|
Advertisement |
|
|
||
 |
|
|||||
|
|||||
|
 |
||||||
|
||||||
|
||||||
|
© 2003 American Society for Clinical Oncology
Unusual Problems in Breast Cancer and a Rare Lung Cancer CaseCase 3. Simultaneous and Synchronous Bilateral Inflammatory Breast CancerCancer and Blood Disease Center and Reid Hospital and Health Care Services, Richmond, IN
A 69-year-old woman with no family history of malignancy presented with a 3-week onset of progressive dyspnea and simultaneous bilateral breast swelling. On physical examination, both breasts were symmetrically enlarged, indurated, warm, erythematous, and had a peau d’orange appearance with inverted nipples (Fig 1
The term bilateral breast cancer implies that, in a patient with a known unilateral breast cancer, a malignancy is detected in the contralateral breast. In a comprehensive review, 836 (3.7%) of 25,563 breast cancers were bilateral, with one third being synchronous and two thirds being metachronous.1 The reported incidence of bilateral breast cancer varies according to the length of follow-up and method of diagnosis. Bilateral primary breast cancers described as synchronous or metachronous are arbitrary regarding designation of time and have no biologic significance. There is no correlation of bilateral breast cancer with tumor size, histologic differentiation, hormonal receptor status, or the number of lymph nodes involved. There are, however, a few true risk factors, including age at the time of initial breast cancer diagnosis, family history, genetic mutation, multicentricity, and pathologically infiltrating lobular carcinoma. Inflammatory breast cancer (IBC) is the reported diagnosis in 1% to 3% of patients with newly identified invasive breast cancer. There is no consistent histologic type of breast carcinoma associated with this entity. The histologic type ranges from infiltrating ductal to medullary. The carcinoma series of Haagensen,2 which studied 40 patients, included 19 (47%) with the large-cell undifferentiated-type carcinoma. The diagnosis of IBC is based on the clinical presentation, defined by the American Joint Committee on Cancer staging manual as "diffuse brawny induration of the skin of the breast with an erysipeloid edge, usually without underlying palpable mass." The skin over the breast is warm and thickened, with an orange peel appearance. The classic histologic finding in IBC on biopsy of affected skin is dermal lymphatic invasion by tumor cells. However, dermal lymphatic invasion is not a necessary criterion for the diagnosis of IBC. IBC is diagnosed by clinical presentation. Affected patients may present with clinical signs only without dermal lymphatic invasion, or with dermal lymphatic involvement without clinical signs, or with both clinical signs and dermal lymphatic invasion. Our patient had both the clinical and the pathologic findings of IBC. Metastatic tumors to the breast appear as relatively small, superficially located, poorly defined, irregular nodules without calcification on mammography and ultrasonography. However, when the lesion is diffuse, the appearance is indistinguishable from that of IBC. Two cases of breast metastasis from signet ring cell gastric cancer3,4 and three case reports of metastasis from primary ovarian carcinoma mimicking bilateral IBC have been published.5–7 In our patient, such possibilities were excluded based on history, physical examination, and histologic and radiologic findings. A patient like ours, who presents with simultaneous and synchronous primary IBC, is exceedingly rare. Similar cases reported in the literature include that of a male patient presenting with bilateral inflammatory medullary breast carcinoma8 and a female patient with bilateral IBC who was treated with chemotherapy, radiation, and bilateral mastectomy.9
REFERENCES 1. Wanebo HJ, Senofsky GM, Fechner RE, et al: Bilateral breast cancer: Risk reduction of contralateral biopsy. Ann Surg 201:667–677, 1985[Medline] 2. Haagensen CD: Diseases of the Breast. Philadelphia, PA, WB Saunders, 1986, pp 808–814 3. Briest S, Horn LC, Haupt R, et al: Metastasizing signet ring carcinoma of the stomach-mimicking bilateral inflammatory breast cancer. Gynecol Oncol 74:491–494, 1999[CrossRef][Medline] 4. Cavazzini G, Colpani F, Cantore M, et al: Breast metastasis from gastric signet ring cell carcinoma, mimicking inflammatory carcinoma. Tumori 79:450–453, 1993[Medline] 5. Krishnan EU, Phillips AK, Randell A, et al: Bilateral metastatic inflammatory carcinoma in the breast from primary ovarian cancer. Obstet Gynecol 55:s94–s96, 1980 (suppl 3)[Medline] 6. Ozguroglu M, Ersavasti G, Ilvan S, et al: Bilateral inflammatory breast metastases of epithelial ovarian cancer. Am J Clin Oncol 22:408–410, 1999[CrossRef][Medline] 7. Oksuzoglu B, Guler N, Kose F: Bilateral inflammatory breast involvement as the first site of relapse of ovarian carcinoma. Am J Clin Oncol 24:211, 2001[Medline] 8. Jeelani G, Beg MA, Hussain A, et al: Simultaneous bilateral inflammatory medullary carcinoma of male breast. Int Surg 62:147–148, 1977[Medline] 9. Nakagawa H, Kikuhara M, Sato M, et al: A case report of inflammatory breast cancer effectively treated with cis-platinum. Gan To Kagaku Ryoho 14:2767–2770, 1987[Medline]
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|
|||||||||||
|
|||||||||||
|
|
Copyright © 2003 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
|
