58y woman with a palpable mass in RT breast

 

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Doctor's Information

Name : Afsaneh,Nastaran
Family : Alikhassi,Abdi
Affiliation :Emam khomeini Hospital,Cancer institute
Academic Degree : Faculty member of TUMS,Fellowship of breast imaging
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : ------------------

 

Case Section

Breast Imaging

 

Patient's Information

Gender : Female
Age : 58

 

Clinical Summary

58y woman with a palpable mass in RT breast from 3w ago

 

Imaging Findings

MLO and CC view in mammography shows ill defined round mass in retroarelar region , prominent lymph node is also seen in axillary region,in sonography large heterogenous mass with central necrosis is noted in retroareolar region

 

Differential Diagnosis

Department of Surgery, UCSD Medical Center, San Diego, California, USA. SCC of the breast was first reported in 1908 by Troell. Squamous cell carcinoma (SCC) of the breast is an uncommon tumor that is rare, constituting less than 0.1% of all breast carcinoma. (1)Certain criteria need to be fulfilled before the tumor can be classified as a pure SCC of the breast. These are 1) greater than 90% of the malignant cells of squamous cell origin, 2) tumor should be independent of the overlying skin and nipple, 3) other sites of primary SCC excluded. (2, 3) Clinical and radiographic characteristics are not specific for this tumor. In general, these are very aggressive, hormone receptor negative and treatment-refractory tumors with a poor prognosis. (4) There are few reported series documenting the management and clinical outcome of these tumors. (5)The prognosis for this type of breast cancer is still a subject of controversy: some reports suggest that it is aggressive, with an outcome comparable to that of poorly differentiated breast adenoarcinoma. (6) As a result of lack of data, the issue of whether to prescribe adjuvant treatment for SCC remains unresolved. (7) The frequent expression of epidermal growth factor receptor (EGFR) in this disease requires further study and may constitute a potential therapeutic target to be exploited, possibly in association with platinum-based treatment. It is thought to arise directly from the epithelium of the mammary ducts, although an altern

 

Final Diagnosis

SCC consistent with metaplastic carcinoma

 

Discussion (Related Text)

Department of Surgery, UCSD Medical Center, San Diego, California, USA. SCC of the breast was first reported in 1908 by Troell. Squamous cell carcinoma (SCC) of the breast is an uncommon tumor that is rare, constituting less than 0.1% of all breast carcinoma. (1)Certain criteria need to be fulfilled before the tumor can be classified as a pure SCC of the breast. These are 1) greater than 90% of the malignant cells of squamous cell origin, 2) tumor should be independent of the overlying skin and nipple, 3) other sites of primary SCC excluded. (2, 3) Clinical and radiographic characteristics are not specific for this tumor. In general, these are very aggressive, hormone receptor negative and treatment-refractory tumors with a poor prognosis. (4) There are few reported series documenting the management and clinical outcome of these tumors. (5)The prognosis for this type of breast cancer is still a subject of controversy: some reports suggest that it is aggressive, with an outcome comparable to that of poorly differentiated breast adenoarcinoma. (6) As a result of lack of data, the issue of whether to prescribe adjuvant treatment for SCC remains unresolved. (7) The frequent expression of epidermal growth factor receptor (EGFR) in this disease requires further study and may constitute a potential therapeutic target to be exploited, possibly in association with platinum-based treatment. It is thought to arise directly from the epithelium of the mammary ducts, although an alternate theory is that the tumor arises from foci of squamous metaplasia within a preexisting adenocarcinoma of the breast. (8) The mean age at presentation is 54 years. (9) Breast SCCs are generally large (usually > 4 cm) at presentation and cystic in more than 50% of cases.(10)

 

References

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.
2-Rosen PR. Rosen's Breast Pathology. Chapter 21: Philadelphia, New York: Lippincott-Raven; 1997.p.397-404.
3-Beharanwala KA, Nasiri N, Abdullaha N, Trott PA, Gui GP. Squamous cell carcinoma of the breast: Clinicopathologic implications and outcome. Eur J Surg Oncol 2003; 29:386-9.
4- Siegelmann-Danieli N, Murphy TJ, Meschter SC, Stein ME, Prichard J. Primary pure squamous cell carcinoma of the breast. Clin Breast Cancer 2005; 6:270-2.
5-Behranwala KA, Nasiri N, Abdullah N, et al: Squamous cell carcinoma of the breast: Clinico-pathologic implications and outcome. Eur J Surg Oncol 29:386-389, 2003
6- Cardoso F, Leal C, Meira A, et al: Squamous cell carcinoma of the breast. Breast 9:315-319, 2000 7-Lafreniere R, Moskowitz LB, Ketcham AS: Pure squamous cell carcinoma of the breast. J Surg Oncol 31:113-119, 1986
7-Lafreniere R, Moskowitz LB, Ketcham AS: Pure squamous cell carcinoma of the breast. J Surg Oncol 31:113-119, 1986
8-Farrand R, Lavigne R, Lokich J, et al: Epidermoid carcinoma of the Breast. J Surg Oncol 12:207-212, 1979
9-Toikkanen S: Primary squamous cell carcinoma of the breast. Cancer 48:1629-1632, 1981
10- Weigel RJ, Ikeda DM, Nowels KW: Primary squamous cell carcinoma of the breast. South Med J 89

 

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