Squamous Cell Carcinoma of the Breast Mimicking Chronic Breast Abscess

Integrating the incident angle of main vessel of breast nodule with BI-RADS can improve the efficacy of breast malignancy evaluation

The aim of this study was to investigate the measurement of the incident angle of the main blood vessel, and the benefits of its integral with ultrasound malignant features of breast nodules for the assessment of breast malignancy based on BI-RADS. The incident angles of main blood vessels of 185 breast nodules in 185 patients who underwent breast nodule surgical excision or biopsy were quantitatively measured using color Doppler ultrasound from October 2022 to October 2023 in a tertiary hospital, and related data were collected and analyzed. Based on histopathology as the gold standard, the breast nodules were classified into benign and malignant groups. The incident angle values of both groups were compared, Receiver Operating Characteristic (ROC) curves were plotted, and the optimal cutoff value for distinguishing between benign and malignant breast nodules was determined. The malignancy risk of the breast nodules was assessed using the incident angle of the breast main vessel, BI-RADS classification, and a combination of ultrasound malignant features with the incident angle. The areas under the ROC curves (AUC) for each method were calculated and compared. The average incident angle of the main vessel of the breast nodule for the benign and malignant breast nodule groups was (41.47 ± 14.27)° and (22.65 ± 11.09)°, respectively, with a statistically significant difference (t = 10.027, P < 0.001). There was a significant negative correlation between the breast nodule vessel incident angle and histopathological malignancy (r = - 0.593, P < 0.001). The ROC curve and Youden index suggested that the optimal cutoff value for distinguishing between benign and malignant breast nodules using the vascular incident angle was 26.9°, with a sensitivity of 76.34%, specificity of 84.78%, positive predictive value of 83.53%, negative predictive value of 78.00%, and AUC of 0.853. The diagnostic performance of BI-RADS classification based on ultrasound malignant features of the breast nodules alone in assessing the malignancy risk of breast nodules showed a sensitivity of 78.50%, specificity of 92.39%, positive predictive value of 91.25%, negative predictive value of 79.95%, and AUC of 0.905. The integral of ultrasound malignant features and vascular incident angle for BI-RADS based assessment for breast nodule malignancy risk demonstrated a sensitivity of 90.32%, specificity of 89.13%, positive predictive value of 89.36%, negative predictive value of 90.11%, and AUC of 0.940. The differences in negative predictive value and AUC between ultrasound malignant features BI-RADS classification alone and the combination of ultrasound malignant features BI-RADS classification with the incident angle of the main vessel of the breast nodule were all statistically significant (x2 = 3.243, P = 0.042; Z = 2.955, P = 0.003). Measuring the incident angle of the main blood vessel of breast nodules and combining this measurement with ultrasound malignant features for BI-RADS classification can enhance the effectiveness of malignancy risk assessment of breast nodules, increase the negative predictive value, and potentially reduce unnecessary biopsies.

Breast implant-associated squamous cell carcinoma in a male patient: A case report and review of the medical literature

Background

Primary squamous cell carcinoma (SCC) of the breast is a rare tumor type. The diagnosis of this tumor type is more frequently made only after microscopy evaluation. Breast implant-associated SCC is rarer with medical literature review indicating only 18 cases reported in female individuals.

Case presentation

We reported an unusual case that a man found a 3-cm sized mass on his left breast at first, who had a implant surgery 18 years previously to reconstruct the deformed left breast, as related to the Poland's syndrome. More than 1 year after the mass was detected, the size of the mass gradually increased to 20 cm with swelling and severe pain, and the patient was admitted to our hospital. The patient underwent surgical excision of the tumor, followed by removal of the implant, complete capsulectomy, and sentinel lymph node biopsy. The microscopy evaluation demonstrated the tumor as moderately and poorly differentiated invasive SCC. Follow-up at 12 months after showed multiple metastases, including the skin of the chest, axillary lymph nodes and pleura.

Conclusion

Breast implant-associated SCC can occur in male patients. Therefore, it should be considered when the clinical manifestation or histopathological appearance is not typical of other breast neoplasms. Malignant transformation of normal epithelial cells takes about 18 years, after which rapid evolution follows leading to fast growth of the tumor.

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, 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.