Pure squamous carcinoma within the breast

 
Squamous cell carcinoma is form of epithelial cell carcinoma which may occur in many different places in the body, and it is also the most common form of skin cancer. Squamous-cell carcinoma is also a type of non-small cell lung cancer. Squamous cell carcinoma is a malignant tumor of squamous epithelial cells, and it does occur in the breast, but very rarely. However it is not a ‘breast cancer‘ in the traditional sense, which tends to evolve in the breast ducts. Rather it might be considered a skin cancer, which sometimes happens in the squamous epithelial cells of the breast. Primary squamous cell carcinoma is very rare, and accounts for only about 0.1% of breast cancers. It is referred to as primary pure squamous cell carcinoma when the malignant cells are all of the squamous cell type, but there is no relation with the skin and no indications for a primary location somewhere else in the body.

 

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Squamous carcinoma of the breast tends to be more common in elderly women. They quite often present with inflammation, and the average tumor size is larger than for adenocarcinomas. There are no typical mammogram findings for squamous cell carcinomas. On ultrasound, they might appear as a suspicious complicated cyst or an inflammatory process. How a pure squamous cell carcinomas of the breast develop remains unclear. They may possibly develop from an abscess or complicated breast cyst. It has also been suggested that squamous carcinoma of the breast might be an ‘extreme‘ form of squamous cell metaplasia that is developing into an andneocarcinoma.

Very few squamous cell breast carcinomas are ‘pure‘.

 
When squamous cell carcinoma occurs in the breast, it typically originates either in the epidermis, the nipple, or perhaps as the malignant transformation of a deep-seated epidermal cyst. In most cases the squamous cell carcinoma is not pure. Only about 13% of squamous cell carcinomas are completely pure and without some kind of glandular cell differentiation. In order for a tumor to be classified as a pure squamous cell breast carcinoma, it has to meet certain criteria. First of all, no other neoplastic elements are to be present in the tumor. Secondly, the tumor must be independent of adjacent cutaneous structures. Finally, no other primary epidermoid carcinoma (such as skin cancer or lung cancer) should exist in the patient, as this would indicate metastatic disease.
 

 

Clinical and cytological presentation of squamous cell breast carcinoma

 
Examined cytologically, squamous cell breast carcinoma will tend to show malignant squamous cells (cancer cells) with keratinising cytoplasm. Nuclei are typically herpchromatic and dense, with coarse chromatin and thick nuclear membranes. Keratin debris and background necrosis are common features. Squamous cell breast tumors are usually estrogen and progesterone receptor negative. In terms of clinical presentation, squamous cell breast carcinomas usually present as a firm-to-hard painless breast lump. Clinically, it would be indistinguishable from other kinds of malignant breast lumps.

Squamous cell carcinoma can present in a very similar way to an adenocarcinoma so differential diagnosis is important. To complicate issues further for diagnosis, some tumors are mixed that is there can be squamous cells (tumor cells) found in adenocarcinomas or from metastatic diseases elsewhere.

Squamous cell breast carcinomas are not as prone to lymph node metastasis

 
It is often the case that patients with squamous carcinoma of the breast present with an advanced disease stage, requiring aggressive management. But otherwise, there does not seem to be any indication that squamous cell breast carcinoma or squamous cell differentiation in other breast cancers has any particular effect on behavior or survival rates. Generally speaking, the behavior of squamous cell breast carcinoma closely resembles that of pure adenocarcinoma of the breast. Curiously, squamous cell breast carcinomas rarely metastasize to the axillary lymph nodes, or do so about 10% of the time. This is actually not the case for squamous cell carcinomas originating in other areas of the body.

Outlook for squamous cell breast carcinoma

 
Generally speaking, squamous cell breast carcinoma has an aggressive clinical course, with an outcome about the same as that of poorly differentiated breast adenocarcinoma. However, squamous cell breast cancers do typically show a reduced tendency for lymphatic spread when compared to breast adenocarcinomas. Statistically, about 10%-30% show lymphatic involvement at the time of surgery, and about 30% of patients will develop a distant metastasis.

Five year survival rate is just below 70%

 
As these tumors are typically estrogen and progesterone receptor negative, they do not respond well to hormone therapy. First-line therapy is typically a combination of surgery, radiation therapy, and chemical therapy. However, squamous cell breast carcinomas are sometimes resistant to commonly used chemotherapy regimens. The two year survival rate for women with squamous cell breast cancer is estimated at about 80%, while the five year survival rate is about 67%.

 

 
 

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Here are a few popular Q&A…

• Where is squamous cell carcinoma found and/or spread to? It can occur in the lining of the digestive tract, lungs and other areas of the body, and occurs as a form of cancer in the diverse tissues including the lips, mouth, esophagus, urinary bladder, prostate, lung, vagina, and cervix, scalp, hands, ears, neck, amongst many others.
• What does squamous cell carcinoma look like? They often look like scaly ed patches, open sores, elevated growths with a central depression, or warts; they may crust or bleed.
• How quickly does squamous cell carcinoma grow? This skin cancer can grow quickly, often becoming a firm, dome-shaped growth with an extremely crusty surface. The breast type of squamous cancer generally is slow-growing.
• What if squamous cell carcinoma doesn’t get treated? Are there any complications? It can destroy nearby healthy tissue, spread to the lymph nodes or other organs, and may be fatal, although this is uncommon.
• When is it known has “aggressive”? It is particularly large or deep, it involves the mucous membranes (such as the lips), or when it occurs in a person with a weakened immune system, such as someone who takes anti-rejection medications after an organ transplant.
• What are the known tests/diagnosis? Physical exams, and/or removing a sample of tissue for testing.
• What are the known treatments/drugs that may be used? Most can be completely removed with relatively minor surgery, which is curative.
• How can squamous cell carcinoma be prevented? For skin cancer, avoid the sun during the middle of the day, wear sunscreen all year round, wear protective clothing, avoid tanning beds, and check your skin regularly and report any possible changes to your doctor. But the breast version of squamous cancer is unrelated to tanning.

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References

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13. Siegelmann-Danieli N, Murphy TJ, Meschter SC, Stein ME, Prichard J: Primary pure squamous cell carcinoma of the breast . in Breast Cancer 2005 , 3:270-272.
14. Tan YM, Yeo A, Chia KH, Wong CY: Breast abscess as the initial presentation of squamous cell carcinoma of the breast. Eur J Surg Oncol 2002 , 1:91-93.

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