Scientific Session 28 — Breast - Screening/PathologyFriday, May 5, 2017
2685. Imaging Characterization of Breast Cancer With Squamous Features
Ruiz-Flores L1,2*, Whitman G2, Sahin A2 1. Baylor College of Medicine, Houston, TX; 2. MD Anderson Cancer Center, Houston, TX
Address correspondence to L. Ruiz-Flores (firstname.lastname@example.org)
Objective: The currently published literature on squamous cell carcinoma of the breast is limited to case reports and small case review series. The largest case review series to date included 33 patients. There is a relative paucity of information on the imaging findings associated with breast cancer with squamous features. The purpose of this study is to characterize imaging findings of carcinoma of the breast with squamous features.
Materials and Methods: Our institutional review board approved this retrospective study and informed consent was waived. Pathology records from 1985 to 2014 were searched, and 15 female patients who met the criteria of pathology-proven squamous cell carcinoma of the breast were identified. No patients were included if they had an additional site of primary squamous cell carcinoma. The patients had a median age of 52.2 years (range, 32–72 years). Electronic medical records were used to retrieve clinical information for each patient, including demographics, treatment, and outcome. Information queried included the presence of an additional cancer, type of surgery, and use of chemotherapy or radiation therapy. Imaging data were classified according to the fifth edition of BI-RADS for mammography and breast ultrasound. The pathology slides were reviewed by a breast pathologist. Tumor biomarkers were evaluated on initial diagnosis in 11 cases. In four cases, tumor biomarker data was missing and we retrospectively performed immunohistochemical staining for estrogen receptor (ER), progesterone receptor (PR), and HER2/neu (HER2).
Results: The presence of additional squamous cell cancers was excluded on all patients. One patient (7%) had an incidental basal cell carcinoma of the nose, unrelated to her breast cancer diagnosis. On retrospective pathologic analysis, nine of the 15 masses contained more than 50% squamous component (60%) and only four were less than 50% squamous component (27%). Pathology slides were not available to review in two cases (13%). Imaging was available for nine of the 15 patients. The imaging modalities used to characterize the disease were mammography and breast ultrasound. All cases that had imaging available presented as breast masses. Six (66%) of the masses presented in the right breast and three (33%) occurred in the left breast. The location within the breast was predominantly superior or lateral in seven patients (78%). Only one mass each was observed in the inferomedial and superomedial locations. The mass size ranged from 1.1–13 cm on maximal dimension. Most masses (n = 6, 66%) presented with a parallel orientation. Five (56%) of the masses identified were oval shaped, and four (44%) were irregularly shape. The predominant mass margins were indistinct (n = 4, 44%) and circumscribed (n = 4, 44%). Seven masses were high density (77%) and two were equal density (22%). Tumor marker analysis showed five tumors were ER-positive, one tumor was PR-positive, and all cases were negative for HER2 overexpression. Most patients (n = 8) received multidrug chemotherapy, and six patients also received radiation therapy. Only five patients were alive at 5 years from diagnosis.
Conclusion: Breast cancer with squamous features is a very rare malignancy with a poor prognosis, and the literature is limited on information regarding the imaging characteristics. From our series, we conclude that most breast cancers with squamous features are seen as solid parallel masses on ultrasound.