RESEARCH ARTICLE


A Case of Poorly Differentiated Squamous Cell Carcinoma in the Breast: A Thorough Investigation of its Origins



Fumie Shono1, 4, Shigeki Inui*, 4, Satoshi Takagi1, Kazuya Kuraoka2, Kiyomi Taniyama2, Shinichi Ansai3, Tetsunori Kimura3
1 Department of Plastic and Reconstructive Surgery and Institute for Clinical Research, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan
2 Institute for Clinical Research, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan
3 Sapporo Institute for Dermatopathology, Hokkaido and Department of Regenerative Dermatology, Graduate School of Medicine, Osaka University, Osaka, Japan
4 Department of Regenerative Dermatology, Graduate School of Medicine, Osaka University, Osaka, Japan


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Creative Commons License
© 2010 Shono et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Regenerative Dermatology, Graduate School of Medicine, Osaka University, 2-2 G2, Yamada-oka, Suita-shi, Osaka 5650871, Japan; Tel: +81-6-6879-3960; Fax: +81-6-6879-3962; E-mail: inui@r-derma.med.osaka-u.ac.jp


Abstract

An 81-year-old female consulted us because of an ulcerated tumor in her left breast of several years' duration. Partial biopsy showed that the tumor consisted of anaplastic squamous cells, indicating squamous cell carcinoma from unknown origin. CT images demonstrated tumors in the left breast, liver and bile duct. However, further investigation was not possible due to the patient's refusal. To avoid possible localized complication caused by tumor rupture and/or infection, the breast tumor was totally excised. Histopathology revealed that irregularly shaped tumor nests had invaded the entire dermis resulting in massive necrosis. The tumor cells were of various sizes and shapes, and showed individual keratinization and atypical mitotic figures. In addition, other larger masses consisted of hyperchromatic small squamous cells with basophilic cytoplasms. These cells were poorly differentiated without apparent keratinization. Immunohistochemically, the excised tumor was stained strongly positive for epidermal growth factor receptor, partially positive for epithelial membrane antigen and BerEP4 but negative for cytokeratins 5, 6 and 20, estrogen receptor, progesterone receptor, ErbB2/HER2, gross cystic disease fluid protein-15, carcinoembryonic antigen and S-100. Since these findings were not sufficient to identify the tumor origin, we carefully rechecked the histopathology of the surgical specimens and found irregular elongation at the periphery of the overlying epidermis, which contained atypical keratinocytes with pleomorphic nuclei, suggesting a diagnosis of Bowen's disease. We therefore concluded that tumor cells of Bowen's disease in the epidermis, independently from the tumors of liver and bile duct, had invaded downward, finally reaching the breast tissue.

Keywords: Squamous cell carcinoma, Bowen's disease, SCC in situ, basal-like subtype of breast cancer.