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

Correlation Between Quantitative Parameters Obtained by Dual Energy Spectral CT and Prognostic Histopathological Factors and Biomarkers in Breast Cancer

RATIONALE AND OBJECTIVES

To investigate the correlation between quantitative parameters obtained by dual energy spectral computed tomography (DESCT) and various histopathological factors and biomarkers associated with the prognosis of breast cancer.

MATERIALS AND METHODS

Quantitative parameters such as iodine content (IC), normalized IC (nIC), iodine enhancement (IE) and normalized IE (nIE) were measured on virtual monochromatic images and iodine mapping images obtained from DESCT in 116 female breast cancer patients. The relationship between these parameters and prognostic biomarkers such as estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) status and Ki67 levels, as well as the correlation with histological grade (HG), lymphovascular invasion (LVI), and metastatic axillary lymphadenopathy (LAP) were evaluated.

RESULTS

ER-negative tumors had significantly higher values of IC, nIC, IE, and nIE compared to ER-positive tumors. PR-negative tumors had significantly higher values of IE and nIEc compared to PR-positive tumors. HER2 overexpressed and Ki-67 high proliferation tumors showed significantly higher values of all quantitative parameters compared to HER2 negative and Ki-67 low proliferation tumors. All quantitative parameters were significantly higher in HG 3 tumors, tumors with detected LVI, and tumors with metastatic axillary LAP compared to low-grade tumors, LVI-negative tumors and tumors without metastatic axillary lymph nodes, respectively.

CONCLUSION

Quantitative parameters of IC and IE obtained from DESCT have shown potential for predicting prognosis in breast cancer patients. Higher values of these parameters have been found to correlate with poor prognostic biomarkers and histopathological features. These results suggest that quantitative DESCT imaging may offer an additional benefit in the noninvasive prediction of breast cancer prognosis.

Bilateral metaplastic squamous cell breast cancer

ABSTRACT

Metaplastic breast cancer is a rare and heterogeneous breast cancer group that encompasses both malign epithelial and mesenchymal tissue components. Squamous cell breast cancer (SCC) is one of the types of metaplastic breast cancer, and diagnosis is established when more than 90% of the malignant cells are of squamous cell origin. Squamous cell metaplastic breast carcinoma is considered an aggressive tumor because of the risk of distant metastases, and there are limited data on treatment patterns. In this study, we report patient characteristics and treatment results of one patient with bilateral metaplastic squamous cell breast cancer.

Invasive squamous cell carcinoma of the breast associated with breast augmentation implant capsule

Primary squamous cell carcinoma (SCC) of the breast is rare, representing less than 0.1% of all breast cancers. To date, there have been 20 reported cases of SCC associated with breast augmentation, usually in patients with long-standing implants. A patient is reported here with primary squamous carcinoma of the breast associated with textured saline implants. Due to the paucity of cases, there is limited information on the incidence and management of implant-associated SCC of the breast.

A Novel Germline Pathogenic Variant of RECQL4 Gene in an Iranian Pedigree with Familial Squamous Cell Carcinoma: A Brief Report

Squamous cell carcinoma (SCC) is the most common human solid tumor and the leading cause of cancer death. SCC of the breast is a very rare type of cancer that has not been well researched. Early identification of the genetic factors involved can lead to early diagnosis and targeted treatment. The present study was conducted in 2018 at Isfahan University of Medical Sciences (Isfahan, Iran). The proband was a 66-year-old woman with SCC of the breast and a positive family history of cancer. Blood DNA samples were used for whole-exome sequencing to identify germline pathogenic variants. Variant annotation and prioritization were done on variant call format files using bioinformatics software tools. The screened variants were confirmed using the Sanger sequencing method. Co-segregation analysis was performed on the blood DNA samples of the first- and second-degree relatives of the proband to assess the presence of the mutation. A novel germline pathogenic variant was identified in the RECQL4 gene of the family. RECQL4 is a known protein in DNA repair and replication. Considering its effect on other types of SCC, it may play an important role in SCC initiation and progression in the breast.

Primary breast squamous cell carcinoma: A case report at a tertiary hospital in Northern Tanzania

Key Clinical Message

Primary SCC of the breast is a very rare disease.Metastasis from elsewhere should be excluded first.The tumor is a very aggressive with poor prognosis.No standard treatment approaches are available.Managed by surgical excision followed by chemotherapy and radiotherapy.

Abstract

Primary squamous cell carcinoma of the breast is an exceedingly rare disease, and its management is still unclear. A-65-year-old lady presented with a progressive swelling of her right breast that started spontaneously. Other potential primary sites were ruled out. She was kept on a neo-adjuvant chemotherapy (AC-T protocol) of doxorubicin, adriamycin, and paclitaxel. Later, she was underwent modified radical mastectomy with axillary lymph node dissection. Her post-operative recovery was uneventful. Currently, she is followed up at oncology outpatient clinic.

DNA damage triggers squamous metaplasia in human lung and mammary cells via mitotic checkpoints

Epithelial transdifferentiation is frequent in tissue hyperplasia and contributes to disease in various degrees. Squamous metaplasia (SQM) precedes epidermoid lung cancer, an aggressive and frequent malignancy, but it is rare in the epithelium of the mammary gland. The mechanisms leading to SQM in the lung have been very poorly investigated. We have studied this issue on human freshly isolated cells and organoids. Here we show that human lung or mammary cells strikingly undergo SQM with polyploidisation when they are exposed to genotoxic or mitotic drugs, such as Doxorubicin or the cigarette carcinogen DMBA, Nocodazole, Taxol or inhibitors of Aurora-B kinase or Polo-like kinase. To note, the epidermoid response was attenuated when DNA repair was enhanced by Enoxacin or when mitotic checkpoints where abrogated by inhibition of Chk1 and Chk2. The results show that DNA damage has the potential to drive SQM via mitotic checkpoints, thus providing novel molecular candidate targets to tackle lung SCC. Our findings might also explain why SCC is frequent in the lung, but not in the mammary gland and why chemotherapy often causes complicating skin toxicity.

Primary squamous cell carcinoma of the breast: A case report and review of the literature

Primary squamous cell carcinoma (PSCC) of the breast, as a rare metaplastic breast cancer, currently has limited clinical data on its biological behavior, treatment and prognosis. At present, the optimal treatment of this tumor is still controversial. We reported a case of a 56-year-old woman with a mass on the right breast. She underwent a modified radical mastectomy and lymph node biopsy, which revealed that the tumor was a metaplastic squamous cell carcinoma with axillary lymph node metastasis, followed by traditional adjuvant chemotherapy and radiotherapy. The patient re-examined by PET/CT after two years in May 2017 and found a recurrence in the right chest wall, so resection of the recurring lesion was resected, then she was given postoperative adjuvant radiotherapy and chemotherapy. In August 2019, the patient re-examined by PET/CT, and there were pulmonary and mediastinal lymph node metastases. After 4 cycles of albumin paclitaxel plus cisplatin chemotherapy combined with nivolumab immunotherapy, the patient achieved complete response (CR), and then switched to nivolumab immune maintenance therapy. So far, no obvious metastasis has been seen. We believe that surgical treatment is necessary for PSCC of the breast;paclitaxel and cisplatin chemotherapy regimens and adjuvant radiotherapy are effective, but it may be resistant to radiotherapy; and immunotherapy may prolong the survival of patients with PSCC of the breast.

Squamous cell carcinoma of the breast: About a case

Squamous cell carcinoma of the breast is a rare metaplastic breast tumor whose histogenesis is controversial. Its prevalence is estimated between 0.06 % and 0.2 % of all breast neoplasms. The histogenesis remains obscure. The clinical aspects are not specific. Squamous cell carcinoma is characterized by a rapid evolution and by an uncodified treatment. The objective of our work, by reporting a new case of primary squamous cell carcinoma of the breast, is to specify through a literature review some characteristics of this particular form of breast cancer. Squamous cell carcinoma of the breast is a rare tumor belonging to the heterogeneous group of metaplastic carcinomas. The clinical and radiological presentations are not specific. The prognosis.

Targeted therapy combined with immunotherapy in patients with breast infiltrating ductal carcinoma with axillary lymph node metastasis of metaplastic SCC

At present, the clinicopathological features, optimal treatment patterns, and prognosis of breast metaplastic squamous cell carcinoma (SCC) are not fully understood and are still controversial. Here, we report a 56‐year‐old female patient with breast infiltrating ductal carcinoma with axillary lymph node metastasis of metaplastic SCC admitted to our hospital. Their homology was clarified by comparing the gene mutation results of the two lesions, that is, the axillary lymph node lesion was a metastasis of breast metaplastic SCC. We treated the patient with Poly ADP‐ribose Polymerase (PARP) inhibitors in combination with immune checkpoint inhibitors (ICIs) and found that she could achieve clinical benefit from the combination regimen. We reported a successful diagnosis and treatment of this rare refractory disease and reviewed the literature on the characteristics, pathogenesis, and advances in the diagnosis and treatment of breast metaplastic SCC.

A rare case of breast squamous cell carcinoma and literature review

Introduction

Presentation of case

Discussion

Conclusion

•

Breast Squamous Cell Carcinoma (SCC) is quite a rare tumour that the features portray squamous cell differentiation.

•

This case highlights the need of early detection along with the obstacles faced in reaching an early diagnosis.

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The prognosis usually depends on the tumour size and the advance age of the patient.

Preoperative MRI of breast squamous cell carcinoma: diagnostic value of distinguishing between two subtypes

AIM

To retrospectively analyse the clinical and MRI data of primary squamous cell carcinoma (SCC), particularly pure squamous cell carcinoma (PSCC) and mixed squamous cell carcinoma (MSCC).

MATERIALS AND METHODS

The MRI data and clinicopathological characteristics of 20 patients with histopathologically confirmed SCC of the breast, including eight PSCC patients and 12 MSCC patients, from multiple centres between January 2013 and December 2020 were analysed retrospectively.

RESULTS

Nine of 12 patients in the MSCC group showed hyperintensity on T1-weighted imaging (WI), while this feature was not observed in the PSCC group (p=0.001). Most of the PSCC group showed rim enhancement, whereas most of the MSCC group showed heterogeneous enhancement (p=0.007). In addition, there was no significant difference in the thickness of the rim enhancement and the percentage of necrotic components in the tumours between the two types of SCCs of the breast (p=0.545 and p=0.662, respectively). Four patients (4/12) in the MSCC group had sentinel lymph node metastasis, while only one patient (1/8) in the PSCC group showed lymph node metastasis (p=0.603). Metastatic disease occurred in 25% of patients with PSCC and in approximately 41.7% of patients with MSCC.

CONCLUSION

The signal on T1WI and internal enhancement characteristics were the key features for differentiating PSCC and MSCC. Therefore, MRI phenotypes may provide additional information for the pathological classification of breast SCC.

Acinar to ductal cell trans-differentiation: A prelude to dysplasia and pancreatic ductal adenocarcinoma

Pancreatic cancer (PC) is the deadliest neoplastic epithelial malignancies and is projected to be the second leading cause of cancer-related mortality by 2024. Five years overall survival being ~10%, mortality and incidence rates are disturbing. Acinar to ductal cell metaplasia (ADM) encompasses cellular reprogramming and phenotypic switch-over, making it a cardinal event in tumor initiation. Differential cues and varied regulatory factors drive synchronous functions of metaplastic cell populations leading to multiple cell fates and physiological outcomes. ADM is a precursor for developing early pre-neoplastic lesions further progressing into PC due to oncogenic signaling. Hence delineating molecular events guiding tumor initiation may provide cues for regenerative medicine and precision onco-medicine. Therefore, understanding PC pathogenesis and early diagnosis are crucial. We hereby provide a timely overview of the current progress in this direction and future perspectives we foresee unfolding in the best interest of patient well-being and better clinical management of PC.

Lumpectomy Combined with Adjuvant Radiotherapy Could Be a Treatment Option for Primary Squamous Cell Carcinoma of the Breast

Background

To investigate the outcomes of primary squamous cell carcinoma (PSCC) of the breast undergoing radical surgery with or without adjuvant radiotherapy (RT).

Materials and Methods

A population cohort with histologically diagnosed PSCC of the breast was identified from the SEER database. The Kaplan-Meier method and Cox-regression proportional hazards model was used to assess the impact of surgical types with or without adjuvant RT on the cause-specific survival (CSS) and overall survival (OS). A retrospective analysis of PSCC between Jan 2010 and Dec 2018 from our institute was performed.

Results

A total of 515 patients with PSCC of the breast were included, 254 patients treated with mastectomy (MAST) alone, 78 with MAST + RT, 87 with lumpectomy (LUMP) alone, and 96 with LUMP + RT. The median follow-up time was 118 months (range: 0-379 months). In the multivariate Cox analyses, LUMP + adjuvant RT was an independent prognostic factor for CSS (p = 0.028) and OS (p = 0.048). Patients treated with LUMP + RT had better survival rates than patients who underwent lumpectomy (CSS, p = 0.034; OS, p = 0.0004), MAST alone (CSS, p = 0.0001; OS, p < 0.0001), and MAST + RT (CSS, p = 0.0001; OS, p = 0.0078), while postmastectomy RT did not significantly improve OS (p = 0.062) and CSS (p = 0.67) when compared to MAST alone. In addition, a total of 28 patients with PSCC of the breast were identified from our institute. All of these patients presented with estrogen receptor-negative type, and three of them had HER-2-positive PSCC; the median tumor size was 3 cm (range: 0.5-15 cm). Eight patients were treated with LUMP + adjuvant RT, thirteen with MAST, and seven with MAST + RT. Until the last follow-up of Sep 2021, 26 patients with PSCC were still alive and free of breast cancer, excepting that one patient treated with MAST and one patient with MAST + RT died from breast cancer.

Conclusion

PSCC of the breast after radical surgery has a poor prognosis. Adjuvant RT after LUMP significantly improves survival of patients with PSCC of the breast. Further studies are still needed to investigate the role of adjuvant RT in PSCC of the breast after mastectomy.

Sonographic and pathological features of metaplastic squamous cell carcinoma of the breast: a case series

Objective

The aim of this study was to evaluate the sonographic features and to compare the sonographic findings with the pathologic features.

Methods

The sonographic and pathological features of all patients were retrospectively reviewed.

Results

All these 9 patients presented with a palpable breast mass first found by the patient before presentation. The median diameters were 3.67 cm. On two-dimensional imaging, 8 masses showed mixed echogenicity with both solid and cystic components, and only 1 mass showed hypoechoic. All the masses had irregular shapes. 1 mass had indistinct margin and 8 masses had microlobulated margins. Calcifications was seen in 1 mass. On color Doppler flow imaging, 8 masses had high vascularity with high resistance index; 5 masses had grade III blood flow signal; 3 masses had grade II blood flow signal. On histopathological examination, 5 masses were adenocarcinoma with squamous metaplasia, and 4 masses were pure SCC. On immunohistochemical staining, estrogen receptors (ER), progesterone receptors (PR) and human epidermal growth factor receptor (HER2) were negative in 5 masses. There were 2 patients with lymph node metastasis.

Conclusions

Most of the sonographic features of MSCC were mixed echogenicity with central cystic components, posterior echo enhancement, abundant vascularity with high resistance.

Clinicopathological Characteristics and Prognosis of Squamous Cell Carcinoma of the Breast: A Population-Based Analysis

Background

To better understand the clinicopathological features and prognostic profiles of squamous cell carcinoma (SCC) of the breast.

Methods

Information on breast cancer was obtained from the Surveillance, Epidemiology, and End Results database (2004–2016). Comparative analyses were carried out to investigate the heterogeneity in the clinicopathological characteristics and survival outcomes between SCC and invasive ductal carcinoma (IDC), while propensity score matching was conducted to analyze the variations among baseline characteristics. Prognostic factors for SCC of the breast were successively identified using Cox regression analysis.

Results

A total of 382 SCC patients and 561477 IDC patients were identified in this study. Comparatively, the SCC cohort exhibited a higher proportion of male individuals, poor differentiation, an advanced TNM stage, an increasing percentage of triple-negative (TN) subtype, an increasing rate of organ involvement, and less access to therapeutics. The aggressive profile was consistent in the TN subgroup, with a significantly higher proportion in SCC than in IDC (25.7% vs 6.8%). Prognosis of SCC was profoundly poorer than that of IDC (mOS, 78.6 months and 121.6 months, P < .0001; mBCSS 91.9 months vs 135.6 months, P < .0001), of which the inferior tendency remained stable among disease stage and therapeutic options, while no difference was detected in the 2 subgroups with the TN subtype. The 2-year survival rate was 66.9% and the 5-year survival rate was 51.4%, with the risk factors being older age, bilateral disease, advanced TNM stage, bone and visceral involvement, surgical intervention, radiation treatment, and chemotherapy.

Conclusions

This study systematically analyzed the heterogeneous characteristics of SCC of the breast in comparison with IDC. Squamous cell breast cancer presented with increasing aggressive behavior and inferior prognosis. Prospective studies should focus on this subgroup and introduce individualized therapeutic protocols in clinical practice.

Squamous Metaplasia in a Borderline Phyllodes Tumor-an Undocumented Histological Finding in Male Breast: Report of a Case and Review of Literature

Phyllodes tumor is a paradigm of fibroepithelial neoplasm that accounts for <1% of the breast neoplastic lesions usually detected in females and uncommonly in the male breast. The World Health Organization classifies the tumor into benign, borderline, and malignant based on the predefined morphological criteria. Squamous differentiation in phyllodes tumor is epithelial metaplasia, which has been occasionally documented in English literature. We report the first undocumented case of a recurrent borderline phyllodes tumor with cystic squamous metaplastic change in a 32-year-old male patient. The histology was that of a fibroepithelial neoplasm with the typical leaf-like projections and cystic spaces lined by squamous epithelium containing keratin debris. The purpose of presenting this case is to elucidate the pathogenesis and discuss other malignant and benign breast lesions that may be included in the differential diagnosis when evaluating a breast lesion with squamous metaplasia, particularly in the context of fine-needle aspirates.

Primary squamous cell carcinoma, breast: A challenging diagnosis

BACKGROUND

Primary squamous cell carcinoma of the breast is an extremely rare malignancy constituting less than 0.1% of all breast cancers with very few cases reported in literature. It is an aggressive, triple-hormone negative tumor, and its appropriate management is still debated. It is diagnostically challenging on both histopathology as well as radiology. Different diagnostic criteria are established for its definite diagnosis. As squamous cells are not found normally in the breast, various theories have been proposed regarding its origin. But the exact pathogenesis is still unclear. We report one such case encountered.

CASE

A 54-year-old female presented with gradually progressive painless lump in the right breast for 3 months with no other clinical features. There was neither any history of chronic or malignant disease in the patient nor in her family. On clinical examination, there was well-defined, firm and nontender swelling in upper inner quadrant measuring 3 × 2 cm with overlying skin being normal. There was no swelling in the contralateral breast as well as in the bilateral axillary region. A suspicion of malignancy was raised on initial core needle biopsy and, on repeat biopsy, was diagnosed as metaplastic carcinoma with squamous differentiation. Later, on final resection, specimen was reported as primary squamous cell carcinoma of the breast without any nodal metastasis. All the metastatic causes were ruled out through proper clinical, radiological, and histopathological correlation.

CONCLUSION

Primary squamous cell carcinoma of the breast is an aggressive tumor with its treatment protocol being still unclear, owing to its rarity. It is important to rule out the metastatic causes. It is relatively resistant to conventional chemotherapy, and its prognosis is also unpredictable. Hence, this requires further studies in terms of management and prognosis.

Primary squamous cell carcinoma of the breast in a young female- A rare ailment

Primary squamous cell carcinoma of the breast is an extremely rare invasive breast carcinoma with rapid progression and worse prognosis. Careful assessment and diagnosis of the entity should also be considered in a rapidly progressing breast tumor.

The Breast Tumor Microenvironment: Could Silicone Breast Implant Elicit Breast Carcinoma?

Complications related to breast implants have received much attention recently. Breast implant-associated anaplastic large cell lymphoma, silicone-induced granuloma of breast implant capsule, and breast implant illness are the main complications reported in the medical literature. However, the literature contains limited evidence regarding the possibility of silicone implants eliciting breast carcinoma. In this manuscript, we propose a theory in which the immune response to silicone breast implant gel bleeding acts as a triggering point for tumor oncogenesis in breast tissue. This hypothesis is derived from our findings of a case of invasive and undifferentiated medullary carcinoma in a patient with a silicone breast implant. The following concepts have been used to support this theory: 1) silicone bleeding from intact breast implants; 2) metaplasia: an adaptation to injury and precursor to dysplasia and cancer; 3) T-cell dysfunction in cancer immunity; 4) inhibitory cells in the tumor microenvironment (TME); 5) morphogenesis and bauplan; and 6) concepts underlying medullary carcinoma. We propose that the inflammatory process in response to silicone particles in the pericapsular glandular tissue favors the development of cellular mutations in specialized epithelial cells. This reverse morphogenesis could have resulted in breast carcinoma of the medullary type in the present case.

Primary squamous cell carcinoma of the breast: report of two cases with HER2 overexpression

OBJECTIVE

To investigate the clinicopathologic features and immunophenotype of primary squamous cell carcinoma of the breast (PSCCB) with HER2 overexpression. Methods Two cases of PSCCB with HER2 overexpression were retrospectively reviewed, and the pathological features, immunophenotype and prognosis were discussed. Results The tumor showed malignant squamous cells arranged in sheets, groups and nests, forming keratin-pearl and intercellular bridges. Immunohistochemical (IHC) analysis showed that the tumor cells were positive for 34βE12, p63, CK5/6, E-cadherin and P120, while negative for ER and PR. Furthermore, HER2 overexpression showed strong continuous expression in cell membrane with a score of 3+ by IHC, or amplification by FISH. Conclusions PSCCB is a rare tumor in breast cancer and HER2 overexpression is rather unusual in PSCCB. The diagnosis mainly depends on the clinicopathologic features together with the immunophenotype. HER2 positive indicates poor prognosis. However, targeted therapy for HER2 may be a new hope for patients.

Postoperative radiotherapy improves overall survival in patients with primary squamous cell carcinoma of the breast

BACKGROUND

Primary squamous cell carcinoma of the breast (PSCCB) is a rare clinical classification of breast tumors. Little is known about its clinicopathological features, prognosis and potential therapeutic strategies. The purpose of this study is to evaluate the effect of postoperative radiotherapy (PORT) on patients with squamous cell carcinoma (SCC) of the breast.

METHODS

We retrospectively analyzed patients diagnosed with PSCCB in our center. All pathological slides were reviewed by an experienced pathologist to confirm the diagnosis. Furthermore, we searched the public database for patients with SCC of the breast. Then, we analyzed the clinicopathological features, treatment methods and patient outcomes.

RESULTS

We identified 14 patients with primary SCC of the breast in our center. Additionally, 739 patients with SCC of the breast from the Surveillance, Epidemiology and End Results (SEER) database were diagnosed between 1975 and 2016. Only 453 patients who underwent surgery were included in this study. Patients from the SEER database had a more advanced tumor node metastasis (TNM) stage than patients from our center. The median overall survival (OS) of all patients was 104 months (95% confidence interval [CI], 87.2-120.8 months), and the 5-year OS was 60.8% (95% CI, 56.1%-65.5%). Most of the patients (58%) tested negative for hormonal receptor expression. Multivariate analysis showed that PORT was an independent prognostic factor for OS.

CONCLUSION

The results of our study demonstrate that SCC of the breast presents aggressive behavior with unique clinical characteristics. PORT improved OS significantly in patients with SCC of the breast. Longer-term studies are needed to confirm our findings.

Clinical outcome of adjuvant radiotherapy for squamous cell carcinoma of the breast; a multicenter retrospective cohort study

BACKGROUND

Because primary squamous cell carcinoma (SCC) of the breast is a rare disease, the standard therapy has not been established. We examined the clinical outcomes of postoperative adjuvant radiotherapy for breast SCC.

MATERIAL AND METHODS

We conducted a multicenter retrospective cohort study. Patients diagnosed with primary breast SCC who received adjuvant radiotherapy as part of their primary definitive treatment were included. Overall survival (OS), breast cancer-specific survival (BCSS), and recurrence-free interval (RFi) were evaluated.

RESULTS

Between January 2002 and December 2017, 25 breast SCC patients received adjuvant radiotherapy as a primary treatment were included. Median follow-up time was 43.5 months. Three (12%), fifteen (60%) and seven (28%) patients had clinical stage I, II and III disease, respectively. Fourteen patients underwent breast-conserving surgery and subsequent adjuvant radiotherapy. Eleven patients underwent mastectomy and post-mastectomy radiotherapy. Ten patients received regional lymph node irradiation. Nine (36%) patients had disease recurrence. The first site of recurrence was locoregional in five, but distant metastasis arose in one. Concurrent local and distant metastasis were seen in two. Six cases of local recurrence occurred within the irradiated site. Seven patients died, and six of the deaths were due to breast cancer. Five-year OS, BCSS, and Rfi were 69%, 70%, and 63%, respectively. In multivariate analysis, age and lymphatic invasion were associated with increased risk of recurrence.

CONCLUSION

Breast SCC has a high incidence of locoregional recurrence and poor prognosis. Age and lymphatic invasion are significant risk factors for recurrence.

Primary Squamous Cell Carcinoma of Breast Responsive to Platinum and Taxane-Based Chemotherapy: A Rare Entity and Review Literature

Pure primary squamous cell carcinoma (SCC) of the breast is a rare malignancy which constitutes < 0.1% of all primary invasive breast carcinomas. It is considered to be more aggressive compared with other infiltrating ductal cancers, and knowledge concerning treatment patterns and outcomes is limited. We treated a 50-year-old woman with SCC of left breast, having metastatic fixed axillary lymph nodes. The tumor was hormone receptor negative. Paclitaxel and carboplatin-based neoadjuvant chemotherapy was given with a good response, followed by modified radical mastectomy. Adjuvant radiotherapy was given to the chest and axilla in view of two lymph nodes positive for tumor out of 12. No local and systemic recurrence encountered in 1 year of follow-up. Surgery along with platinum and taxane-based chemotherapy and radiotherapy is an effective mode of treatment for SCC in other parts of the body. More data is necessary to formulate management guidelines, and further define if there is any role for systemic chemotherapy, radiation therapy, or hormonal blockade.

SOX10 - A Novel Marker for the Differential Diagnosis of Breast Metaplastic Squamous Cell Carcinoma

Introduction

Differential diagnosis of metaplastic squamous cell carcinoma of breast (MSCCB) is difficult. In particular, in terms of metastatic MSCCB, because of the low speciality of traditional markers such as mammaglobin, gross cystic disease fluid protein-15 (GCDFP-15) and GATA binding protein 3 (GATA3), the most common problem is differentiating the spread of MSCCB to the lung from a primary lung squamous cell carcinoma. It is urgently required to explore a novel marker to aid in differential diagnosis.

Aim

The aim of this study is to explore a novel marker to aid in the differential diagnosis of MSCCB from other squamous cell carcinomas (SCC) in other organs.

Methods

We tested the expression of SOX10 in 375 human SCC specimens with immunohistochemistry (IHC).

Results

In a series of 20 MSCCB, 9 (45%) were positive for SOX10. All of them were triple-negative MSCCB. Conversely, SOX10 was totally negative in another 205 SCC originating from lung, skin, cervix, oral mucosa, and esophagus. In a series of 150 triple-negative breast cancer and their metastatic foci, SOX10 labeling in the primary tumor and metastasis was 78% and 79.3%, respectively, and the agreement rate was 97.3% (P>0.05).

Conclusion

Our findings demonstrate that SOX10 was recommended for differentiating MSCCB from non-mammary metastasis to the breast, as well as for distinguishing primary SCC from metastatic MSCCB, and SOX10 may be valuable in the pathological diagnosis of breast-derived metaplastic squamous cell carcinoma.

Change of Pathological Type to Metaplastic Squamous Cell Carcinoma of the Breast During Disease Recurrence: Case Report and Literature Review

Background: Metaplastic squamous cell carcinoma (SCC) of the breast is a rare and heterogeneous group of primary breast malignancies. The etiology, pathogenesis, and proper treatment for this kind rare breast cancer are still unclear.

Case presentation: We reported a case of a 55-year-old woman with a palpable lump in the inner quadrant of the right breast. She underwent a right breast mass resection and sentinel lymph node biopsy, which revealed that the tumor was an invasive ductal carcinoma, followed by four cycles of doxorubicin plus cyclophosphamide and four cycles of docetaxel as adjuvant chemotherapy, and then simultaneous integrated boost intensity modulated radiotherapy to the whole right breast. After 2 years' follow-up, she had biopsy-proven disease recurrence in the right breast, which revealed SCC, and a mammogram showed abnormalities in the lower inner quadrant of the right breast and left axillary lymph nodes. Then we performed bilateral breast modified radical mastectomy, which confirmed that the recurrent tumors were metaplastic SCC, followed by adjuvant chemotherapy and adjuvant radiotherapy of the left supraclavicular and apical axillary regions. There has been no recurrent or metastatic evidence in the 16 months' follow-up since the second surgery.

Conclusion: This case report shows that evolution of pathology type in recurrent breast cancer after initial treatment is possible. Detailed pathologic and immunohistochemical analyses are needed for identification of this change. Surgery and adjuvant radiation and chemotherapy are appropriate treatments for recurrent primary SCC of the breast.

Squamous cell carcinoma of the breast, are there two entities with distinct prognosis? A series of 39 patients

PURPOSE

Squamous cell carcinoma (SCC) of the breast is a rare entity of breast cancer, with a very poor prognosis, and whose pathophysiology is still unwell established. Therapeutic management is very heterogeneous due to its incomplete understanding. Nevertheless, it seems that two histological entities can be distinguished: pure SCC close to the cutaneous origin, and metaplastic squamous breast cancer (MSBC). The aim of this study is therefore to assess the difference in survival according to the histological type (SCC or MSBC) and to describe the demographic, clinical, and therapeutic characteristics of the two underlying populations.

METHODS

Our data came from a monocentric retrospective series of 39 patients treated between 1985 and 2018 at the Gustave Roussy Institute (France) for a breast SCC.

RESULTS

Of the 39 patients included, 64% had MSBC and 36% had a pure form. The overall and recurrence-free survival at 3 years [CI 95%] was 72.3% [56.9%; 87.0%] and 67.2% [51.2%; 83.2%], respectively. The overall 3-year survival of patients with MSBC was significantly lower than that with pure SCC: HR [CI 95%] 9.5 [1.2; 73.1], p = 0.008. The 3-year recurrence-free survival of patients with MSBC was also poorer: HR [CI 95%] 11.9 [1.6; 90.7], p = 0.002. Patients with MSBC also tended to be younger, have a large lesion size, and be more metastatic.

CONCLUSION

The histological nature of SCC seems to bring fundamental new elements to the therapeutic management as it impacts recurrence and survival. It should therefore be better characterized at diagnosis in order to possibly adapt treatments.

Case Reports on Metaplastic Squamous Cell Carcinoma of the Breast and Treatment Dilemma

Metaplastic squamous cell carcinoma of the breast is a very rare form of breast cancer that consists of both glandular and nonglandular components mixed with epithelial and mesenchymal tissues. Worldwide, the incidence of this tumor is between 0.1 and 2%. Because of the rarity of this tumor and heterogeneous behavior of the tumor cells, it is difficult to establish the standard therapeutic approach. We report 2 cases of metaplastic squamous cell carcinoma of the breast in young patients with different responses to treatment strategies. The first case is a premenopausal female with metaplastic squamous cell carcinoma treated with surgery, chemotherapy, and radiotherapy, and the second case is perimenopausal metaplastic squamous cell carcinoma with sarcomatoid subtype and osteoid matrix production which progressed on chemotherapy and was treated with surgery and radiation.

Rare epithelial breast cancer: surgery and adjuvant therapy

Breast cancer is a heterogenous disease, exhibiting a wide range of morphological phenotypes shaping its prognosis and clinical course. However, optimal management of rarer breast cancer subtypes is often undefined and controversial in literature due to the lack of large studies and randomised trials. This review aims to discuss the treatment of 13 rare epithelial subtypes, focussing on surgery and adjuvant therapies.

Ki67 index in intrinsic breast cancer subtypes and its association with prognostic parameters

Objectives

Ki67 is the most commonly used marker to evaluate proliferative index in breast cancer, however no cutoff values have been clearly defined for high ki67 index. Cancer management should be according to loco-regional profile; therefore, we aimed to determine ki67 index in 1951 cases of intrinsic breast cancer subtypes and its association with other prognostic parameters in our set up.

Results

Triple negative breast cancers showed highest ki67 index (mean 50.9 ± 23.7%) followed by Her2neu (mean 42.6 ± 21.6%) and luminal B cancers (mean 34.9 ± 20.05%). Metaplastic and medullary breast cancers significantly showed higher ki67 index as compared to ductal carcinoma, NOS. No significant association of ki67 index was noted with any of the histologic parameters in different subtypes of breast cancer expect for tumor grade. Although, ki67 index is a valuable biomarker in breast cancer, however no independent prognostic significance of ki67 could be established in our study.

Primitive squamous cell carcinoma of the breast (SCCB): case report of an uncommon variant of metaplastic carcinoma

INTRODUCTION

Metaplastic carcinoma of the breast includes a heterogeneous group of neoplasms characterized by admixture of adenocarcinoma with area of squamous, chondroid and osseous differentiation. If the tumor shows pure squamous differentiation, it is designated as squamous carcinoma. SCCB accounts for less than 1% of all invasive breast carcinoma. It can present as cystic lesions and simulate a breast abscess.

CASE REPORT

A 75-year old woman was visited at our General Surgery Unit for a palpable lump, about 5 cm in size, at the lower inner quadrant of right breast. Mammography revealed 3cm oval opacity with micro calcifications and US appearance as isoechogenic lump with lesion solid-cystic appearance; cytology deposes for cystic inflammatory lesion(C2) to be monitored. A subsequent ultrasound check one year later confirmed an increase of volume, so micro histology sampling was made with suspect malignancy(B4). After biopsy, the patient underwent excision of cyst. Final histological examination showed SCCB with diffuse positivity for Cytokeratin 34beta-E12 and p63; negative reactions to ER and PR; monoclonal antibody Ki67 > 40%; HER2/neu with score 2+ and FISH examination negative. Subsequently, the patient underwent radical Madden mastectomy which confirmed the histological diagnosis and the negativity of the lymph nodes.

DISCUSSION

In literature, prognosis and therapy are still discussed; SCCB has shown very little responsiveness to common chemotherapy.

CONCLUSION

A quadrantectomy or a radical mastectomy with lymph node dissection must be considered the best treatment for this rare neoplasia.

Case Report: A Simple Thoraco - Abdominal Flap to Reconstruct Wide Defect of Radical Mastectomy in Squamous Cell Carcinoma of Breast

BACKGROUND

Squamous cell carcinoma (SCC) of the breast is very unusual. Thoraco-abdominal (TA) flap is a simple flap, and it is a rotation advancement fasciocutaneous flap. Here, we present a case of using TA flap for chest wall reconstruction in quick in-quick outpatient.

CASE PRESENTATION

A Russian woman 48 years old presented enlarging lump on her left breast for the last 5 years. She was diagnosed as stage IV low-differentiated breast cancer luminal B and had a history of 4 cycles chemotherapy. Patient getting worsening and no response to chemotherapy. We decided to perform palliative radical mastectomy to improve quality of life. Primary skin closure was not possible due to the wide defect of skin and soft tissue. We decided to use TA flap to cover the defect. Histopathology result was compatible with SCC.

CONCLUSION

TA flap can be the choice in patients with a wide defect of skin and soft tissue after a radical mastectomy. Given its simplicity and shorter operative time, TA flap is an ideal option for quick in-quick outpatient.

Change of HER2 status during disease recurrence predicts good prognosis for primary squamous cell carcinoma of the breast: A case report

RATIONALE

Primary squamous cell carcinoma (PSCC) of the breast is one of the least common types of breast cancer. Adjuvant treatment for PSCC remains an unresolved issue.

PATIENT CONCERNS

We reported a case of a 48-year-old postmenopausal female patients with a 2 × 2.5 cm lump presented with no symptoms.

DIAGNOSES

This patient was diagnosed as PSCC of the breast. The original tumor and first recurrence exhibited triple negative phenotype, whereas the second recurrence was HER2-positive.

INTERVENTIONS

A tumorectomy with latissimus dorsi flap reconstruction for the second recurrence was performed followed by targeted therapy with trastuzumab.

OUTCOMES

The patient had a complete remission, which was sustained over the 25 months of follow-up after the tumorectomy.

LESSONS

This is the first reported case in literature of a breast PSCC patient with switched immunohistochemical phenotypes during disease recurrence. Surgical resection with flap reconstruction and targeted therapy successfully treated the recurrence.

Clinicopathological features, treatment patterns, and prognosis of squamous cell carcinoma of the breast: an NCDB analysis

Background

Squamous cell carcinoma (SCC) of the breast is a rare malignancy. The clinicopathological features, treatment patterns and prognosis of SCC of the breast is still unclear.

Methods

In this study, we performed a 1:4 SCC-IDC (infiltrating ductal carcinoma) matching analysis of patients diagnosed between 2004 and 2014, using the data from the national cancer database. We used Chi-square test to compare the clinicopathological features and treatment patterns between SCC (n = 686) and IDC (n = 2744) patients. We used Kaplan-Meier analysis and Cox-regression to estimate the survival of SCC and IDC patients.

Results

We observed that SCC patients are more likely to have T3–4, grade III, and ER negative diseases, when compared to IDC patients. Breast conserving surgery (BCS) (58.3% vs 65.4%, p = 0.048), as well as radiotherapy after BCS (65.3% vs. 83.0%, p < 0.001), was less performed in SCC patients. Among low-risk patients, chemotherapy was used more often for SCC patients (42.9%) than for IDC (18.7%) patients (p = 0.002). In HR-positive patients, endocrine therapy was used less often for SCC patients (51.6%) than for IDC patients (70.5%) (p < 0.001). SCC (vs. IDC) was associated with no responses to neoadjuvant chemotherapy (20% vs. 5.05%, p = 0.019). Adjusted analysis confirmed that SCC (vs. IDC) was associated with worse OS (HR = 1.40, 95%CI 1.17–1.67, P < 0.01), after a median follow-up of 58.3 months. In SCC patients, HR status is not prognostic of OS, but endocrine therapy was significantly associated with improved OS in HR-positive SCC patients.

Conclusions

We conclude that SCC is associated with poorer clinicopathological features, no responses to neoadjuvant chemotherapy and worse clinical outcomes than IDC. The treatment patterns for SCC and IDC are different. Endocrine therapy is necessary for HR-positive SCC patients.

Electronic supplementary material

The online version of this article (10.1186/s12885-018-5212-x) contains supplementary material, which is available to authorized users.

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.

Metaplasia: tissue injury adaptation and a precursor to the dysplasia-cancer sequence

Metaplasia is the replacement of one differentiated somatic cell type with another differentiated somatic cell type in the same tissue. Typically, metaplasia is triggered by environmental stimuli, which may act in concert with the deleterious effects of microorganisms and inflammation. The cell of origin for intestinal metaplasia in the oesophagus and stomach and for pancreatic acinar-ductal metaplasia has been posited through genetic mouse models and lineage tracing but has not been identified in other types of metaplasia, such as squamous metaplasia. A hallmark of metaplasia is a change in cellular identity, and this process can be regulated by transcription factors that initiate and/or maintain cellular identity, perhaps in concert with epigenetic reprogramming. Universally, metaplasia is a precursor to low-grade dysplasia, which can culminate in high-grade dysplasia and carcinoma. Improved clinical screening for and surveillance of metaplasia might lead to better prevention or early detection of dysplasia and cancer.

Breast implant capsule-associated squamous cell carcinoma: a report of 2 cases

The use of prosthetic implants for breast augmentation has become commonplace. Although implants do not increase the risk of conventional mammary carcinoma, they are rarely associated with anaplastic large cell lymphoma. We report 2 cases of breast implant capsule-associated squamous cell carcinoma with poor clinical outcomes. Both patients (56-year-old woman and 81-year-old woman) had long-standing implants (>25 years) and presented with acute unilateral breast enlargement. In both cases, squamous cell carcinoma arose in (focally dysplastic) squamous epithelium-lined breast implant capsules and widely invaded surrounding breast parenchyma or chest wall. Neither patient had evidence of a primary mammary carcinoma or squamous cell carcinoma at any other anatomic site. Within 1 year, one patient developed extensive, treatment-refractory, locoregional soft tissue metastasis, and the second patient developed hepatic and soft tissue metastases and died of disease. There are 2 prior reported cases of implant-associated squamous cell carcinoma in the plastic surgery literature; one provides no pathologic staging or outcome information, and the second case was a capsule-confined squamous cell carcinoma. Together, all 4 cases share notable commonalities: the patients had long-standing breast implants and presented with acute unilateral breast pain and enlargement secondary to tumors arising on the posterior aspect of squamous epithelialized implant capsules. Because of both its rarity and its unusual clinical presentation, implant capsule-associated squamous cell carcinoma may be underrecognized. The aggressive behavior of the tumors in this series underscores the importance of excluding malignancy in patients with long-standing breast implants who present with acute unilateral breast pain and enlargement.

Metaplastic squamous cell carcinoma of the breast: A case report and literature review

Metaplastic tumors are rare and represent a heterogeneous group of neoplasms showing dominant areas of non-glandular differentiation. Etiology and pathogenesis of this type of lesion in the breast is uncertain. The most common sources of metastatic squamous cell carcinoma of the breast are lung, esophagus, cervix, and urinary bladder. Squamous cell carcinomas may present clinically with inflammation and average size greater than breast adenocarcinoma. As for imaging studies, mammography shows no typical findings and ultrasound can show a complicated cyst or an inflammatory process, among the differential diagnoses. Therefore, knowing this pathological entity, its clinical course and imaging findings is important to safely treat such a rare and aggressive disease. We herein report a case of metaplastic carcinoma, squamous subtype, diagnosed by core needle biopsy.

Squamous cell carcinoma of the breast in the United States: incidence, demographics, tumor characteristics, and survival

PURPOSE

Squamous cell carcinoma of breast accounts for less than 0.1% of all breast cancers. The purpose of this study is to describe the epidemiology and survival of this rare malignancy.

METHODS

Data were extracted from the National Cancer Institute's Surveillance, Epidemiology and End Results Registry to identify women diagnosed with squamous cell carcinoma of breast between 1998 and 2013. SEER*Stat 8.3.1 was used to calculate age-adjusted incidence, age-wise distribution, and annual percentage change in incidence. Kaplan-Meier curves were plotted for survival analysis. Univariate and multivariate Cox proportional hazard regression model was used to determine predictors of survival.

RESULTS

A total of 445 cases of squamous cell carcinoma of breast were diagnosed during the study period. The median age of diagnosis was 67 years. The overall age-adjusted incidence between 1998 and 2013 was 0.62 per 1,000,000 per year, and the incidence has been on a decline. Approximately half of the tumors were poorly differentiated. Stage II was the most common stage at presentation. Majority of the cases were negative for expression of estrogen and progesterone receptor. One-third of the cases underwent breast conservation surgery while more than half of the cases underwent mastectomy (unilateral or bilateral). Approximately one-third of cases received radiation treatment. The 1-year and 5-year cause-specific survival was 81.6 and 63.5%, respectively. Excluding patient with metastasis or unknown stage at presentation, in multivariate Cox proportional hazard model, older age at diagnosis and higher tumor stage (T3 or T4) or nodal stage at presentation were significant predictors of poor survival.

CONCLUSIONS

Our study describes the unique characteristics of squamous cell carcinoma of breast and demonstrates that it is an aggressive tumor with a poor survival. Older age and higher tumor or nodal stages at presentation were independent predictors of poor survival for loco-regional stages.

Bilateral Breast Metastases from Vulvar Carcinoma: A Case Report and Literature Review

Vulvar carcinoma is a rare disease that accounts for 3-5% of all gynecologic malignancies. Breast represents an unusual site of metastasis and only a few cases are reported. We describe the first case of bilateral metastatic breast carcinoma of vulvar origin, at an 80-year-old female patient. Six months after treatment of her primary disease, she presented with bilateral metastatic squamous cell breast carcinoma. Diagnosis was based on clinical, radiological, and histological facts. Breast although rare is another potential site of metastasis in vulvar cancer and thus mammary gland examination should be considered in the follow-up of these patients. Differential diagnosis between primary and metastatic lesions is of utmost importance for appropriate management.

Estrogen receptor-positive primary squamous cell carcinoma of the breast

Pure primary squamous cell carcinoma of the breast (SCCB) represents around 0.1% of breast carcinomas. Diagnosis requires independence from adjacent skin without metastatic disease. SCCB is often large at presentation with nonspecific mammographic and ultrasound findings. It is typically hormone receptor negative and aggressive. Mastectomy and adjuvant chemotherapy is the most common treatment, although treatment guidelines are not well established. We present a case of pure primary SCCB detected by high risk screening mammogram and treated with breast conserving surgery, chemotherapy, and radiation. We discuss clinical, radiologic, and pathologic findings.

Effect of postoperative radiotherapy for squamous cell cancer of the breast in a surveillance epidemiology and end results population-based study

The therapeutic value of postoperative radiotherapy (RT) for squamous cell cancer of the breast (SCCB) is unclear. This retrospective study used a population-based national registry to determine the impact of postoperative RT on survival of women with SCCB. The Surveillance Epidemiology and End Results (SEER) database was used to identify females with SCCB who underwent primary surgical resection from 1973 to 2012. Kaplan–Meier survival analysis and Cox regression proportional hazard methods were used to determine the impact of RT following resection associated with cause-specific survival (CSS) and overall survival (OS). A total of 523 patients met the eligibility criteria. The median follow-up time was 55 months, the 10-year CSS and OS rates were 65.6%, and 46.0%, respectively. A total of 167 patients (31.9%) received postoperative RT. Multivariate analysis indicated that advanced pT and pN stage, and no postoperative RT were independently associated with poor OS; advanced pT and pN stage were independently associated with poor CSS. Postoperative RT was significantly associated with improved 10-year OS (54.5% vs. 42.0%, P =.001), but had no effect on CSS (P =.217). Analysis of patients with different stages of SCCB indicated that RT was associated with improved CSS (P =.047) and OS (P <.001) in those with stage II cancer and improved OS in patients with stage pN0 cancer (P <.001). Postoperative RT improved the survival of SCCB patients, especially in those with stage II and stage pN0 cancer.