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Table of Contents
Definition / general | Clinical features | Case reports | Treatment | Clinical images | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Differential diagnosisCite this page: Inflammatory carcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/breastmalignantinflamcar.html. Accessed July 14th, 2017.
Definition / general
- 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 features
- 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
Case reports
- Breast cancer presenting as subclavian / axillary deep vein thrombosis and upper limb lymphoedema (Ann R Coll Surg Engl 2012;94:e55)
Treatment
- Aggressive, with 5 year disease free survival < 45%, even if node negative (Arch Surg 2006;141:567)
- Treated with neoadjuvant (preoperative) chemotherapy
Clinical images
Images hosted on PathOut server:
Images hosted on other servers:
Courtesy of Dr. Mark R. Wick
Images hosted on other servers:
Enlarged erythematous breast
Microscopic (histologic) description
- Usually dermal plugging of lymphatics by tumor, may not be seen in small biopsies
- No specific histology, although usually high grade ductal NOS
Microscopic (histologic) images
Images hosted on PathOut server:
Images hosted on other servers:
Flickr images:
Nature.com images:
Tumor in dermal lymphatics
Images hosted on other servers:
Tumor in dermal lymphatics
Flickr images:
Contributed by Weijie Li, MD
Nature.com images:
Tumor embolus in a dermal lymphatic channel
E-cadherin+
Positive stains
- E-cadherin, even if lobular histology (Mod Pathol 2001;14:458)
- High MIB1 score
- Also HER2 (50%, Breast 2004;13:97), p53 (41%, Breast Cancer 2006;13:172), BP1 (Cancer Biomark 2009;5:9)
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)
- Postsurgical changes: dilated dermal lymphatics but no tumor (Mayo Clin Proc 1996;71:552)
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