Miura Hiroyuki, Taira Osamu, Hiraguri Shunsuke, Maeda Junichi, Kato Harubumi
Department of Thoracic Surgery, Hachioji Medical Center of Tokyo Medical University, 1163 Tate-machi, Hachioji, Tokyo 193-0998, Japan.
Surg Today. 2002;32(10):891-5. doi: 10.1007/s005950200174.
Squamous cell carcinoma of the breast is a rare type of cancer, the origin of which is still uncertain. We report a case of squamous cell carcinoma of the breast with a recurrent tumor that showed undifferentiated features. The patient was a 55-year-old woman who originally presented with a left breast mass in the upper outer quadrant. Echography showed a 46 x 29 x 23-mm mass with cavity formation, and aspiration cytology confirmed a diagnosis of squamous cell carcinoma. A modified radical mastectomy with level III lymph node dissection was performed. Pathologically, the tumor was composed of squamous cell carcinoma and noninvasive ductal carcinoma. A recurrent tumor showing undifferentiated features was detected in the left forechest 3 months after the operation, and tumorectomy with partial resection of the major and minor pectoralis muscles was performed. Despite intensive therapy including chemotherapy (CEF: cyclophosphamide, epirubicin, 5-fluorouracil) and irradiation (50 Gy), the patient died from pulmonary and skin metastases 20 months after her initial operation. The squamous cell carcinoma of the breast in this patient grew rapidly and her prognosis was poor. Immunohistochemical findings indicated the possibility that the squamous cell carcinoma developed from noninvasive ductal carcinoma of the comedo type, and that the undifferentiated cells from the site of recurrence developed from dedifferentiation of the squamous cell carcinoma.
乳腺鳞状细胞癌是一种罕见的癌症类型，其起源尚不确定。我们报告一例乳腺鳞状细胞癌伴复发肿瘤，该复发肿瘤表现出未分化特征。患者为一名55岁女性，最初表现为左乳外上象限肿块。超声检查显示一个46×29×23毫米的肿块，伴有空洞形成，细针穿刺细胞学检查确诊为鳞状细胞癌。行改良根治性乳房切除术并清扫Ⅲ级淋巴结。病理检查显示，肿瘤由鳞状细胞癌和非浸润性导管癌组成。术后3个月在左前胸发现一个表现出未分化特征的复发肿瘤，遂行肿瘤切除术并部分切除胸大肌和胸小肌。尽管接受了包括化疗（CEF方案：环磷酰胺、表柔比星、5-氟尿嘧啶）和放疗（50 Gy）在内的强化治疗，患者在初次手术后20个月因肺转移和皮肤转移死亡。该患者的乳腺鳞状细胞癌生长迅速，预后较差。免疫组化结果提示，鳞状细胞癌可能由粉刺型非浸润性导管癌发展而来，复发部位的未分化细胞可能由鳞状细胞癌去分化形成。
