline/ifosfamide has been reported effective for patients with high-risk sarcomas in a prospective trial.

Case presentation: A 52-year-old Japanese woman presented with a mass in her left breast. The 10 cm tumor was fixed to her chest wall on examination. A skin biopsy was performed which showed leiomyosarcoma. Neoadjuvant chemotherapy was given and the tumor became mobile. A mastectomy and axillary dissection were performed with surgically negative margins. After neoadjuvant chemotherapy, the amount of necrosis was profoundly influenced by chemotherapy, and the histological effect of neoadjuvant chemotherapy was assessed in reference to pre-neoadjuvant chemotherapy magnetic resonance imaging.

Conclusion: In contrast to many other cancers, the evaluation of various treatments and of the histological effect of neoadjuvant chemotherapy for sarcoma has been difficult due to the rarity of these tumors. We report the case of a patient with a breast sarcoma, treated with neoadjuvant chemotherapy and discuss the appropriate pathological evaluation and therapeutic management.

Introduction

Breast sarcoma is a rare entity; it is a heterogeneous group of uncommon neoplasms arising from mesenchymal tissues of the breast. Breast sarcomas accounted for 0.0006% of all breast malignancies.[1] Over the past decade, the number of cases of breast sarcoma after breast irradiation for previous breast carcinoma has increased.[2–4]

Surgery with an adequate resection margin is the only potentially curative therapy for patients with sarcomas. However, a recent randomized trial provided evidence to support the use of neoadjuvant chemotherapy for patients with high-risk soft tissue sarcomas of the extremities and trunk by European sarcoma groups.[5,6] We describe here a case of breast sarcoma treated with neoadjuvant chemotherapy and successful resection. The case is discussed with a review of appropriate pathological evaluation and therapeutic management.

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