Histopathological Changes Following Neoadjuvant Therapy in Non-Hematological Malignancies

Abstract

Background: A comprehensive study describing the histopathological changes following neoadjuvant therapy in spectrum of non-hematological malignancies is imperative because these studies are barely undertaken.

Aims and objectives:

To study the histopathological changes after neoadjuvant therapy in non-hematological malignancies and to assess tumor regression.

Materials and Methods: Two-year prospective and one-year retrospective study was conducted from the month of June 2016 to May 2019. Appropriate tumor regression scores were employed.

Results: A total of 50 cases were studied. The most frequent site encountered was ovary (42%) followed by head and neck (22%), breast (20%), gastrointestinal tract (10%), endometrium (2%), penis (2%) and bone (2%). Post therapy changes consistently found in all malignancies irrespective of site include - changes in tumor cells like dyscohesion, bizarre cells, cytoplasmic vacuolation and eosinophilia, nuclear karyorrhexis, karyolysis and pyknosis. Stromal changes studied were necrosis, hyalinization, fibrosis, foamy macrophages, hemosiderin laden macrophages, cholesterol clefts, giant cells, hyalinized blood vessels and chronic inflammation etc. Numerous site-specific changes were ascertained. Out of 50 cases, (n=3) cases of breast carcinoma, (n=1) case of ovarian carcinoma, (n=1) case of head and neck malignancy, (n=1) case of penile carcinoma and (n=1) case of giant cell tumor showed complete response.

Conclusion: Response to therapy is not uniform in all malignancies and hence sound knowledge of it is required to gauge the response effectively. Tumor response grading system has to be standardized and incorporated in routine reporting.