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Carcinoma en cuirasse.

Byline: Sajad Ahmad Salati and Ajaz Ahmad Rather

Abstract

Carcinoma en cuirasse is a rare form of metastatic cutaneous breast cancer. We report a typical case of cancer en cuirasse in a 36 years old female who presented with diffuse erythema and scaly nodular lesions over the left breast axilla neck and arm. Imaging revealed a lump in upper-outer quadrant of affected breast. Histopathological examination of the cutaneous nodules and fine needle aspiration cytology of the breast lump revealed features of infiltrating ductal cell carcinoma.

Key words

Carcinoma en cuirasse breast cancer infiltrating ductal cell carcinoma.

Introduction

Carcinoma en cuirasse is a rare form of cutaneous metastasis.12 This condition is most commonly associated with breast cancer with local recurrence after mastectomy and presents most commonly a few months or years after the surgical operation.2 More rarely the condition presents as the presenting manifestation of the disease as happened in our reported case. In this condition the thoracic wall is studded with carcinomatous indurated lesions and the affected skin seems to resemble a breast plate (armor). Carcinoma en cuirasse like other cutaneous metastasis signifies advanced malignant disease with poor prognosis and short survival.

Case report

A 36-year-old female multigravida with no significant co-morbidities reported with diffuse discoloration and lumpiness over the left side of chest and axilla. The patient had noticed an initial nodule seven months prior to appointment with us. She had been using over the counter skin preparations (steroid antihistaminic antibiotic) till the disease reached the presenting proportions.

On examination the patient was average built with stable vital signs. Local examination revealed diffuse erythema firm to hard nodularity with scaling over the left breast left axilla neck and left arm (Figures 1 and 2). Ultrasonography revealed a 2.3 cm x 1.6 cm x 1.5cm lump in upper-outer quadrant of the affected breast. FNAC of the breast lump and biopsy of the skin lesion revealed features of infiltrating ductal cell cancer. The patient was attached to the services of tertiary care cancer center for further evaluation and management.

Discussion

Cancer en cuirasse is a rare cutaneous manifestation of breast cancer.

This term was coined by Alfred Velpeau a well-known French anatomist and surgeon after describing this condition for the first time in 1838.3 In females breast is the commonest primary source of cutaneous metastases and about 23.9% of breast cancer patients have been reported in literature to manifest cutaneous metastasis.4 These cutaneous metastases can occur in form of nodules and/or papules or telangiectatic lesions in more than 90% cases and cancer en cuirasse accounts for only about 2-3 % of such lesions.2

Cancer en cuirasse most commonly appears as a local recurrence after a few months or years of mastectomy for breast cancer. More rarely the condition presents as the presenting initial manifestation of breast cancer as happened in our reported case.2 Cancer en cuirasse may initially appear as few small discrete cutaneous nodule/papules which progressively increase in size and coalesce to form a leathery indurated sheet (Figures 1 and 2) resembling a breast plate of armor.5 Uncommonly the lesion may appear as a subcutaneous nodule or yellowish marbling when it may be regarded as insignificant. Mullinax and Cohen have reported a case where cancer en cuirasse presented as keloids of the chest wall.6

Breast fibromatosis (also called extra-abdominal desmoid tumor) is an uncommon differential diagnosis of cancer en cuirasse.7 It is indistinguishable on physical examination and imaging but histology shows fibromatosis to have distinctive features of benign infiltrative proliferation of fibrous tissue.

Cancer en cuirasse develops continuitatem by dissemination via lymphogenous and 8 hematogenous pathways. The prognosis depends upon the type and biological behavior 2 of the underlying primary tumor and is generally poor as the cutaneous metastases represent the advanced stage of the disease.

Acknowledgement

We thank the patient for allowing the use of images for academic purposes.

References

1. Lee SH Cheng HM Cheng SF et al. Breast carcinoma en cuirasse a case report and literature review. Dermatol Sinica1993;11:129-352. Mahore SD Bothale KA Patrikar AD Joshi AM. Carcinoma en cuirasse: a rare presentation of breast cancer. Indian J Pathol Microbiol. 2010;53:351-8.3. Savatard L. Cancer en cuirasse. Br JDermatol. 1943;2:31-9.4. De Giorgi V Grazzini M Alfaioli B et al.Cutaneous manifestations of breast carcinoma. Dermatol Ther. 2010; 23:581-9.5. Lacout A Marcy PY Lesecc G. Long-standing scirrhous breast carcinoma en cuirasse. Breast Care (Basel). 2010;5:327-9.6. Mullinax K Cohen JB. Carcinoma en cuirasse presenting as keloids of the chest. Dermatol Surg. 2004;30:226-8.7. Somerville JE Biggart JD. Fibromatosis of the breast: a benign lesion which simulates a carcinoma. Ulster Med J. 1989;58:97-9.8. Arapovic SJ Simic L. Cutaneousmetastases--carcinoma en cuirasse. ActaDermatovenerol Croat. 2002;10:167-70.
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Article Details
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Title Annotation:rare form of metastatic breast cancer
Publication:Journal of Pakistan Association of Dermatologists
Article Type:Clinical report
Date:Dec 31, 2013
Words:806
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