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About Claes-Gustaf Nordquist, M.D.
Expertise
I`m a doctor of medicine and a specialist in radiation therapy and medical oncology. I have long experience in diagnostics and treatment of breast tumours.

Experience
I'm a Doctor of Medicine. Licensed/certified physician and surgeon and specialist in Medical Oncology and Radiation therapy in Sweden, Denmark, Finland, Iceland, Norway and the European Union. Background in Radiation Therapy, Medical Oncology, Radiation Protection, Nuclear Medicine, Diagnostic Radiology, Gynecological Oncology, Clinical Pathology, Clinical Cytology,Hematology and Internal Medicine. M.D. from the faculty of medicine, Royal Karolinska Institute, Stockholm, Sweden. Have also been an exchange student at the Hebrew University, Hadassah Medical School, Jerusalem Israel. Former medical consultant, Swedish National Board of Radiation Protection. Former Police Surgeon and Medical Examiner, Stockholm Police Department. Former Chief Medical Officer, The Royal Guards, The Royal Horse Guards and the Royal Household Brigade, Royal Swedish Army Medical Corps. Now in private practice in Stockholm, Sweden.

I also answer questions about Oncology (General Cancer), General History, Military History, Brain Tumors, Colon Cancer

You are here: Experts > Health/Fitness > Women's Health > Breast Cancer > Squamous Cell Carcinoma of the Breast

Breast Cancer - Squamous Cell Carcinoma of the Breast

Expert: Claes-Gustaf Nordquist, M.D. - 10/20/2009

Question
QUESTION: I had a fibroid mass for years in my right breast. This spring I noticed it was larger and more dense. In July I found lumps in my right armpit. Mamms/Diagnostic ultrasound showed a fluid filled complex mass. FN aspiration drained 5cc of only white blood cells (no bacteria). Core biopsy path report said Squamous Cell Carcinoma. CT scan ruled out other source tumors. Second opinion path report said it's a primary SCC of the breast (.04-.07% rare). Second FNA of mass yielded another 3cc cystic fluid. FNA of lymph nodes was positive for SCC. Surgeon recommends partial masectomy and axillary clearance. Could this be a mis-diagnosed complex mass with partial cyst? Oncology Journals online state certain cysts appear identical to SCC under the microscope. State university doctors say it is SCC, but all based on path reports. There is no treatment protocol. Only 4 cases seen in 14 years at UM. Help! Should I have the surgery or request further surgical biopsy?

ANSWER: We SHOULD believe pathology reports! It is the strongest foundation we have for our actions! I strongly recommend that you follow the surgery recommendation and that surgery is followed by both radiation therapy (axilla, sternal region, supraclavicular region and remaining breast) and chemotherapy since your cancer had spread to lymph nodes. Even though there is no protocol for this we can still rely on common cancer experience! Good luck! Yes it is indeed rare! I can not remember a single case.

---------- FOLLOW-UP ----------

QUESTION: I understand that medical actions are based on pathology reports. However, I have read several oncology journals that reported mis-diagnoses of SCC. For example, this abstract from http://www.accessmylibrary.com/coms2/summary_0286-3395694_ITM -

OBGYN & Reproduction Week
"2003 MAR 17 - (NewsRx.com & NewsRx.net) -- A false positive squamous cell carcinoma diagnosis is usually found to be due to dysplasia.
According to recent research from the United States, "Cytologic features of squamous intraepithelial lesions (SIL) can mimic those of invasive squamous cell carcinoma. We compare and correlate the cytological findings of 19 false positive squamous cell carcinomas (SCC)..."Out of 128 patients diagnosed with invasive SCC from 1994-2000, 19 (14.8%) with followup cone biopsies or hysterectomy specimens were false positive cases."

Although this article is not specifically referring to SCC of the breast, I still have trouble with the rarity of this presentation. If .07% of breast cancers present with SCC, and only 10-20% of those have nodal involvement, then we are in the .007 percentile of probability.

I do plan to have the surgery and radiation. However, what about the cystic fluid? They have drained this part of the mass twice. The radiologist said it looked like cystic fluid, not necrotic fluid. Is that part a cyst? Short of a lumpectomy, is there a surgical procedure that could rule out a complex cystic mass with squamous features?

Thank you again for your time.

Answer
In this case the material was uterine. That can not with certainty be used for a breast tumor evaluation. Furthermore your lesion has already sent out metastases to your axillar lymph nodes. So it does have all the characteristics of an invasive cancer! When your partial mastectomy is done your tumor will be removed and will be studied by the pathologists. There will be a pathology report on your whole tumor (also on those in your axilla - arm pit). You may very well have cysts and an invasive cancer in the same complex. But it is the WORST diagnosis in such a complex that is of primary interest not things that are not of much clinical significance. Since metastases are present in your axilla just a cyst is already ruled out! Breast tissue is a glandular tissue (actually derived from transformed sweat glands). The normal cancer offspring of glandular tissue is an adenocarcinoma which is something different from a squamous cell carcinoma/cancer (such tumors are normally derived from mucosas, skin and similar tissues). So it is actually not surprising that squamous cell cancers are that rare in breasts. Please do not forget to have chemotherapy too!

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