J Breast Cancer.  2019 Sep;22(3):484-490. 10.4048/jbc.2019.22.e31.

Human Epidermal Growth Factor Receptor 2-Subtype Invasive Ductal Carcinoma Recurring as Basal-Human Epidermal Growth Factor Receptor 2-Subtype Squamous Cell Carcinoma

• An J
• Yoo Y
• Kim HG
• Woo J
• Lee KE
• Kwon H
• Lim W
• Sung SH
• Paik NS
• Moon BI

• KMID: 2458868
• DOI: http://doi.org/10.4048/jbc.2019.22.e31

Abstract

Squamous cell carcinoma of the breast and its subtype, basal-human epidermal growth factor receptor 2 (HER2) phenotype, are very rare. Herein, we report a patient who developed recurrence of squamous cell carcinoma of the breast with basal-HER2 subtype 6 years after the initial diagnosis of invasive ductal carcinoma of the HER2 subtype. To the best of our knowledge, recurrence of invasive ductal carcinoma in the form of metaplastic squamous cell carcinoma of basal-HER2 subtype has not been reported previously. We present a pathological perspective of our experience.

Keyword

Breast; Ductal carcinoma; Pathology; Squamous cell carcinoma

MeSH Terms

Breast
Carcinoma, Ductal*
Carcinoma, Squamous Cell
Diagnosis
Epidermal Growth Factor*
Humans*
Pathology
Phenotype
Receptor, Epidermal Growth Factor*
Recurrence
Epidermal Growth Factor
Receptor, Epidermal Growth Factor

Figure

• 

  Figure 1 Microscopic findings of the surgical specimen in May 2012. (A) High-grade invasive ductal carcinoma during the first surgery in May 2012 (×200, hematoxylin and eosin stain). (B) Human epidermal growth factor receptor 2 positivity of the invasive ductal carcinoma during the first surgery in May 2012 (×200, immunohistochemistry). (C) Cytokeratin 5/6 was not expressed in all tumor cells of the invasive ductal carcinoma. (D) Epidermal growth factor receptor was also not expressed in the invasive ductal carcinoma.

• 

  Figure 2 Ultrasound images and gross pictures of the left breast in 2018. (A) An approximately 3.5 × 1.9-cm, complex, solid, and cystic mass was detected in April 2018. (B) The presence of minimal peripheral vascularity was noted on Doppler ultrasound in April 2018. (C) Incision and drainage of the left breast mass was performed in May 2018. (D) An increased suspicious complex echoic mass was observed in July 2018. The enlarged mass in the left upper center breast was shown on breast ultrasound. (E) Increased vascularity was noted on Doppler ultrasound in July 2018. (F) The enlarged mass in the left breast was noted in July 2018, which was rapidly growing with whole-breast edema and nipple invasion.

• 

  Figure 3 MRI and specimen sections of squamous cell carcinoma of the left breast in July 2018. (A) Preoperative magnetic resonance imaging in July 2018 showed malignancy in the left upper center breast with direct invasion of the nipple–areolar complex and skin. Multiple enlarged lymph nodes in the right axilla were shown, and these lymph nodes were confirmed to be nonmalignant. (B) and (C) Postoperative specimen sections were evaluated after the second surgery in July 2018. On multiple sectioning, the cut surface showed an ill-defined, grayish-white mass with firm consistency (7.2 × 4.0 × 3.5 cm), which was very close to the nipple, areola, and deep margin.

• 

  Figure 4 Microscopic findings of the surgical specimen in July 2018. (A) Pure squamous cell carcinoma was noted during the second surgery in July 2018 (×200, hematoxylin and eosin stain). (B) HER2 tested positive in the squamous cell carcinoma during the second surgery in July 2018. HER2 IHC showed 3+ immunoreactivities within the circumferential membrane of the tumor cells (×200, IHC). (C) Cytokeratin 5/6 showed strong expression in the recurred cancer (×200, IHC). (D) Epidermal growth factor receptor demonstrated diffuse moderate membranous staining (×200, IHC). HER2 = human epidermal growth factor receptor 2; IHC = immunohistochemistry.

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