926
Chapter 33
from those in women with primary IBC, and these patients
are predisposed to develop inflammatory recurrences.
234
Treatment and Prognosis
Until the introduction of combined modality treatment,
including intensive chemotherapy, fewer than 5% of pa
tients with IBC survived 5 years.
234
In recent years, the man
agement of this disease has evolved into a multimodality
approach that combines chemotherapy, surgery, and radio
therapy.
271
In general, the currently favored therapeutic ap
proach is preoperative chemotherapy to render the tumor
operable, followed by mastectomy and radiation.
272
Although one group of investigators suggested that IBC
patients with no detectable dermal lymphatic tumor emboli
had a more favorable prognosis,
223
others did not find this
to be the case.
237,269,273
Patients with “occult” IBC may have a
the clinical signs of inflammatory carcinoma when initially
treated, parenchymal intralymphatic tumor emboli were seen
in many of the mastectomy specimens. A number of these
patients also had lymphatic tumor emboli in the nipple and/
or the skin of the breast (Fig. 33.37). The majority of patients
with an inflammatory recurrence initially have metastases in
volving many enlarged ALNs, but this type of recurrence can
develop in a patient who did not have ALN metastases.
The term “occult inflammatory carcinoma” describes
a group of patients who have cutaneous and parenchymal
lymphatic tumor emboli associated with their primary tu
mor in the absence of cutaneous erythema and other clinical
changes that typify IBC.
224,269
Occult inflammatory carci
noma occurs in 1% to 2% of patients with invasive carci
nomas that are not clinically inflammatory.
269
The primary
tumors tend to be central, larger than 4 cm, and often multi
centric. The pathologic findings are not appreciably different
FIG. 33.36.
Inflammatory recurrent carcinoma.
Dermal infiltration with recurrent carcinomas on
the chest wall and the clinical manifestations of inflammatory carcinoma. Shown here are poorly dif-
ferentiated ductal carcinoma
(A)
, papillary carcinoma
(B)
, mucinous carcinoma
(C)
, and ILC
(D,
detail
in inset
)
.
A
C
B
D
