Human Papillomavirus brings about a challenging differential diagnosis: Glycogen-rich clear cell carcinoma of the breast vs. cervix adenosquamous carcinoma


13. Ulusal Meme Hastalıkları Kongresi, Antalya, Turkey, 21 - 25 October 2015, pp.1

  • Publication Type: Conference Paper / Full Text
  • City: Antalya
  • Country: Turkey
  • Page Numbers: pp.1
  • Akdeniz University Affiliated: Yes


Glycogen-rich clear cell (GRCC) breast carcinoma is a rare neoplasm of the breast characterized by cells containing an optically clear cytoplasm and intracytoplasmic glycogen. It shares common characteristics with clear cell carcinomas of the lung, endometrium, cervix, ovary, kidneys and salivary glands.

Case Report
A 58-year-old woman was admitted with vaginal bleeding and found to have cervix adenosquamous carcinoma. Neoadjuvant chemoradiotherapy for advanced cervical cancer was administered. PET-CT scan revealed a 1 cm hypermetabolic mass lesion adjacent to thoracic wall in the upper lateral quadrant of the left breast. Subsequent USG depicted the involvement of the left breast as well. Non-palpable but a firm mass (~1.5 cm) sonographically delineated and a core biopsy affirmed the malignancy. However, biopsy results engendered a challenging differential diagnosis as histopathologic similarities made it nearly impossible to discriminate whether the lesion is a distant metastasis or a second primary, and posed a clinical dilemma necessitating surgery to resolve the issue. Both tumors had diffuse p16 immunopositivity and DNA genotyping test for Human Papillomavirus (HPV) on the paraffin-embedded tissue of the cervical cancer and the mammary mass both revealed positive for HPV-16. A precision mammographic wire-guided conventional lumpectomy with sentinel node biopsy and intraoperative frozen section analysis were performed. The analysis concluded that the node was benign. Elevated Ca 15-3 resolved after surgery. Ultimate diagnosis after the paraffin section came up as a second primary; GRCC of the breast. As a matter of fact, this discrimination provided further clarification on clinical staging for the primary cervical cancer and the patient is classified as T4,N1,M0.

Differential diagnosis of GRCC of the breast could be challenging. HPV infestation makes it harder to reach an absolute differential, whilst it is of great importance to render a versatile clinical strategy as the disease usually follows an aggresive course.