Squamous cell carcinoma of the breast

Primary squamous cell carcinoma of the breast: predictors of locoregional recurrence and overall survival

Studies evaluating the biological behavior of primary squamous cell carcinoma (SCC) of the breast have yielded inconsistent results, perhaps in part because most studies have not taken into consideration specific histologic subtypes. We identified 21 cases of primary SCC of the breast diagnosed between the years 1985 and 2010 and analyzed the association between particular histologic features and disease outcome. Most tumors (17/21) were moderately or poorly differentiated, and most had a high nuclear grade (15/21). Five-year locoregional recurrence-free survival (LRRFS) for all patients was 54%±12%, and 5-year overall survival (OS) was 51%±13%. The only statistically significant feature associated with LRRFS was the presence of a spindle cell component in the tumor. Patients with >10% spindle cell component had decreased LRRFS (log rank; P=0.006). The only statistically significant features associated with OS were patient age and tumor keratinization. Patients more than 60 years of age had decreased OS (log rank; P=0.035), and patients with tumors having at least focal keratinization had improved OS (log rank; P=0.027). Lymph node status, mitotic rate, tumor necrosis, cystic degeneration, clear cell change, and the presence of a pleomorphic component or associated ductal carcinoma in situ were not associated with either LRRFS or OS. In summary, primary SCC of the breast tends to be aggressive, particularly in patients more than 60 years of age and those with tumors having >10% spindle cell component. The presence of at least focal keratinization, however, is associated with significantly improved OS.

Primary epidermoid carcinoma of the breast presenting as a breast abscess and sepsis

CONTEXT

Squamous cell carcinoma (SCC) of the breast is an extremely rare form of cancer, accounting for approximately 0.04% of all malignant breast tumors. To date, only a limited number of cases of SCC of the breast have been reported, and most of them presented like the usual breast carcinomas.

CASE REPORT

A 39-year-old woman presented with a large breast abscess and signs of sepsis. After surgical debridement of the lesion, histopathological examination of the abscess capsule revealed the presence of SCC of the breast. The definitive treatment for the tumor consisted of modified radical mastectomy with resection of the residual lesion in the right breast.

CONCLUSIONS

This unusual case illustrates how an apparently benign disorder such as a breast abscess might be related to a clinically occult malignancy. A review of the literature on SCC of the breast is presented.

Squamous cell carcinoma of the breast

OBJECTIVE

Pure squamous cell carcinoma (SCC) of the breast is a rare tumour and its clinical behaviour is not correctly known. The aim of the study is to evaluate the prevalence, epidemiological and clinical characteristics of the cases of SCC studied in our institution.

STUDY DESIGN

The breast department's database was searched for patients diagnosed with breast SCC between September 1979 and June 2006. Pathological features, outcome aspects and prognosis were studied. All specimens were reviewed by our pathologist who performed inmunohistochemistry for hormone receptors.

RESULTS

Eleven patients were identified (0.19%) between 5771 cases of breast cancer. Mean age was 64 (37-76) years and mean follow-up was 46 (6-216) months. Mean disease free survival (DFS) was 92 months (S.E.=33), with a 36% DFS rate at 5 years and the mean overall survival was 93 months (S.E.=34). Mean survival from the time recurrent disease was recognized was 9 (1-16) months. Tumours were hormone receptor negative.

CONCLUSIONS

SCC of the breast is aggressive and often treatment-refractory. The role of different new chemotherapy regimens need to be explored.

Primary Pure Squamous Cell Carcinoma of the Breast

Primary squamous cell carcinoma (SCC) of the breast is an extremely rare tumor. It is diagnosed when the malignant cells are entirely of squamous type, the tumor is independent from overlying skin, and other primary SCC sites are excluded. This report presents clinical, radiologic, and histologic correlative findings of a patient diagnosed with pure SCC of the breast. Literature review suggests that primary SCC tumors of the breast are large, often cystic lesions, with a low rate of nodal involvement, no expression of estrogen and progesterone receptors, and resistance to the chemotherapy regimens commonly used in breast cancer.

Primary squamous cell carcinoma (SqCC) of the breast

Primary squamous cell carcinoma (SqCC) of the breast is a rare tumor that presents a unique biologic behavior. Thus, it challenges the justification for routine axillary dissection and adjuvant therapy. A MEDLINE search of all reported cases of primary SqCC of the breast was performed. Data on lymph node status, estrogen receptor (ER) and progesterone receptor (PR) status, and surgical and adjuvant treatment modalities were collected. We add three cases from our own experience. SqCC has several unique biologic characteristics; it is associated with a lower rate of lymph node metastasis at presentation (22% vs. 40-60% for infiltrating ductal carcinoma [IDC]) and a significant rate of distant metastasis without lymph node involvement. ER and PR receptor levels are usually very low. Because lymph node involvement plays a lesser prognostic and therapeutic role in this disease, we propose a more selective approach (i.e., sentinel node biopsy). The issue of adjuvant treatment remains unresolved, owing to lack of data. Surgical and medical treatment of SqCC of the breast should be tailored to fit its distinct biologic characteristics. The 5-fluorouracil-doxorubicin-cisplatin combination may be warranted in lieu of the combinations used for IDC.

Squamous cell carcinoma of the breast: clinico-pathologic implications and outcome

AIMS

Pure squamous cell carcinoma (SCC) of the breast is a rare tumour and little is known about long-term outcome. We report our experience of a consecutive series of patients.

METHODS

All patients with SCC treated at our institution between 1970 and 2001 were included. The pathological features, outcome and prognosis were studied.

RESULTS

Eleven patients were identified. The median age was 55 (38-90) years and median follow-up was 62 (3-332) months. Four tumours were T1, three were T2 and three were T3 (one tumour size was unknown). There were seven poorly differentiated and three moderately differentiated SCC. Tumour grade could not be assessed in one patient. Primary treatment was mastectomy in six patients, wide local excision in four patients and radiotherapy in one patient. There was lymph node (LN) involvement in two patients. Oestrogen receptor status was assessed in seven patients and only one tumour was positive. Adjuvant chemotherapy was given to three patients and five patients received adjuvant radiotherapy. Two patients developed local recurrence at 5 and 12 months and three patients developed distant metastasis at 2, 36 and 306 months. Three patients were treated with chemotherapy at recurrence. Three patients have died of the disease, two are alive with disease and six remain well. The 2- and 5-year overall survival was 80% (SE=13%) and 67% (SE=16%) respectively. Large tumour size and positive LN status were prognostic indicators of poor outcome.

CONCLUSION

SCC of the breast adopts an aggressive course with outcome comparable to poorly differentiated breast adenocarcinoma.

Cytodiagnosis of pure primary squamous-cell carcinoma of the breast by fine-needle aspiration cytology

In this communication five cases of pure primary squamous-cell carcinoma of the breast are presented in which the diagnosis was made by fine-needle aspiration cytology. All patients were women. The aspiration cytodiagnosis was further confirmed by subsequent examination of cell blocks from the aspirated material and biopsy of the breast mass. The cytohistologic features in all cases were characterized by numerous malignant squamous cells with keratinizing cytoplasm, hyperchromatic dense nuclei, coarse chromatin, thickened nuclear membranes, keratin debris, and background necrosis. The identification of malignant squamous cells as predominant cells in aspirate samples from the breast is quite important and should be followed by a search for other sources of a primary tumor before a diagnosis of pure primary squamous-cell carcinoma of the breast is accepted. The value of immunocytochemical study despite immunopositivity for cytokeratin and epithelial membrane antigen (EMA) and immunonegativity for carcinoembryonic antigen (CEA) and B72.3 was considered to be somewhat uncertain.

Squamous cell carcinoma of the breast: a clinical approach

BACKGROUND

Squamous cell carcinoma (SCC) of the breast is rare. It remains unclear whether a "pure" form of SCC exists or if all known cases actually represent an extreme form of squamous metaplasia within adenocarcinoma. Due to its rarity and controversy over its definition, there are no good data on appropriate management and prognosis.

METHODS

All cases of breast carcinoma indexed at our institution were reviewed to identify seven cases where squamous metaplasia was a significant component of the pathologic diagnosis. Slides and electron micrographs were reviewed by a single pathologist. Clinical information was obtained from medical records.

RESULTS

These cases support the concept of a disease continuum with varying degrees of squamous metaplasia. When tumors identified as "pure" SCC on light microscopy are subjected to ultrastructural analysis, either separate squamous and glandular cells are present or both histologic features are noted to coexist in the same cell.

CONCLUSIONS

Identification of "pure" cases of SCC appears clinically unimportant. All patients presented with advanced disease, thus necessitating aggressive management regardless of histology. Mastectomy was performed due to large tumor size and adjuvant chemotherapy given rather than hormones because of receptor negativity. The mixed histology should direct future drug choice. The role of radiation remains unclear.

Metaplastic carcinomas of the breast. IV. Squamous cell carcinoma of ductal origin

The clinical and pathologic features of 22 examples of pure ductal squamous cell carcinoma (SqCC) of the breast are reported. All patients were women with a mean age of 53 years. Only two of the 19 women with axillary dissection had metastases, but one woman had a positive supraclavicular lymph node in the presence of negative axillary nodes. All metastases were squamous carcinoma. All patients were eligible for a minimum of 5 years' follow-up; the cumulative 5-year disease-specific survival rate was 63%. Eight women developed metastases and one also developed local recurrence, all within 2 years, and all eight died from tumor within 4 years of initial therapy (mean, 2 years). Prophylactic postoperative radiation therapy and radiation for lymph node metastases at initial surgery did not prolong survival as four of the five recipients died from tumor. Although there were no statistically significant gross or histologic differences between recurrent and nonrecurrent neoplasms, larger neoplasms tended to metastasize. Immunohistochemical study for S-100 protein identified an immunoreactive cell component in five of seven neoplasms tested. This and light microscopic findings suggest myoepithelial proliferation, differentiation, or origin.

Magnetic resonance imaging appearance of primary squamous cell carcinoma of the breast

Primary squamous cell carcinoma is a rare form of carcinoma of the breast. This article reports on two such lesions with their appearance in magnetic resonance imaging and reviews the scant English literature of the past 10 years. Most of these tumors are circumscribed and have areas of necrosis. The prognosis in patients with this disease is the same as that of adenocarcinoma of the same size and stage.

Pure squamous cell carcinoma of the breast

Pathological curiosities have always fascinated the surgical community, and management of breast cancer by the physician has, at times, revealed such rarities. A recent case of squamous cell carcinoma in a clear fluid breast cyst has prompted a review of our experience with this rare pathology, and allowed us to make the following statements: We propose that squamous cell carcinoma of the breast arises from ductal metaplasia. When the T.N.M. system is applied to the squamous cell lesion, the apparent poor prognosis that it is believed to carry may not be so apparent. If no other primaries are identified after extensive metastatic work-up, surgical therapy consisting of total mastectomy with complete axillary dissection, is very effective in local control of tumor progress. Nodal status will indicate the need for additional modalities of therapy.