The patient was a 74 years old female affected by locally advanced IDC. Prior to chemotherapy and subsequent surgery, the patient underwent needle biopsy. The histological diagnosis was infiltrating breast carcinoma with weak (< 1%) ER staining (clone SP1), negative for PgR (clone 1E2), 60% cells positive for Ki-67 (clone MIB1) and HER2 positive with intense staining > 10% (score 3+). Thus, the patient underwent neoadjuvant chemotherapy including liposomal doxorubicin and cyclophosphamide followed by paclitaxel and trastuzumab. Trastuzumab was also administered in the post-operative setting. A partial clinical and radiographic response was documented after neoadjuvant treatment with a 50% reduction of the tumor diameter. As a surgical procedure a quadrantectomy with sentinel node biopsy and removal of 2 additional I level axillary lymph nodes was performed. The histological and biological characteristics of the tumor were the following: high grade (G3) IDC not otherwise specified, ER/PR, HER2+ 40% (color intensity score 3+), 60% of cells positive for Ki-67 (i.e. highly proliferating tumor). The pathological stage evaluated post-neoadjuvant chemotherapy was: ypT1c; ypN0 (sn)(mol). The patient is disease-free 5-years after adjuvant chemotherapy. The patient gave her written informed consent to the use of part of the surgical specimen for the study purposes. The study was approved by the local ethics committee of the Careggi Hospital, University of Florence (Firenze, Italy), and all the relative procedures were performed in accordance with SOPs (Standard Operating Procedures) and relevant guidelines and regulations of the Careggi Hospital, University of Florence (Firenze, Italy).

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