A 35-year-old woman who underwent a modified radical mastectomy of her right breast for infiltrating ductal carcinoma 2 years ago presents with enlargement of her right breast. The breast has a swollen, red-discolored appearance. It is diffusely indurated and tender on palpation. Multiple axillary lymph nodes are palpable in the lower axilla. The working clinical diagnosis is inflammatory carcinoma. Which histologic features is most characteristic of this clinical diagnosis?
B. Extensive invasion of dermal lymphatics
C. Infiltrating malignant ducts surrounded by numerous neutrophils
D. Malignant vascular tumor forming slit-like spaces
Ans.
B. Extensive invasion of dermal lymphatics
Inflammatory breast carcinoma is often
misunderstood because of the qualifying adjective inflammatory. The term does
not refer to the presence of inflammatory cells, abscess, or any special
histologic-type of breast carcinoma; rather, it refers to more of a clinical
phenomenon, in that the breast is swollen, erythematous, and indurated and
demonstrates a marked increase in warmth. These changes are caused by
widespread lymphatic and vascular permeation within the breast itself and in
the deep dermis of the overlying skin by breast carcinoma cells. The clinical
induration and erythema are presumably related to lymphatic-vascular blockage
by tumor cells; if present, these findings mean a worse prognosis.
