Unusual Clinical Presentation of Carcinoma
921
FIG. 33.29.
Aberrant breast tissue.
A:
A mammary duct
in the subcutaneous tissue around a carcinoma excised
from the upper abdominal wall below the inframammary
fold.
B:
Intraductal carcinoma in the same specimen.
C:
Infiltrating ductal carcinoma.
chest wall.
217
Excisional biopsy confirmed the presence of in
filtrating duct carcinoma that arose in ectopic breast tissue.
Benign glandular inclusions in ALNs can mimic carci
noma. This topic is considered in detail in Chapter 43.
INFLAMMATORY CARCINOMA
In 1807, Charles Bell reported that “when a purple color is on
the skin over the tumor it is a very unpropitious beginning.”
219
This is said to be the first clinical reference to inflammatory car
cinoma
.
Lee and Tannenbaum
220
proposed the currently used
term
inflammatory carcinoma
in 1924. In the latest American
Joint Committee onCancer (AJCC) Staging System, inflamma
tory breast carcinoma (IBC) is defined as “a clinical and patho
logical entity characterized by erythema and edema involving
a third or more of the skin of the breast,” and is classified as
T4d.
221
IBC is not a specific histologic subtype of mammary
carcinoma. However, some investigators have included histo
pathologic findings among their diagnostic criteria.
An assessment of the frequency of this uncommon condi
tion depends largely on clinical reporting, but IBC is gener
ally thought to account for not more than 2.5% of all breast
carcinoma cases.
222
In institutional series, the frequency of IBC
reportedly varies from 1% to 10%, depending upon diagnostic
criteria and also upon the nature of the institution. Patientswith
this condition are often referred to tertiary treatment centers
where they constitute a relatively higher proportion of patients
than would be encountered in general clinical practice. IBC has
been reported to be more common in African Americans than
in whites irrespective of whether clinical or histopathologic di
agnostic criteria are used.
223–226
However, recent Surveillance,
Epidemiology and End Results (SEER) data suggest that Afri
can American women are generally susceptible tomore aggres
sive forms of breast carcinoma, but not to IBC.
227
The disease
was originally thought to be prevalent in Tunisia until a review
revealed that ulcerated breast carcinomas had been included in
the category of IBC,
228
exemplifying the importance of apply
ing appropriate diagnostic criteria to characterize this disease.
The age distribution of primary IBC is not significantly
different from that of common infiltrating duct carcinoma,
averaging about 55 years. It is only rarely encountered in
children
229,230
and men.
231
Pregnancy and lactation do not
predispose to the clinical presentation of IBC, although
breast carcinomas that arise in this setting are prone to have
lymphatic tumor emboli in the breast parenchyma.
232,233
