Breast – Malignant, Males, Children - Inflammatory carcinoma

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Breast-malignant, males, children

Inflammatory carcinoma

Author: Nat Pernick, M.D, PathologyOutlines.com, Inc.

Reviewer: Daniel Visscher, M.D., University of Michigan Hospitals, February 2009 (see Reviewers page)

Revised: 26 September 2009

Last major update: September 2009

Definition

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● A clinical (not pathologic) diagnosis of an enlarged, erythematous and edematous breast, presumed to be due to dermal plugging of lymphatic vessels by tumor (Breast Cancer Res 2005;7:52)

Clinical

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● Mean age 53 years

● Tumor may not be palpable on clinical exam

● Stage T4d in TNM classification

● Peau d’orange: lymphatics are so involved by tumor microemboli that skin drainage is blocked, causing lymphedema and thickening of skin of majority of breast

Treatment and prognosis

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● Aggressive, with 5 year disease free survival < 45%, even if node negative (Arch Surg 2006;141:567)

● Treated with neoadjuvant (pre-operative) chemotherapy

Clinical images

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Enlarged erythematous breast

Microscopic description

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● Usually dermal plugging of lymphatics by tumor, may not be seen in small biopsies

● No specific histology, although usually high grade ductal NOS

Micro images

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Tumor in dermal lymphatics AFIP image

Fig A: tumor emboli in dermal lymphatic Fig A: lobular histology

Fig B: membranous E cadherin staining Fig B: membranous E cadherin staining

Post radiation

p53, MDM2, MUC1

Positive stains

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● E-cadherin, even if lobular histology (Mod Path 2001;14:458)

● Also HER2 (50%, Breast 2004;13:97), p53 (41%, Breast Cancer 2006;13:172) and new marker BP1 (Cancer Biomark 2009;5:9)

Differential diagnosis (based on clinical findings)

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● Mastitis - no tumor present

● Metastatic carcinoma - tumor present other than in dermal lymphatics (Breast Cancer 2008;15:315, Int J Dermatol 2007;46:303); primary may not be apparent (Breast J 2009;15:176)

● Other primary tumors, including lymphoma (Arch Gynecol Obstet 2009;280:149) and plasmacytoma (Clin Lymphoma Myeloma 2008;8:191)

● Nephrogenic systemic fibrosis - different histology (Archives 2007;131:145)

● Post-surgical changes - dilated dermal lymphatics but no tumor (Mayo Clin Proc 1996;71:552)

Additional references

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● Wikipedia

End of Breast – Malignant, Males, Children > Inflammatory carcinoma

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