Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obervation Letter
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF
Net Quiz
2013:79:6;849-849
doi: 10.4103/0378-6323.120761
PMID: 24177635

Erythematous indurated plaque lesions on the breast

Bilge Blbl Sen1 , Emine Nur Rifaioğlu1 , zlem Ekiz1 , Tmay zgr2 , Sekin Akkk3 , Mehmet Uğur İnan1 , Asena iğdem Doğramacı1
1 Department of Dermatology, Mustafa Kemal University School of Medicine, Hatay, Turkey
2 Department of Pathology, Mustafa Kemal University School of Medicine, Hatay, Turkey
3 Department of General Surgery, Mustafa Kemal University School of Medicine, Hatay, Turkey

Correspondence Address:
Bilge Blbl Sen
Department of Dermatology, Mustafa Kemal University, Tayfur Ata Sokmen Medical School, Serinyol, Antakya, Hatay 31005
Turkey
How to cite this article:
Sen BB, Rifaioğlu EN, Ekiz , zgr T, Akkk S, İnan MU, Doğramacı A. Erythematous indurated plaque lesions on the breast. Indian J Dermatol Venereol Leprol 2013;79:849
Copyright: (C)2013 Indian Journal of Dermatology, Venereology, and Leprology

A 50-year-old female patient, who had retraction of the right nipple for 2 years and erythema in the same breast for 2 months, was referred to our clinic. Mammography and breast ultrasonography performed at the time of onset of nipple retraction were normal. Dermatological examination revealed three erythematous, mildly indurated plaque lesions on the right breast, one of which involved the areola [Figure - 1]. The nipple was retracted. The patient had no subjective complaints. The right axillary examination detected several lymphadenopathies, as confirmed by ultrasonography. The histopathological examination of the skin biopsy revealed islands of tumor cells in the dermal lymphatics [Figure - 2]. These infiltrations consisted of round-shaped atypical cells with vesiculated nuclei and marked nucleoli. In immunohistochemical studies, strong positive staining by low-molecular weight keratin (LMWCK) and epithelial membrane antigen (EMA) and non-specific staining by vimentin have been detected.

Figure 1: Three erythemateous plaques on the right breast, one involving the areola
Figure 2: Tumor islands consisted of atypical epithelium cells in the lymphatics (H and E, ×200)

What is your Diagnosis?



Click here to view answer. View Answer

Discussion

The rate of skin metastasis in internal malignancies varies from 0.7 to 10%. [1] The skin metastases may occur as a result of lymphogenous, hematogenous spread, or direct invasion of surrounding tissue by tumor cells. Skin metastases usually occur as a finding of the spread or the recurrence of internal malignancies; however, they may rarely be an initial finding of an undetected malignancy.

Carcinoma erysipeloides (CE) is a rare cutaneous metastasis, which results from the lymphatic spread of an inflammatory carcinoma. While it is mostly related to breast cancer, it may also result from other tumors. [2],[3],[4] In our case, a solid mass lesion was also detected in the right breast, and the biopsy performed at the General Surgery Department was reported as invasive ductal carcinoma.

In the differential diagnosis of CE, erysipelas, cellulitis, radiation dermatitis, and contact dermatitis should be considered. The exact diagnosis of CE is made by histopathology. The dermal lymphatic invasion is considered as the characteristic feature of CE.

Other than breast cancer, nipple retraction may occur due to periductal mastitis, ductal ectasia, tuberculosis, sarcoidosis, fungal infections, and granulomatous inflammatory diseases, including Wegener′s granulomatosis and idiopathic granulomatosis lobular mastitis. [5] In our case, nipple retraction began 2 years ago, and the laboratory examinations performed at that time revealed no pathology. Therefore, nipple retraction was not considered to be associated with breast cancer.

In general, CE develops several months or years after the diagnosis of primary carcinoma. CE is an indicator of poor prognosis, and patients often die within few months of its diagnosis. CE developing as an initial sign of undiagnosed tumor is rare. [2] Interestingly, in our patient, CE was diagnosed before the diagnosis of breast cancer.

In cases of CE, treatment of primary tumor is sufficient. Surgical treatment is not recommended. Systemic chemotherapy and hormonal therapies alone or in combination with radiotherapy represent the basic treatment options. [2] We also referred our patient to the general surgery and oncology departments for planning the treatment of primary tumor.

Conclusion

While the skin metastases generally occur after the diagnosis of primary tumor, they may also develop prior to diagnosis. The skin invasions can be clinically confused with other disorders. This may result in delayed diagnosis of the malignancy and decrease in survival. Our case demonstrated the importance of non-specific skin lesions such as erythema in diagnosis of breast cancer. Therefore, the dermatologists should be careful with respect to cutaneous metastases, even if the patient′s medical history does not include malignancy.

References
1.
Krathen RA, Orengo IF, Rosen T. Cutaneous metastasis: A meta-analysis of data. South Med J 2003;96:164-7.
[Google Scholar]
2.
Cox SE, Cruz PD Jr. A spectrum of inflammatory metastasis to skin via lymphatics: Three cases of carcinoma erysipeloides. J Am Acad Dermatol 1994;30:304-7.
[Google Scholar]
3.
Lee SY, Chang SE, Bae GY, Choi JH, Sung KJ, Moon KC, et al. Carcinoma erysipeloides associated with anaplastic thyroid carcinoma. Clin Exp Dermatol 2001;26:671-3.
[Google Scholar]
4.
Nikolaou V, Stratigos A, Frangia K, Nikolaidis I, Syrigos K. Carcinoma erysipeloides deriving from a primary cutaneous squamous cell carcinoma. Int J Dermatol 2011;50:754-6.
[Google Scholar]
5.
Nicholson BT, Harvey JA, Cohen MA. Nipple-areolar complex: Normal anatomy and benign and malignant processes. Radiographics 2009;29:509-23.
[Google Scholar]

Fulltext Views
98

PDF downloads
87
Show Sections