Yoneto Toshihiko, Hasumi Kenichiro, Yoshimoto Takayuki, Takahashi Nobukazu, Takeda Yasutaka
Department of General Medicine, Hijirigaoka Hospital Department of Immunoregulation, Institute of Medical Science, Tokyo Medical University Department of Surgery, Oguchi-higashi General Hospital Breast Oncology Center, Fukujuji Hospital, Tokyo, Japan.
Medicine (Baltimore). 2018 Sep;97(37):e12340. doi: 10.1097/MD.0000000000012340.
Since primary pure squamous cell carcinoma of the breast is a rare disease, few reports describe the characteristic findings on performing preoperative imaging that can be used to distinguish it from normal breast cancer. The rapid evolution and lack of an established method of treatment has resulted in several reports of advanced cases of primary pure squamous cell carcinoma of the breast.
Case 1 was a 44-year-old woman with an elastic, hard tumor in the left C region. Ultrasonographic analysis revealed a maximal 11-mm hypoechoic area. Histologically, the tumor was a well-differentiated squamous cell carcinoma with prominent keratinization, and there was prominent inflammatory cell infiltration, necrosis, and fibrosis. Case 2 was a 58-year-old woman with an elastic, hard tumor in the left C/D region. Ultrasonographic analysis revealed a maximal 31-mm hypoechoic area with partially calcified areas and a hyperechoic margin. Histologically, the tumor was a squamous cell carcinoma with prominent keratinization exhibiting an infiltrative growth pattern. The tumor had no connection to the epidermis and partially transitioned into the atypical ductal epithelium in the area surrounding the focus.
The patient in Case 1 was preoperatively diagnosed with T1cN0M0 Stage I cancer of the left breast, but both patients were finally diagnosed with T2N0M0 Stage IIA cancer.
Case 1: left partial mastectomy and axillary lymph node dissection were performed. The patient was administered 4 courses of FEC100 and 4 courses of DTX as postoperative adjuvant therapy. Case 2: left modified radical mastectomy and axillary lymph node dissection were performed without any postoperative adjuvant therapy.
Case 1: no sign of relapse was observed, but the patient moved away from the area to another hospital in March 2014 and eventually died due to relapse in January 2016. Case 2: four years after surgery, no relapse has been observed.
We should always keep the presence of primary pure squamous cell carcinoma among breast cancers in mind although the crisis rate is very low. Due to its high malignancy, needle biopsy and aspiration biopsy cytology should be performed to make a definitive diagnosis.
由于原发性乳腺纯鳞状细胞癌是一种罕见疾病，很少有报告描述术前影像学检查的特征性表现，这些表现可用于将其与普通乳腺癌区分开来。原发性乳腺纯鳞状细胞癌进展迅速且缺乏成熟的治疗方法，已有数篇关于晚期病例的报道。
病例1是一名44岁女性，左C区有一个质地硬且有弹性的肿瘤。超声检查显示最大直径为11毫米的低回声区。组织学检查显示，肿瘤为高分化鳞状细胞癌，有明显角化，并有明显的炎性细胞浸润、坏死和纤维化。病例2是一名58岁女性，左C/D区有一个质地硬且有弹性的肿瘤。超声检查显示最大直径为31毫米的低回声区，伴有部分钙化区和高回声边缘。组织学检查显示，肿瘤为鳞状细胞癌，有明显角化，呈浸润性生长模式。肿瘤与表皮无连接，在病灶周围区域部分转变为非典型导管上皮。
病例1患者术前诊断为左乳T1cN0M0 Ⅰ期癌，但两名患者最终均被诊断为T2N0M0 ⅡA期癌。
病例1：行左乳部分切除术和腋窝淋巴结清扫术。术后给予4个疗程的FEC100和4个疗程的多西他赛作为辅助治疗。病例2：行左乳改良根治术和腋窝淋巴结清扫术，术后未进行任何辅助治疗。
病例1：未观察到复发迹象，但患者于２０１４年３月搬离该地区到另一家医院，最终于2016年1月因复发死亡。病例2：术后四年未观察到复发。
尽管原发性乳腺纯鳞状细胞癌的发病率很低，但我们应始终牢记其在乳腺癌中的存在。由于其恶性程度高，应进行针吸活检和细针穿刺活检细胞学检查以明确诊断。
