Pure Squamous Cell Carcinoma of the Breast Presenting as a Pyogenic Abscess: A Case Report

Squamous cell carcinoma of the breast as a clinical diagnostic challenge

Squamous cell carcinoma (SqCC) of the breast should be differentiated between the primary skin keratinizing squamous carcinoma and squamous metaplastic cancer. In the current study, the cases of two patients who were diagnosed with SqCC originated from skin and the breast were discussed. A fine-needle aspiration biopsy confirmed the presence of atypical squamous cells. In both cases, the microscopic examination of the surgical specimen revealed a malignant neoplasm differentiated into SqCC characterized by keratinizing cancer cells with abundant eosiphilic cytoplasm with large, hyperchromatic vesicular nuclei. Immunohistochemical studies showed negative for progesterone and estrogen receptors and human epidermal growth factor receptor 2. Moreover, negative expression of cytokeratin 7 and 20 was confirmed. The diagnosis of the both tumors was established based on the detailed analysis of clinical, macroscopical and microscopical information. SqCC localized in the breast is a great diagnostic challenge in pathomorphology and more attention should be paid for analysis of such lesions in daily practice.

Impact of Squamous Differentiation in Breast Carcinoma

This study attempted to review the impact of extent of squamous differentiation in 56 infiltrating duct carcinomas (IDC) with squamous differentiation (metaplastic squamous carcinomas [MSC]). Tumors showing 100% squamous elements were labeled as primary squamous carcinomas (PSC; n = 28) and compared with 28 MSC showing lesser squamous components. A clinicopathological comparison revealed that lymphovascular emboli were never seen in any PSC but were noted in 7/28 of other MSC, while perineural invasion was seen only in PSC and not in MSC. Nodal metastasis was significantly more in other MSC as opposed to PSC. Most MSC presented with 2- to 5-cm sized tumors while PSC were 5 to 10 cm in size. PSC showed cystic change while MSC did not. Disease free survival (DFS) for MSC versus PSC was 64% versus 39.8%, while overall survival (OAS) was 72.7% in MSC versus 66.7% in PSC. Tumor stage affected DFS in MSC while none of the factors affected DFS/OAS in PSC. The extent of squamous differentiation affected DFS with best behavior for metaplastic carcinomas showing <40% squamous elements and worse for those with >90% squamous component ( P = .024). PSC of breast is an aggressive disease and show distinct clinicopathological features from other MSC, and though the current definition of MSC does not advocate quantifying the squamous element, clearly this affects prognosis.

Idiopathic granulomatous lobular mastitis

Idiopathic granulomatous lobular mastitis (IGLM) is a rare breast condition with prominent skin findings. It is typically seen in young parous women. Painful breast masses, draining sinuses, scarring, and breast atrophy are the main clinical manifestations. IGLM can resemble a variety of other inflammatory and neoplastic processes of the breast. It is thought to result from obstruction and rupture of breast lobules. Extravasated breast secretions then induce an inflammatory reaction. Corynebacteria have also been implicated in the pathogenesis. Treatment is surgical, but systemic corticosteroids, methotrexate, and antibiotics also play a role.

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.

Primary squamous cell carcinoma of the breast: achieving long-term control with cisplatin-based chemotherapy

Pure primary squamous cell carcinoma (SCC) of the breast is rare and difficult to treat. Published series suggest a poor response to conventional breast chemotherapy. A 66-year-old woman with locally advanced SCC of the breast received combined-modality treatment with high-dose radiation therapy (59 Gy in 22 fractions); mastectomy; and chemotherapy with cisplatin 50 mg/m(2), mitomycin-C 6 mg/m(2), and ifosfamide 3 g/m(2) given in 21-day cycles. She remained disease free for 10 years from presentation and died from an unrelated cause. We would suggest that this case lends support to the use of high-dose radiation therapy and platinum-based chemotherapy in the management of this difficult condition.

Squamous Cell Carcinoma of the Breast: A Review of 177 Cases

Squamous cell carcinoma (SCO of the breast is an uncommon breast neoplasm. There are limited data about its epidemiology and few studies focusing on outcomes. This study aims to identify specific characteristics of patients with breast SCC, investigate its natural history, and determine its long-term prognosis. One hundred and seventy-seven cases of SCC of the breast were identified in the California Cancer Registry from the years 1988 to 2006. At the time of diagnosis, 53 per cent of patients had localized disease, 32 per cent of patients had regional lymph node or locally advanced disease, and 8 per cent of patients had distant disease. The relative cumulative survival of patients was 68.1 per cent at 5 years and 60.2 per cent at 10 years. This is significantly worse than the relative cumulative survival of patients with all other invasive breast tumors during the same time period. Squamous cell carcinoma of the breast is a rare and aggressive disease, and it has significantly worse prognosis than other nonsquamous cell tumors of the breast. Clinicians should be aware of the aggressive nature of the tumor when counseling patients.