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Breast malignant, males, children

Carcinoma subtypes

Inflammatory carcinoma

Reviewer: Monika Roychowdhury, M.D., (see Reviewers page)
Revised: 10 October 2012, last major update August 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

General
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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, Wikipedia)

Clinical description
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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
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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

Case reports
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● Breast cancer presenting as subclavian/axillary deep vein thrombosis and upper limb lymphoedema (Ann R Coll Surg Engl 2012;94:e55)

Clinical images
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Enlarged erythematous breast

Micro 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


Fig A: tumor emboli in dermal lymphatic
Fig B: membranous E cadherin staining


Fig A: lobular histology
Fig B: membranous E cadherin staining

   
Post radiation

Positive stains
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● E-cadherin, even if lobular histology (Mod Pathol 2001;14:458)
● High MIB-1 score
● Also HER2 (50%, Breast 2004;13:97), p53 (41%, Breast Cancer 2006;13:172), BP1 (Cancer Biomark 2009;5:9)

Differential diagnosis
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Differential diagnosis (based on clinical findings):
● 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 (Arch Pathol Lab Med 2007;131:145)
● Post-surgical changes: dilated dermal lymphatics but no tumor (Mayo Clin Proc 1996;71:552)

End of Breast malignant, males, children > Carcinoma subtypes > Inflammatory carcinoma

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