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. 2015:14:53-7.
doi: 10.1016/j.ijscr.2015.06.040. Epub 2015 Jul 13.

Bilateral synchronous low-grade adenosquamous carcinoma of the breast: A Case report with review of the current literature

J L Senger  1 , P Meiers  2 , R Kanthan  3
Affiliations

Bilateral synchronous low-grade adenosquamous carcinoma of the breast: A Case report with review of the current literature

J L Senger et al. Int J Surg Case Rep. 2015.

Abstract

Introduction: Low-grade adenosquamous carcinoma (LGASC) is a rare, unique variant of metaplastic breast carcinoma, characterized by clinical indolence and low-grade cytomorphology. Being clinically asymptomatic with indefinite imaging characteristics, diagnosis is solely dependent on histopathology.

Presentation of case: A 68-year-old woman presented to the Breast Health Center with mammogram-detected left-sided retroareolar calcifications. She had a three-year history of non-progressive bilateral nipple inversion, and was otherwise asymptomatic. Left breast biopsy revealed atypical metaplastic squamous epithelial cells. Subsequently a wire-guided lumpectomy diagnosed a syringomatous adenoma of the nipple. A surveillance MRI identified a contralateral breast lesion, which on core biopsy showed an atypical adenosquamous lesion. Bilateral central mastectomies with bilateral sentinel node biopsies were undertaken. Histopathological review of both breast specimens confirmed the unique features of adenosquamous carcinoma identified by an infiltrative pattern of small rounded compressed angulated glands with squamous differentiation and low-grade cytomorphology. The tumors were triple negative [ER, PR, HER2]. The sentinel lymph nodes were negative.

Conclusion: Bilateral synchronous LGASC of the breasts is exceedingly uncommon and remains a diagnostic and therapeutic challenge. Despite being triple negative, due to its indolent behavior, recognition of this unusual primary breast malignancy is important as it has a more favorable prognosis. Yet, due to its rarity, there are no guidelines for best practice management regarding the role of adjuvant therapy.

Keywords: Low-grade adenosquamous carcinoma; Metaplastic breast cancer; Sclerosing lesions of the breast; Syringomatous adenoma of the nipple.

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Figures

Fig. 1
Fig. 1
Mammogram of the left breast shows irregular spiculated calcifications in a retroareolar distribution on both compressed views.
Fig. 2
Fig. 2
Excision biopsy of left breast lesion. Photomicrograph of haematoxylin and eosin stained slide at low (A), medium (B) and high (C) magnifications show a focal nodular lesion (A) with compressed duct-like structures (*) surrounded by fibrotic stromal cells (#) (B) admixed with proliferating atypical squamous metaplastic cells (→) and lymphocytic infiltration (^) (C).
Fig. 3
Fig. 3
Right breast central mastectomy. Photomicrograph of haematoxylin and eosin stained slide at low (A), medium (B) and high (C) magnifications show a complex sclerosing lesion (A) with infiltrating duct-like structures (*) (B) and single infiltrating atypical squamous cells with metaplastic squamous cells lining the ducts (→) (C).
Fig. 4
Fig. 4
Left breast central mastectomy. Photomicrograph of haematoxylin and eosin stained slide at low (A), medium (B) and high (C) magnifications show similar features of infiltrating atypical squamous cells in the background of dense stromal lamellar fibrosis and lymphocytic aggregates.
See this image and copyright information in PMC

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