Pure squamous cell carcinoma of the breast is a very
rare cancer. The first case was reported in 1908 and till
2002, 85 cases were reported in the literature [
4]. Breast
metastasis of squamous cell carcinoma could originate
from skin, cervix, pharynx, stomach and lung. Pure
squamous cell carcinoma of the breast can derivate from
epidermis, the nipple or epithelium of a deep-seated dermoid
cyst or squamous metaplasia on chronic inflammation
background [
1,
5-
7]. Histopathologic examination of squamous cell carcinoma shows sheets of large squamoid
cells with intercellular bridges and keratin formation
[
7,
8].
Squamous cell carcinoma of the breast is the tumor
of elderly age group [9]. Tumors frequently reach large
volumes and can be as large as 5 cm [5]. Our patient was
60 years old and she had a mass of 3 cm. As it was seen
in our patient, these tumors are usually estrogen and progesterone
receptor negative, thereby hormonal adjuvant
therapy could not be performed. In a report of Menes et al.
[10] squamous cell carcinoma was found to be associated
with a lower rate of lymph node metastasis at presentation
(22% vs. 40-60% for infiltrating ductal carcinoma) and a
significant rate of distant metastasis without lymph node involvement.
The prognosis of this type of breast cancer is still the
subject of controversy. Some series suggest an indolent
clinical course and a relatively good prognosis [11,12].
But some investigators thought squamous cell carcinoma
of the breast had an aggressive course with outcome comparable
to poorly differentiated breast adenocarcinoma
[9]. Upon reexamination of about 4000 breast cancer
biopsies, Toikkanen et al. [13] found three pure primary
squamous cell carcinomas and reported that prognosis of
these patients were extremely bad. Also Eusebi et al. [5] reported aggressive clinical course in their series of three patients.
Today management of patients with pure squamous
cell carcinoma is still not clear. Dejager et al. [14] thought
that cisplatinum-based chemotherapy should be considered
in the treatment regimen of this disease. In this type of
cancer Weigel et al. [1] recommended the same multi-modality
management as adenocarcinoma at the same stage.
Most of the squamous cell carcinomas are radiosensitive.
Smaller primary squamous cell carcinomas of the breast
could be treated with lumpectomy with axillary dissection
followed by radiotherapy [6]. Menes et al. [10] proposed
a more selective approach like sentinel node biopsy, because
lymph node involvement plays a lesser prognostic
and therapeutic role in this disease. Mass of our patient
was as large as 3 cm and no radiotherapy were given because
breast conserving surgery was not preferred. Patient
has taken chemotherapy like an adenocarcinoma in the
same stage. She is still in our routine follow up and has no
recurrence or metastasis in her 24 months follow up.
Pure squamous cell carcinoma of the breast is an extremely
rare malignancy. Its prognosis and appropriate
approach for treatment is still debated. New case reports
would help to determine the right approach to this disease.
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