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Inflammatory Breast CA : Clinical

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Introduction: Inflammatory breast carcinoma (IBC) is defined as a breast carcinoma accompanied by diffuse erythema and edema (peau d'orange) involving a third or more of the skin overlying the breast (AJCC-TNM Staging system).

The skin changes are due to edema caused by widespread tumor emboli within dermal lymphatics. It accounts for up to 2.5% of all breast cancers. The average age at presentation is around 55 years (similar to common infiltrating ductal carcinoma).

Clinical Features: IBC is primarily a clinical diagnosis and not a specific histologic subtype of breast cancer. A skin biopsy is not necessary to make the diagnosis of IBC when a patient with biopsy-proven breast carcinoma presents with characteristic skin changes.

The mammary skin is thickened, diffusely erythematous and shows peau d'orange changes. The changes may extend to the skin of the chest wall. There is rapid onset with pain and discomfort and can mimic mastitis. As the condition progresses, the entire breast becomes indurated and red.

An underlying breast mass may or may not be palpable. Erythema is sometimes limited to the mammary skin directly overlying a palpable tumor. AJCC-TNM definition requires involvement of at least one-third of the mammary skin to satisfy the diagnostic criteria of IBC; however, even less extensive skin involvement is associated with adverse prognosis. Axillary lymphadenopathy is frequently present.

The underlying carcinoma is usually high-grade invasive ductal carcinoma of no specific type.

Case courtesy of: Dr. Sanjay D. Deshmukh (Professor of Pathology) and Dr. J. M. Gadekar (Chief of Surgery), Dr. Vithalrao Vikhe Patil Medical College & Hospitals, Ahmednagar, India

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