title: Exuberant Squamous Metaplasia with Calcification Following Intraoperative Radiotherapy for Breast Carcinoma: Report of an Unusual Case and Retrospective Review of Cases from a Single Institution.
abstract: Intraoperative radiotherapy (IORT) is a novel and increasingly utilized radiation technique in the treatment of breast carcinoma. There are few reports on the histologic changes seen in breast tissue from patients who have undergone IORT. We sought to evaluate the histologic changes observed in specimens received following IORT, as well as report an unusual case which prompted our study. A retrospective review of patients who received IORT and subsequently had breast tissue histologically evaluated at our institution was performed. Fifteen post-IORT specimens from 12 patients, including the patient from the reported case, were studied. We report a case of a 77-year-old woman found to have mammographic microcalcifications at the lumpectomy site 6 months following lumpectomy and IORT for ductal carcinoma in situ (DCIS). A stereotactic biopsy showed abundant desquamated anucleate squamous cells with calcification and keratin material associated with squamous metaplasia of ducts. Carcinoma was not present. The predominant findings in the post-IORT specimens were fat necrosis and scar (n = 5), recurrent invasive carcinoma (n = 5), surgical site changes (n = 3), abscess (n = 1), and exuberant squamous metaplasia with calcification (n = 1). Five of fifteen (33%) post-IORT specimens showed squamous metaplasia, all of which were collected within 6 months of IORT delivery. The morphologic changes observed after IORT are similar to those seen after external beam radiotherapy. Exuberant squamous metaplasia is an uncommon consequence of IORT; however, pathologists should be aware of this phenomenon and review a history of prior intraoperative radiation before raising concern for malignancy.
authors.affiliation: Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York.
authors.forename: Paula S
authors.initials: PS
authors.lastname: Ginter
authors.affiliation: Department of Radiation Oncology, Weill Cornell Medicine, New York, New York.
authors.forename: John
authors.initials: J
authors.lastname: Ng
authors.affiliation: Department of Radiation Oncology, Weill Cornell Medicine, New York, New York.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Zhuo
authors.affiliation: Department of Surgery, Weill Cornell Medicine, New York, New York.
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Swistel
authors.affiliation: Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: D'Alfonso
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001941:Breast Diseases / Q000473:pathology; D001943:Breast Neoplasms / Q000532:radiotherapy*; D002114:Calcinosis / Q000473:pathology; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000532:radiotherapy; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D042361:Mammary Glands, Human / Q000473:pathology* / Q000528:radiation effects; D008679:Metaplasia / Q000473:pathology; D008875:Middle Aged; D011878:Radiotherapy / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies
keywords: 
  IORT
  ; breast; intraoperative radiation; keratin; squamous