Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 
  Users Online: 1648 Home Print this page Email this page Small font sizeDefault font sizeIncrease font size  

 Table of Contents  
CASE REPORT
Year : 2014  |  Volume : 4  |  Issue : 1  |  Page : 53-55  

Primary squamous cell carcinoma of the breast


Department of Pathology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India

Date of Web Publication22-Jan-2014

Correspondence Address:
Sachin A Badge
Department of Pathology, Mahatma Gandhi Institute of Medical Sciences, Sevagram - 442 102, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-516X.125697

Rights and Permissions
   Abstract 

Primary squamous cell carcinoma (SqCC) of the breast is a very rare tumor accounting for less than 0.1% of all invasive breast carcinomas. This is a very aggressive, hormone receptor negative and treatment refractory tumor with poor prognosis. We report a case of primary SqCC of the breast in a 72-year-old postmenopausal lady who presented with a lump in the right breast. The treatment of primary SqCC of the breast does not differ from other common histological types of breast cancer and may involve surgery, chemotherapy, hormonal therapy and radiation therapy. Clinical trials including large series of these rare tumors are needed to increase our knowledge and to improve patient's outcome.

Keywords: Breast, carcinoma, squamous cell


How to cite this article:
Badge SA, Gangane NM, Shivkumar VB, Sharma SM. Primary squamous cell carcinoma of the breast. Int J App Basic Med Res 2014;4:53-5

How to cite this URL:
Badge SA, Gangane NM, Shivkumar VB, Sharma SM. Primary squamous cell carcinoma of the breast. Int J App Basic Med Res [serial online] 2014 [cited 2020 May 29];4:53-5. Available from: http://www.ijabmr.org/text.asp?2014/4/1/53/125697


   Introduction Top


Squamous cell carcinoma (SqCC) is most common in the skin and other organs lined by squamous cells such as the esophagus and the anus. Primary SqCC of the breast is very rare accounting less than 0.1% of all invasive breast carcinomas. [1] Literature review showed that very few cases have been reported until now. This is a very aggressive, hormone receptor negative and treatment refractory tumor with poor prognosis. We report a case of this rare malignancy.


   Case Report Top


A 72-year-old postmenopausal lady presented with a lump in the right breast. The lump was gradually progressive in size, not associated with pain, nipple discharge and retraction or dimpling of the skin. There was no family history of breast malignancy. Physical examination revealed firm, rubbery, non-tender and non-mobile lesion of 8 × 7 cm in upper outer quadrant of the right breast. Axillary lymph nodes were not enlarged. Mammogram of the right breast demonstrated a spherical mass lesion with ill-defined speculated margins. The skin and the nipple-areola complex were not involved. Lumpectomy was performed. Grossly, the tumor was 8 × 6 × 4 cm in size. The cut section showed gray white appearance with few cystic areas. On histopathology, diagnosis of SqCC with involvement of surgical margins was given. An extensive work-up ruled out other primary site or metastatic disease. Right modified radical mastectomy with axillary lymph nodes dissection was performed. Microscopically, the tumor was composed of sheets and clusters of round to polyhedral cells with pleomorphic hyperchromatic nuclei and a moderate amount of eosinophilic cytoplasm. Individual cell keratinization and keratin pearls were also seen [Figure 1]. The tumor cells were positive for cytokeratin and negative for estrogen and progesterone receptors. Hence diagnosis of primary SqCC of the breast was given. All 12 axillary lymph nodes were free of tumor. Overlying skin and areola was uninvolved by tumor.
Figure 1: Sheets and clusters of round to polyhedral cells with pleomorphic hyperchromatic nuclei and moderate amount of eosinophilic cytoplasm along with individual cell keratinization and keratin pearls

Click here to view



   Discussion Top


Pure primary squamous carcinoma is a rare and aggressive form of metaplastic carcinoma of the breast. Macia et al. defined pure SqCC with following criteria. [2]

  • No other neoplastic components such as ductal or mesenchymal elements are present in the tumor
  • The tumor origin is independent of the overlying skin and nipple
  • Absence of an associated primary SqCC in a second site.


According to Rosen et al., the presence of in situ squamous carcinoma in the ducts is a must for the diagnosis of primary squamous cell carcinoma. [3] They have defined squamous carcinoma as a lesion in which more than 90% of the neoplasm is comprised of squamous carcinoma or its variant. [3] In the case reported here, the tumor had an intraductal component and the carcinoma was comprised of more than 90% of malignant squamous cells. Rosen et al. have also mentioned that cystic degeneration was associated with primary SqCC and not with metastatic squamous cell carcinoma. [3] The etiology and pathogenesis of SqCC of the breast is still unclear. It has been suggested that it may be a very extreme form of squamous cell metaplasia developing into an adenocarcinoma. This could also explain the mixed forms. [4] Moreover, squamous cell metaplasia is also seen in cysts, chronic inflammations, abscesses and adenofibromas. [5] In our case, however, there was no such preexistent abnormality. In addition to a presentation with inflammation, the average size of the tumor is larger than adenocarcinoma of the breast. [5] SqCC of the breast is the tumor of elderly age group. [5] Tumors frequently reach large volumes and can be as large as 5 cm. [6] Our patient was 72 year old and she had a mass of 8 cm. There are no typical findings on the mammogram. Ultrasound may show a complicated cyst or an inflammatory process. Histopathologic examination of SqCC shows sheets of large malignant squamoid cells with intercellular bridges and keratin formation. [7] Squamous cell carcinomas are reported to result in less lymphatic spread than adenocarcinomas. In 10-30% of cases, there is lymph node infiltration at the time of surgery. [1],[5] In contrast, about 30% of the patients will develop distant metastasis. The treatment of SqCC of the breast does not differ from other common histological types of breast cancer and may involve surgery, chemotherapy, hormonal therapy and radiation therapy. Due to its rarity the most appropriate therapeutic regimen for SqCC of the breast is still unclear. A recent literature review reveals that an average of 70% of patients with SqCC of the breast do not present axillary lymph nodes involvement, but due to unpredictable lymph node dissemination, axillary lymph nodes dissection could always be performed for staging purposes. [5] Rostock et al. suggests that SqCC is not sensitive to chemotherapeutic agents commonly used for ductal carcinoma such as methotrexate, cyclophosphamide, 5-fluorouracil (5-FU) and anthracycline. [8] A good response on metastatic disease has been reported in one patient who received cisplatin and 5-FU, but this has never been investigated in other report. [9] The breast SqCC is usually a high-grade and hormone receptor-negative tumor. [5] This means that hormone based therapy may not be effective in these tumors. Human epidermal growth factor receptor 2/neu is also usually not over-expressed or amplified in this disease. [8] The high frequency of epidermal growth factor receptor (EGFR) positivity is interesting and may be exploited in the development of future treatments. The prognosis of this type of breast cancer is still regarded as somewhat controversial, though many studies suggest that it is an aggressive disease that may behave like poorly differentiated breast carcinoma. [3],[10] The 5-year survival is 67% in a small retrospective series of eleven patients. [5]


   Conclusion Top


Primary SqCC of the breast is very rare and aggressive tumor having poor prognosis. Poor response of SqCC of the breast to chemotherapeutic regimens commonly used in breast cancer, suggests that EGFR inhibitors and platin based regimens could be a promising option for treatment of these tumors. Clinical trials including large series of these rare tumors are needed to increase our knowledge and to improve patient's outcome.

 
   References Top

1.Gupta C, Malani AK, Weigand RT, Rangineni G. Pure primary squamous cell carcinoma of the breast: A rare presentation and clinicopathologic comparison with usual ductal carcinoma of the breast. Pathol Res Pract 2006;202:465-9.  Back to cited text no. 1
[PUBMED]    
2.Macia M, Ces JA, Becerra E, Novo A. Pure squamous carcinoma of the breast. Report of a case diagnosed by aspiration cytology. Acta Cytol 1989;33:201-4.  Back to cited text no. 2
[PUBMED]    
3.Rosen PR. Rosen′s Breast Pathology. Ch. 21. Philadelphia, New York: Lippincott-Raven; 1997. p. 397-404.  Back to cited text no. 3
    
4.Stevenson JT, Graham DJ, Khiyami A, Mansour EG. Squamous cell carcinoma of the breast: A clinical approach. Ann Surg Oncol 1996;3:367-74.  Back to cited text no. 4
[PUBMED]    
5.Behranwala KA, Nasiri N, Abdullah N, Trott PA, Gui GP. Squamous cell carcinoma of the breast: Clinico-pathologic implications and outcome. Eur J Surg Oncol 2003;29:386-9.  Back to cited text no. 5
[PUBMED]    
6.Eusebi V, Lamovec J, Cattani MG, Fedeli F, Millis RR. Acantholytic variant of squamous-cell carcinoma of the breast. Am J Surg Pathol 1986;10:855-61.  Back to cited text no. 6
[PUBMED]    
7.Pramesh CS, Chaturvedi P, Saklani AP, Badwe RA. Squamous cell carcinoma of breast. J Postgrad Med 2001;47:270-1.  Back to cited text no. 7
[PUBMED]  Medknow Journal  
8.Rostock RA, Bauer TW, Eggleston JC. Primary squamous carcinoma of the breast: A review. Breast 1984; 10:27-31.  Back to cited text no. 8
    
9.Hiramatsu K, Kato K, Hirata A, Matsuba H, Hara T, Ito T, et al. A resected case of squamous cell carcinoma of the breast successfully treated by FU plus cisplatin (CDDP) adjuvant therapy against recurrent metastases. Gan To Kagaku Ryoho 2007;34:443-6.  Back to cited text no. 9
[PUBMED]    
10.Moisidis E, Ahmed S, Carmalt H, Gillett D. Primary squamous cell carcinoma of the breast. ANZ J Surg 2002;72:65-7.  Back to cited text no. 10
[PUBMED]    


    Figures

  [Figure 1]


This article has been cited by
1 Squamous cell carcinoma of the breast, are there two entities with distinct prognosis? A series of 39 patients
F. Pirot,D. Chaltiel,A. Ben Lakhdar,M. C. Mathieu,F. Rimareix,A. Conversano
Breast Cancer Research and Treatment. 2020;
[Pubmed] | [DOI]
2 Case Reports on Metaplastic Squamous Cell Carcinoma of the Breast and Treatment Dilemma
Anita Pandey,Kishor Joshi,Harry Moussouris,Gardith Joseph
Case Reports in Oncological Medicine. 2019; 2019: 1
[Pubmed] | [DOI]
3 Primary squamous cell carcinoma of the breast: a case report and review of the literature
Nirupama Anne,Elisabeth Sulger,Ratnakishore Pallapothu
Journal of Surgical Case Reports. 2019; 2019(6)
[Pubmed] | [DOI]
4 Management and prognosis of pure primary squamous cell carcinoma of the breast
P. Benoist,A. Mureau,Y. Joueidi,F. Arbion,A. Vilde,G. Body,P. Michenet,J. Leveque,L. Ouldamer
Journal of Gynecology Obstetrics and Human Reproduction. 2018;
[Pubmed] | [DOI]
5 A Comparative Review of Mixed Mammary Tumors in Mammals
Eman S. A. Saad,Jacqueline S. Y. Lam,Awf A. Al-Khan,Mourad Tayebi,Michael J. Day,Samantha J. Richardson,Janine A. Danks
Journal of Mammary Gland Biology and Neoplasia. 2018;
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
   Case Report
   Discussion
   Conclusion
    References
    Article Figures

 Article Access Statistics
    Viewed2797    
    Printed60    
    Emailed2    
    PDF Downloaded406    
    Comments [Add]    
    Cited by others 5    

Recommend this journal