Squamous cell carcinoma of the breast

Case contributed by Dr Ammar Ashraf

Presentation

Mildly painful right breast mass for a few weeks. No nipple discharge or skin color changes.

Patient Data

Age: 45 years
Gender: Female
Mammography

Well-defined lobulated high density lesion with fine spiculations in the lower inner quadrant of the right breast. No parenchymal distortion, pleomorphic microcalcification clusters, abnormal skin thickening, nipple retraction or significant axillary lymphadenopathy is seen. No suspicious abnormality is seen in the left breast. 

Ultrasound

Complex septated lobulated cystic lesion at 4 o'clock position in the right breast. No significant internal vascularity is seen in it.  

Procedure: Ultrasound-guided tru-cut biopsy.

Diagnosis: Metaplastic breast carcinoma (Squamous cell carcinoma).

Immunohistochemical study

  • CK7 (OV-TL 12/20): Diffusely positive.
  • CK HMW (34βE12):  Diffusely positive.
  • P63 (4A4): Positive, highlighting the major component (squamous cell carcinoma).
  • Estrogen receptor status: Positive in 50% of tumor cells with strong intensity of staining.
  • Progesterone receptor status: Positive in 30% of tumor cells with strong intensity of staining.
  • Her2 Neu (4B5): Equivocal (Score 2+). 
  • Ki-67 (30-9) labeling index: 60% in hot spots.

Case Discussion

Based on the imaging features, the right breast lesion was reported as BI-RADS category 4 and tissue diagnosis was advised.  

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