Prediction of lack of response to neoadjuvant chemotherapy in rare breast tumour histology with Tc-99m sestamibi scintimammography

Abstract

The authors report a case of a 47-year-old female with a malignant lump in the right breast and ipsilateral axillary nodal involvement. She was pathologically misinterpreted as a case of ductal cell carcinoma with papillary component on fine needle aspiration cytology (FNAC) pre-operatively. On lines of the FNAC report, the patient underwent scintimammography (SMM) for prediction of treatment response based on washout pattern. The SMM revealed rapid washout of radiotracer predictive of poor responder. Despite unfavourable result seen with SMM, the patient received 4 cycles of neo-adjuvant chemotherapy (NACT). However, there was no clinical response after chemotherapy. The post-surgical histopathology revealed the actual histology to be pleomorphic liposarcoma. This case highlights that SMM has the ability to predict non-responsiveness of unusual tumour histology to standard NACT.