CHALLENGES IN THE MANAGEMENT OF METAPLASTIC SQUAMOUS CELL BREAST CARCINOMA

Abstract

Purpose: To present a clinical case of metaplastic squamous cell sarcomatoid breast carcinoma – a rare entity within the spectrum of breast cancer, comprising up to 1% of all cases. Material/Methods: We report the clinical course of a 68-year-old woman who sought medical attention regarding a locally advanced breast cancer characterized by exophytic growth. Results: Despite initial systemic treatment, the tumor displayed rapid progression and extensive ulceration with spontaneous bleeding, prompting additional cycles of systemic and radiotherapy. Subsequently, the patient experienced life-threatening acute breast bleeding and hemorrhagic shock, leading to an admission to the Intensive care unit, followed by an emergent modified radical mastectomy. Histological examination of the specimen revealed a high-grade sarcomatoid variant of squamous cell metaplastic breast carcinoma (MBCa) without lymph node (LN) metastasis. Adjuvant radiation therapy was performed, yet a local recurrence was diagnosed, necessitating a second surgical intervention. Despite also receiving adjuvant systemic therapy, the patient presented with a second recurrence with distant metastases in the lungs. A transcatheter arterial embolization (TAE) of the tumor-supplying artery was performed, aiming to impede the tumor vasculature, thus reducing the risk of recurrent life-threatening hemorrhage. However, only a short-term effect was observed, and the patient experienced an unfavorable outcome. Conclusions: This case underscores the challenges in managing advanced MBCa, its aggressive clinical course, and the struggles of achieving a favorable prognosis.